SMA first approach Pancreaticoduodenectomy for cancer – should it be standard approach?

  • Binay Thakur
  • Mukti Devkota
  • Di Yonghui
  • Yogesh Regmi
  • Durga Khanal
  • Kopila Khadaka

Abstract

Background: pancreaticoduodenectomy (PD) has become the standard treatment for cancer of head of pancreaseand periampullary malignancies. Recently superior mesenteric artery (SMA) first approach has shown to haveseveral advantages over the conventional superior mesenteric vein (SMV) first approach. We present our initialexperience with SMA first approach for PD.Methods: Thirteen patients undergoing SMA first PD during year 2014-2015 (1 year) were prospectivelystudied. A posterior approach with “hanging maneuver” was used to identify SMA first and the resectibility wasconfirmed. Inferior pancreaticoduodenal artery (IPDA) was ligated before the division of pancreatic neck. Ductto mucosa pancreaticojejunostomy followed by hepaticojejunostomy and gastrojejunostomy was performed.Results: patients with mean age of 53 years presented with abdominal pain and jaundice (100%). Tumors wereof periampullary region in 10 cases and of head of pancrease in three cases. Two patients required partialSMV wall resection with tangential repair. Mean operating time, blood loss and postoperative stay was 304minutes, 380 ml and 14 days, respectively. Replaced/ aberrant right hepatic artery from SMA was observed in38% cases. Mean number of dissected nodes was 16. R0 resection was achieved in 100% cases. There wasonepostoperative mortality (7.7%) and minor complications were noted in 46% cases.Conclusion: SMA first PD helps to properly identify and control anomalous or accessory right hepatic arteryarising from SMA, minimizes intraoperative bleeding due to proper control
Published
2016-03-18
How to Cite
THAKUR, Binay et al. SMA first approach Pancreaticoduodenectomy for cancer – should it be standard approach?. J Soc Surg Nep, [S.l.], v. 18, mar. 2016. ISSN 2392-4772. Available at: <https://jssn.org.np/index.php?journal=jssn&page=article&op=view&path%5B%5D=116>. Date accessed: 29 mar. 2024.

Keywords

pancreaticoduodenectomy; superior mesenteric artery; hanging maneuver