title: Anterior approach to the superior mesenteric artery by using nerve plexus hanging maneuver for borderline resectable pancreatic head carcinoma.
abstract: To achieve R0 resection for pancreatic ductal adenocarcinoma (PDAC) of the pancreatic head, complete resection of the retropancreatic nerve plexus around the superior mesenteric artery (SMA) is thought to be required. Twenty-five patients with borderline resectable right-sided PDAC were divided into two groups after neoadjuvant chemoradiotherapy: those with portal vein (PV) invasion alone (n = 12), and those with invasion of both PV and SMA (n = 13). A tape for guidance was passed in a space ventral to the SMA and behind the pancreatic parenchyma, followed by resection of the pancreatic parenchyma with the splenic vein. Another tape was passed behind the nerve plexus lateral to the hepatic artery and the SMA ventral to the inferior vena cava and the nerve plexus was dissected, resulting in complete resection of the nerve plexus around the SMA. Pathological findings revealed that the rates of R0, R01 (a margin less than 1 mm) and R1 were 58.3 %, 41.7 % and 0 % in PV group, and 53.8 %, 30.8 % and 15.4 % in PV/A group, respectively. The median survival time was 23.3 and 22.8 months in PV and PV/A groups, respectively. The plexus hanging maneuver for PDAC of the pancreatic head achieved complete resection of the retropancreatic nerve plexus around the SMA, helping to secure a negative surgical margin.
authors.affiliation: Department of Hepatobiliary-Pancreatic and Transplant Surgery, Mie University School of Medicine, 2-174 Edobashi, Tsu, Mie, 514-0001, Japan, mizunos@clin.medic.mie-u.ac.jp.
authors.forename: Shugo
authors.initials: S
authors.lastname: Mizuno
authors.forename: Shuji
authors.initials: S
authors.lastname: Isaji
authors.forename: Akihiro
authors.initials: A
authors.lastname: Tanemura
authors.forename: Masashi
authors.initials: M
authors.lastname: Kishiwada
authors.forename: Yasuhiro
authors.initials: Y
authors.lastname: Murata
authors.forename: Yoshinori
authors.initials: Y
authors.lastname: Azumi
authors.forename: Naohisa
authors.initials: N
authors.lastname: Kuriyama
authors.forename: Masanobu
authors.initials: M
authors.lastname: Usui
authors.forename: Hiroyuki
authors.initials: H
authors.lastname: Sakurai
authors.forename: Masami
authors.initials: M
authors.lastname: Tabata
mesh_terms: D000230:Adenocarcinoma / Q000473:pathology / Q000601:surgery* / Q000628:therapy; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002447:Celiac Plexus / Q000601:surgery*; D059186:Chemoradiotherapy, Adjuvant; D005260:Female; D006801:Humans; D008297:Male; D017538:Mesenteric Artery, Superior / Q000473:pathology / Q000601:surgery*; D008875:Middle Aged; D020360:Neoadjuvant Therapy; D009361:Neoplasm Invasiveness; D018365:Neoplasm, Residual; D010183:Pancreatic Ducts; D010190:Pancreatic Neoplasms / Q000473:pathology / Q000601:surgery* / Q000628:therapy; D016577:Pancreaticoduodenectomy / Q000379:methods*; D011169:Portal Vein / Q000473:pathology; D015996:Survival Rate