scholarly journals Evolution of surgery for pancreatic head and periampullary cancer

2019 ◽  
Vol 24 (3) ◽  
pp. 45-53
Author(s):  
Yu. I. Patyutko ◽  
A. G. Kotelnikov ◽  
A. N. Polyakov ◽  
V. D. Podluzhnyi
Keyword(s):  
Pancreatic Cancer ◽  
Superior Mesenteric Artery ◽  
Mesenteric Artery ◽  
Standard Procedure ◽  
Combined Treatment ◽  
Pancreatic Head ◽  
Periampullary Cancer ◽  
National Medical ◽  
Ductal Pancreatic Cancer ◽  
The Right

Development of surgical approach for pancreatic head and periampullary cancer at the Blokhin National Medical Research Center of Oncology over the past 30 years and global surgical tendencies of surgery for pancreatic cancer are demonstrated in the article. Over this period, gastropancreaticoduodenectomy has evolved from standard procedure without complete lymph node dissection and neurodissection and extended gastropancreaticoduodenectomy with obligatory circular skeletonization of superior mesenteric artery and para-aortic lymphadenectomy to standard gastropancreaticoduodenectomy. The last procedure implies mandatory skeletonization of the right semicircle of superior mesenteric artery, all tubular structures of hepatoduodenal ligament and possible resection of portal and superior mesenteric vein for suspected invasion. Surgical possibilities in the treatment of patients with pancreatic head and periampullary cancer are exhausted. The concept of “early diagnosis” is not applicable for patients with ductal pancreatic cancer. Further progress is exclusively associated with medicamentous combined treatment based on the molecular-biological characteristics of pancreatic and periampular cancer and, possibly, with primary prevention of pancreatic cancer.

scholarly journals What comprises the plate-like structure between the pancreatic head and the celiac trunk and superior mesenteric artery? A proposal for the term “P–A ligament” based on anatomical findings

2021 ◽  
Author(s):  
Satoru Muro ◽  
Wachirawit Sirirat ◽  
Daisuke Ban ◽  
Yuichi Nagakawa ◽  
Keiichi Akita
Keyword(s):  
Superior Mesenteric Artery ◽  
Mesenteric Artery ◽  
Pancreatic Head ◽  
Celiac Trunk ◽  
Dorsal Side ◽  
Uncinate Process ◽  
Anatomical Basis ◽  
The Right ◽  
Upper Abdomen ◽  
Macroscopic Examination

AbstractA plate-like structure is located posterior to the portal vein system, between the pancreatic head and roots and/or branches of two major arteries of the aorta: the celiac trunk and superior mesenteric artery. We aimed to clarify the distribution and components of this plate-like structure. Macroscopic examination of the upper abdomen and histological examination of the plate-like structure were performed on 26 cadavers. The plate-like structure is connected to major arteries (aorta, celiac trunk, superior mesenteric artery) and the pancreatic head; it contains abundant fibrous bundles comprising nerves, vessels, collagen fibers, and adipose tissue. Furthermore, it consists of three partly overlapping fibrous components: rich fibrous bundles (superior mesenteric artery plexus) fused to the uncinate process of the pancreas; fibrous bundles arising from the right celiac ganglion and celiac trunk that spread radially to the dorsal side of the pancreatic head and superior mesenteric artery plexus; and fibrous bundles, accompanied by the inferior pancreaticoduodenal artery, entering the pancreatic head. The plate-like structure is the pancreas–major arteries (aorta, celiac trunk, superior mesenteric artery) ligament (P–A ligament). The term “P–A ligament” may be clinically useful and can facilitate comprehensive understanding of the anatomy surrounding the pancreatic head and provide an anatomical basis for further pancreatic surgery studies.

scholarly journals Lethal Bleeding from a Duodenal Cancerous Ulcer Communicating with the Superior Mesenteric Artery in a Patient with Pancreatic Head Cancer

2018 ◽  
Vol 12 (2) ◽  
pp. 479-486
Author(s):  
Yoshifumi Morita ◽  
Takanori Sakaguchi ◽  
Ryo Kitajima ◽  
Satoru Furuhashi ◽  
Ryota Kiuchi ◽  
...  
Keyword(s):  
Pancreatic Cancer ◽  
Superior Mesenteric Artery ◽  
Mesenteric Artery ◽  
Pancreatic Head ◽  
Severe Bleeding ◽  
Main Trunk ◽  
Head Cancer ◽  
Pancreatic Head Cancer ◽  
Aortic Balloon Occlusion ◽  
Duodenal Bleeding

Pancreatic cancer often invades the duodenum and causes obstruction, but rarely causes massive duodenal bleeding. A 68-year-old male was admitted to our hospital because of vomiting. Enhanced abdominal CT showed a hypovascular tumor with air bubbles in the uncinate process of the pancreas. The tumor invaded the duodenum and metastasized to the liver and peritoneum. The main trunk of the superior mesenteric artery (SMA) was circumferentially involved. After admission, he had hematemesis and melena. Emergency gastroduodenoscopy revealed pulsating vessels in the third portion of the duodenum and he eventually experienced hemorrhagic shock. Severe bleeding occurred from his mouth and anus like a catastrophic flood. It was difficult to sustain blood pressure even with massive blood transfusion with pumping. After insertion of an intra-aortic balloon occlusion catheter, the massive bleeding was eventually stopped. Although we attempted interventional radiography, aortography revealed direct communication between the main SMA trunk and the duodenal lumen. The tumor was considered anatomically and oncologically unresectable. Thus, we did not perform further intervention. The patient died 2 h after angiography. Herein, we report the case of pancreatic head cancer causing lethal bleeding associated with tumor-involved SMA. Duodenal bleeding associated with pancreatic cancer invasion should be considered as an oncogenic emergency.

Anomalous arterial supply to the gallbladder from the superior mesenteric artery: angiography and computed tomography findings in two cases

2008 ◽  
Vol 49 (9) ◽  
pp. 987-990 ◽  
Author(s):  
Y. Katada ◽  
M. Kishino ◽  
K. Ishihara ◽  
T. Takeguchi ◽  
H. Shibuya
Keyword(s):  
Computed Tomography ◽  
Superior Mesenteric Artery ◽  
Hepatic Artery ◽  
Mesenteric Artery ◽  
Cystic Artery ◽  
Arterial Supply ◽  
Hepatic Arteries ◽  
Right Hepatic Artery ◽  
Pancreatic Artery ◽  
The Right

The arterial supply of the gallbladder usually arises from the right hepatic artery. Other origins include the left, proper, and common hepatic arteries. We report cases of the cystic artery arising from the superior mesenteric artery and arising from the dorsal pancreatic artery originating in turn from the superior mesenteric artery, as demonstrated by angiography and computed tomography.

scholarly journals Vascular Structures of the Right Colon: Incidence and Variations with Their Clinical Implications

2016 ◽  
Vol 106 (2) ◽  
pp. 107-115 ◽  
Author(s):  
J. Alsabilah ◽  
W. R. Kim ◽  
N. K. Kim
Keyword(s):  
Colon Cancer ◽  
Superior Mesenteric Artery ◽  
Mesenteric Artery ◽  
Vascular Anatomy ◽  
Colic Artery ◽  
Right Colon ◽  
Right Colon Cancer ◽  
Vascular Structures ◽  
Gastrocolic Trunk ◽  
The Right

Background and Aims: There is a demand for a better understanding of the vascular structures around the right colonic area. Although right hemicolectomy with the recent concept of meticulous lymph node dissection is a standardized procedure for malignant diseases among most surgeons, variations in the actual anatomical vascular are not well understood. The aim of the present review was to present a detailed overview of the vascular variation pertinent to the surgery for right colon cancer. Materials and Methods: Medical literature was searched for the articles highlighting the vascular variation relevant to the right colon cancer surgery. Results: Recently, there have been many detailed studies on applied surgical vascular anatomy based on cadaveric dissections, as well as radiological and intraoperative examinations to overcome misconceptions concerning the arterial supply and venous drainage to the right colon. Ileocolic artery and middle colic artery are consistently present in all patients arising from the superior mesenteric artery. Even though the ileocolic artery passes posterior to the superior mesenteric vein in most of the cases, in some cases courses anterior to the superior mesenteric artery. The right colic artery is inconsistently present ranging from 63% to 10% across different studies. Ileocolic vein and middle colic vein is always present, while the right colic vein is absent in 50% of patients. The gastrocolic trunk of Henle is present in 46%–100% patients across many studies with variation in the tributaries ranging from bipodal to tetrapodal. Commonly, it is found that the right colonic veins, including the right colic vein, middle colic vein, and superior right colic vein, share the confluence forming the gastrocolic trunk of Henle in a highly variable frequency and different forms. Conclusion: Understanding the incidence and variations of the vascular anatomy of right side colon is of crucial importance. Failure to recognize the variation during surgery can result in troublesome bleeding especially during minimal invasive surgery.

An anatomical review of various superior mesenteric artery-first approaches during pancreatoduodenectomy for pancreatic cancer

Surgery Today ◽  
2020 ◽  
Author(s):  
Junji Yamamoto ◽  
Hiroki Kudo ◽  
Yusuke Kyoden ◽  
Yoshinori Ajiro ◽  
Masaya Hiyoshi ◽  
...  
Keyword(s):  
Pancreatic Cancer ◽  
Superior Mesenteric Artery ◽  
Mesenteric Artery ◽  
Artery First
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