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Top‐down approach to the superior mesenteric artery and the mesopancreas during pancreatoduodenectomy for pancreatic cancer
Author(s) -
Welsch Thilo,
Bork Ulrich,
Distler Marius,
Weitz Jürgen
Publication year - 2016
Publication title -
journal of surgical oncology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.201
H-Index - 111
eISSN - 1096-9098
pISSN - 0022-4790
DOI - 10.1002/jso.24204
Subject(s) - medicine , superior mesenteric artery , superior mesenteric vein , pancreaticoduodenectomy , pancreatic cancer , dissection (medical) , mesentery , portal vein , radiology , resection , artery , surgery , cancer
Complete surgical resection with microscopically tumor‐free resection margins (R0) is the most important survival determinant for patients with localized pancreatic cancer. The medial and posterior resection margins are the dominant sites of microscopic tumor involvement, and outline the so‐called mesopancreas . In this study, we present a modified surgical approach to the superior mesenteric artery, celiac trunc, and mesopancreas during pancreatoduodenectomy, which enables a comfortable exposure and radical en bloc clearance of the mesopancreas and the tissue adjacent to the superior mesenteric artery. The dissection of the mesopancreas is directed from the ventral aspect of the portal vein downward along the superior mesenteric artery and the celiac trunc, before the transection of the duodenal mesentery is accomplished. The described technique complements the established surgical approaches to pancreatic head tumors, and is indicated in the absence of portal vein infiltration. J. Surg. Oncol. 2016;113:668–671 . © 2016 Wiley Periodicals, Inc.