Pancreaticoduodenectomy for invasive pancreatic cancer (with video)

Abstract

Pancreaticoduodenectomy (PD) is the only treatment option that potentially provides a cure for pancreatic head cancer. Various arrangements and modifications have been proposed to achieve pathological margin negative (R0) resection safely. In this article, we introduce a standard procedure for PD, including pancreaticogastrostomy with invagination and mattress sutures (video clip provided), for invasive ductal carcinoma of the pancreatic head, with a description of the need-to-know pitfalls for Board-certified HBP surgeons in Japan. The important points in performing PD for pancreatic cancer are: (1) While dissecting connective tissue and nerve plexus as well as lymph nodes, maintain a dissection plane to expose the surfaces of vessels or other organs to be preserved to achieve R0 resection: i.e., while dissecting the anterior surface of the inferior vena cava and the right side of the superior mesenteric artery, these vessels should be completely exposed with the connective tissue and nerve plexuses being attached to the resection side. (2) There should be early interruption of the afferent blood supply via the inferior pancreaticoduodenal artery to reduce blood loss by avoiding congestion of the pancreatic head and to increase the operative safety (video clip provided). (3) Eligibility for PD should be carefully evaluated because there are many “resectable” but not many “curable” cases. In addition, the clinical significance of various modifications of the surgical techniques used for PD are also discussed.

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Acknowledgments

This work was partly supported by a grant from the Princess Takamatsu Cancer Research Fund and a grant from the Otsuka Research Fund.

Conflict of Interest

The authors declare that they have no conflicts of interest.

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Correspondence to Hidenori Takahashi.

Additional information

This article is based on studies first reported in Highly Advanced Surgery for Hepato-Biliary-Pancreatic Field (in Japanese). Tokyo: Igaku-Shoin, 2010.

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Takahashi, H., Ohigashi, H. & Ishikawa, O. Pancreaticoduodenectomy for invasive pancreatic cancer (with video). J Hepatobiliary Pancreat Sci 19, 100–108 (2012). https://doi.org/10.1007/s00534-011-0467-5

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Keywords

  • Pancreaticoduodenectomy
  • Pancreatic cancer
  • Pancreaticogastrostomy
  • Retroperitoneal and nerve plexus dissection
  • Preceding interruption of the afferent blood flow