©2014 Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Oncol. Sep 15, 2014; 6(9): 344-350
Published online Sep 15, 2014. doi: 10.4251/wjgo.v6.i9.344
Published online Sep 15, 2014. doi: 10.4251/wjgo.v6.i9.344
Tricks and tips in pancreatoduodenectomy
Anna Pallisera, Rafael Morales, Department of Surgery, Hospital Son Llatzer, 07198 Palma de Mallorca, Spain
Jose Manuel Ramia, HPB Unit, Department of Surgery, Hospital Universitario de Guadalajara, 19002 Guadalajara, Spain
Author contributions: Pallisera A wrote the introduction and the section on the artery-first approach; Ramia JM wrote the section on arterial complications during pancreatoduodenectomy; Morales R wrote the section on extended lymphadenectomy for pancreatic head adenocarcinoma.
Correspondence to: Jose Manuel Ramia, MD, PhD, FACS, HPB Unit, Department of Surgery, Hospital Universitario de Guadalajara, C/General Moscardó 26, 5-1, Madrid 28020, Spain. jose_ramia@hotmail.com
Telephone: +34-616-292056 Fax: +34-616-292056
Received: August 8, 2013
Revised: September 23, 2013
Accepted: March 17, 2014
Published online: September 15, 2014
Processing time: 407 Days and 5.8 Hours
Revised: September 23, 2013
Accepted: March 17, 2014
Published online: September 15, 2014
Processing time: 407 Days and 5.8 Hours
Core Tip
Core tip: The “artery-first approach” prioritized the dissection of the origin of the superior mesenteric artery (SMA), allowing complete lymphadenectomy, safe dissection of the SMA, and accurate identification of the most frequent anatomic variations such as a hepatic artery originating in the SMA. It has been demonstrated that patients with intraoperative arterial complications have longer operative time, higher transfusion rate and more postoperative complications. Another controversial issue is the extent of lymphadenectomy in the pancreaticoduodenectomy. The randomized trials published do not recommend radical lymphadenectomy as a standard approach for pancreatic ductal adenocarcinoma.