Controlling the arterial supply into the pancreatic head region as a whole peripancreatic arterial arcade via a mesenteric approach during isolated pancreatoduodenectomy

• DOI: 10.1007/s00595-021-02298-2
• Publication Date: 2021-05-20T11:20:11Z
• Authors: Kiyotsugu Iede; Akimasa Nakao; Kenji Oshima; Ryota Suzuki; Hironori Yamada; Mitsuru Tashiro; Yukiko Oshima; Hironobu Kobayashi
• Keywords: Adult; Aged, 80 and over; Male; 0301 basic medicine; Intraoperative Care; Blood Loss, Surgical; Collateral Circulation; Middle Aged; Mesenteric Arteries; Pancreaticoduodenectomy; 3. Good health; Pancreatic Neoplasms; 03 medical and health sciences; Multidetector Computed Tomography; Humans; Female; Pancreas; Aged; Retrospective Studies

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.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.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).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.