Superior mesenteric vein-identified middle line approach in patients of colonic cancer(T4b) undergoing right hemicolectomy combined with pancreaticoduodenectomy

Objective To explore the safety and efficacy of middle line approach identified with superior mesenteric vein in the right hemicolectomy combined with pancreaticoduodenectomy for colonic carcinoma involing liver and duodenun. Methods Clinical data of 13 patient′s with right colonic cancer(T4b) undergoing right hemicolectomy combined with pancreaticoduodenectomy from Jan 2016 to Jul 2019 in He′nan Provincial Tumor Hospital were retrospectively analyzed. The superior mesenteric vein was used to mark the medial border of tumor resection. Vertical cutline was made to transverse mesocolon and all the way done to the root of superior mesenteric vein, the pancreas was cut in front of superior mesenteric vein, superior mesenteric artery and the affiliated lymph nodes were dissected. The stomach and pancreas were transected, the specimen was removed. Then the GI tract was reconstructed. Results Surgery was successful in all 13 patients . The operation time was (249±27) min, blood loss was (442±129)ml, 2 cases suffered pancreatic fistula, there was no biliary fistula, and 1 case of delayed gastric emptying. There were no other major complications. The number of lymph node dissection was (20±4) and hospital stay was (23.2±9.4) d. Conclusions It is safe and feasible to use the superior mesenteric vein-identified middle line approach in patients of right colonic cancer undergoing right hemicolectomy plus pancreaticoduodenectomy. Key words: Colonic neoplasms; Mesenteric veins; Pancreaticoduodenectomy; Colectomy