Pancreaticoduodenectomy with early superior mesenteric artery dissection.
BACKGROUND
Pancreatic adenocarcinoma remains the fourth leading cause of cancer-related death and is one of the most aggressive human tumors. At present, surgical resection is the only potentially curative treatment. Early neck division is inadequate when invasion of the superior mesenteric artery (SMA) is suspected or in cases of replaced or accessory right hepatic artery. Malignant periampullary tumors often invade retroperitoneal peripancreatic tissues and a positive resection margin is associated with a poor long-term survival.


METHODS
English-language medical databases, PubMed, ELSEVIER and SPRINGERLINK, were searched for articles on "posterior approach pancreaticoduodenectomy", "superior mesenteric artery first approach", "retroperitoneal tissue", "hanging maneuver", and related topics.


RESULTS
The modification allowed the surgeon to early identify the nonresectability of a replaced right hepatic artery if present, enabling complete dissection of the right side of the SMA and portal vein as well as complete excision of the retroportal pancreatic lamina.


CONCLUSIONS
Pancreaticoduodenectomy with early retropancreatic dissection is a useful and safe technical variant, which is indicated for the improvement of the safety and curative effect of the procedure.
Department of Hepatobiliary Surgery, Second Affiliated Hospital, Chongqing University of Medicine and Science, Chongqing 400010, China.
Yu-Fei
YF
Xu
Zuo-Jin
ZJ
Liu
Jian-Ping
JP
Gong
D000230:Adenocarcinoma / Q000401:mortality / Q000601:surgery*; D004210:Dissection / Q000379:methods / Q000401:mortality; D006801:Humans; D017538:Mesenteric Artery, Superior / Q000601:surgery*; D010190:Pancreatic Neoplasms / Q000401:mortality / Q000601:surgery*; D016577:Pancreaticoduodenectomy / Q000379:methods* / Q000401:mortality; D014656:Vascular Surgical Procedures / Q000379:methods / Q000401:mortality