Abstract
Artery-first pancreaticoduodenectomy (PD) is a technique to ligate the feeding arteries before the division of the pancreas with intents to reduce the blood loss and to perform more oncologic resection. The superior mesenteric artery (SMA) is the most common site of positive margins after PD, especially in the setting of borderline resectable and locally advanced pancreatic cancer. We use the “Tora-no-Ana” approach, which consists of a division of the ligament of Treitz, an entry into the retroperitoneal space behind the pancreatic body, and dissection around SMA. In order to determine feasibility to achieve negative margins, SMA is first approached in this technique. The R0 ratio has been satisfactory high in our practice utilizing “Tora-no-Ana” approach.
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References
Are C, Dhir M, Ravipati L. History of pancreaticoduodenectomy: early misconceptions, initial milestones and the pioneers. HPB (Oxf). 2011;13:377–84.
Nakao A, Takagi H. Isolated pancreatectomy for pancreatic head carcinoma using catheter bypass of the portal vein. Hepatogastroenterology. 1993;40:426–9.
Weitz J, Rahbari N, Koch M, Büchler MW. The artery first approach for resection of pancreatic head cancer. J Am Coll Surg. 2010;210:e1–4.
Sanjay P, Takaori K, Govil S, Shrikhande SV, Windsor JA. ‘Artery-first’ approaches to pancreatoduodenectomy. Br J Surg. 2012;99:1027–35.
Takaori K, Masui T, Kawaguchi M, Iwanaga Y, Mizumoto M, Uemoto S. Distal pancreatectomy with celiac artery resection by artery-first approach. Shujutsu. 2014;68:581–6 [in Japanese].
Dumitrascu T, David L, Popescu I. Posterior versus standard approach in pancreatoduodenectomy: case-match study. Langenbecks Arch Surg. 2010;395:677–984.
Kurosaki I, Minagawa M, Takano K, Takizawa K, Hatakeyama K. Left posterior approach to the superior mesenteric vascular pedicle in pancreaticoduodenectomy for cancer of the pancreatic head. JOP. 2011;12:220–9.
Katz MH, Pisters PW, Evans DB, Sun CC, Lee JE, Fleming JB, Vauthey JN, Abdalla EK, Crane CH, Wolff RA, Varadhachary GR, Hwang RF. Borderline resectable pancreatic cancer: the importance of this emerging stage of disease. J Am Coll Surg. 2008;206:833–46.
Bockhorn M, Uzunoglu FG, Adham M, Imrie C, Milicevic M, Sandberg AA, Asbun HJ, Bassi C, Büchler M, Charnley RM, Conlon K, Cruz LF, Dervenis C, Fingerhutt A, Friess H, Gouma DJ, Hartwig W, Lillemoe KD, Montorsi M, Neoptolemos JP, Shrikhande SV, Takaori K, Traverso W, Vashist YK, Vollmer C, Yeo CJ, Izbicki JR, International Study Group of Pancreatic Surgery. Borderline resectable pancreatic cancer: a consensus statement by the International Study Group of Pancreatic Surgery (ISGPS). Surgery. 2014;155:977–88.
Gillen S, Schuster T, Meyer Zum Büschenfelde C, Friess H, Kleeff J. Preoperative/neoadjuvant therapy in pancreatic cancer: a systematic review and meta-analysis of response and resection percentages. PLoS Med. 2010;7, e1000267.
Katz MH, Wang H, Balachandran A, Bhosale P, Crane CH, Wang X, Pisters PW, Lee JE, Vauthey JN, Abdalla EK, Wolff R, Abbruzzese J, Varadhachary G, Chopin-Laly X, Charnsangavej C, Fleming JB. Effect of neoadjuvant chemoradiation and surgical technique on recurrence of localized pancreatic cancer. J Gastrointest Surg. 2012;16:68–78.
Makino I, Kitagawa H, Ohta T, Nakagawara H, Tajima H, Ohnishi I, Takamura H, Tani T, Kayahara M. Nerve plexus invasion in pancreatic cancer: spread patterns on histopathologic and embryological analyses. Pancreas. 2008;37:358–65.
Horiguchi A, Ishihara S, Ito M, Asano Y, Yamamoto T, Miyakawa S. Three-dimensional models of arteries constructed using multidetector-row CT images to perform pancreatoduodenectomy safely following dissection of the inferior pancreaticoduodenal artery. J Hepatobiliary Pancreat Sci. 2010;17:523–6.
Kawai M, Tani M, Ina S, Hirono S, Nishioka R, Miyazawa M, Uchiyama K, Shimamoto T, Yamaue H. CLIP method (preoperative CT image-assessed ligation of inferior pancreaticoduodenal artery) reduces intraoperative bleeding during pancreaticoduodenectomy. World J Surg. 2008;32:82–7.
Strasberg SM, Sanchez LA, Hawkins WG, Fields RC, Linehan DC. Resection of tumors of the neck of the pancreas with venous invasion: the “Whipple at the Splenic Artery (WATSA)” procedure. J Gastrointest Surg. 2012;16:1048–54.
Nimura Y, Nagino M, Takao S, Takada T, Miyazaki K, Kawarada Y, Miyagawa S, Yamaguchi A, Ishiyama S, Takeda Y, Sakoda K, Kinoshita T, Yasui K, Shimada H, Katoh H. Standard versus extended lymphadenectomy in radical pancreatoduodenectomy for ductal adenocarcinoma of the head of the pancreas: long-term results of a Japanese multicenter randomized controlled trial. J Hepatobiliary Pancreat Sci. 2012;19:230–41.
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Takaori, K., Uemoto, S. (2016). Artery-First Approaches to Pancreaticoduodenectomy. In: Katz, M., Ahmad, S. (eds) Multimodality Management of Borderline Resectable Pancreatic Cancer. Springer, Cham. https://doi.org/10.1007/978-3-319-22780-1_14
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DOI: https://doi.org/10.1007/978-3-319-22780-1_14
Publisher Name: Springer, Cham
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