title: Pancreaticoduodenectomy with right-oblique posterior dissection of superior mesenteric nerve plexus is logical procedure for pancreatic cancer with extrapancreatic nerve plexus invasion.
abstract: OBJECTIVE
  To achieve R0 resection, pancreaticoduodenectomy with right-side half dissection of the superior mesenteric artery nerve plexus is performed for pancreatic cancer with extrapancreatic nerve plexus invasion in many facilities. However, this cancer mainly spreads behind the superior mesenteric artery.
  
  
  METHODS
  Forty-two patients underwent pancreaticoduodenectomy with right-oblique posterior dissection of the superior mesenteric artery nerve plexus from the 4 to 10 o'clock position for pancreatic ductal adenocarcinoma. The cancer spread was evaluated using preoperative multi-detector computed tomography and postoperative pathological examination.
  
  
  RESULTS
  Thirty-one patients (73.8%) showed extrapancreatic nerve plexus invasion on multi-detector computed tomography. In 20 patients (47.6%), the tumor extended within 5 mm of the superior mesenteric artery, ranging between the 4-10 o'clock position in 19 (95.0%) patients. Although pathological examination revealed that the cancer infiltrated within 3 mm of the superior mesenteric artery margin in 17 (54.8%) patients with extrapancreatic nerve plexus invasion, R0 resection was achieved in 95.2% of cases. Six patients (14.3%) experienced postoperative diarrhea requiring administration of antidiarrheal agents.
  
  
  CONCLUSIONS
  Pancreatic head cancer spreads mainly right-posterior of the superior mesenteric artery; and therefore, right-oblique posterior dissection is a logical procedure to achieve negative margin resection with complete clearance of nerve plexus involvement.
authors.forename: Yuichi
authors.initials: Y
authors.lastname: Nagakawa
authors.forename: Yuichi
authors.initials: Y
authors.lastname: Hosokawa
authors.forename: Hiroaki
authors.initials: H
authors.lastname: Osakabe
authors.forename: Yatsuka
authors.initials: Y
authors.lastname: Sahara
authors.forename: Chie
authors.initials: C
authors.lastname: Takishita
authors.forename: Tetsushi
authors.initials: T
authors.lastname: Nakajima
authors.forename: Yousuke
authors.initials: Y
authors.lastname: Hijikata
authors.forename: Kenta
authors.initials: K
authors.lastname: Kasahara
authors.forename: Kasuya
authors.initials: K
authors.lastname: Kazuhiko
authors.forename: Kazuhiro
authors.initials: K
authors.lastname: Saito
authors.forename: Akihiko
authors.initials: A
authors.lastname: Tsuchida
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006801:Humans; D008297:Male; D017538:Mesenteric Artery, Superior / Q000601:surgery*; D008875:Middle Aged; D061330:Multidetector Computed Tomography; D009361:Neoplasm Invasiveness; D010190:Pancreatic Neoplasms / Q000473:pathology / Q000601:surgery*; D016577:Pancreaticoduodenectomy / Q000379:methods*