title: Top-down approach to the superior mesenteric artery and the mesopancreas during pancreatoduodenectomy for pancreatic cancer.
abstract: Complete surgical resection with microscopically tumor-free resection margins (R0) is the most important survival determinant for patients with localized pancreatic cancer. The medial and posterior resection margins are the dominant sites of microscopic tumor involvement, and outline the so-called mesopancreas. In this study, we present a modified surgical approach to the superior mesenteric artery, celiac trunc, and mesopancreas during pancreatoduodenectomy, which enables a comfortable exposure and radical en bloc clearance of the mesopancreas and the tissue adjacent to the superior mesenteric artery. The dissection of the mesopancreas is directed from the ventral aspect of the portal vein downward along the superior mesenteric artery and the celiac trunc, before the transection of the duodenal mesentery is accomplished. The described technique complements the established surgical approaches to pancreatic head tumors, and is indicated in the absence of portal vein infiltration. J. Surg. Oncol. 2016;113:668-671. © 2016 Wiley Periodicals, Inc.
authors.affiliation: Department of Visceral, Thoracic and Vascular Surgery, University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany.
authors.forename: Thilo
authors.initials: T
authors.lastname: Welsch
authors.affiliation: Department of Visceral, Thoracic and Vascular Surgery, University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany.
authors.forename: Ulrich
authors.initials: U
authors.lastname: Bork
authors.affiliation: Department of Visceral, Thoracic and Vascular Surgery, University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany.
authors.forename: Marius
authors.initials: M
authors.lastname: Distler
authors.affiliation: Department of Visceral, Thoracic and Vascular Surgery, University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany.
authors.forename: Jürgen
authors.initials: J
authors.lastname: Weitz
mesh_terms: D000230:Adenocarcinoma / Q000000981:diagnostic imaging / Q000601:surgery*; D004210:Dissection / Q000379:methods; D006801:Humans; D000072662:Margins of Excision; D017538:Mesenteric Artery, Superior / Q000000981:diagnostic imaging / Q000601:surgery*; D010190:Pancreatic Neoplasms / Q000000981:diagnostic imaging / Q000601:surgery*; D016577:Pancreaticoduodenectomy / Q000379:methods*; D015641:Radiography, Interventional; D014057:Tomography, X-Ray Computed
keywords: Whipple; mesopancreas; pancreatic cancer; pancreatoduodenectomy; superior mesenteric artery