A Novel Classification and Staged Approach for Dissection Along the Celiac and Hepatic Artery During Pancreaticoduodenectomy

World Journal of Surgery
Yosuke InoueYu Takahashi

Abstract

In recent decades, there have been enthusiastic discussions of, and active proposals for, new approaches to dissection around the superior mesenteric artery during pancreaticoduodenectomy (PD). In contrast, dissection along the celiac axis (CA) and hepatic artery (HA) and in the hepatoduodenal ligament has rarely been systematically discussed. In this report, we propose and describe a three-level classification of dissection along the CA-HA system which is applicable to a variety of diseases for which PD is indicated. The extent of dissection is classified into three levels. With the first level (LV-1), neither LN nor plexus dissection is required. The second level (LV-2) includes en bloc resection of LNs along the CA, HA, and in the hepatoduodenal ligament, preserving the nerve plexus around the artery. The third level (LV-3) includes en bloc dissection of LNs and the nerve plexus close to cancer invasion, for example, being accompanied by half circumferential dissection of the nerve plexus around the CA or circumferential dissection of that of HA. LV-1 dissection is indicated for benign lesions, low grade malignancy, pancreatic metastasis, or intraductal papillary mucinous neoplasm. LV-2 is indicated for periampullary maligna...Continue Reading

References

Mar 9, 2012·Journal of Gastrointestinal Surgery : Official Journal of the Society for Surgery of the Alimentary Tract·Steven M StrasbergDavid C Linehan
May 10, 2012·The British Journal of Surgery·P SanjayJ A Windsor

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Citations

Nov 8, 2020·Langenbeck's Archives of Surgery·Kenjiro OkadaShinya Takahashi
Jul 24, 2021·HPB : the Official Journal of the International Hepato Pancreato Biliary Association·Rosa KlotzMarkus W Büchler
Aug 28, 2021·Annals of Surgical Oncology·Georgios GemenetzisJin He

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