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Review Article

Journal of Digestive Cancer Research 2016; 4(2): 77-82

Published online December 31, 2016

© Korean Society of Gastrointestinal Cancer

Mesenteric Approach in Pancreatoduodenectomy


Akimasa Nakao



Professor Emeritus, Nagoya University, Nagoya Central Hospital, Japan

Abstract

The 26th World Congress of the International Association of Surgeons, Gastroenterologists and Oncologists (IASGO) was held in Seoul, Korea from September 8 to 10, 2016. In this congress, I gave a State-of‐the-Art Lecture II entitled “Mesenteric Approach in Pancreatoduodenectomy.” The ideal surgery for pancreatic head cancer is isolated pancreatoduodenectomy, which involves en bloc resection using a non-touch isolation technique. My team has been developing isolated pancreatoduodenectomy for pancreatic cancer since 1981, when we developed an antithrombogenic bypass catheter for the portal vein. In this operation, the first and most important step is the use of a mesenteric approach instead of Kocher’s maneuver. The mesenteric approach allows dissection from the non‐cancer infiltrating side and determination of cancer‐free margins and resectability, followed by systematic lymphadenectomy around the superior mesenteric artery. This approach enables early ligation of the inferior pancreatoduodenal artery and total mesopancreas excision. It is the ideal surgery for pancreatic head cancer from both oncological and surgical viewpoints. The precise surgical techniques of the mesenteric approach are herein described.

KeywordsMesenteric approach Pancreatoduodenectomy Pancreatic cancer Isolated pancreatectomy Mesopancreas excision

Article

Review Article

Journal of Digestive Cancer Research 2016; 4(2): 77-82

Published online December 31, 2016

Copyright © Korean Society of Gastrointestinal Cancer Research.

Mesenteric Approach in Pancreatoduodenectomy

Akimasa Nakao

Professor Emeritus, Nagoya University, Nagoya Central Hospital, Japan

Abstract

The 26th World Congress of the International Association of Surgeons, Gastroenterologists and Oncologists (IASGO) was held in Seoul, Korea from September 8 to 10, 2016. In this congress, I gave a State-of‐the-Art Lecture II entitled “Mesenteric Approach in Pancreatoduodenectomy.” The ideal surgery for pancreatic head cancer is isolated pancreatoduodenectomy, which involves en bloc resection using a non-touch isolation technique. My team has been developing isolated pancreatoduodenectomy for pancreatic cancer since 1981, when we developed an antithrombogenic bypass catheter for the portal vein. In this operation, the first and most important step is the use of a mesenteric approach instead of Kocher’s maneuver. The mesenteric approach allows dissection from the non‐cancer infiltrating side and determination of cancer‐free margins and resectability, followed by systematic lymphadenectomy around the superior mesenteric artery. This approach enables early ligation of the inferior pancreatoduodenal artery and total mesopancreas excision. It is the ideal surgery for pancreatic head cancer from both oncological and surgical viewpoints. The precise surgical techniques of the mesenteric approach are herein described.

Keywords: Mesenteric approach, Pancreatoduodenectomy, Pancreatic cancer, Isolated pancreatectomy, Mesopancreas excision

Journal Info

JDCR
Vol.12 No.1
April 20, 2024
eISSN : 2950-9505
pISSN : 2950-9394
Frequency: Triannual

open access

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Journal of Digestive Cancer Research

eISSN 2950-9505
pISSN 2950-9394

  • 2021
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  • 2024