紀要論文 The significance of pancreatic head plexuses dissection in pancreaticoduodenectomy for pancreatic adenocarcinoma : Surgery for achieving pathological curative (R0) resection
膵癌に対する膵頭神経叢切除の意義 : 病理学的にROをめざす手術
The significance of pancreatic head plexuses dissection in pancreaticoduodenectomy for pancreatic adenocarcinoma : Surgery for achieving pathological curative (R0) resection

木村, 理  ,  渡邊, 利広  ,  平井, 一郎  ,  山川, 光徳

内容記述
Background/Aims: We aimed to histopathologically examine the significance of intraoperative histological diagnosis of pancreatic head plexus stumps in patients with pancreatic cancer.Methodology: We included 94 patients (including 39 with pancreatic adenocarcinoma) who underwent dissection of pancreatic head nerve plexus (PLph) I and II in addition to pancreaticoduodenectomy between 2003 and 2011. The pancreatic nerve plexus dissection was performed en bloc with pancreaticoduodenectomy and resection of the anterior nerve tissue of the pancreas, including PLph I and II to the right of the celiac artery and superior mesenteric plexus. Intraoperative histopathological diagnoses were performed on all PLph I and II stumps. If malignancy was confirmed, partial resection of PLph II toward the left rear of the superior mesenteric artery (SMA) and/or the nerve plexuses surrounding SMA were additionally resected. In the absence of malignancy, R0 resection was performed.Results: Intraoperative histopathological diagnoses of all patients were performed on a total of 1456 sites (PLph I: 542 sites, PLph II: 914 sites) with an average of 16 sites per patient. Cancer was discovered in part of the pancreatic nerve plexuses with high frequency: 15 of 94 patients (16%); 10 of 39 patients (25.6%) were diagnosed as pancreatic adenocarcinoma. In the 39 cases of pancreatic adenocarcinoma, the group with positive resection stumps that were later confirmed to be negative for cancer [PLph (+)→(-)], i.e., those with nerve plexus stumps positive for cancer initially but were negative for cancer after additional resection, showed no statistical difference from the [PLph (-)] group, in which all resection stumps were negative for cancer initially (p = 0.51).Conclusion: It was important to perform R0 pancreaticoduodenectomy for pancreatic adenocarcinoma.
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