Anterior Approach to the Superior Mesenteric Artery by Using Nerve Plexus Hanging Maneuver for Borderline Resectable Pancreatic Head Carcinoma

Shugo Mizuno, Shuji Isaji, Akihiro Tanemura, Masashi Kishiwada, Yasuhiro Murata, Yoshinori Azumi, Naohisa Kuriyama, Masanobu Usui, Hiroyuki Sakurai, Masami Tabata

Research output: Contribution to journalArticle

18 Citations (Scopus)

Abstract

To achieve R0 resection for pancreatic ductal adenocarcinoma (PDAC) of the pancreatic head, complete resection of the retropancreatic nerve plexus around the superior mesenteric artery (SMA) is thought to be required. Twenty-five patients with borderline resectable right-sided PDAC were divided into two groups after neoadjuvant chemoradiotherapy: those with portal vein (PV) invasion alone (n = 12), and those with invasion of both PV and SMA (n = 13). A tape for guidance was passed in a space ventral to the SMA and behind the pancreatic parenchyma, followed by resection of the pancreatic parenchyma with the splenic vein. Another tape was passed behind the nerve plexus lateral to the hepatic artery and the SMA ventral to the inferior vena cava and the nerve plexus was dissected, resulting in complete resection of the nerve plexus around the SMA. Pathological findings revealed that the rates of R0, R01 (a margin less than 1 mm) and R1 were 58.3 %, 41.7 % and 0 % in PV group, and 53.8 %, 30.8 % and 15.4 % in PV/A group, respectively. The median survival time was 23.3 and 22.8 months in PV and PV/A groups, respectively. The plexus hanging maneuver for PDAC of the pancreatic head achieved complete resection of the retropancreatic nerve plexus around the SMA, helping to secure a negative surgical margin.

Original languageEnglish
Pages (from-to)1209-1215
Number of pages7
JournalJournal of Gastrointestinal Surgery
Volume18
Issue number6
DOIs
Publication statusPublished - 06-2014
Externally publishedYes

All Science Journal Classification (ASJC) codes

  • Surgery
  • Gastroenterology

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