Work

Left posterior superior mesenteric artery first approach and circumferential lymphadenectomy with total mesopancreas dissection in laparoscopic pancreaticoduodenectomy

Year: 2025

Type: article

Abstract: PURPOSE: The purpose of this study is to evaluate the efficacy of laparoscopic pancreaticoduodenectomy (LPD) with superior mesenteric artery (SMA) left posterior first approach and circumferential lymphadenectomy with total meso-pancreas (MP) dissection for periampullary malignancies. METHODS: 31 patients who underwent LPD with left posterior SMA first-approach and circumferential lymphadenectomy with total MP dissection between September 2021 and September 2023. General characteristics, operative techniques, short-term outcomes and pathological results were prospectively evaluated. RESULTS: The mean operation time and SMA first-approach time were 441.9 ± 73.7 min and 99.9 ± 27.7 min, respectively. The median intraoperative blood loss was 143 ml (range: 50-1500 ml). The median number of total LNs and left-sided SMA LNs harvested were 32,7 ± 13 (16-74) and 7,4 ± 6 (range: 3-30), respectively. The rate of metastatic left-sided SMA LNs and meso-pancreas were 25.8% and 22.6%, respectively. 22.6% of patients had pancreatic fistula, but mostly in grade A, with only one case that required conversion. Only one case developed postoperative refractory diarrhea. The mean postoperative hospital stay was 14.1 days. No 90-day mortality was reported. CONCLUSION: LPD with left posterior SMA first-approach and circumferential lymphadenectomy with total MP dissection was safe and effective with favorable short-term outcomes.

Source: Langenbeck s Archives of Surgery

DOI: 10.1007/s00423-025-03620-z