Follow “the superior mesenteric artery”: laparoscopic approach for total mesopancreas excision during pancreaticoduodenectomy

Morales, Edouardo; Zimmitti, Giuseppe; Codignola, Claudio; Manzoni, Alberto; Garatti, Marco; Sega, Valentina; Rosso, Edoardo

doi:10.1007/s00464-019-06994-6

Cited by 22 publications

(16 citation statements)

References 22 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Wu et al retrospectively analyzed 120 patients with pancreatic head cancer who received PDs with TMpE and revealed a 71.6% of R0 resection [29]. Besides, a recent laparoscope-related study reported that R0 resection rate and number of harvested lymph nodes reached 86% and 26, respectively, regardless of surgical procedures [30].…”

Section: Discussionmentioning

confidence: 99%

Laparoscopic assisted pancreaticoduodenectomy: an important link in the process of transition from open to total laparoscopic pancreaticoduodenectomy

Tian¹,

Wang²,

Hua³

et al. 2020

BMC Surg

View full text Add to dashboard Cite

Background: The safety of total laparoscopic pancreaticoduodenectomy still remains controversial. Laparoscopic assisted pancreaticoduodenectomy (LAPD) may be an alternative selection. The purpose of the present study is to compare a consecutive cohort of LAPD and open pancreaticoduodenectomy (OPD) from a single surgeon. Methods: A comparison was conducted between LAPD and OPD from January 2013 to December 2018. Perioperative outcomes and short-term oncological results were compared. Univariate and multivariable analyses were performed to determine associations among variables. Results: 133 patients were enrolled, 36 patients (27.1%) underwent LAPD and 97 (72.9%) underwent OPD. No 30day and 90-day mortality occurred. LAPD was associated with decreased intraoperative estimated blood loss (300 versus 500 ml; P = 0.002), longer operative time (372 versus 305 min; P < 0.001) compared with OPD. LAPD had a conversion rate of 16.7%, and wasn't associated with an increased grade B/C pancreatic fistula rate, major surgical complications, intraoperative blood transfusion, reoperation rate or length of hospital stay after surgery. In the subset of 58 pancreatic ductal adenocarcinomas, R0 resection rate, median total harvested lymph node or lymph nodes ≥12 did not differ between the two groups. Conclusion: LAPD could be performed with non-inferior short-term perioperative and oncologic outcomes achieved by OPD in selected patients.

show abstract

Section: Discussionmentioning

confidence: 99%

Laparoscopic assisted pancreaticoduodenectomy: an important link in the process of transition from open to total laparoscopic pancreaticoduodenectomy

Tian¹,

Wang²,

Hua³

et al. 2020

BMC Surg

View full text Add to dashboard Cite

show abstract

“…In recent years, after introduction of the concept of the "mesopancreas" [7], it has come to be believed that R1 resection is caused by incomplete resection of the mesopancreas in many patients with pancreatic head cancer [6,16]. Accordingly, the concept of "total mesopancreas excision (TMpE)" was proposed and applied, helping to increase the R0 resection rate (ranged between 57 and 96.7%) and improve the prognosis of pancreatic cancer [5,14,15,18,20]. While these studies contributed to understanding the anatomy of the retropancreatic region, a peculiar technical description of so-called "total mesopancreas excision" resulted from two different concepts of the mesopancreas based on differing experience in surgical dissection.…”

Section: Introductionmentioning

confidence: 99%

The mesopancreas and pancreatic head plexus: morphological, developmental, and clinical perspectives

Nagakawa

Ren

et al. 2020

Surg Radiol Anat

View full text Add to dashboard Cite

Purpose Total mesopancreas excision has been found to be helpful for increasing no residual tumor resection rate and improving the prognosis of pancreatic cancer. This study analyzed the relationships among the mesopancreas and pancreatic head plexus from the morphological, developmental, and clinical perspectives. Methods Twenty-four cadavers were employed. The upper abdominal viscera were resected en-bloc with the hepatoduodenal ligament, abdominal aorta, and nerve plexuses, and the innervation of the pancreas was dissected. Ten additional cadavers were used for histological examination of the pancreatic head and neck, part of the duodenum, the superior mesenteric artery (SMA) and its surrounding tissues, and the related arteries and veins. Results As results, cross-sections of the SMA revealed 6-9 layers of membranous structures resembling the layers of an onion, and the nerve fibers of the superior mesenteric plexus ran between the layers. Loose areolar tissue, adipose tissue, and lymphatics existed between the SMA and the pancreatic head/uncinate process, along with abundant thin blood vessels and capillaries, but very few nerves were found approaching the pancreas. Several parallel layers of collagen fibers (so-called Treitz's fusion fascia) existed between the dorsal aspect of the pancreatic head and the aortocaval plane. ConclusionThe mesopancreas was continuous and connected with the para-aortic area. It may be better termed the mesopancreatoduodenum than the mesopancreas, as the duodenum-pancreas-SMA forms a complex morphological, developmental, functional, and pathological structure.

show abstract

“…The approach is almost the same as those described in the right approach with SMA exposure for MIPD. Three articles reported a surgical technique to divide the common artery of the IPDA and the first jejunal artery (J1A) by approaching the left side of the SMA in MIPD 13,33,34 . Cho et al 33 reported in detail the artery-first surgical procedure of LPD.…”

Section: Right Approachmentioning

confidence: 99%

Surgical approaches to the superior mesenteric artery during minimally invasive pancreaticoduodenectomy: A systematic review

Nagakawa

Watanabe

Kozono

et al. 2021

J Hepato Biliary Pancreat

Self Cite

View full text Add to dashboard Cite

Background Minimally invasive pancreaticoduodenectomy (MIPD) has recently been safely performed by experts, and various methods for resection have been reported. This review summarizes the literature describing surgical approaches for MIPD. Methods A systematic literature search of PubMed (MEDLINE) was conducted for studies reporting robotic and laparoscopic pancreaticoduodenectomy; the reference lists of review articles were searched. Of 444 articles yielded, 23 manuscripts describing the surgical approach to dissect around the superior mesenteric artery (SMA), including hand‐searched articles, were assessed. Results Various approaches to dissect around the SMA have been reported. These approaches were categorized according to the direction toward the SMA when initiating dissection around the SMA: anterior approach (two articles), posterior approach (four articles), right approach (16 articles), and left approach (three articles). Thus, many reports used the right approach. Most articles provided a technical description. Some articles showed the advantage of their method in a comparison study. However, these were single‐center retrospective studies with a small sample size. Conclusions Various approaches for MIPD have been reported; however, few authors have reported the advantage of their methods compared to other methods. Further discussion is needed to clarify the appropriate surgical approach to the SMA during MIPD.

show abstract

Follow “the superior mesenteric artery”: laparoscopic approach for total mesopancreas excision during pancreaticoduodenectomy

Cited by 22 publications

References 22 publications

Laparoscopic assisted pancreaticoduodenectomy: an important link in the process of transition from open to total laparoscopic pancreaticoduodenectomy

Laparoscopic assisted pancreaticoduodenectomy: an important link in the process of transition from open to total laparoscopic pancreaticoduodenectomy

The mesopancreas and pancreatic head plexus: morphological, developmental, and clinical perspectives

Surgical approaches to the superior mesenteric artery during minimally invasive pancreaticoduodenectomy: A systematic review

Contact Info

Product

Resources

About