Nakao mesenteric approach in pancreatoduodenectomy for pancreatic head cancer

Abstract

Abstract The ideal surgery for pancreatic head cancer is isolated pancreatoduodenectomy (PD); that is, en bloc resection using a non-touch isolation technique. We have been developing isolated PD for pancreatic cancer since 1981, when we developed an anti-thrombogenic bypass catheter for the portal vein. In this operation, the first and most important step is the use of a mesenteric approach instead of Kocher's maneuver. The mesenteric approach allows dissection from the non-cancer infiltrating side and determination of cancer-free surgical margins and resectability, followed by systemic lymphadenectomy around the superior mesenteric artery. This approach enables early ligation of the inferior pancreatoduodenal artery and mesopancreas excision. The mesopancreas is the second portion of the pancreatic head nerve plexus. Isolated PD is the ideal surgery for pancreatic head cancer from both surgical and oncological viewpoints. In patients with resectable pancreatic head cancer, isolated PD using the mesenteric approach is suspected to have a higher survival rate than conventional PD using Kocher's maneuver. The precise surgical techniques of the mesenteric approach are herein described.