• Yuichi Nagakawa, Yuichi Hosokawa, Hiroaki Osakabe, Yatsuka Sahara, Chie Takishita, Tetsushi Nakajima, Yousuke Hijikata, Kenta Kasahara, Kasuya Kazuhiko, Kazuhiro Saito, and Akihiko Tsuchida.
• Hepato Gastroenterol. 2014 Nov 1; 61 (136): 2371-6.

Background/AimsTo achieve R0 resection, pancreaticoduodenectomy with right-side half dissection of the superior mesenteric artery nerve plexus is performed for pancreatic cancer with extrapancreatic nerve plexus invasion in many facilities. However, this cancer mainly spreads behind the superior mesenteric artery.MethodologyForty-two patients underwent pancreaticoduodenectomy with right-oblique posterior dissection of the superior mesenteric artery nerve plexus from the 4 to 10 o'clock position for pancreatic ductal adenocarcinoma. The cancer spread was evaluated using preoperative multi-detector computed tomography and postoperative pathological examination.ResultsThirty-one patients (73.8%) showed extrapancreatic nerve plexus invasion on multi-detector computed tomography. In 20 patients (47.6%), the tumor extended within 5 mm of the superior mesenteric artery, ranging between the 4-10 o'clock position in 19 (95.0%) patients. Although pathological examination revealed that the cancer infiltrated within 3 mm of the superior mesenteric artery margin in 17 (54.8%) patients with extrapancreatic nerve plexus invasion, R0 resection was achieved in 95.2% of cases. Six patients (14.3%) experienced postoperative diarrhea requiring administration of antidiarrheal agents.ConclusionsPancreatic head cancer spreads mainly right-posterior of the superior mesenteric artery; and therefore, right-oblique posterior dissection is a logical procedure to achieve negative margin resection with complete clearance of nerve plexus involvement.

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