Skip to main content

Advertisement

SpringerLink
Log in

Sub-adventitial divestment technique for resecting artery-involved pancreatic cancer: a retrospective cohort study

  • Original Article
  • Published:
Langenbeck's Archives of Surgery Aims and scope Submit manuscript

Abstract

Purpose

To introduce sub-adventitial divestment technique (SDT), a procedure to remove the tumor while preserving the artery during curative pancreatectomy. Peri-operative safety profile was also evaluated.

Methods

In a single center consecutive series of pancreatectomy for pancreatic cancer, the outcome of patients who had pancreatectomy with SDT was compared to standard pancreatic surgery.

Results

From June 2014 to June 2016, 72 patients had pancreatectomy with SDT and 235 had standard surgery. Tumor stage was T4 in all 72 (100%) tumors removed using SDT compared to four (2%) with standard pancreatectomy (p < 0.001). All 72 (100%) tumors in the SDT group were stage III compared to 24 (10%) in the standard surgery group (p < 0.001). Both groups had a high proportion of poorly differentiated tumors (52 (72%) and 163 (69%) respectively) and perineural tumor invasion (62 (86%) and 186 (79%) respectively). R1 (< 1 mm) was found in 24 (86%) of 28 tumors in the SDT group, and in 72 (60%) out of 120 standard pancreatectomy tumors (p = 0.01). Complications occurred in 29 (40%) of the SDT group and in 88 (37%) of the standard group. The in-hospital mortality was four (6%) in the SDT group and one (0.4%) in the standard group (p = 0.01), with a 90-day mortality of 5 (8%)/60 and 6 (3%)/209 (p = 0.07) respectively.

Conclusions

The sub-adventitial divestment technique appeared to be an effective surgical technique to remove the tumor while preserving the artery. This approach warrants further validation in prospective studies.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3

Similar content being viewed by others

Data availability

All data and material used or analyzed during the current study are available from the corresponding author on reasonable request.

References

  1. Neoptolemos JP, Palmer DH, Ghaneh P, Psarelli EE, Valle JW, Halloran CM, Faluyi O, O'Reilly DA, Cunningham D, Wadsley J, Darby S, Meyer T, Gillmore R, Anthoney A, Lind P, Glimelius B, Falk S, Izbicki JR, Middleton GW, Cummins S, Ross PJ, Wasan H, McDonald A, Crosby T, Ma YT, Patel K, Sherriff D, Soomal R, Borg D, Sothi S, Hammel P, Hackert T, Jackson R, Buchler MW, European Study Group for Pancreatic C (2017) Comparison of adjuvant gemcitabine and capecitabine with gemcitabine monotherapy in patients with resected pancreatic cancer (ESPAC-4): a multicentre, open-label, randomised, phase 3 trial. Lancet 389(10073):1011–1024. https://doi.org/10.1016/S0140-6736(16)32409-6

    Article  CAS  PubMed  Google Scholar 

  2. Conroy T, Hammel P, Hebbar M, Ben Abdelghani M, Wei AC, Raoul JL, Chone L, Francois E, Artru P, Biagi JJ, Lecomte T, Assenat E, Faroux R, Ychou M, Volet J, Sauvanet A, Breysacher G, Di Fiore F, Cripps C, Kavan P, Texereau P, Bouhier-Leporrier K, Khemissa-Akouz F, Legoux JL, Juzyna B, Gourgou S, O'Callaghan CJ, Jouffroy-Zeller C, Rat P, Malka D, Castan F, Bachet JB, Canadian Cancer Trials G, the Unicancer GIPG (2018) FOLFIRINOX or gemcitabine as adjuvant therapy for pancreatic cancer. N Engl J Med 379(25):2395–2406. https://doi.org/10.1056/NEJMoa1809775

    Article  CAS  PubMed  Google Scholar 

  3. Jones RP, Psarelli EE, Jackson R, Ghaneh P, Halloran CM, Palmer DH, Campbell F, Valle JW, Faluyi O, O'Reilly DA, Cunningham D, Wadsley J, Darby S, Meyer T, Gillmore R, Anthoney A, Lind P, Glimelius B, Falk S, Izbicki JR, Middleton GW, Cummins S, Ross PJ, Wasan H, McDonald A, Crosby T, Ting Y, Patel K, Sherriff D, Soomal R, Borg D, Sothi S, Hammel P, Lerch MM, Mayerle J, Tjaden C, Strobel O, Hackert T, Buchler MW, Neoptolemos JP, European Study Group for Pancreatic C (2019) Patterns of recurrence after resection of pancreatic ductal adenocarcinoma: a secondary analysis of the ESPAC-4 randomized adjuvant chemotherapy trial. JAMA Surg 154:1038–1048. https://doi.org/10.1001/jamasurg.2019.3337

    Article  PubMed  PubMed Central  Google Scholar 

  4. Ghaneh P, Kleeff J, Halloran CM, Raraty M, Jackson R, Melling J, Jones O, Palmer DH, Cox TF, Smith CJ, O'Reilly DA, Izbicki JR, Scarfe AG, Valle JW, McDonald AC, Carter R, Tebbutt NC, Goldstein D, Padbury R, Shannon J, Dervenis C, Glimelius B, Deakin M, Anthoney A, Lerch MM, Mayerle J, Olah A, Rawcliffe CL, Campbell F, Strobel O, Buchler MW, Neoptolemos JP, European Study Group for Pancreatic C (2019) The impact of positive resection margins on survival and recurrence following resection and adjuvant chemotherapy for pancreatic ductal adenocarcinoma. Ann Surg 269(3):520–529. https://doi.org/10.1097/SLA.0000000000002557

    Article  PubMed  Google Scholar 

  5. Hackert T, Sachsenmaier M, Hinz U, Schneider L, Michalski CW, Springfeld C, Strobel O, Jager D, Ulrich A, Buchler MW (2016) Locally advanced pancreatic cancer: neoadjuvant therapy with Folfirinox results in resectability in 60% of the patients. Ann Surg 264(3):457–463. https://doi.org/10.1097/SLA.0000000000001850

    Article  PubMed  Google Scholar 

  6. Murphy JE, Wo JY, Ryan DP, Clark JW, Jiang W, Yeap BY, Drapek LC, Ly L, Baglini CV, Blaszkowsky LS, Ferrone CR, Parikh AR, Weekes CD, Nipp RD, Kwak EL, Allen JN, Corcoran RB, Ting DT, Faris JE, Zhu AX, Goyal L, Berger DL, Qadan M, Lillemoe KD, Talele N, Jain RK, DeLaney TF, Duda DG, Boucher Y, Fernandez-Del Castillo C, Hong TS (2019) Total neoadjuvant therapy with FOLFIRINOX in combination with losartan followed by chemoradiotherapy for locally advanced pancreatic cancer: a phase 2 clinical trial. JAMA Oncol 5(7):1020–1027. https://doi.org/10.1001/jamaoncol.2019.0892

    Article  PubMed  PubMed Central  Google Scholar 

  7. Varadhachary GR, Tamm EP, Abbruzzese JL, Xiong HQ, Crane CH, Wang H, Lee JE, Pisters PW, Evans DB, Wolff RA (2006) Borderline resectable pancreatic cancer: definitions, management, and role of preoperative therapy. Ann Surg Oncol 13(8):1035–1046. https://doi.org/10.1245/ASO.2006.08.011

    Article  PubMed  Google Scholar 

  8. Katz MH, Pisters PW, Evans DB, Sun CC, Lee JE, Fleming JB, Vauthey JN, Abdalla EK, Crane CH, Wolff RA, Varadhachary GR, Hwang RF (2008) Borderline resectable pancreatic cancer: the importance of this emerging stage of disease. J Am Coll Surg 206(5):833–846; discussion 846-838. https://doi.org/10.1016/j.jamcollsurg.2007.12.020

    Article  PubMed  PubMed Central  Google Scholar 

  9. Callery MP, Chang KJ, Fishman EK, Talamonti MS, William Traverso L, Linehan DC (2009) Pretreatment assessment of resectable and borderline resectable pancreatic cancer: expert consensus statement. Ann Surg Oncol 16(7):1727–1733. https://doi.org/10.1245/s10434-009-0408-6

    Article  PubMed  Google Scholar 

  10. Katz MH, Marsh R, Herman JM, Shi Q, Collison E, Venook AP, Kindler HL, Alberts SR, Philip P, Lowy AM, Pisters PW, Posner MC, Berlin JD, Ahmad SA (2013) Borderline resectable pancreatic cancer: need for standardization and methods for optimal clinical trial design. Ann Surg Oncol 20(8):2787–2795. https://doi.org/10.1245/s10434-013-2886-9

    Article  PubMed  PubMed Central  Google Scholar 

  11. Bockhorn M, Uzunoglu FG, Adham M, Imrie C, Milicevic M, Sandberg AA, Asbun HJ, Bassi C, Buchler M, Charnley RM, Conlon K, Cruz LF, Dervenis C, Fingerhutt A, Friess H, Gouma DJ, Hartwig W, Lillemoe KD, Montorsi M, Neoptolemos JP, Shrikhande SV, Takaori K, Traverso W, Vashist YK, Vollmer C, Yeo CJ, Izbicki JR, International Study Group of Pancreatic S (2014) Borderline resectable pancreatic cancer: a consensus statement by the International Study Group of Pancreatic Surgery (ISGPS). Surgery 155(6):977–988. https://doi.org/10.1016/j.surg.2014.02.001

    Article  PubMed  Google Scholar 

  12. Al-Hawary MM, Francis IR, Chari ST, Fishman EK, Hough DM, Lu DS, Macari M, Megibow AJ, Miller FH, Mortele KJ, Merchant NB, Minter RM, Tamm EP, Sahani DV, Simeone DM (2014) Pancreatic ductal adenocarcinoma radiology reporting template: consensus statement of the society of abdominal radiology and the american pancreatic association. Gastroenterology 146(1):291–304 e291. https://doi.org/10.1053/j.gastro.2013.11.004

    Article  PubMed  Google Scholar 

  13. Hartwig W, Vollmer CM, Fingerhut A, Yeo CJ, Neoptolemos JP, Adham M, Andren-Sandberg A, Asbun HJ, Bassi C, Bockhorn M, Charnley R, Conlon KC, Dervenis C, Fernandez-Cruz L, Friess H, Gouma DJ, Imrie CW, Lillemoe KD, Milicevic MN, Montorsi M, Shrikhande SV, Vashist YK, Izbicki JR, Buchler MW, International Study Group on Pancreatic S (2014) Extended pancreatectomy in pancreatic ductal adenocarcinoma: definition and consensus of the International Study Group for Pancreatic Surgery (ISGPS). Surgery 156(1):1–14. https://doi.org/10.1016/j.surg.2014.02.009

    Article  PubMed  Google Scholar 

  14. Tol JA, Gouma DJ, Bassi C, Dervenis C, Montorsi M, Adham M, Andren-Sandberg A, Asbun HJ, Bockhorn M, Buchler MW, Conlon KC, Fernandez-Cruz L, Fingerhut A, Friess H, Hartwig W, Izbicki JR, Lillemoe KD, Milicevic MN, Neoptolemos JP, Shrikhande SV, Vollmer CM, Yeo CJ, Charnley RM, International Study Group on Pancreatic S (2014) Definition of a standard lymphadenectomy in surgery for pancreatic ductal adenocarcinoma: a consensus statement by the International Study Group on Pancreatic Surgery (ISGPS). Surgery 156(3):591–600. https://doi.org/10.1016/j.surg.2014.06.016

    Article  PubMed  Google Scholar 

  15. Hartwig W, Gluth A, Hinz U, Bergmann F, Spronk PE, Hackert T, Werner J, Buchler MW (2015) Total pancreatectomy for primary pancreatic neoplasms: renaissance of an unpopular operation. Ann Surg 261(3):537–546. https://doi.org/10.1097/SLA.0000000000000791

    Article  PubMed  Google Scholar 

  16. Klompmaker S, Boggi U, Hackert T, Salvia R, Weiss M, Yamaue H, Zeh HJ, Besselink MG (2018) Distal pancreatectomy with celiac axis resection (DP-CAR) for pancreatic cancer. How I do It J Gastrointest Surg 22(10):1804–1810. https://doi.org/10.1007/s11605-018-3894-7

    Article  Google Scholar 

  17. Truty MJ, Colglazier JJ, Mendes BC, Nagorney DM, Bower TC, Smoot RL, DeMartino RR, Cleary SP, Oderich GS, Kendrick ML (2020) En bloc celiac axis resection for pancreatic cancer: classification of anatomical variants based on tumor extent. J Am Coll Surg 231(1):8–29. https://doi.org/10.1016/j.jamcollsurg.2020.05.005

    Article  PubMed  Google Scholar 

  18. Sonohara F, Yamada S, Takami H, Hayashi M, Kanda M, Tanaka C, Kobayashi D, Nakayama G, Koike M, Fujiwara M, Fujii T, Kodera Y (2019) Novel implications of combined arterial resection for locally advanced pancreatic cancer in the era of newer chemo-regimens. Eur J Surg Oncol 45(10):1895–1900. https://doi.org/10.1016/j.ejso.2019.05.019

    Article  PubMed  Google Scholar 

  19. Tee MC, Krajewski AC, Groeschl RT, Farnell MB, Nagorney DM, Kendrick ML, Cleary SP, Smoot RL, Croome KP, Truty MJ (2018) Indications and perioperative outcomes for pancreatectomy with arterial resection. J Am Coll Surg 227(2):255–269. https://doi.org/10.1016/j.jamcollsurg.2018.05.001

    Article  PubMed  Google Scholar 

  20. Habib JR, Kinny-Koster B, van Oosten F, Javed AA, Cameron JL, Lafaro KJ, Burkhart RA, Burns WR, He J, Thompson ED, Fishman EK, Wolfgang CL (2020) Periadventitial dissection of the superior mesenteric artery for locally advanced pancreatic cancer: surgical planning with the “halo sign” and “string sign”. Surgery. https://doi.org/10.1016/j.surg.2020.08.031

  21. Loos M, Kester T, Klaiber U, Mihaljevic AL, Mehrabi A, Muller-Stich BM, Diener MK, Schneider MA, Berchtold C, Hinz U, Feisst M, Strobel O, Hackert T, Buchler MW (2020) Arterial resection in pancreatic cancer surgery: effective after a learning curve. Ann Surg Publish Ahead of Print. https://doi.org/10.1097/SLA.0000000000004054

  22. Diener MK, Mihaljevic AL, Strobel O, Loos M, Schmidt T, Schneider M, Berchtold C, Mehrabi A, Muller-Stich BP, Jiang K, Neoptolemos JP, Hackert T, Miao Y, Buchler MW (2020) Periarterial divestment in pancreatic cancer surgery. Surgery. https://doi.org/10.1016/j.surg.2020.08.030

  23. Hackert T, Strobel O, Michalski CW, Mihaljevic AL, Mehrabi A, Muller-Stich B, Berchtold C, Ulrich A, Buchler MW (2017) The TRIANGLE operation - radical surgery after neoadjuvant treatment for advanced pancreatic cancer: a single arm observational study. HPB (Oxford) 19(11):1001–1007. https://doi.org/10.1016/j.hpb.2017.07.007

    Article  Google Scholar 

  24. Bachellier P, Rosso E, Lucescu I, Oussoultzoglou E, Tracey J, Pessaux P, Ferreira N, Jaeck D (2011) 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 103(1):75–84. https://doi.org/10.1002/jso.21769

    Article  PubMed  Google Scholar 

  25. Watanabe S, Kobayashi N, Kubota K, Sato T, Kato S, Hosono K, Shimamura T, Inayama Y, Nakajima A, Endo I (2013) A novel scoring system for arterial invasion of pancreatic body and tail cancer based on multidetector row computed tomography and biomarkers. Pancreatology 13(2):161–169. https://doi.org/10.1016/j.pan.2012.12.364

    Article  PubMed  Google Scholar 

  26. Miao Y, Jiang K, Cai B, Lu Z, Wu J, Gao W, Chen J, Guo F, Wei J, Dai C (2016) Arterial divestment instead of resection for locally advanced pancreatic cancer (LAPC). Pancreatology 16(3):S59

    Article  Google Scholar 

  27. Cai B, Lu Z, Jiang K, Wu J, Gao W, Chen J, Guo F, Wei J, Dai C, Miao Y (2018) AB081. P053 survival of unresectable pancreatic cancer patients after artery divestment combined pancreatectomy: a retrospective and propensity score-matched analysis. Annals of Pancreatic Cancer 1

  28. Schneider M, Strobel O, Hackert T, Buchler MW (2019) Pancreatic resection for cancer-the Heidelberg technique. Langenbeck's Arch Surg 404(8):1017–1022. https://doi.org/10.1007/s00423-019-01839-1

    Article  Google Scholar 

  29. Weitz J, Rahbari N, Koch M, Buchler MW (2010) The “artery first” approach for resection of pancreatic head cancer. J Am Coll Surg 210(2):e1–e4. https://doi.org/10.1016/j.jamcollsurg.2009.10.019

    Article  PubMed  Google Scholar 

  30. Bassi C, Marchegiani G, Dervenis C, Sarr M, Abu Hilal M, Adham M, Allen P, Andersson R, Asbun HJ, Besselink MG, Conlon K, Del Chiaro M, Falconi M, Fernandez-Cruz L, Fernandez-Del Castillo C, Fingerhut A, Friess H, Gouma DJ, Hackert T, Izbicki J, Lillemoe KD, Neoptolemos JP, Olah A, Schulick R, Shrikhande SV, Takada T, Takaori K, Traverso W, Vollmer CR, Wolfgang CL, Yeo CJ, Salvia R, Buchler M, International Study Group on Pancreatic S (2017) The 2016 update of the International Study Group (ISGPS) definition and grading of postoperative pancreatic fistula: 11 years after. Surgery 161(3):584–591. https://doi.org/10.1016/j.surg.2016.11.014

    Article  PubMed  Google Scholar 

  31. Wente MN, Bassi C, Dervenis C, Fingerhut A, Gouma DJ, Izbicki JR, Neoptolemos JP, Padbury RT, Sarr MG, Traverso LW, Yeo CJ, Buchler MW (2007) Delayed gastric emptying (DGE) after pancreatic surgery: a suggested definition by the International Study Group of Pancreatic Surgery (ISGPS). Surgery 142(5):761–768. https://doi.org/10.1016/j.surg.2007.05.005

    Article  PubMed  Google Scholar 

  32. Wente MN, Veit JA, Bassi C, Dervenis C, Fingerhut A, Gouma DJ, Izbicki JR, Neoptolemos JP, Padbury RT, Sarr MG, Yeo CJ, Buchler MW (2007) Postpancreatectomy hemorrhage (PPH): an International Study Group of Pancreatic Surgery (ISGPS) definition. Surgery 142(1):20–25. https://doi.org/10.1016/j.surg.2007.02.001

    Article  PubMed  Google Scholar 

  33. Besselink MG, van Rijssen LB, Bassi C, Dervenis C, Montorsi M, Adham M, Asbun HJ, Bockhorn M, Strobel O, Buchler MW, Busch OR, Charnley RM, Conlon KC, Fernandez-Cruz L, Fingerhut A, Friess H, Izbicki JR, Lillemoe KD, Neoptolemos JP, Sarr MG, Shrikhande SV, Sitarz R, Vollmer CM, Yeo CJ, Hartwig W, Wolfgang CL, Gouma DJ, International Study Group on Pancreatic S (2017) Definition and classification of chyle leak after pancreatic operation: a consensus statement by the International Study Group on Pancreatic Surgery. Surgery 161 (2):365–372. doi:https://doi.org/10.1016/j.surg.2016.06.058

  34. Doyle DJ, Garmon EH (2020) American Society of Anesthesiologists Classification (ASA class). In: StatPearls. Treasure Island (FL),

  35. Amin MB, Edge SB, Greene FL, Byrd DR, Brookland RK, Washington MK, Gershenwald JE, Compton CC, Hess KR, Sullivan DC (2018) AJCC Cancer staging manual. Springer International Publishing,

  36. Mollberg N, Rahbari NN, Koch M, Hartwig W, Hoeger Y, Buchler MW, Weitz J (2011) Arterial resection during pancreatectomy for pancreatic cancer: a systematic review and meta-analysis. Ann Surg 254(6):882–893. https://doi.org/10.1097/SLA.0b013e31823ac299

    Article  PubMed  Google Scholar 

  37. Jegatheeswaran S, Baltatzis M, Jamdar S, Siriwardena AK (2017) Superior mesenteric artery (SMA) resection during pancreatectomy for malignant disease of the pancreas: a systematic review. HPB (Oxford) 19:483–490. https://doi.org/10.1016/j.hpb.2017.02.437

    Article  Google Scholar 

  38. Klompmaker S, van Hilst J, Gerritsen SL, Adham M, Teresa Albiol Quer M, Bassi C, Berrevoet F, Boggi U, Busch OR, Cesaretti M, Dalla Valle R, Darnis B, De Pastena M, Del Chiaro M, Grutzmann R, Diener MK, Dumitrascu T, Friess H, Ivanecz A, Karayiannakis A, Fusai GK, Labori KJ, Lombardo C, Lopez-Ben S, Mabrut JY, Niesen W, Pardo F, Perinel J, Popescu I, Roeyen G, Sauvanet A, Prasad R, Sturesson C, Lesurtel M, Kleeff J, Salvia R, Besselink MG, group EAD-Cs (2018) Outcomes after distal pancreatectomy with celiac axis resection for pancreatic cancer: a Pan-European retrospective cohort study. Ann Surg Oncol 25 (5):1440–1447. doi:https://doi.org/10.1245/s10434-018-6391-z

  39. Hartwig W, Gluth A, Hinz U, Koliogiannis D, Strobel O, Hackert T, Werner J, Buchler MW (2016) Outcomes after extended pancreatectomy in patients with borderline resectable and locally advanced pancreatic cancer. Br J Surg 103(12):1683–1694. https://doi.org/10.1002/bjs.10221

    Article  CAS  PubMed  Google Scholar 

Download references

Code availability

Not applicable.

Funding

This study was supported by the grant from the National Natural Science Foundation of China (81672449), the Project of Invigorating Health Care through Science, Technology and Education, Jiangsu Provincial Medical Outstanding Talent (JCRCA2016009), and the Innovation Capability Development Project of Jiangsu Province (BM2015004).

Author information

Author notes

  1. Baobao Cai and Zipeng Lu contributed equally to this work. Markus W. Büchler and Yi Miao shared the correspondence authorship.

Authors and Affiliations

  1. Pancreas Centre, The First Affiliated Hospital Nanjing Medical University, 300 Guangzhou Road, Nanjing, Jiangsu Province, People’s Republic of China

    Baobao Cai, Zipeng Lu, John P. Neoptolemos, Lingdi Yin, Yong Gao, Jishu Wei, Jianmin Chen, Feng Guo, Min Tu, Chunhua Xi, Junli Wu, Wentao Gao, Cuncai Dai, Kuirong Jiang & Yi Miao

  2. Department of General, Visceral and Transplantation Surgery, University of Heidelberg, Im Neuenheimer Feld 110, 69120, Heidelberg, Germany

    John P. Neoptolemos, Markus K. Diener & Markus W. Büchler

  3. Pathology Department, First Affiliated Hospital, Nanjing Medical University, Nanjing, People’s Republic of China

    Mingna Li

  4. Pancreas Centre, The Affiliated BenQ Hospital of Nanjing Medical University, Nanjing, People’s Republic of China

    Yi Miao

Authors
  1. Baobao Cai
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Zipeng Lu
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. John P. Neoptolemos
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Markus K. Diener
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Mingna Li
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Lingdi Yin
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Yong Gao
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Jishu Wei
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Jianmin Chen
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. Feng Guo
    View author publications

    You can also search for this author in PubMed Google Scholar

  11. Min Tu
    View author publications

    You can also search for this author in PubMed Google Scholar

  12. Chunhua Xi
    View author publications

    You can also search for this author in PubMed Google Scholar

  13. Junli Wu
    View author publications

    You can also search for this author in PubMed Google Scholar

  14. Wentao Gao
    View author publications

    You can also search for this author in PubMed Google Scholar

  15. Cuncai Dai
    View author publications

    You can also search for this author in PubMed Google Scholar

  16. Kuirong Jiang
    View author publications

    You can also search for this author in PubMed Google Scholar

  17. Markus W. Büchler
    View author publications

    You can also search for this author in PubMed Google Scholar

  18. Yi Miao
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

Baobao Cai and Zipeng Lu collected the data and drafted the manuscript; John P. Neoptolemos interpreted data of the cohort and made critical review of the work; Lingdi Yin and Yong Gao acquired informed consent from patients and collected the data; Mingna Li, Markus K. Diener, Jishu Wei, Jianmin Chen, Feng Guo, Min Tu, and Chunhua Xi reviewed and analyzed data and contributed to draft revision; Junli Wu, Wentao Gao, and Cuncai Dai performed the procedure and interpreted the data; Kuirong Jiang performed and developed the procedure and refined the design of this study; Markus W. Büchler and Yi Miao designed, performed, and developed the procedure, conducted this study, and refined and determined the final submitted version of manuscript

Corresponding authors

Correspondence to Markus W. Büchler or Yi Miao.

Ethics declarations

Conflict of interest

The authors declare that they have no competing interests.

Ethics approval

Not applicable.

Consent to participate

Not applicable.

Consent for publication

Publication has been approved by all co-authors.

Additional information

Publisher’s note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Cai, B., Lu, Z., Neoptolemos, J.P. et al. Sub-adventitial divestment technique for resecting artery-involved pancreatic cancer: a retrospective cohort study. Langenbecks Arch Surg 406, 691–701 (2021). https://doi.org/10.1007/s00423-021-02080-5

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00423-021-02080-5

Keywords

Search

Navigation