‘Artery-first’ approaches to pancreatoduodenectomy

Pandanaboyana, Sanjay; Takaori, Kyoichi; Govil, Sanjay; Shrikhande, Shailesh V.; Windsor, John A.

doi:10.1002/bjs.8763

Cited by 294 publications

(183 citation statements)

References 36 publications

Supporting

Mentioning

173

Contrasting

Unclassified

Order By: Relevance

“…The concept of the artery‐first approach is to start from the dissection of the connective tissues around the SMA during PD. The aims of this approach are: (i) early determination of the resectability status before committing an irreversible step during operation; (ii) reduction of intraoperative blood loss by early control of blood inflow into the pancreatic head; and (iii) increase of R0 rates by complete dissection of the connected tissues around the SMA 7, 8, 9, 10, 11, 12, 13…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Mesenteric approach during pancreaticoduodenectomy for pancreatic ductal adenocarcinoma

Hirono

Kawai

Okada

et al. 2017

Annals of Gastroent Surgery

View full text Add to dashboard Cite

Mesenteric approach is an artery‐first approach during pancreaticoduodenectomy (PD). In the present study, we evaluated clinical and oncological benefits of this procedure for pancreatic ductal adenocarcinoma (PDAC) of the pancreas head. Between 2000 and 2015, 237 consecutive PDAC patients underwent PD. Among them, 72 experienced the mesenteric approach (mesenteric group) and 165 the conventional approach (conventional group). A matched‐pairs group consisted of 116 patients (58 patients in each group) matched for age, gender, resectability status, and neoadjuvant therapy. Surgical and oncological outcomes were compared between the two groups in unmatched‐ and matched‐pair analyses. Intraoperative blood loss was lower in the mesenteric group than in the conventional group in both resectable PDAC (R‐PDAC) and borderline resectable PDAC (BR‐PDAC) on unmatched‐ and matched‐pairs analyses (R‐PDAC, unmatched: 312.5 vs 510 mL, P=.008; matched: 312.5 vs 501.5 mL, P=.023; BR‐PDAC, unmatched: 507.5 vs 935 mL, P<.001; matched: 507.5 vs 920 mL, P=.003). Negative surgical margins (R0) and overall survival (OS) rates in the mesenteric group were better in R‐PDAC patients (R0 rates, unmatched: 100% vs 87.7%, P=.044; matched: 100% vs 86.7%, P=.045; OS, unmatched: P=.008, matched: P=.021), although there were no significant differences in BR‐PDAC patients. Mesenteric approach might reduce blood loss by early ligation of the vessels to the pancreatic head. Furthermore, it might increase R0 rate, leading to improvement of survival for R‐PDAC patients. However, R0 and survival rates could not be improved only by the mesenteric approach for BR‐PDAC patients. Therefore, effective multidisciplinary treatment is essential to improve survival in BR‐PDAC patients.

show abstract

Section: Introductionmentioning

confidence: 99%

“…The ‘mesenteric approach’, first reported by Nakao and Takagi8 in 1993, is one artery‐first approach and is synonymous with the ‘infracolic approach’ 11. This approach allows dissection around the SMA from the noncancerous or less inflammatory side at the mesenterium, around the root of the middle colic artery (MCA) 8, 9, 12, 14.…”

Section: Introductionmentioning

confidence: 99%

Mesenteric approach during pancreaticoduodenectomy for pancreatic ductal adenocarcinoma

Hirono

Kawai

Okada

et al. 2017

Annals of Gastroent Surgery

View full text Add to dashboard Cite

show abstract

“…Several technical refinements such as "artery-first" approaches were developed aiming to improve the surgical results after PDAC resection (6,(23)(24)(25). Furthermore, the role of total mesopancreas excision was emphasized to better resect the patients with PDAC (13,23,26).…”

Section: Resectable Pdacmentioning

confidence: 99%

Onco-surgical Strategies in Pancreatic Ductal Adenocarcinoma

Popescu¹,

Dumitraşcu²

2017

SGO

View full text Add to dashboard Cite

Pancreatic ductal adenocarcinoma (PDAC) is an important healthcare problem because is a leading cause of death by cancer. PDAC is a highly lethal disease with a very dismal prognosis. Most patients present advanced disease at diagnosis. The management of a patient diagnosed with PDAC should be discussed in a multidisciplinary team in high-volume centers. Pancreatectomy represents the single hope of long-term survival for a patient with PDAC but the resectability rate is less than 20% of the cases. Several progresses were observed in the last years regarding the surgical and oncological approach for PDAC. The aim of the paper is to make a brief review of the current onco-surgical strategies available for patients with PDAC.

show abstract

“…[24] Through a surgical perspective -the surgeon is made more aware of margin positive resections by improved concepts in pathology, [25] hence surgeons have also strived to improve techniques to achieve margin negative resections. [26] …”

Section: Resection Margins and Adjuvant Decision Makingmentioning

confidence: 99%