title: Cattell-Braasch maneuver combined with local hypothermia during superior mesenteric artery resection in pancreatectomy.
abstract: BACKGROUND
  The recent development of new neo-adjuvant treatment regimens associated with a higher success rate of down-staging has increased the interest of pancreatic surgeons on the role of extended surgery for patients affected by locally advanced pancreatic cancer. Pancreatectomy together with resection of the portal/superior mesenteric vein is considered nowadays standard of care for patients affected by pancreatic cancer. However, the resection of major abdominal arteries is still debatable. In particular, the short- and long-term results after resection of the superior mesenteric artery (SMA) remain controversial and only few cases have been described in literature. The present paper describes a new, quick, and easy technique for resection of the SMA.
  
  
  METHODS
  A 71-year-old patient affected by IPMN cancer with infiltration of the SMA received FOLFIRINOX-based neo-adjuvant treatment. After 4 months of treatment, the patient underwent total pancreatectomy with en bloc resection of the SMA and direct end-to-end anastomosis. The vascular resection was performed combining a complete Cattell-Braasch maneuver with local bowel hypothermia in an attempt to avoid graft interposition by facilitating an end-to-end anastomosis and to reduce the warm ischemia time. The post-operative course was uneventful and the patient was discharged 8 days post-operatively.
authors: Pancreatic Surgery Unit, Division of Surgery, Department of Clinical Science, Intervention and Technology (CLINTEC) Karolinska Institutet at Center for Digestive Diseases, Karolinska University Hospital, K53, 14186, Stockholm, Sweden.
authors: Sofia
authors: S
authors: Westermark
authors: Pancreatic Surgery Unit, Division of Surgery, Department of Clinical Science, Intervention and Technology (CLINTEC) Karolinska Institutet at Center for Digestive Diseases, Karolinska University Hospital, K53, 14186, Stockholm, Sweden.
authors: Elena
authors: E
authors: Rangelova
authors: Pancreatic Surgery Unit, Division of Surgery, Department of Clinical Science, Intervention and Technology (CLINTEC) Karolinska Institutet at Center for Digestive Diseases, Karolinska University Hospital, K53, 14186, Stockholm, Sweden.
authors: Christoph
authors: C
authors: Ansorge
authors: Pancreatic Surgery Unit, Division of Surgery, Department of Clinical Science, Intervention and Technology (CLINTEC) Karolinska Institutet at Center for Digestive Diseases, Karolinska University Hospital, K53, 14186, Stockholm, Sweden.
authors: Lars
authors: L
authors: Lundell
authors: Pancreatic Surgery Unit, Division of Surgery, Department of Clinical Science, Intervention and Technology (CLINTEC) Karolinska Institutet at Center for Digestive Diseases, Karolinska University Hospital, K53, 14186, Stockholm, Sweden.
authors: Ralf
authors: R
authors: Segersvärd
authors: Pancreatic Surgery Unit, Division of Surgery, Department of Clinical Science, Intervention and Technology (CLINTEC) Karolinska Institutet at Center for Digestive Diseases, Karolinska University Hospital, K53, 14186, Stockholm, Sweden. marco.del.chiaro@ki.se.
authors: Marco
authors: M
authors: Del Chiaro
mesh_terms: D000230:Adenocarcinoma / Q000601:surgery*; D000368:Aged; D006801:Humans; D007036:Hypothermia, Induced; D017538:Mesenteric Artery, Superior / Q000601:surgery*; D020360:Neoadjuvant Therapy; D010180:Pancreatectomy / Q000379:methods*; D010190:Pancreatic Neoplasms / Q000601:surgery*
keywords: Artery resection; Pancreas cancer; Pancreas surgery; Pancreatectomy associated to vascular resection; Resection of superior mesenteric artery; Vascular resection