Pancreaticoduodenectomy With Early Superior Mesentery Artery Dissection

BACKGROUND: Pancreatic adenocarcinoma remains the fourth leading cause of cancer related death and one of the most aggressive human tumors. At present, surgical resection represents the only potentially curative treatment of the disease. Early neck division is inadequate when invasion of superior mesenteric artery is suspected or in case of replaced or accessory right hepatic artery. Malignant periampullary tumors often invade retroperitoneal peripancreatic tissues and a positive resection margin is associated with a poor long-term survival.METHODS: The modified surgical technique for pancreaticoduodenectomy is characterized by early retropancreatic dissection before transection of pancreas or alimentary tract. The superior mesenteric artery is dissected firstly from the posterior of pancreatic head. The pancreas is transected until adequate mobilization from vessels.RESULTS: The modification allows surgeon achieves early identification of nonresectability with safeguarding of a replaced right hepatic artery if appearing, enabling a complete dissection of the right side of superior mesenteric artery and portal vein as well as a complete excision of the retroportal pancreatic lamina.CONCLUSION: Pancreaticoduodenectomy with early retropancreatic dissection is a useful and safe technical variant, which can be recommended in selective indications to improve safety and curative of the procedure.