title: Modified extended pancreatoduodenectomy: en bloc resection of the peripancreatic retroperitoneal tissue and the head of pancreas.
abstract: Malignant periampullary tumours often invade into retroperitoneal peripancreatic tissues and a positive resection margin following pancreatoduodenectomy is associated with a poor survival. For complete extirpation of the tumour, en bloc resection of the pancreatic head with all retroperitoneal peripancreatic tissue is essential to achieve negative resection margin. A modified radical pancreatoduodenectomy technique that aims to resect all peripancreatic retroperitoneal tissue en bloc with the head of the pancreas is described. We have used this new technique in the last 30 consecutive cases of pancreatoduodenectomy with excellent results as presented in this paper. This technique allows complete en bloc resection of retroperitoneal peripancreatic tissues while preserving normal functional tissue. This technique's advantage is that the resection can be carried out without breaching the retroperitoneal tumour extension plane, thereby minimizing tumour cell spillage.
authors.affiliation: Upper Gastrointestinal Surgical Unit, University of Sydney, Royal North Shore Hospital, Sydney, New South Wales, Australia. jaswinder.samra@optusnet.com.au
authors.forename: Jaswinder S
authors.initials: JS
authors.lastname: Samra
authors.forename: Sivakumar
authors.initials: S
authors.lastname: Gananadha
authors.forename: Anthony
authors.initials: A
authors.lastname: Gill
authors.forename: Ross C
authors.initials: RC
authors.lastname: Smith
authors.forename: Thomas J
authors.initials: TJ
authors.lastname: Hugh
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D009361:Neoplasm Invasiveness; D010179:Pancreas / Q000473:pathology / Q000601:surgery*; D010190:Pancreatic Neoplasms / Q000473:pathology / Q000601:surgery*; D016577:Pancreaticoduodenectomy / Q000379:methods*; D012187:Retroperitoneal Space / Q000473:pathology* / Q000601:surgery; D012189:Retrospective Studies; D016896:Treatment Outcome