An anatomical review of various superior mesenteric artery-first approaches during pancreatoduodenectomy for pancreatic cancer

Yamamoto, Junji; Kudo, Hiroki; Kyoden, Yusuke; Ajiro, Y.; Hiyoshi, Masaya; Okuno, Takayuki; Kawasaki, Hiroshi; Nemoto, Masaru; Yoshimi, Fuyo

doi:10.1007/s00595-020-02150-z

Cited by 17 publications

(9 citation statements)

References 30 publications

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“…Besides, PBTC differs from pancreatic head cancer in that, even when involving the CA, there is still an opportunity for DP‐CAR, whereas the latter is more prone to SMA invasion, 31 making surgery unfeasible. In recent years, with the advancement of surgical techniques, an increasing number of centers have been performing DP‐CAR surgeries 21–23 .…”

Section: Discussionmentioning

confidence: 99%

“…29 In addition, evaluation of artery invasion by preoperative imaging is sometimes ambiguous due to the elasticity of the arterial wall, which may lead to overestimation of local invasion and delay the possibility of primary resection. 30 Besides, PBTC differs from pancreatic head cancer in that, even when involving the CA, there is still an opportunity for DP-CAR, whereas the latter is more prone to SMA invasion, 31 making surgery unfeasible. In recent years, with the advancement of surgical techniques, an increasing number of centers have been performing DP-CAR surgeries.…”

Section: Subgroup Analysismentioning

confidence: 99%

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Pancreatic index: A prognostic factor of upfront surgery for body or tail pancreatic ductal adenocarcinoma with vascular involvement—A retrospective study

Qian,

Li,

Sun

et al. 2023

Cancer Medicine

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BackgroundThe pancreatic index (PI) is a useful preoperative imaging predictor for pancreatic ductal adenocarcinoma (PDAC). In this retrospective study, we determined the predictive effect of PI to distinguish patients of pancreatic body/tail cancer (PBTC) with vascular involvement who can benefit from upfront surgery.MethodAll patients who received distal pancreatectomy for PDAC from 2016 to 2020 at the Pancreatic Disease Center, Ruijin Hospital, Shanghai Jiaotong University School of Medicine were considered for the study. A total of 429 patients with PBTC were assessed in relation to the value of PI. Fifty‐five patients were eventually included and divided into low PI group and 29 patients in the normal PI group.ResultsThe median overall survival (mOS) was significantly shorter in the low PI group (13.1 vs. 30.0 months, p = 0.002) in this study, and PI ≥ 0.78 (OR = 0.552, 95% CI: 0.301–0.904, p = 0.020) was an independent influencing factor confirmed by multivariate analysis. Subgroup analysis showed that PI was an independent prognostic factor for LA‐PBTC (OR = 0.272, 95% CI: 0.077–0.969, p = 0.045). As for BR PBTC, PI (OR = 0.519, 95% CI: 0.285–0.947, p = 0.033) combined with carbohydrate antigen 125 (CA125) (OR = 2.806, 95% CI: 1.206–6.526, p = 0.017) and chemotherapy (OR = 0.327, 95% CI: 0.140–0.763, p = 0.010) were independent factors.ConclusionThis study suggests that the PI can be used as a predictive factor to optimize the surgical indication for PBTC with vascular involvement. Preoperative patients with normal PI and CA125 can achieve a long‐term prognosis comparable to that of resectable PBTC patients.

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Section: Discussionmentioning

confidence: 99%

Section: Subgroup Analysismentioning

confidence: 99%

Pancreatic index: A prognostic factor of upfront surgery for body or tail pancreatic ductal adenocarcinoma with vascular involvement—A retrospective study

Qian,

Li,

Sun

et al. 2023

Cancer Medicine

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“…Therefore, to ensure that each stitch was performed under direct vision, all minimally invasive pancreatic surgery with vascular reconstruction was performed in 3D laparoscopy. The artery-first approach (supracolic right posterior, infracolic anterior, supracolic anterior, and infracolic left posterior) has been shown to improve overall R0 resection in pancreatic ductal adenocarcinoma ( 27 ).…”

Section: Discussionmentioning

confidence: 99%

A single-center initial experience on laparoscopic pancreatic operation combined with hepatic arterial resection and reconstruction

Wang

Lei

et al. 2023

Front. Surg.

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ObjectiveThis study aims to summarize our single-center initial experience in laparoscopic pancreatic operation (LPO) combined with hepatic arterial resection and reconstruction, as well as to demonstrate the feasibility, safety, and key surgical procedure for LPO.MethodsWe retrospectively analyzed 7 patients who had undergone LPO combined with hepatic arterial resection and reconstruction in our center from January 2021 to December 2022. The clinical data of these 7 patients were collected and analyzed.ResultsIn our case series, two patients underwent passive arterial resection and reconstruction due to iatrogenic arterial injury, and five patients underwent forward arterial resection and reconstruction due to arterial invasion. The arterial anastomosis was successful in 5 cases, including 2 cases of end-to-end in situ and 3 cases of arterial transposition, and the vascular reconstruction time was 38.28 ± 15.32 min. There were two conversions to laparotomy. The postoperative recovery of all patients was uneventful, with one liver abscess (Segment 4) and no Clavien III–IV complications. We also share valuable technical feedback and experience gained from the initial practice.ConclusionsBased on the surgeon's proficiency in open arterial resection and reconstruction and laparoscopic technique. This study demonstrated the feasibility of total laparoscopic hepatic arterial resection and reconstruction in properly selected cases of arterial involvement or iatrogenic arterial injury. Our initial experience provides valuable information for laparoscopic pancreas surgery with arterial resection and reconstruction.

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“…An artery‐first approach to the superior mesenteric artery (SMA) during pancreaticoduodenectomy (PD) has the advantages of early judgment of resectability, secure surgical margins, less intraoperative blood loss, and shorter operation time compared with conventional PD [1–4]. However, despite the benefits of an artery‐first approach to SMA, mesopancreas excision around the SMA is sometimes technically difficult because the three‐dimensional anatomical structures around the SMA are complex and difficult to recognize [5].…”

Section: Introductionmentioning

confidence: 99%

“…An artery-first approach to the superior mesenteric artery (SMA) during pancreaticoduodenectomy (PD) has the advantages of early judgment of resectability, secure surgical margins, less intraoperative blood loss, and shorter operation time compared with conventional PD [1][2][3][4].…”

Section: Introductionmentioning

confidence: 99%

Modified Intestinal Derotation Procedure with Reversed Kocherization to Facilitate Mesopancreas Excision During Pancreaticoduodenectomy

et al. 2023

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Background Although intestinal derotation procedure has advantages of facilitating mesopancreas excision during pancreaticoduodenectomy, the wide mobilization takes time and risks injuring other organs. This article describes a modified intestinal derotation procedure in pancreaticoduodenectomy and its clinical impact on short-term outcomes. Methods The modified procedure comprised the pinpoint mobilization of the proximal jejunum following reversed Kocherization. Among 99 consecutive patients who underwent pancreaticoduodenectomy between 2016 and 2022, the short-term outcomes of pancreaticoduodenectomy with the modified procedure were compared with those of conventional pancreaticoduodenectomy. The feasibility of the modified procedure was investigated based on the vascular anatomy of the mesopancreas. Results Compared with conventional pancreaticoduodenectomy (n = 55), the modified procedure (n = 44) involved less blood loss and shorter operation time (p \ 0.001 and 0.017, respectively). Severe morbidity, clinically relevant postoperative pancreatic fistula, and prolonged hospitalization occurred less often with the modified procedure compared with conventional pancreaticoduodenectomy (p = 0.003, 0.008, and \ 0.001, respectively). According to preoperative image findings, most (72%) patients had a single inferior pancreaticoduodenal artery sharing a common trunk with the first jejunal artery. The inferior pancreaticoduodenal vein drained into the jejunal vein in 71% of the patients. The first jejunal vein ran behind the superior mesenteric artery in 77% of the patients. Conclusions By combining our modified intestinal derotation procedure with preoperative recognition of the vascular anatomy of mesopancreas, mesopancreas excision during pancreaticoduodenectomy can be performed safely and accurately.

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An anatomical review of various superior mesenteric artery-first approaches during pancreatoduodenectomy for pancreatic cancer

Cited by 17 publications

References 30 publications

Pancreatic index: A prognostic factor of upfront surgery for body or tail pancreatic ductal adenocarcinoma with vascular involvement—A retrospective study

Pancreatic index: A prognostic factor of upfront surgery for body or tail pancreatic ductal adenocarcinoma with vascular involvement—A retrospective study

A single-center initial experience on laparoscopic pancreatic operation combined with hepatic arterial resection and reconstruction

Modified Intestinal Derotation Procedure with Reversed Kocherization to Facilitate Mesopancreas Excision During Pancreaticoduodenectomy

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