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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
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.
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.
