Total Pancreatectomy with 'SMA-First Approach'.

Abstract

Introduction: Total pancreatectomy (TP) is technically demanding procedure for patients with multifocal pancreatic diseases. Although the benefits of the superior mesenteric artery (SMA)-first approach for pancreatic cancer (PC) have been reported in pancreatic surgery, few studies have demonstrated surgical techniques of SMA-first approach in TP.

Methods: This report presents our novel SMA-first approach for PC in TP, including six steps. First, the resectability was confirmed (step 1). Next, SMA approach was applied (step 2). In this step, the anterior and left sides of the SMA were dissected, and the left renal vein was confirmed. Following retroperitoneal dissection (step 3), the pancreatic body and tail were completely mobilized (step 4). Subsequently, Whipple procedure was performed with lymphadenectomy around the right side of the SMA (step 5). Finally, hepaticojejunostomy and gastrojejunostomy were performed (step 6). Using SMA-first approach, en bloc resection with adequate lymphadenectomy around the SMA and retroperitoneal dissection was performed.

Conclusion: The present study presents surgical techniques of TP using the SMA-first approach for PC. This unique approach may be useful to perform TP for PC to obtain negative resection margins.