Erschienen in:
01.08.2012 | Letter to the Editor
Combined posterior and anterior approach to the superior mesenteric artery : the advantages of the “hanging maneuver”
verfasst von:
Ettore Marzano, Tullio Piardi, Jacques Marescaux, Patrick Pessaux
Erschienen in:
Langenbeck's Archives of Surgery
|
Ausgabe 6/2012
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Excerpt
We read with great interest the article by Shrikhande and colleagues [
1] recently published in
Langenbecks Arch Surg entitled “Superior mesenteric artery first combined with uncinate process approach versus uncinate process first apporach in pancreatoduodenectomy: a comparative study evaluating perioperative outcomes.” Firstly, we want to congratulate the authors for describing the “artery first” approach in pancreatic head resection, which strives for a complete tumor resection, especially at the superior mesenteric artery (SMA). The retroperitoneal peripancreatic tissue is often invaded at the time of pancreaticoduodenectomy resulting in R1 resection with dismal survival. Since several years, we are convinced that it is of utmost importance to remove “en bloc” together with the head of the pancreas all the retroperitoneal peripancreatic tissue, in order to increase the number of R0 resections and to extend the circumferential resection margins. However, as the author cited our technique only partially, some comments seem necessary to better clarify our surgical approach to SMA and especially the evolution that characterized the technique since 2003 [
2]. …
