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The TRIANGLE operation for pancreatic head and body cancers: early postoperative outcomes

Background - Surgical resection is the mainstay of potential cure for patients with pancreatic cancer, however, local recurrence is frequent. Previously, we have described an extended resection technique for pancreatoduodenectomy aiming at a radical resection of the nerve and lymphatic tissue betwee...

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Main Authors: Klotz, Rosa (Author) , Hackert, Thilo (Author) , Heger, Patrick (Author) , Probst, Pascal (Author) , Hinz, Ulf (Author) , Loos, Martin (Author) , Berchtold, Christoph (Author) , Mehrabi, Arianeb (Author) , Schneider, Martin (Author) , Müller, Beat P. (Author) , Strobel, Oliver (Author) , Diener, Markus K. (Author) , Mihaljevic, André Leopold (Author) , Büchler, Markus W. (Author)
Format: Article (Journal)
Language:English
Published: 2022
In: HPB
Year: 2022, Volume: 24, Issue: 3, Pages: 332-341
ISSN:1477-2574
DOI:10.1016/j.hpb.2021.06.432
Online Access:Verlag, lizenzpflichtig, Volltext: https://doi.org/10.1016/j.hpb.2021.06.432
Verlag, lizenzpflichtig, Volltext: https://www.sciencedirect.com/science/article/pii/S1365182X21006146
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Author Notes:Rosa Klotz, Thilo Hackert, Patrick Heger, Pascal Probst, Ulf Hinz, Martin Loos, Christoph Berchtold, Arianeb Mehrabi, Martin Schneider, Beat P. Müller-Stich, Oliver Strobel, Markus K. Diener, André L. Mihaljevic, Markus W. Büchler

MARC

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520 |a Background - Surgical resection is the mainstay of potential cure for patients with pancreatic cancer, however, local recurrence is frequent. Previously, we have described an extended resection technique for pancreatoduodenectomy aiming at a radical resection of the nerve and lymphatic tissue between celiac artery, superior mesenteric artery and mesenteric-portal axis (TRIANGLE operation). Until now, data on postoperative outcome have not been reported, yet. - Methods - Patients who underwent either partial (PD) or total pancreatoduodenectomy (TP) applying the TRIANGLE procedure were identified. These cohorts were compared to matched historic cohorts with standard resections. - Results - Overall, 330 patients were analysed (PDTRIANGLE and PDSTANDARD, each n = 108; TPTRIANGLE and TPSTANDARD, each n = 57). More lymph nodes were harvested in TRIANGLE compared to standard resection (PD: 27.5 (21-35) versus 31.5 (24-40); P = 0.0187, TP: 33 (28-49) versus 44 (29-53); P = 0.3174) and the rate of tumour positive resections margins, R1(direct), dropped. Duration of operation was significantly longer and blood loss higher. Postoperative mortality and complications did not differ significantly. - Conclusion - Pancreatoduodenectomy according to the TRIANGLE protocol can be performed without increased morbidity and mortality at a high-volume centre. Long-term survival and quality of life need to be investigated in prospective clinical trials with adequate sample size. 
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