Recently, Prof. Liu Xubao and Associate Professor Ke Nengwen of the Department of Pancreatic Surgery, West China Hospital, Sichuan University, completed the first in-situ laparoscopic pancreaticoduodenectomy via the subvertricular zone of colon combined with the portal vein resection for pancreatic head cancers in the world. The 6-hour operation was performed by Associate Professor Ke Nengwen. The patient’s postoperative recovery was smooth. According to literature retrieval, no similar surgical case has been reported in the world.

Pancreatic head cancer is a solid tumor of an extremely high malignant degree, while pancreatoduodenectomy is regarded as the sole cure for it. However, at present, about 1/3 of such patients are prone to liver metastasis after operation, which often leads to treatment failure. Recent studies have shown that the traditional pancreaticoduodenectomy will significantly increase the chance of liver metastasis due to repeated compression of tumors during the operation. Guided by Prof. Liu Xubao, Associate Professor Ke Nengwen has been exploring a new surgical method for pancreatic head cancer resection using laparoscopic in-situ resection technology since 2016, so as to overcome the inherent defects of the traditional pancreaticoduodenectomy. After four years of exploration, the team has successfully designed a new kind of pancreaticoduodenectomy for pancreatic head cancer that conforms to the No-touch Principle in the radical tumor surgery. Preliminary follow-up data suggest that this operation can significantly reduce the incidence of liver metastasis after the pancreatic cancer surgery. At present, there are patients who have been followed up for four years, without metastasis or recurrence.

In recent years, Prof. Ke has perfected the technology. The video of this operation was accepted by the 2020 Annual Meeting of the Society of American Gastrointestinal and Endoscopic Surgeons, with the technique being displayed thereat. Also, nearly 4,000 times of observation was registered on the well-known academic Wechat public account ‘isurgery’ in China.

The surgical method adopted in this operation emphasized that the pancreatic head cancer shall not be dissociated or squeezed before the blood vessels around the tumor were severed, thus minimizing tumor metastasis caused by the operation. Since the pancreatic head was not dissociated, even in the open surgery, the operation was more difficult than the ordinary pancreaticoduodenectomy; moreover, it was more challenging to complete the laparoscopic in-situ pancreaticoduodenectomy, especially in case of combined vascular resection and reconstruction. It is necessary to have a profound understanding of the local anatomy in the pancreatic head region. At present, there is no report of laparoscopic in situ resection combined with vascular resection at home and abroad.