Research progress of arterial resection reconstruction and arterial sheath removal in the treatment of locally advanced pancreatic cancer involving arteries_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

LAN Qingqing ,  YANG Haifeng

Department of Hepatobiliary and Tutmor Surgery, The Second Affiliated Hospital of Guizhou Medical University, Kaili, Guizhou 556000, P. R. China;

Corresponding?author：

YANG Haifeng, Email: 15519443884@163.com

Keywords：

locally advanced pancreatic cancer; arterial resection reconstruction; arterial sheath removal

DOI：

10.7507/1007-9424.202505118

Video：

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Objective To understand the research progress of arterial resection reconstruction and arterial sheath removal in the treatment of local advanced pancreatic cancer with arterial involvement, and to provide reference for the treatment of this disease. Methods A review of relevant studies on the treatment of locally advanced pancreatic cancer involving arteries using arterial resection reconstruction and arterial sheath removal in recent years, both domestically and internationally. Results Arterial resection and reconstruction techniques can achieve complete tumor removal and improve patient survival rates, but they have high complexity and risks, patients may suffer from severe complications such as massive hemorrhage, vessel stenosis, vessel obstruction, and thrombosis postoperatively. In recent years, with advancements in artificial vascular materials, optimization of surgical techniques, and the promotion of stratified anticoagulation strategies, the incidence of complications associated with arterial resection and reconstruction is expected to be further reduced. arterial sheath removal has advantages such as lower surgical risks, lower incidence of complications, and the ability to preserve arterial function, but their application scope remains relatively limited. Conclusions Arterial resection reconstruction and arterial sheath removal can change locally advanced pancreatic cancer involving arteries into resectable cancer. There is no absolute boundary between the two surgical procedures and accurate preoperative assessment of patient helps determine a more suitable approach. With the continuous advancement of surgical technology and the deepening of multidisciplinary comprehensive treatment model, the treatment effect of locally advanced pancreatic cancer involving arteries can be improved.

Citation： LAN Qingqing, YANG Haifeng. Research progress of arterial resection reconstruction and arterial sheath removal in the treatment of locally advanced pancreatic cancer involving arteries. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2026, 33(3): 406-412. doi: 10.7507/1007-9424.202505118 Copy

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2.	Reames BN, Blair AB, Krell RW, et al. Management of locally advanced pancreatic cancer: results of an international survey of current practice. Ann Surg, 2021, 273(6): 1173-1181.
3.	Siegel RL, Miller KD, Fuchs HE, et al. Cancer statistics, 2021. CA Cancer J Clin, 2021, 71(1): 7-33.
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7.	程顯斌, 張冬杰, 王首寒, 等. 聯合血管切除重建在胰腺癌根治術中的療效觀察. 癌癥進展, 2019, 17(1): 76-78.
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9.	苗毅. 局部進展期胰腺癌綜合治療難點及對策. 中國實用外科雜志, 2017, 37(7): 721-723.
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21.	Bockhorn M, Burdelski C, Bogoevski D, et al. Arterial en bloc resection for pancreatic carcinoma. Br J Surg, 2011, 98(1): 86-92.
22.	龍海若, 侯圣忠 , 田伯樂. 胰腺癌聯合動脈切除術的安全性與療效Meta分析. 肝膽胰外科雜志, 2020, 32(9): 542-548.
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29.	吳鵬飛, 蔣奎榮. 胰腺癌根治術中動脈切除相關問題. 肝膽外科雜志, 2024, 32(2): 85-88,92.
30.	Witter K, Tonar Z, Sch?pper H. How many layers has the adventitia? Structure of the arterial tunica externa revisited. Anat Histol Embryol, 2017, 46(2): 110-120.
31.	王大軍, 徐紅偉, 王亮, 等. 增強CT對胰腺癌的周圍血管侵犯的評估價值分析. 中國CT和MRI雜志, 2024, 22(11): 106-108.
32.	Bachellier P, Rosso E, Lucescu I, et al. Is the need for an arterial resection a contraindication to pancreatic resection for locally advanced pancreatic adenocarcinoma? A case-matched controlled study. J Surg Oncol, 2011, 103(1): 75-84.
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34.	Loos M, Kester T, Klaiber U, et al. Arterial resection in pancreatic cancer surgery: effective after a learning curve. Ann Surg, 2022, 275(4): 759-768.
35.	高依莎. GRHL2在胰腺導管腺癌中的表達及其抑制胰腺癌轉移的機制研究. 上海: 中國人民解放軍海軍軍醫大學, 2018.
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40.	蔣建強, 李曉勇, 張德曉, 等. 聯合血管切除重建技術應用于胰腺癌根治術中的價值. 實用癌癥雜志, 2021, 36(3): 457-460.
41.	Zhang Q, Wu J, Tian Y, et al. Arterial resection and reconstruction in pancreatectomy: surgical technique and outcomes. BMC Surg, 2019, 19(1): 141. doi: 10.1186/s12893-019-0560-2.
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1. 孫長杰, 鄧俠興, 沈柏用, 等. 機器人胰腺切除聯合血管重建臨床分析. 外科理論與實踐, 2019, 24(2): 159-162.
2. Reames BN, Blair AB, Krell RW, et al. Management of locally advanced pancreatic cancer: results of an international survey of current practice. Ann Surg, 2021, 273(6): 1173-1181.
3. Siegel RL, Miller KD, Fuchs HE, et al. Cancer statistics, 2021. CA Cancer J Clin, 2021, 71(1): 7-33.
4. 苗毅, 蔡寶寶, 陸子鵬. 侵犯動脈的胰腺癌外科治療新選擇: 動脈鞘剝除技術. 中華消化外科雜志, 2022, 21(4): 456-460.
5. 黃徐敏, 尹杰, 陸子鵬, 等. 改良Appleby手術和動脈鞘剝除技術治療動脈受累胰體尾癌的臨床效果分析. 中華外科雜志, 2022, 60(5): 441-448.
6. 朱春宇, 劉榮. 胰十二指腸切除術中靜脈切除重建的研究現狀. 中華腔鏡外科雜志 (電子版), 2019, 12(5): 301-306.
7. 程顯斌, 張冬杰, 王首寒, 等. 聯合血管切除重建在胰腺癌根治術中的療效觀察. 癌癥進展, 2019, 17(1): 76-78.
8. Hackert T, Sachsenmaier M, Hinz U, et al. Locally advanced pancreatic cancer: neoadjuvant therapy with folfirinox results in resectability in 60% of the patients. Ann Surg, 2016, 264(3): 457-463.
9. 苗毅. 局部進展期胰腺癌綜合治療難點及對策. 中國實用外科雜志, 2017, 37(7): 721-723.
10. Tempero MA, Malafa MP, Al-Hawary M, et al. Pancreatic adenocarcinoma, version 2. 2021, NCCN Clinical Practice Guidelines in oncology. J Natl Compr Canc Netw, 2021, 19(4): 439-457.
11. Cai B, Bergmann F, Lu Z, et al. A histopathological study of artery wall involvement in pancreatic cancer surgery. Langenbecks Arch Surg, 2022, 407(8): 3501-3511.
12. Watanabe S, Kobayashi N, Kubota K, et al. A novel scoring system for arterial invasion of pancreatic body and tail cancer based on multidetector row computed tomography and biomarkers. Pancreatology, 2013, 13(2): 161-169.
13. Cai B, Lu Z, Neoptolemos JP, et al. Sub-adventitial divestment technique for resecting artery-involved pancreatic cancer: a retrospective cohort study. Langenbecks Arch Surg, 2021, 406(3): 691-701.
14. Sato T, Saiura A, Inoue Y, et al. Distal pancreatectomy with en bloc resection of the celiac axis with preservation or reconstruction of the left gastric artery in patients with pancreatic body cancer. World J Surg, 2016, 40(9): 2245-2253.
15. Hicks CW, Burkhart RA, Weiss MJ, et al. Management of type 9 hepatic arterial anatomy at the time of pancreaticoduodenectomy: considerations for preservation and reconstruction of a completely replaced common hepatic artery. J Gastrointest Surg, 2016, 20(7): 1400-1404.
16. Appleby LH. The coeliac axis in the expansion of the operation for gastric carcinoma. Cancer, 1953, 6(4): 704-707.
17. Christians KK, Pilgrim CH, Tsai S, et al. Arterial resection at the time of pancreatectomy for cancer. Surgery, 2014, 155(5): 919-926.
18. Stitzenberg KB, Watson JC, Roberts A, et al. Survival after pancreatectomy with major arterial resection and reconstruction. Ann Surg Oncol, 2008, 15(5): 1399-1406.
19. 馬成云, 王嘉毅, 李少華, 等. 聯合血管切除重建在胰腺癌根治術中的應用效果及對不良反應發生情況的影響. 臨床醫學研究與實踐, 2022, 7(26): 78-80.
20. 楊永超, 李宜雄. 胰腺癌外科治療的歷史和現狀. 中國普通外科雜志, 2018, 27(3): 269-283.
21. Bockhorn M, Burdelski C, Bogoevski D, et al. Arterial en bloc resection for pancreatic carcinoma. Br J Surg, 2011, 98(1): 86-92.
22. 龍海若, 侯圣忠 , 田伯樂. 胰腺癌聯合動脈切除術的安全性與療效Meta分析. 肝膽胰外科雜志, 2020, 32(9): 542-548.
23. 苗毅. 規范化實施胰十二指腸切除術幾個關鍵問題. 中國實用外科雜志, 2016, 36(8): 821-824.
24. Schmocker RK, Wright MJ, Ding D, et al. An aggressive approach to locally confined pancreatic cancer: defining surgical and oncologic outcomes unique to pancreatectomy with celiac axis resection (DP-CAR). Ann Surg Oncol, 2021, 28(6): 3125-3134.
25. Inoue Y, Saiura A, Oba A, et al. Optimal extent of superior mesenteric artery dissection during pancreaticoduodenectomy for pancreatic cancer: balancing surgical and oncological safety. J Gastrointest Surg, 2019, 23(7): 1373-1383.
26. 王芳菲, 呂少誠, 朱繼巧, 等. 結腸下區腸系膜上動脈優先入路在交界可切除胰頭癌外科治療中的應用價值. 中華普通外科雜志, 2023, 38(5): 330-334.
27. Wang M, Li D, Chen R, et al. Laparoscopic versus open pancreatoduodenectomy for pancreatic or periampullary tumours: a multicentre, open-label, randomised controlled trial. Lancet Gastroenterol Hepatol, 2021, 6(6): 438-447.
28. 李相成, 陳妍安瀾, 李長賢. 肝門部膽管癌根治性切除術中的血管重建技術. 外科理論與實踐, 2023, 28(2): 104-109.
29. 吳鵬飛, 蔣奎榮. 胰腺癌根治術中動脈切除相關問題. 肝膽外科雜志, 2024, 32(2): 85-88,92.
30. Witter K, Tonar Z, Sch?pper H. How many layers has the adventitia? Structure of the arterial tunica externa revisited. Anat Histol Embryol, 2017, 46(2): 110-120.
31. 王大軍, 徐紅偉, 王亮, 等. 增強CT對胰腺癌的周圍血管侵犯的評估價值分析. 中國CT和MRI雜志, 2024, 22(11): 106-108.
32. Bachellier P, Rosso E, Lucescu I, et al. Is the need for an arterial resection a contraindication to pancreatic resection for locally advanced pancreatic adenocarcinoma? A case-matched controlled study. J Surg Oncol, 2011, 103(1): 75-84.
33. Truty MJ, Colglazier JJ, Mendes BC, et al. En bloc celiac axis resection for pancreatic cancer: classification of anatomical variants based on tumor extent. J Am Coll Surg, 2020, 231(1): 8-29.
34. Loos M, Kester T, Klaiber U, et al. Arterial resection in pancreatic cancer surgery: effective after a learning curve. Ann Surg, 2022, 275(4): 759-768.
35. 高依莎. GRHL2在胰腺導管腺癌中的表達及其抑制胰腺癌轉移的機制研究. 上海: 中國人民解放軍海軍軍醫大學, 2018.
36. 鄒晨. Prrx1基因在胰腺癌EMT中的作用及機制研究. 南京: 南京醫科大學, 2016.
37. 梁雨榮, 王敬, 史憲杰, 等. 肝動脈切除重建技術在肝門部膽管癌手術中的應用. 中華肝膽外科雜志, 2014, 20(1): 48-50.
38. 李會星, 萬濤, 梁雨榮, 等. 聯合肝動脈切除重建的肝門部膽管癌根治術技術要點. 解放軍醫學院學報, 2014, 35(4): 312-315.
39. Balci D, Ahn CS. Hepatic artery reconstruction in living donor liver transplantation. Curr Opin Organ Transplant, 2019, 24(5): 631-636.
40. 蔣建強, 李曉勇, 張德曉, 等. 聯合血管切除重建技術應用于胰腺癌根治術中的價值. 實用癌癥雜志, 2021, 36(3): 457-460.
41. Zhang Q, Wu J, Tian Y, et al. Arterial resection and reconstruction in pancreatectomy: surgical technique and outcomes. BMC Surg, 2019, 19(1): 141. doi: 10.1186/s12893-019-0560-2.
42. 賈江坤, 賈萌, 余淼, 等. 胰十二指腸擴大切除術聯合血管切除重建治療胰腺癌的臨床價值分析. 四川解剖學雜志, 2020, 28(2): 184-185.
43. 卓翔, 江斌, 王文杰. 聯合血管切除重建的胰腺癌根治術對胰腺癌患者并發癥發生率及生存質量的影響. 中華普外科手術學雜志 (電子版), 2020, 14(2): 166-169.
44. 王藝睿, 李近陽, 李相成. 聯合血管切除重建在肝門部膽管癌根治術中的應用進展. 中國臨床醫學, 2021, 28(3): 518-522.
45. Liu L, Jia C, Xu S, et al. Arterial reconstruction by anastomosis of left gastric artery and superior mesenteric artery for locally advanced pancreatic carcinoma. J Vasc Surg Cases Innov Tech, 2018, 5(1): 4-6.
46. Sato T, Inoue Y, Takahashi Y, et al. Distal pancreatectomy with celiac axis resection combined with reconstruction of the left gastric artery. J Gastrointest Surg, 2017, 21(5): 910-917.
47. Bacalbasa N, Balescu I, Barbu I, et al. Vascular resections in association with pancreatic resections for locally advanced pancreatic cancer. In Vivo, 2022, 36(2): 1001-1006.
48. Gong Y, Zhang L, He T, et al. Pancreaticoduodenectomy combined with vascular resection and reconstruction for patients with locally advanced pancreatic cancer: a multicenter, retrospective analysis. PLoS One, 2013, 8(8): e70340. doi: 10.1371/journal.pone.0070340.
49. 邢穎, 李有國, 鄭建偉, 等. 胰腺癌聯合血管重建手術要點. 中國臨床醫生雜志, 2023, 51(6): 636-639.
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CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Research progress of arterial resection reconstruction and arterial sheath removal in the treatment of locally advanced pancreatic cancer involving arteries

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