Despair: The whole body is yellow, but it is actually the "king of cancer" that cannot be removed locally
"Until now, I still can't believe it." Mr. Wang recalled that during the 2022 Spring Festival, he found that his skin and urine were yellower than usual, so he went to the local hospital for treatment, "I thought it was a minor illness, but the doctor said I have pancreatic cancer, and it's at an advanced stage, so I don't even have a chance for surgery," said Mr. Wang.
It is understood that pancreatic cancer is known as the "king of cancers" because of its special location, difficult surgery, high degree of malignancy, and a 5-year survival rate of less than 10%. Surgical resection is currently the only curative treatment. Unfortunately, Mr. Wang's tumor has invaded the main artery supplying the liver, the main trunk of the common hepatic artery, and many hospitals across the country have judged it as "unresectable" and recommended conservative treatment. , I decided to let them see if I still have a chance to operate and try again." Mr. Wang said.
Hope: Arterial invasion is not a "surgical taboo", the key is to "cut clean"
After being hospitalized, the "one-stop" multidisciplinary diagnosis and treatment team of the Provincial People's Medical Pancreas Center made a detailed assessment for Mr. Wang. "The patient's common hepatic artery is invaded by the tumor, and the blood vessels are twisted and narrowed. For example, it is difficult to strip the common hepatic artery from the tumor, and the tumor may remain," a doctor reminded when reading multidisciplinary images. At this time, Director Jiang Kuirong put forward a bold idea, "The patient's artery supplying the spleen is not affected by the tumor, why not remove the hepatic artery, and then reconnect the splenic artery and the distal hepatic artery to rebuild the blood supply to the liver?" "It is reported in the literature that this kind of surgery has huge risks, and a little carelessness can lead to serious consequences." "However, the data of pre-arterial resection and reconstruction in our center show that the pancreatic surgery for arteriotomy and reconstruction in our center is safe and reliable" … After careful multidisciplinary discussions, the expert team finally decided to take a risk: "I checked the relevant literature, and similar surgeries are rarely reported, but we are confident and capable of winning this tough battle," said Director Jiang.
After the surgical plan was determined, on February 16, 2022, Mr. Wang underwent surgical treatment. "The operation is more complicated than expected. The tumor in the head and neck of the pancreas has invaded the origin of the proper hepatic artery, and the portal vein and superior mesenteric vein are also closely related to the tumor," said Director Jiang. The characteristic technique of arterial sheath stripping removes the surrounding soft tissue along the superior mesenteric artery and the celiac trunk, and frees the splenic artery for a long enough distance for reconstruction. After the two ends of the common hepatic artery are cut off, the tumor and the entire pancreas is en bloc. Complete resection." When the splenic artery and proper hepatic artery were quickly re-sutured with a needle to open the blood flow, Director Jiang touched the distal hepatic artery: normal pulsation! The surgical team finally breathed a sigh of relief. The whole operation took 583 minutes. "This should be the longest operation in my career, from morning to night, but everything went smoothly!" Director Jiang said. After the operation, Mr. Wang was closely observed in the intensive care unit of the Pancreatic Center for 7 days and then was successfully transferred back to the general ward. The postoperative recovery was much better than expected. Even Mr. Wang himself did not believe that such a major operation would recover so quickly. The pathology report showed that there were no tumor residues at all margins, and the operation was very successful!
Breaking through the "technical bottleneck" of arterial invasion of pancreatic cancer, locally advanced pancreatic cancer "reborn" at the Provincial People's Medical Pancreatic Center
It is understood that "arterial invasion of pancreatic cancer" is considered to be locally advanced unresectable according to international guidelines. In fact, experienced and skilled professional pancreatic surgeons can still perform resection for some locally advanced pancreatic cancers. Professor Miao Yi from the Pancreatic Center of Jiangsu Provincial People's Hospital, based on decades of practical experience in pancreatic surgery, put forward for the first time in the world the view that "the depth of arterial invasion of pancreatic cancer is more important than the circumference", which has been widely recognized by domestic and foreign counterparts and promotion. In this case, through detailed preoperative planning and design, superb surgical techniques and ingenious surgical strategies, a radical surgical resection was successfully performed under the condition of ensuring surgical safety. "The real 'clean cut' is the goal of our pancreatic surgeons," said Director Jiang Kuirong, "because only in this way can patients benefit."
It is understood that the Pancreatic Center of Jiangsu Provincial People's Hospital (The First Affiliated Hospital of Nanjing Medical University), as the only multidisciplinary team in China with surgery, intensive care, endoscopy and chemotherapy, performs more than 1,000 pancreatic surgeries every year, with a number of Thousands of pancreatic cancer patients provide one-stop medical services. He has created key technologies such as arterial sheath stripping and single-layer pancreaticojejunostomy. He is the first in China to carry out Heidelberg triangle dissection technology for pancreatic cancer, radical Shunxing modular pancreatectomy and splenectomy, and radical pancreatic cancer surgery combined with arterial resection and reconstruction to overcome pancreatic cancer. Cancer adds another weapon.
