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Total Pancreatectomy with "Superior Mesenteric Artery-First Approach".

Kosei Takagi1, Tomokazu Fuji1, Kazuya Yasui1

  • 1Department of Gastroenterological Surgery, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, Okayama, Japan.

Digestive Surgery
|May 11, 2025
PubMed
Summary

This study introduces a novel superior mesenteric artery (SMA)-first approach for total pancreatectomy (TP) in pancreatic cancer (PC) patients. This technique facilitates en bloc resection and adequate lymphadenectomy for improved outcomes.

Keywords:
Artery-first approachPancreatic cancerTotal pancreatectomy

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Area of Science:

  • Surgical Oncology
  • Gastrointestinal Surgery

Background:

  • Total pancreatectomy (TP) is a complex procedure for multifocal pancreatic diseases.
  • The superior mesenteric artery (SMA)-first approach is beneficial in pancreatic cancer (PC) surgery, but its application in TP is less documented.

Purpose of the Study:

  • To present a novel SMA-first surgical technique for TP in patients with PC.
  • To detail the six-step procedure for performing TP using the SMA-first approach.

Main Methods:

  • The SMA-first approach involves confirming resectability, dissecting the SMA and surrounding structures, performing retroperitoneal dissection, and mobilizing the pancreatic body and tail.
  • The procedure includes a modified Whipple procedure with lymphadenectomy around the SMA, followed by hepaticojejunostomy and gastrojejunostomy.

Main Results:

  • The SMA-first approach enables en bloc resection with adequate lymphadenectomy.
  • This technique facilitates comprehensive retroperitoneal dissection during TP.

Conclusions:

  • The described SMA-first approach provides a viable surgical technique for TP in PC.
  • This method may help achieve negative resection margins in TP for PC.