Abstract
Purpose
The peripancreatic arterial system forms various arterial arcades and collateral branches; therefore, it stands to reason that the arterial supply into the pancreatic head region should be controlled as a whole peripancreatic arterial arcade rather than as the three major supplying arteries during isolated pancreatoduodenectomy (PD). We investigated the clinical importance of early control of the whole peripancreatic arterial arcade during PD.
Methods
The subjects of this retrospective study were 63 consecutive patients who underwent PD via a mesenteric approach at our hospital between October, 2014 and February, 2017. The patients were divided into an early control group (n = 27) and a late control group (n = 36) for comparative analysis.
Results
The peripancreatic arterial arcades and collateral branches were seen on preoperative multidetector row computed tomography (CT) images and during PD in all 63 patients. The early control group had significantly less intraoperative blood loss than the late control group. Early control of the whole peripancreatic arterial arcade was an independent factor associated with lower intraoperative blood loss in the multivariable analysis (P = 0.012).
Conclusion
The arterial supply into the pancreatic head region should be controlled as a whole peripancreatic arterial arcade rather than as the three major supplying arteries during isolated PD.
Similar content being viewed by others
References
Kocher T. Mobilisierung des duodenum und gastroduodenostomie. Zentralbl Chir. 1903;2:33–40.
Nakao A, Nonami T, Harada A, Kasuga T, Takagi H. Portal vein resection with a new antithrombogenic catheter. Surgery. 1990;108(5):913–8.
Nakao A, Takagi H. Isolated pancreatectomy for pancreatic head carcinoma using catheter bypass of the portal vein. Hepatogastroenterology. 1993;40(5):426–9.
Sakamoto K, Ogawa K, Takai A, Tamura K, Shine M, Matsui T, et al. Technical details of a left-side approach to the superior mesenteric artery during pancreaticoduodenectomy. Surg Today. 2021;20:2. https://doi.org/10.1007/s00595-021-02255-z.
Yamamoto J, Kudo H, Kyoden Y, Ajiro Y, Hiyoshi M, Okuno T, et al. An anatomical review of various superior mesenteric artery-first approaches during pancreatoduodenectomy for pancreatic cancer. Surg Today. 2020. https://doi.org/10.1007/s00595-020-02150-z.
Nakao A. Nakao mesenteric approach in pancreatoduodenectomy for pancreatic head cancer. J Pancreatol. 2019;2(4):117–22.
Iede K, Nakao A, Oshima K, Suzuki R, Yamada H, Oshima Y, et al. Early ligation of the dorsal pancreatic artery with a mesenteric approach reduces intraoperative blood loss during pancreatoduodenectomy. J Hepatobiliary Pancreat Sci. 2018;25(7):329–34.
Nakao A. The mesenteric approach in pancreatoduodenectomy. Dig Surg. 2016;33(4):308–13.
Nakao A, Takeda S, Inoue S, Nomoto S, Kanazumi N, Sugimoto H, et al. Indications and techniques of extended resection for pancreatic cancer. World J Surg 2006;30(6):976–82; discussion 83–4.
Hirono S, Kawai M, Okada KI, Miyazawa M, Shimizu A, Kitahata Y, et al. Mesenteric approach during pancreaticoduodenectomy for pancreatic ductal adenocarcinoma. Ann Gastroenterol Surg. 2017;1(3):208–18.
Kawai M, Tani M, Ina S, Hirono S, Nishioka R, Miyazawa M, et al. CLIP method (preoperative CT image-assessed ligation of inferior pancreaticoduodenal artery) reduces intraoperative bleeding during pancreaticoduodenectomy. World J Surg. 2008;32(1):82–7.
Horiguchi A, Ishihara S, Ito M, Nagata H, Shimizu T, Furusawa K, et al. Pancreatoduodenectomy in which dissection of the efferent arteries of the head of the pancreas is performed first. J Hepatobiliary Pancreat Surg. 2007;14(6):575–8.
Ohigashi H, Ishikawa O, Eguchi H, Yamada T, Sasaki Y, Noura S, et al. Early ligation of the inferior pancreaticoduodenal artery to reduce blood loss during pancreaticoduodenectomy. Hepatogastroenterology. 2004;51(55):4–5.
Bertelli E, Di Gregorio F, Mosca S, Bastianini A. The arterial blood supply of the pancreas: a review. V. The dorsal pancreatic artery. An anatomic review and a radiologic study. Surg Radiol Anatomy. 1998;20(6):445–52.
Bertelli E, Di Gregorio F, Bertelli L, Orazioli D, Bastianini A. The arterial blood supply of the pancreas: a review. IV. The anterior inferior and posterior pancreaticoduodenal aa., and minor sources of blood supply for the head of the pancreas. An anatomical review and radiologic study. Surg Radiol Anatomy. 1997;19(4):203–12.
Bertelli E, Di Gregorio F, Bertelli L, Civeli L, Mosca S. The arterial blood supply of the pancreas: a review. II. The posterior superior pancreaticoduodenal artery. An anatomical and radiological study. Surg Radiol Anatomy. 1996;18(1):1–9.
Bertelli E, Di Gregorio F, Bertelli L, Civeli L, Mosca S. The arterial blood supply of the pancreas: a review. III. The inferior pancreaticoduodenal artery. An anatomical review and a radiological study. Surg Radiol Anatomy. 1996;18(2):67–74.
Bertelli E, Di Gregorio F, Bertelli L, Mosca S. The arterial blood supply of the pancreas: a review. I. The superior pancreaticoduodenal and the anterior superior pancreaticoduodenal arteries. An anatomical and radiological study. Surg Radiol Anatomy 1995;17(2):97–106, 1–3.
Kimura W, Hirai I, Yamaguchi H, Wakiguchi S, Murakami G, Kimura Y. Surgical anatomy of arteries running transversely in the pancreas, with special reference to the superior transverse pancreatic artery. Hepatogastroenterology. 2004;51(58):973–9.
Bassi C, Dervenis C, Butturini G, Fingerhut A, Yeo C, Izbicki J, et al. Postoperative pancreatic fistula: an international study group (ISGPF) definition. Surgery. 2005;138(1):8–13.
Wente MN, Bassi C, Dervenis C, Fingerhut A, Gouma DJ, Izbicki JR, et al. Delayed gastric emptying (DGE) after pancreatic surgery: a suggested definition by the International Study Group of Pancreatic Surgery (ISGPS). Surgery. 2007;142(5):761–8.
Woodburne RT, Olsen LL. The arteries of the pancreas. Anat Rec. 1951;111(2):255–70.
Funding
This work was supported by the Charitable Trust SOYU Medical Foundation.
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Conflict of interest
We have no conflicts of interest to declare in relation to this article.
Ethical approval
All procedures were performed in accordance with the ethical standards laid down in the 1964 Declaration of Helsinki and its later amendments or comparable ethical standards.
Informed consent
Written informed consent was obtained from all the patients before surgery.
Additional information
Publisher's Note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Rights and permissions
About this article
Cite this article
Iede, K., Nakao, A., Oshima, K. et al. Controlling the arterial supply into the pancreatic head region as a whole peripancreatic arterial arcade via a mesenteric approach during isolated pancreatoduodenectomy. Surg Today 51, 1819–1827 (2021). https://doi.org/10.1007/s00595-021-02298-2
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00595-021-02298-2