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Mesopancreas Excision for Pancreatic Cancer

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Pancreatic Cancer

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Abstract

Although central vascular ligation (CVL) has been advocated and disseminated throughout the field of gastrointestinal cancer surgery, application of CVL during dissection around the superior mesenteric artery (SMA) in pancreaticoduodenectomy (PD) for periampullary malignancies has rarely been documented. An artery-first approach in which the mesopancreas is dissected from the SMA before division of other organs has recently been introduced in pancreatic cancer to judge resectability, clear the SMA margin from invasion, or reduce blood loss. The SMA hanging technique accompanied with a supracolic anterior artery-first approach described in this chapter facilitates central vascular ligation during PD. Briefly, SMA dissection was initiated from the right dorsal aspect using the supracolic anterior approach, followed by left-sided dissection. During the right-sided dissection process, the inferior pancreaticoduodenal artery is ligated at the origin, and the jejunal vein running behind the SMA is separated from the SMA pedicle. To safely connect the dissection planes of both sides of the SMA, the SMA was taped under finger guidance immediately after right-sided dissection. The ligament of Treitz was detached from the SMA during left-sided dissection, facilitating adequate lymph node dissection while preserving the nerve plexus around the SMA. SMA hanging technique is a feasible and safe technique with acceptable short-term outcomes. We propose this procedure as one of the standardized technique for CVL around the SMA.

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Authors and Affiliations

  1. Department of Hepato-Biliary-Pancreatic Surgery, Cancer Institute Hospital, Japanese Foundation for Cancer Research, Tokyo, Japan

    Yosuke Inoue & Akio Saiura

Authors
  1. Yosuke Inoue
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  2. Akio Saiura
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Correspondence to Akio Saiura .

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Editors and Affiliations

  1. Department of Surgery, Seoul National University, College of Medicine, Seoul, Korea (Republic of)

    Sun-Whe Kim

  2. Department of Surgery, Wakayama Medical University, Wakayama, Japan

    Hiroki Yamaue

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Inoue, Y., Saiura, A. (2017). Mesopancreas Excision for Pancreatic Cancer. In: Kim, SW., Yamaue, H. (eds) Pancreatic Cancer. Springer, Berlin, Heidelberg. https://doi.org/10.1007/978-3-662-47181-4_19

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  • DOI: https://doi.org/10.1007/978-3-662-47181-4_19

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