Periarterial divestment in pancreatic cancer surgery.

Published on May 1, 2021in Surgery3.356
· DOI :10.1016/J.SURG.2020.08.030
Markus K. Diener48
Estimated H-index: 48
(Heidelberg University),
André L. Mihaljevic20
Estimated H-index: 20
(Heidelberg University)
+ 11 AuthorsMarkus W. Büchler173
Estimated H-index: 173
(Heidelberg University)
Abstract Background Modern pancreatic cancer surgery changed with the introduction of effective neoadjuvant therapies. Complete tumor resection is the mainstay for long-term, disease-free, and overall survival and has been a prerequisite for decreasing local recurrence. The medial resection margin in the area of the superior mesenteric vessels limits the radicalness of the resection, especially in borderline and locally advanced cases. Therefore, the periarterial soft tissue around the peripancreatic visceral arteries must be completely cleared. This procedure, namely periarterial divestment, is technically demanding but often represents an alternative to arterial resection. Objective Here we describe the technique and our initial experience with periarterial divestment along the peripancreatic visceral arteries during pancreatic surgery. This technique, in combination with previously published resection strategies, such as artery first maneuver and mesenterico-portal venous bypass first, enables tumor resection in locally advanced pancreatic cancer. Conclusion Periarterial divestment can prevent the need for arterial resection in borderline and locally advanced pancreatic cancer, especially after neoadjuvant therapy. The feasibility, improved safety, and oncologic equivalence of arterial divestment versus arterial resection for pancreatic cancer surgery must be evaluated by clinical trials.
#1Thomas Schmidt (Heidelberg University)H-Index: 31
#2Oliver Strobel (Heidelberg University)H-Index: 50
Last. Markus W. Büchler (Heidelberg University)H-Index: 173
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#1Paula Ghaneh (University of Liverpool)H-Index: 62
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#1Martin Schneider (Heidelberg University)H-Index: 23
#2Oliver Strobel (Heidelberg University)H-Index: 50
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#1Masayuki Tanaka (Heidelberg University)H-Index: 8
#2André L. Mihaljevic (Heidelberg University)H-Index: 20
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#1Vincent P. Groot (UU: Utrecht University)H-Index: 16
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Cited By14
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BACKGROUND Multimodal treatment concepts enhance options for surgery in locally advanced pancreatic ductal adenocarcinoma (PDAC). This review provides an overview of technical advances to facilitate curative-intent resection in PDAC. METHODS A review of the literature addressing current technical advances in surgery for PDAC was performed, and current state-of-the-art surgical techniques summarized. RESULTS Artery-first and uncinate-first approaches, dissection of the anatomical triangle between...
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Borderline resectable pancreatic cancer and vascular resections in the era of neoadjuvant therapy
#1Thomas Hank (University of Vienna)
#2Ulla Klaiber (University of Vienna)
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Purpose null The resection of retropancreatic nerve plexuses for pancreatic head cancer became standard of care during open pancreatoduodenectomy to minimize local recurrences. Since more surgical centers are progressing on the learning curve, robotically-assisted pancreatoduodenectomy is now increasingly performed with decreasing anatomic exclusion criteria. To achieve comparable and favorable oncologic outcomes, advanced surgical techniques should be transferred and implemented when performing...
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