[Theories and techniques for resection of the extrapancreatic nerve plexus in the head of the pancreas during a Whipple procedure for carcinoma of the pancreas--suggestions from the perspective of surgical anatomy and pathology].
Although various therapeutic modalities for carcinoma of the pancreas are available, "curative (R0) resection" is the most important. Thus, the aim of surgery for carcinoma of the pancreas is local complete resection of the carcinoma. We offer two suggestions for complete resection of carcinoma of the pancreas, which shows a strong invasive tendency around nerve fibers, during a Whipple procedure. 1. En bloc resection of the right side of nerve plexus of the superior mesenteric artery and the first and second nerve plexus of the pancreatic head should be performed. It is easy to perform this procedure when the superior mesenteric artery should be moved to the right side of the superior mesenteric vein through under this vein. 2. The entire cut end of the nerve plexus should be investigated during the operation using frozen specimens and confirmed to be negative for cancer. If the cut end is positive for cancer, additional resection of the nerve plexus should be performed to achieve curative resection. The reason is that it is impossible to completely investigate positive or negative carcinoma in the cut end of the nerve plexus after surgery, since the cut end is long and some specimens are deformed by formalin fixation.
Kimura
Wataru
W
Department of Gastroenterological and General Surgery, Yamagata University Faculty of Medicine, Yamagata, Japan.
D006801:Humans; D017538:Mesenteric Artery, Superior / Q000294:innervation; D010179:Pancreas / Q000294:innervation*; D010190:Pancreatic Neoplasms / Q000601:surgery*; D016577:Pancreaticoduodenectomy / Q000379:methods*; D010525:Peripheral Nerves / Q000473:pathology / Q000601:surgery