ArticleAnnals of surgical oncology2026
How to Deal with Median Arcuate Ligament during Pancreaticoduodenectomy? Management Strategies and Impact on Perioperative Outcomes.
Article in Annals of surgical oncology, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 1 paper.
What it found
Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.
The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.
Who cites it
1 citing paper in PubMed.
Corrections and comments
PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.
Authors and funding
21 authors.
Funding
No grant is acknowledged in the PubMed record.
Abstract
backgroundMedian arcuate ligament (MAL) can cause coeliac trunk (CT) stenosis, which is often asymptomatic but may lead to severe hepatic, splenic, or digestive ischemia following pancreaticoduodenectomy (PD). Optimal diagnosis and management remain debated. The purpose of this study was to evaluate management strategies and perioperative outcomes of patients with MAL undergoing PD. PATIENTS AND
methodsA retrospective multicenter study across ten high-volume French centers included patients diagnosed with MAL (hemodynamically significant or not) who underwent PD between 2005 and 2024. Diagnosis and management strategies and postoperative outcomes were collected.
resultsMAL stenosis was suspected in 1.3% of patients (115/8676), with 59 cases (0.7%) showing hemodynamically significant MAL. MAL stenosis was suspected before surgery in 90% of patients (n = 104). Overall, 8 patients (13.8%) underwent preoperative stenting, 48 patients (82.8%) underwent intraoperative MAL division, and 2 patients (3.4%) underwent primary vascular reconstruction. Seven failures of MAL division (14%) required vascular reconstruction. Overall morbidity (Clavien-Dindo ≥ III) was 25%, pancreatic fistula B-C was 10%, biliary fistula was 6.9%, hemorrhage was 15%, and mortality was 4.3% (n = 5). Ischemic complications were observed in five patients (4.5%), including four hepatic ischemias and one bowel ischemia; two hepatic ischemias were directly related to MAL management. Overall postoperative mortality was 4.3%, with two deaths attributable to MAL-related hepatic ischemia.
conclusionsMAL is rare but clinically impactful in patients undergoing PD. Early recognition and appropriate intraoperative assessment are essential to prevent ischemic complications. When properly identified and managed, MAL does not appear to significantly worsen overall postoperative outcomes. Management should remain individualized, and pancreatic surgeons should be prepared to perform MAL division and vascular reconstruction when indicated.
Indexed as
Identifiers
42177373What OpenQuestion holds
Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.