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What are the different things that we do in our program that gives us great results?

Many developments have happened in pancreatic cancer surgery in the last decade. For the first time, we are having long term survivors and in Chennai, in our group, we are seeing patients with disease spread to the liver, living for more than one year and in good health. These experiences vindicate our protocol.

Today, we discuss how we provide excellent results in Whipple's operation for pancreatic cancer. These techniques are developed for removing the pancreatic cancer with excellent margins.

  1. The principle of complete mesopancreas dissection: 

    If you want best results in Whipple's surgery, the key margin is the retroperitoneal margin, which lies along the margin of the superior mesenteric artery. The longer margin you give, the better the results will be.

    (The following stuff is highly technical. Please skip it, if it is too much to digest)

    In 2011, we standardised the artery first approach to pancreatic cancer and since 2016, we use it as a standard process. The next approach that we did was getting the key artery from superior mesenteric artery, which is the inferior pancreatico duodenal artery (See picture).

    The next step that we did is to remove the left half of the superior mesenteric artery nerve plexus. This gives the ultimate margin on the retroperitoneum. These techniques have given us an edge in our results that are not available       elsewhere.

  2. The principle of level 3 dissection on the hepatic artery

    The second key margin which is important is the dissection along the artery to the liver (hepatic artery). Normally, a surgeon pulls off the node that lies in front of the artery and removes it (station 8 node or liver artery node) and completes the blood vessel part.

    We started removing the tissue around the artery to clear some tumour tissue in some patients and found that it is safe and very good to clear cancerous tissue. Now after experience in handling other arteries in transplant, we are clearing the liver artery completely. This technique which we follow is of Japanese origin. There are some physical differences between Indians and Japanese people and we are noticing that. We also take extra precautions to prevent arterial bleed called the "double security" approach.
These are our foundation principles to improve the lives of our fellowmen and women who are unfortunate to develop pancreatic cancer.

(If there are any questions on the technical aspects, please ask the questions in the comments section)

Comments

  1. drsundeepjain12 January 2022 at 05:26

    Wonderful Post. This is a very helpful post. These are the useful tips for. I would like to share with my friends. To know more about me visit here Gallbladder cancer surgery Jaipur

    ReplyDelete

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