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

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

Research output: Contribution to journalReview articlepeer-review

15 Citations (Scopus)

Abstract

When pancreatic head cancer invades the superior mesenteric artery (SMA), attempts at curative resection are aborted. Preoperative imaging diagnostics to determine the surgical curability have yet to surpass the intraoperative information acquired via inspection, palpation, and trial dissection. Pancreatoduodenectomy (PD) is a standard measure for treating periampullary cancers. In conventional PD, SMA invasion is usually identified by dissecting the retroportal lamina, which connects the uncinate process and SMA nerve plexus after dividing the neck of the pancreas. During PD for pancreatic head cancer, this retroperitoneal margin frequently vitiates surgical curability. SMA-first approaches during PD are methods where the SMA is dissected first by severing the posterior pancreatic capsule to assess the SMA involvement of pancreatic cancer early in the operation. The first report of such an approach prompted subsequent reports of various maneuvers that are now known collectively as “artery-first” approaches. We herein review those approaches by classifying them according to (1) the side of the mesocolon from where the SMA approach occurs (supracolic or infracolic) and (2) the direction of access (right or left and anterior or posterior). The steps of the reported PD procedures are numbered according to a timeline and summarized using anatomical division of the SMA.

Original languageEnglish
Pages (from-to)872-879
Number of pages8
JournalSurgery Today
Volume51
Issue number6
DOIs
Publication statusPublished - 06-2021
Externally publishedYes

All Science Journal Classification (ASJC) codes

  • Surgery

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