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. 2020 Sep 15;5(1):111-118.
doi: 10.1002/ags3.12399. eCollection 2021 Jan.

Multicenter randomized phase II trial of prophylactic right-half dissection of superior mesenteric artery nerve plexus in pancreatoduodenectomy for pancreatic head cancer

Suguru Yamada  1 , Sohei Satoi  2 , Hideki Takami  1 , Tomohisa Yamamoto  2 , Isaku Yoshioka  3 , Fuminori Sonohara  1 , So Yamaki  2 , Kazuto Shibuya  3 , Masamichi Hayashi  1 , Daisuke Hashimoto  2 , Masahiko Ando  4 , Kenta Murotani  5 , Mitsugu Sekimoto  2 , Yasuhiro Kodera  1 , Tsutomu Fujii  3
Affiliations

Multicenter randomized phase II trial of prophylactic right-half dissection of superior mesenteric artery nerve plexus in pancreatoduodenectomy for pancreatic head cancer

Suguru Yamada et al. Ann Gastroenterol Surg. .

Abstract

Aim: Right-half dissection of the superior mesenteric artery (SMA) nerve plexus in pancreatoduodenectomy for pancreatic cancer was initiated to accomplish R0 resection; however, subsequent refractory diarrhea was a major concern. This study aimed to evaluate the necessity of this technique.

Methods: From April 2014 to June 2018, 74 patients with pancreatic head cancer were randomly allocated to either Group A, in which right-half dissection of the SMA nerve plexus was performed (n = 37), or Group B, in which total preservation of the nerve plexus was performed (n = 37). Short-term, long-term, and survival outcomes were prospectively compared between the groups.

Results: The patient demographics, including the R0 resection rate, were not significantly different between the groups. Postoperative diarrhea occurred in 26 (70.3%) patients in Group A and 18 (48.6%) patients in Group B. There was a tendency for the development of severe diarrhea in Group A within 1 year postoperatively, and the frequency of diarrhea gradually decreased within 2 years, although that did not affect tolerance to adjuvant chemotherapy. There was no difference in either locoregional recurrence (27.0% vs 32.4%) or systemic recurrence (46.0% vs 46.0%). The median overall survival time in Groups A and B was 37.9 and 34.6 months, respectively (P = 0.77).

Conclusion: We did not demonstrate a clinical impact of right-half dissection of the SMA nerve plexus on locoregional recurrence or survival. Therefore, the prophylactic dissection of the SMA nerve plexus is unnecessary given that refractory diarrhea could be induced by this technique (UMIN000012241).

Keywords: pancreatic head cancer; pancreatoduodenectomy; phase II trial; superior mesenteric artery nerve plexus.

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Conflict of interest statement

Conflict of Interest: The authors have no commercial affiliations that can pose any conflicts of interest in connection with this study. Funding: No funding was received for this study.

Figures

FIGURE 1
FIGURE 1
Study schema. The blue line indicates right‐half dissection, and the red line indicates preservation of the SMA nerve plexus. SMA, superior mesenteric artery
FIGURE 2
FIGURE 2
CONSORT diagram. SMA, superior mesenteric artery
FIGURE 3
FIGURE 3
Postoperative course of diarrhea between the two groups. Group A, right‐half dissection of the superior mesenteric artery nerve plexus; Group B, preservation of the nerve plexus
FIGURE 4
FIGURE 4
A, Recurrence‐free survival and B, overall survival were compared between the groups. Group A, right‐half dissection of the superior mesenteric artery nerve plexus; Group B, preservation of the nerve plexus. MST, median survival time; CI, confidence interval; NA, not available; RFS, recurrence‐free survival; OS, overall survival
See this image and copyright information in PMC

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