Precision anatomy for safe approach to pancreatoduodenectomy for both open and minimally invasive procedure: A systematic review

Abstract

Background: Minimally invasive pancreatoduodenectomy (MIPD) has recently gained popularity. Several international meetings focusing on the existing literature on MIPD were held; however, the precise surgical anatomy of the pancreas for the safe use of MIPD has not yet been fully discussed. The aim of this study was to carry out a systematic review of available articles and to show the importance of identifying the anatomical variation in pancreatoduodenectomy. Methods: In this review, we described variations in surgical anatomy related to MIPD. A systematic search of PubMed (MEDLINE) was conducted, and the references were identified manually. Results: The search strategy yielded 272 articles, with 77 retained for analysis. The important anatomy to be considered during MIPD includes the aberrant right hepatic artery, first jejunal vein, first jejunal artery, and dorsal pancreatic artery. Celiac artery stenosis and a circumportal pancreas are also important to recognize.

International expert consensus on precision anatomy for minimally invasive pancreatoduodenectomy: PAM‐HBP surgery project

“…The method of cutting the pancreas should be considered before PD. One method is to determine two cut margins, and the other is to cut the pancreas at a position farther to the left than usual 21,29 …”

“…The first jejunal vein (FJV) is the first major branch of SMV and is usually embedded around SMA. There are two types of FJVs related to SMA: the anterior and posterior types, with a frequency of 63.0%‐87.2% and 5.8%‐41.0%, respectively 21,24‐26 . In the anterior type, FJV usually branches from the dorsal side of SMV, contacts the uncinate process of the pancreas, and drains the inferior pancreatoduodenal veins (IPDVs).…”

“…Aberrant RHA increases PD surgical complexity and should be resected if the tumor is adjacent to the pancreatic carcinoma. However, postoperative and oncological outcomes were observed to be unaffected by this variation, provided aberrant RHA is preoperatively identified and correctly managed 21 …”

“…Systematic literature reviews on the surgical anatomy and approaches to MIPD have already been reported. The detailed results and processes of these literature reviews were published as two systematic review articles in the Journal of Hepato‐Biliary‐Pancreatic Sciences 20,21 . These reviews were used to answer the three aforementioned CQs.…”

“…The detailed results and processes of these literature reviews were published as two systematic review articles in the Journal of Hepato-Biliary-Pancreatic Sciences. 20,21 These reviews were used to answer the three aforementioned CQs. The Scottish Intercollegiate Guidelines Network (SIGN) method was used to assess evidence quality.…”