title: Perioperative challenges associated with a pancreaticoduodenectomy and distal pancreatectomy for pancreatic cancer in patients with situs inversus totalis: report of two cases.
abstract: Situs inversus totalis is a rare anatomic variant of a complete mirror-image transposition of the thoracic and abdominal viscera. The performance of a pancreaticoduodenectomy and distal pancreatectomy in patients with situs inversus totalis is both rare and challenging. We herein present two cases of pancreatic cancer with situs inversus totalis. The abdominal anatomy was preoperatively assessed by multidetectorrow computed tomography, three-dimensional reconstruction, and angiography. We herein report that a pancreaticoduodenectomy and distal pancreatectomy with standard regional lymphadenectomy are feasible in patients with situs inversus totalis. Due to the transposition of the viscera and major blood vessels in such cases, preoperative knowledge of the exact anatomy, mapping of anomalies, and meticulous forward planning are essential for performing these technically difficult and complex hepatobiliary-pancreatic surgeries.
authors.affiliation: Department of Surgery, Kurume University School of Medicine, 67 Asahi-machi, Kurume, Fukuoka, 830-0011, Japan.
authors.forename: Yuichiro
authors.initials: Y
authors.lastname: Maruyama
authors.forename: Hiroyuki
authors.initials: H
authors.lastname: Horiuchi
authors.forename: Yoshinobu
authors.initials: Y
authors.lastname: Okabe
authors.forename: Ryuichi
authors.initials: R
authors.lastname: Kawahara
authors.forename: Shinji
authors.initials: S
authors.lastname: Uchida
authors.forename: Takenori
authors.initials: T
authors.lastname: Sakai
authors.forename: Toru
authors.initials: T
authors.lastname: Hisaka
authors.forename: Hiroto
authors.initials: H
authors.lastname: Ishikawa
authors.forename: Kazuhiro
authors.initials: K
authors.lastname: Mikagi
authors.forename: Munehiro
authors.initials: M
authors.lastname: Yoshitomi
authors.forename: Yusuke
authors.initials: Y
authors.lastname: Kawashima
authors.forename: Manami
authors.initials: M
authors.lastname: Fujishita
authors.forename: Gen
authors.initials: G
authors.lastname: Akasu
authors.forename: Mitsuru
authors.initials: M
authors.lastname: Katsumoto
authors.forename: Daimei
authors.initials: D
authors.lastname: Eto
authors.forename: Mitsutoshi
authors.initials: M
authors.lastname: Ureshino
authors.forename: Yuichi
authors.initials: Y
authors.lastname: Goto
authors.forename: Hiroki
authors.initials: H
authors.lastname: Ureshino
authors.forename: Hisafumi
authors.initials: H
authors.lastname: Kinoshita
mesh_terms: D000230:Adenocarcinoma / Q000150:complications / Q000601:surgery*; D000368:Aged; D006801:Humans; D008197:Lymph Node Excision; D008297:Male; D008875:Middle Aged; D010180:Pancreatectomy / Q000379:methods*; D010190:Pancreatic Neoplasms / Q000150:complications / Q000601:surgery*; D016577:Pancreaticoduodenectomy / Q000379:methods*; D019990:Perioperative Care; D012857:Situs Inversus / Q000150:complications*; D014057:Tomography, X-Ray Computed