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The importance of vascular anatomy and r1 site in the oncologic outcome of pancreatoduodenectomy for pancreatic cancer: The case of an aberrant right hepatic artery

      Radical resection of pancreatic ductal adenocarcinoma (PDAC) requires a vessel-oriented approach, because of the close anatomic relationships with retroperitoneal vessels and the high frequency of extrapancreatic nerve plexus (ENP) invasion. Therefore, pancreatic surgeons should be familiar with vascular surgery techniques. This is the vision of a pancreatic surgeon who also performs transplants and received training in vascular surgery. On practical grounds, I never left a macroscopic tumor residual in over 2,000 pancreatic resections. Avoiding R2 resection requires careful preoperative planning and selection. I have performed more than 550 vascular resections, including more than 150 arterial resections. However, approximately 50% of my pancreatoduodenectomies (PDs) for PDAC are R1.
      • Kauffmann E.F.
      • Napoli N.
      • Menonna F.
      • et al.
      A propensity score-matched analysis of robotic versus open pancreatoduodenectomy for pancreatic cancer based on margin status.
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      References

        • Kauffmann E.F.
        • Napoli N.
        • Menonna F.
        • et al.
        A propensity score-matched analysis of robotic versus open pancreatoduodenectomy for pancreatic cancer based on margin status.
        Surg Endosc. 2019; 33: 234-242
        • Nakajima T.
        • Ikuta S.
        • Nakamura I.
        • et al.
        Impact of the aberrant right hepatic artery on local recurrence of pancreatic ductal adenocarcinoma after pancreaticoduodenectomy.
        Surgery. 2022; 172: 691-699
        • Shah M.M.
        • Datta J.
        • Merchant N.B.
        • Kooby D.A.
        Landmark series: importance of pancreatic resection margins.
        Ann Surg Oncol. 2022; 29: 1542-1550
        • Verbeke C.S.
        Resection margins in pancreatic cancer.
        Surg Clin North Am. 2013; 93: 647-662
        • Yamada S.
        • Satoi S.
        • Takami H.
        • et al.
        Multicenter randomized phase II trial of prophylactic right-half dissection of superior mesenteric artery nerve plexus in pancreatoduodenectomy for pancreatic head cancer.
        Ann Gastroenterol Surg. 2020; 5: 111-118

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