A proposal of no-touch isolation technique in pancreatoduodenectomy for periampullary carcinomas.
OBJECTIVE
The procedure of pancreatoduodenectomy for periampullary cancers accompanies a risk to shed cancer cells into a portal vein while handling the pancreas head lesion. This manipulation may subsequently cause a liver metastasis. We devised the no-touch isolation technique for pancreatoduodenectomy without removing a portal vein, for the purpose of preventing the manipulated shedding of cancer cells into a portal vein and liver metastasis.


METHODS
The fundamental procedure of this technique is that isolation of portal vein precedes the handling of tumor mass. Isolation of a portal vein is carried out with the ligature of its surrounding veins after dividing of duodenum and pancreas. We applied the no-touch isolation technique for 10 cases, which consisted of 6 cases of distal bile duct carcinoma and 4 cases of ampullary carcinoma, between May 1993 and July 2000.


RESULTS
There was neither operative mortality nor liver metastasis cases in these cases.


CONCLUSIONS
The no-touch isolation technique without removing a portal vein might be recommended as a safe and reasonable procedure for periampullary cancer patients who have the potential for subsequent liver metastasis.
Kobayashi
S
S
Second Department of Surgery, Chiba University School of Medicine, 1-8-1 Inohana, Chuoh-ku, Chiba 260-8670, Japan. kobayasi@med.m.chiba-u.ac.jp
Asano
T
T
Ochiai
T
T
D001650:Bile Duct Neoplasms / Q000601:surgery*; D006801:Humans; D008113:Liver Neoplasms / Q000209:etiology / Q000517:prevention & control; D009366:Neoplasm Seeding; D010190:Pancreatic Neoplasms / Q000601:surgery*; D016577:Pancreaticoduodenectomy / Q000009:adverse effects / Q000379:methods*; D011169:Portal Vein