Pancreatoduodenectomy with colon-last approach for advanced pancreatic head cancer

Abstract

Purpose: Margin-negative surgery is very important in surgical oncology. Considering margin-negative pancreatectomy is known to be es sential for cure of the pancreatic cancer, pancreatoduodenectomy with combined venous vascular or arterial resection can be a potential op tion for margin-negative resection, especially, in era of neoadjuvant treatment with potent systemic chemotherapy. To the contrary, special attention was not paid on combined colonic resection during PD. In this article, safe surgical technique for PD with combined colonic resec tion is introduced, under the name of PD with “colon-last” approach. Methods: At Severance Hospital (Yonsei University College of Medicine, Seoul, Republic of Korea), between 2014 and 2021, a total of six pa tients underwent PD with “colon-last” approach. The surgical technique and surgical outcome are reviewed. Results: All patients recovered without major complications (Clavien-Dindo classification grade ≥III) after surgery, and most of them recov ered after conservative treatment with postoperative pancreatic fistula biochemical leak. None of the patients were readmitted. Only the first and second cases represent cancer-related mortality, and the other patients are still alive and are being followed up. Conclusion: It is hoped that the present technique, PD with colon-last approach, could be helpful enhance the procedural safety in treating advanced cancer requiring PD with combined colon resection. However, its technical safety and oncologic role should be validated by many pancreatic surgeons’ collaborative studies in the near future.