title: Totally laparoscopic pancreaticoduodenectomy for locally advanced gastric cancer.
abstract: BACKGROUND
  In patients having locally advanced cancer of the stomach with suspected tumor infiltration to the pancreatic head or the duodenum, a concurrent pancreaticoduodenectomy with gastrectomy is occasionally prerequisite to achieve a microscopically tumor-free surgical margin.
  
  
  METHODS
  We present the first series of successful totally laparoscopic pancreaticoduodenectomy (TLPD) for advanced gastric cancer with suspected infiltration to the pancreatic head.
  
  
  RESULTS
  TLPD was successfully performed without adverse events during surgery and resulted in favorable short-term outcomes of three patients with locally advanced gastric cancer with suspected invasion to the pancreas.
  
  
  CONCLUSIONS
  Although TLPD for locally advanced gastric cancer is a technically difficult challenging operation that requires careful dissection along the major vessels, intracorporeal tie sutures, and the placement of an external drainage tube into a narrow pancreatic duct, this procedure is technically feasible and safe in the hands of experienced surgeons. Long-term follow-up is mandatory to validate oncological outcome.
authors.affiliation: Department of Surgery, Fujita Health University School of Medicine, 1-98 Dengakugakubo, Kutsukakecho, Toyoake, 470-1192, Aichi, Japan. shinohara@jikei.ac.jp
authors.forename: Toshihiko
authors.initials: T
authors.lastname: Shinohara
authors.forename: Ichiro
authors.initials: I
authors.lastname: Uyama
authors.forename: Seiichiro
authors.initials: S
authors.lastname: Kanaya
authors.forename: Kazuki
authors.initials: K
authors.lastname: Inaba
authors.forename: Jun
authors.initials: J
authors.lastname: Isogaki
authors.forename: Akihiko
authors.initials: A
authors.lastname: Horiguchi
authors.forename: Shuichi
authors.initials: S
authors.lastname: Miyakawa
mesh_terms: D000368:Aged; D004322:Drainage; D005260:Female; D006801:Humans; D010535:Laparoscopy; D008197:Lymph Node Excision / Q000379:methods; D008297:Male; D008875:Middle Aged; D009361:Neoplasm Invasiveness; D010179:Pancreas / Q000473:pathology*; D016577:Pancreaticoduodenectomy / Q000379:methods*; D010537:Peritoneum / Q000601:surgery; D013274:Stomach Neoplasms / Q000473:pathology* / Q000601:surgery*