Combined posterior and anterior approach to the superior mesenteric artery : the advantages of the 'hanging maneuver'

摘要

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 Rl 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 RO resections and to extend the circumferential resection margins.