ArticleSurgical endoscopy2019
Follow "the superior mesenteric artery": laparoscopic approach for total mesopancreas excision during pancreaticoduodenectomy.
Article in Surgical endoscopy, 2019. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 11 papers.
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Who cites it
11 citing papers in PubMed, 25 citations in OpenAlex.
- Article
- Mesopancreas dissection level 3 for pancreatic head cancer in combined robotic/open pancreatoduodenectomy: a propensity score-matched study.Surgical endoscopy · 2025Article
- Feasibility of middle colic artery as a landmark for superior mesenteric artery - first approach in laparoscopic pancreatoduodenectomy: a prospective study.World journal of surgical oncology · 2024Article
- Application of the superior mesenteric artery-first approach in laparoscopic pancreatoduodenectomy: A literature review.Heliyon · 2024Review
- Current Approaches for the Curative-Intent Surgical Treatment of Pancreatic Ductal Adenocarcinoma.Cancers · 2023Review
- Comparative study of pancreatic vessels and mesopancreas of rhesus monkeys and humans.Frontiers in surgery · 2023Article
- Laparoscopic hybrid pancreaticoduodenectomy: Initial single center experience.Annals of hepato-biliary-pancreatic surgery · 2021Article
- The mesopancreas and pancreatic head plexus: morphological, developmental, and clinical perspectives.Surgical and radiologic anatomy : SRA · 2020Article
- Laparoscopic Radical Antegrade Modular Pancreatosplenectomy with Vascular Resection for Pancreatic Cancer: Tips and Tricks.Journal of gastrointestinal surgery : official journal of the Society for Surgery of the Alimentary Tract · 2020Article
- Is Laparoscopic Pancreaticoduodenectomy Feasible for Pancreatic Ductal Adenocarcinoma?Cancers · 2020Review
- Laparoscopic assisted pancreaticoduodenectomy: an important link in the process of transition from open to total laparoscopic pancreaticoduodenectomy.BMC surgery · 2020Article
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Authors and funding
7 authors at 1 institution in 1 country.
Funding
No grant is acknowledged in the PubMed record.
Abstract
backgroundThe prognosis of patients affected by pancreatic adenocarcinoma and periampullary tumors is dismal, mainly due to aggressive tumor biology and low rate of resectability at the diagnosis. Among resectable patients, the quality of surgical resection, with a particular focus on the complete resection of the retropancreatic tissue (the so-called "mesopancreas") encircling the superior mesenteric artery (SMA), has a cardinal role. With this assumption, many pancreatic surgeons recommend periadventitial dissection of the SMA in order to obtain a total mesopancreas excision (TMpE), maximizing surgical margin and minimizing R1 resection rate.
objectiveTo introduce our approaches for periadventitial dissection of the SMA, tailored to patient and tumor characteristics and aiming at obtaining a TMpE, during laparoscopic pancreatoduodenectomy (LPD).
methodsThree different approaches for the SMA periadventitial dissection during LPD are described: the right, the right-left, and the anterior SMA-first approach. Indications, advantages, and technical aspects of each technique are reported, as well as pathologic results, particularly focusing on resection margin status and removed lymphnodes number, safety, and feasibility.
resultsOverall, R0 rate and number of lymphnodes retrieved were 86% and 26, respectively, without significant differences according to the SMA approach performed. Rate of conversion to laparotomy due to intraoperative bleeding during SMA dissection step was 6% (3/48) among patients who underwent the right SMA approach and nil among remaining patients.
conclusionDuring LPD, a tailored approach for periadventitial dissection of SMA makes TMpE feasible, safe, and oncologic valid, when performed by a team experienced with mininvasive approach and pancreatic surgery.
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