Avoiding pancreatic necrosis following pancreas-preserving D3 lymphadenectomy for gastric cancer (original) (raw)

Pancreatic dissection in the procedure of pancreaticoduodenectomy (with videos)

Journal of hepato-biliary-pancreatic sciences, 2012

The procedure of pancreaticoduodenectomy consists of three parts: resection, lymph node dissection, and reconstruction. A transection of the pancreas is commonly performed after a maneuver of the pancreatic head, exposing of the portal vein or lymph node dissection, and it should be confirmed as a safe method for pancreatic transection for decreasing the incidence of pancreatic fistula. However, there are only a few clinical trials with high levels of evidence for pancreatic surgery. In this report, we discuss the following issues: dissection of peripancreatic tissue, exposing the portal vein, pancreatic transection, dissection of the right hemicircle of the peri-superior mesenteric artery including plexus and lymph nodes, and dissection of the pancreatic parenchyma.

Technical Aspects of Left-Sided Pancreatic Resection for Cancer

Digestive Surgery, 1999

Adenocarcinoma of the pancreas that originates to the left of the portal vein, i.e. in the body or tail of the pancreas, is seen in approximately one third of all cases with exocrine pancreatic cancer. Except for symptoms of pain and weight loss, these patients usually appear normal upon physical examination. In 5-10% of cases, the tumor is resectable by standard surgical procedures. Unresectability is due to local spread (30-40%) or distant metastases (50-65%). The technique of distal pancreatic resection was outlined by Mayo in 1913. The intimate relationship of the splenic artery and vein to the body of the pancreas makes en bloc mobilization of the spleen and pancreatic tail a safe option; the splenic artery and vein being ligated near their origin and termination. Although the spleen can frequently be preserved when performing a distal pancreatectomy for benign disease, splenic artery preservation is hazardous for oncologic radicality when resection is performed for cancer. Therefore, splenectomy is routine in distal pancreatectomy-in Mayo's and all subsequent descriptions-with the splenic artery being ligated early in the procedure. Recent reports from specialized centers indicate that the procedure is associated with a decrease in mortality rate, often zero or less than a few percent.

The surgical anatomy of the lymphatic system of the pancreas

Clinical Anatomy, 2014

The lymphatic system of the pancreas is a complex, intricate network of lymphatic vessels and nodes responsible for the drainage of the head, neck, body, and tail of the pancreas. Its anatomical divisions and embryological development have been well described in the literature with emphasis on its clinical relevance in regards to pancreatic pathologies. A thorough knowledge and understanding of the lymphatic system surrounding the pancreas is critical for physicians in providing diagnostic and treatment strategies for patients with pancreatic cancer and pancreatitis. Pancreatic cancer has an extremely poor prognosis and is a notable cause of morbidity and mortality worldwide. Although a surgeon may try to predict the routes for metastasis for pancreatic cancer, the complexity of this system presents difficulty due to variable drainage patterns. Pancreatitis also presents as another severe disease which has been shown to have an association with the lymphatics. The aim of this article is to review the literature on the lymphatics of the pancreas, pancreatic pathologies, and the available imaging methodologies used to study the pancreatic lymphatics. Clin.

Pylorus-preserving pancreatoduodenectomy ? technical aspects

Langenbecks Archiv fur Chirurgie, 1991

Zusammenfassung. Die pyloruserhaltende Pankreatoduodenektomie ist die Resektionsmethode der Wahl bei Patienten mit einem Karzinom des Pankreaskopfes und der periampullfiren Region und bei einigen Patienten mit chronischer Pankreatitis. Pr/ioperative Vorbereitung, Operationstechnik und Ergebnisse werden besprochen.

Pyloric and Gastric Preserving Pancreatic Resection

Annals of Surgery, 1986

Eighty-seven patients with neoplasm (57 cases), pancreatitis (28 cases), or benign biliary obstruction (2 cases) were treated with pyloric preserving pancreatectomy with two postoperative deaths, neither due to abdominal complications. About 50% of patients had delay in recovery of gastrointestinal function. Six and seven patients had clinically significant biliary and pancreatic fistulas, respectively, with some patients having both. Complications required 16 reoperations. Marginal ulcer was suggested by endoscopy or barium study in five patients, three of whom were successfully managed by a medical regimen. In the other two patients, exploration failed to demonstrate an ulcer or jejunitis. In most patients, long-term gastrointestinal function was judged to be excellent based on weight gain and lack ofdigestive symptoms. Pyloric function and gastric motility were evaluated by abdominal scaning using indium 111 and technetium 99m. Gastric emptying of liquids and solids was normal. Estimations of enterogastric reflux showed a moderate difference between normal subjects and pancreatectomy patients. Cancer-free survival was comparable to that after the standard Whipple procedure. W x rHIPPLE AND ASSOCIATES introduced two-stage limited pancreatoduodenectomy for carcinoma of the ampulla of Vater in 1935' and one-stage radical pancreatoduodenectomy in 1945.2 Since then, many modifications of the original procedure have evolved, and various methods ofreconstruction have been developed, particularly for management ofthe pancreatic remnant.36 In addition, the indications for pancreatoduodenectomy have been extended to treatment of chronic pancreatitis and periampullary and pancreatic neoplasms. Although the original technique did not include gastric resection," 3'7'8 partial gastrectomy was thought to be a