Advantages of Mesenteric Access to Pancreatoduodenal Resection of Pancreatic Head Cancer With Invasion of the Main Vessels

The aim of the study was to compare standard and mesenteric approaches to surgical treatment of patients with pancreatic head cancer that invades the portal and/or superior mesenteric veins, and to evaluate their advantages. Materials and methods: 192 patients with pancreatic head cancer with invasion of the portal and/or superior mesenteric vein underwent surgical treatment, in 43 (22.4%) cases pancreatoduodenal resection was performed through mesenteric access, in the remaining 149 (77.3%) patients a standard approach to surgical treatment was used. Results: The median duration of operations with mesenteric access was 290 minutes, with standard access – 300 minutes, the median blood loss was 1120 ml and 1800 ml, respectively, p=0.0002. There were no statistically significant differences in long–term treatment outcomes with mesenteric and standard approaches: progression of pancreatic head adenocarcinoma was diagnosed in 48.8% and 49%, respectively, the median overall survival was 24.5 months and 22.3 months, the median progression-free survival was 21.3 months and 22.1 months, respectively. An analysis of long-term treatment outcomes depending on the type of access and the degree of radical surgical intervention showed that the incidence of local recurrence with standard access in non-radically operated patients was significantly higher (40.6% vs 7.7%, p=0.001). Conclusion: the advantages of mesenteric access over the standard approach to surgical treatment of patients with pancreatic head cancer with invasion of the portal and/or superior mesenteric vein were as follows: 1) provides an opportunity to assess the prevalence and operability of the tumor already at the beginning of surgery, 2) provides a significantly higher frequency of operations in the volume of R0, 3) provides significantly less blood loss during surgery, 4) after circular resection of the main veins, it provides more opportunities to perform end-to-end plastic surgery, this reduces the risk of thrombosis due to the formation of only one anastomosis and reduces the time of compression of the main veins, reducing the risk of liver and intestinal ischemia.