Cattell‐Braasch maneuver facilitates the artery‐first approach and complete excision of the mesopancreas for pancreatoduodenectomy

Abstract

How to cite this article: Akita M, Yamasaki N, Miyake T, et al.Cattell-Braasch maneuver facilitates the artery-first approach and complete excision of the mesopancreas for pancreatoduodenectomy.

Cattell‐Braasch maneuver in pancreatic surgery. No need of venous graft for vascular resection

“…11 Also, it presents some advantages for pancreatic cancer resection: allows a better exposure of the operating field and a better bleeding control in case of an accident, allows an easier mesopancreas dissection, including the division of the inferior pancreaticoduodenal artery and lymph nodes retrieval. 8,12 The importance of total mesopancreas excision during pancreaticoduodenectomy was recently highlighted and it has been reported as primary site for R1 resection in pancreatic head cancers, then total mesopancreas resection is mandatory for obtain R0 resection. [13][14][15] Another advantage is represented by an easier assessment of a possible neoplastic SMA involvement in the beginning of the operation and the resulting decrease of unnecessary resections.…”

“…The use of the Cattell‐Braasch maneuver is easy to perform, it is not associated with morbidity and allows a safe and tension free direct venous anastomosis independently of the length of the segment to be resected 11 . Also, it presents some advantages for pancreatic cancer resection: allows a better exposure of the operating field and a better bleeding control in case of an accident, allows an easier mesopancreas dissection, including the division of the inferior pancreaticoduodenal artery and lymph nodes retrieval 8,12 . The importance of total mesopancreas excision during pancreaticoduodenectomy was recently highlighted and it has been reported as primary site for R1 resection in pancreatic head cancers, then total mesopancreas resection is mandatory for obtain R0 resection 13‐15 .…”

“Mesopancreas-first” radical resection of pancreatic head cancer following the Cattell–Braasch–Valdoni maneuver: Appreciating the legacy of pioneers in visceral surgery

“…Accurate knowledge of peripancreatic surgical anatomy can be extracted from a number of very important, recently published clinical [6,[25][26][27] and radiologic studies [28,29]. The latter, nicely describe the anatomy of peripancreatic and proximal jejunal vessels using three-dimensional computed tomography imaging.…”

Response to letter to the editor “Beyond ‘artery‐first’ pancreaticoduodenectomy for pancreatic carcinoma: Cattell‐Braasch maneuver in ‘mesopancreas‐first’ pancreaticoduodenectomy”

“…2 Our finding that the Cattell-Braasch maneuver could harvest more lymph nodes around the SMA than standard pancreatectomy also indicated that this technique contributed to complete mesopancreas resection. 3 Further research is needed to ascertain whether it is necessary to distinguish the "mesopancreas-first" from the "artery-first" approach, because the mesopancreas includes SMA branches such as the IPDA and J1a.…”