title: Pancreatoduodenectomy using a no-touch isolation technique.
abstract: BACKGROUND
  Pancreatoduodenectomy is the only effective treatment for cancers of the periampullary region. Because surgeons usually grasp tumors during pancreatoduodenectomy, this procedure may increase the risk of squeezing and shedding the cancer cells into the portal vein, retroperitoneum, and/or peritoneal cavity. In an effort to overcome these problems, we have developed a surgical technique for no-touch pancreatoduodenectomy.
  
  
  METHODS
  From March 2005 through May 2008, 42 patients have been operated on following this technique. Resected margins were microscopically analyzed.
  
  
  RESULTS
  We describe a technique for pancreatoduodenectomy using a no-touch isolation technique. We resect cancers with wrapping them within Gerota's fascia and transect the retroperitoneal margin along the right surface of the superior mesenteric artery and abdominal aorta without grasping tumors.
  
  
  CONCLUSIONS
  No-touch pancreatoduodenectomy has many potential advantages that merit further investigation in future randomized controlled trials.
authors.affiliation: Department of Surgery, Kumamoto Regional Medical Center, 5-16-10 Honjo, Kumamoto City, Kumamoto 860-0811, Japan. mhirota@krmc.or.jp
authors.forename: Masahiko
authors.initials: M
authors.lastname: Hirota
authors.forename: Keiichiro
authors.initials: K
authors.lastname: Kanemitsu
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Takamori
authors.forename: Akira
authors.initials: A
authors.lastname: Chikamoto
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Tanaka
authors.forename: Hiroki
authors.initials: H
authors.lastname: Sugita
authors.forename: Juhani
authors.initials: J
authors.lastname: Sand
authors.forename: Isto
authors.initials: I
authors.lastname: Nordback
authors.forename: Hideo
authors.initials: H
authors.lastname: Baba
mesh_terms: D014670:Ampulla of Vater / Q000473:pathology / Q000601:surgery; D001650:Bile Duct Neoplasms / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D001653:Bile Ducts, Intrahepatic / Q000473:pathology / Q000601:surgery; D015331:Cohort Studies; D004210:Dissection / Q000379:methods; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007430:Intraoperative Care / Q000379:methods; D008297:Male; D017538:Mesenteric Artery, Superior / Q000601:surgery; D010190:Pancreatic Neoplasms / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D016577:Pancreaticoduodenectomy / Q000379:methods* / Q000401:mortality; D011169:Portal Vein / Q000601:surgery; D012189:Retrospective Studies; D018570:Risk Assessment; D016019:Survival Analysis; D016896:Treatment Outcome