Abstract
Resections of the pancreas typically involve removal of either the pancreatic head or varying portions of the pancreatic body and tail depending on the actual location of the tumor. The line of transection during a typical pancreaticoduodenectomy is constant in most cases and is that region of parenchyma directly overlying the SMV/portal vein, often called the pancreatic neck. Occasionally, that line of transection will move to the patient’s left should the tumor extend out of the pancreatic head. However, from a surgical anatomy standpoint the pancreatic head is defined as all of the pancreatic tissue lying to the right of the SMV/portal vein. Similarly, the left pancreas is defined as all of the pancreatic tissue lying to the left of the SMV/portal vein. It contains both the body and tail of the pancreas as is commonly depicted in anatomy texts. Traditionally, the line of parenchymal transection for tumors of the left pancreas is not always constant and can move leftward from the SMV/portal vein with more distal locations of disease (i.e., those located in the tail.) Thus, a distal pancreatectomy is a more nebulously defined concept in comparison to the typical Whipple procedure when referring to the actual location of parenchymal transection. In this chapter we will be discussing what we believe is the optimal approach to the oncologic resection of the left side of the pancreas. We advocate for a modular approach employing a constant transection line in typical resections of malignant tumors of the left pancreas. That line is at the SMV/portal vein. Thus, the entire left pancreas is removed regardless of the tumor’s location within the body or tail. Occasionally, the pancreas will require division at the union of the head and neck in order achieve a negative margin.
Access this chapter
Tax calculation will be finalised at checkout
Purchases are for personal use only
Similar content being viewed by others
References
Strasberg SM, Drebin JA, Linehan D. Radical antegrade modular pancreatosplenectomy. Surgery. 2003;133(5):521–7.
O’Morchoe CC. Lymphatic system of the pancreas. Microsc Res Tech. 1997;37(5–6):456–77.
Hamilton NA, Porembka MR, Johnston FM, Gao F, Strasberg SM, Linehan DC, Hawkins WG. Mesh reinforcement of pancreatic transection decreases incidence of pancreatic occlusion failure for left pancreatectomy: a single-blinded, randomized controlled trial. Ann Surg. 2012;255(6):1037–42.
Strasberg SM, Fields R. Left-sided pancreatic cancer: distal pancreatectomy and its variants: radical antegrade modular pancreatosplenectomy and distal pancreatectomy with celiac axis resection. Cancer J. 2012;18(6):562–70.
Reddy SK, Tyler DS, Pappas TN, Clary BM. Extended resection for pancreatic adenocarcinoma. Oncologist. 2007;12(6):654–63.
Shoup M, Conlon KC, Klimstra D, Brennan MF. Is extended resection for adenocarcinoma of the body or tail of the pancreas justified? J Gastrointest Surg. 2003;7(8):946–52. discussion 952.
Christein JD, Kendrick ML, Iqbal CW, Nagorney DM, Farnell MB. Distal pancreatectomy for resectable adenocarcinoma of the body and tail of the pancreas. J Gastrointest Surg. 2005;9(7):922–7.
Strasberg SM, Linehan DC, Hawkins WG. Radical antegrade modular pancreatosplenectomy procedure for adenocarcinoma of the body and tail of the pancreas: ability to obtain negative tangential margins. J Am Coll Surg. 2007;204(2):244–9.
Chang YR, Han SS, Park SJ, Lee SD, Yoo TS, Kim YK, Kim TH, Woo SM, Lee WJ, Hong EK. Surgical outcome of pancreatic cancer using radical antegrade modular pancreatosplenectomy procedure. World J Gastroenterol. 2012;18(39):5595–600.
Mitchem JB, Hamilton N, Gao F, Hawkins WG, Linehan DC, Strasberg SM. Long-term results of resection of adenocarcinoma of the body and tail of the pancreas using radical antegrade modular pancreatosplenectomy procedure. J Am Coll Surg. 2012;214(1):46–52.
Latorre M, Ziparo V, Nigri G, Balducci G, Cavallini M, Ramacciato G. Standard retrograde pancreatosplenectomy versus radical antegrade modular pancreatosplenectomy for body and tail pancreatic adenocarcinoma. Am Surg. 2013;79(11):1154–8.
Trottman P, Swett K, Shen P, Sirintrapun J. Comparison of standard distal pancreatectomy and splenectomy with radical antegrade modular pancreatosplenectomy. Am Surg. 2014;80(3):295–300.
Park HJ, You DD, Choi DW, Heo JS, Choi SH. Role of radical antegrade modular pancreatosplenectomy for adenocarcinoma of the body and tail of the pancreas. World J Surg. 2014;38(1):186–93.
Author information
Authors and Affiliations
Corresponding author
Editor information
Editors and Affiliations
Rights and permissions
Copyright information
© 2016 Springer International Publishing Switzerland
About this chapter
Cite this chapter
Spinelli, N., Hawkins, W. (2016). Surgical Approach to Borderline Resectable Tumors of the Left Pancreas. In: Katz, M., Ahmad, S. (eds) Multimodality Management of Borderline Resectable Pancreatic Cancer. Springer, Cham. https://doi.org/10.1007/978-3-319-22780-1_19
Download citation
DOI: https://doi.org/10.1007/978-3-319-22780-1_19
Publisher Name: Springer, Cham
Print ISBN: 978-3-319-22779-5
Online ISBN: 978-3-319-22780-1
eBook Packages: MedicineMedicine (R0)