title: Left posterior approach pancreaticoduodenectomy with total mesopancreas excision and circumferential lymphadenectomy around the superior mesenteric artery for pancreatic head carcinoma.
abstract: BACKGROUND
  In most cases of pancreatic head cancer, surgery often results in noncurative resection, which is frequently related to inadequate clearance of the mesopancreas.
  
  
  OBJECTIVE
  The aim of this report is to introduce the surgical technique of left posterior approach pancreaticoduodenectomy (PD) with total mesopancreas excision and circumferential lymphadenectomy around the superior mesenteric artery (SMA) (LPA-PD) and to examine whether this procedure increases the rate of true curative resection and decreases the rate of locoregional recurrence.
  
  
  METHODS
  Nineteen patients underwent standard PD, and 19 patients underwent LPA-PD. The demographic characteristics, intraoperative outcomes (mean operative time and mean blood loss), postoperative outcomes (complications, type of recurrence and survival), and pathological findings (R number, number of removed regional lymph nodes and positive resection margins) were evaluated.
  
  
  RESULTS
  The patient characteristics did not differ significantly between the groups. The mean blood loss in the LPA-PD group was significantly less than that in the standard PD group (p<0.05). The incidence rate of postoperative complications did not differ between the groups. No surgery-related deaths occurred in either group. The number of removed regional lymph nodes around the superior mesenteric artery in the LPA-PD group was significantly greater than that in the standard PD group (p<0.01). The R0 resection rate in the LPA-PD group was higher, although not significantly so, than that in the standard PD group. The resection margin of the mesopancreas was negative in all patients of the LPA-PD group. The rate of locoregional recurrence in the LPA-PD group was significantly lower than that in the standard PD group (p<0.01). The postoperative survival rate did not differ significantly between the groups.
  
  
  CONCLUSIONS
  Our method of LPA-PD helps secure the negative margin of the mesopancreas and enables complete circumferential lymphadenectomy around the SMA. Therefore, LPA-PD may increase the true curative resection rate and decrease the locoregional recurrence rate compared with standard PD.
authors.affiliation: Department of Surgery, Nippon Medical School.
authors.forename: Takayuki
authors.initials: T
authors.lastname: Aimoto
authors.forename: Satoshi
authors.initials: S
authors.lastname: Mizutani
authors.forename: Youichi
authors.initials: Y
authors.lastname: Kawano
authors.forename: Akira
authors.initials: A
authors.lastname: Matsushita
authors.forename: Naoyuki
authors.initials: N
authors.lastname: Yamashita
authors.forename: Hideyuki
authors.initials: H
authors.lastname: Suzuki
authors.forename: Eiji
authors.initials: E
authors.lastname: Uchida
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D017024:Chemotherapy, Adjuvant; D005260:Female; D006801:Humans; D007430:Intraoperative Care; D008197:Lymph Node Excision / Q000009:adverse effects / Q000379:methods*; D008297:Male; D017538:Mesenteric Artery, Superior / Q000601:surgery*; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000473:pathology / Q000601:surgery; D010179:Pancreas / Q000473:pathology / Q000601:surgery*; D010190:Pancreatic Neoplasms / Q000188:drug therapy / Q000473:pathology* / Q000601:surgery*; D016577:Pancreaticoduodenectomy / Q000009:adverse effects / Q000379:methods*; D011183:Postoperative Complications / Q000209:etiology; D016019:Survival Analysis; D016896:Treatment Outcome