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1Liver blood supply after a modified Appleby procedure in classical and aberrant arterial anatomy显示文摘Reported here are two cases of a modified Appleby operation for borderline resectable ductal adenocarcinoma of the pancreatic body, in one of which a R0 distal resection was attended to by excision, not only of the celiac axis, but also of the common and left hepatic arteries in the presence of arterial anatomic variation Michels, type Ⅷb. The possibility and avenues of the maintenance of the blood supply to the left hepatic lobe after surgical aggression of this kind are demonstrated employing computed tomography (CT) and 3-D CT angiography. Furthermore, both cases highlight all important worrisome aspects of pancreatic cancer resectability prediction.Vyacheslav I Egorov Roman V Petrov Michail V Lozhkin Olga A Maynovskaya Natalia S Starostina Natalia R Chernaya Ekaterina M Filippova 2013World Journal of Gastrointestinal Surgery2013,5,3:7
2Implications of the presence of an aberrant right hepatic artery in patients undergoing pancreaticoduodenectomy显示文摘AIM:To analyze the differences in outcomes and the clinical impact following pancreatoduodenectomy(PD)in patients with and without aberrant right hepatic artery(aRHA).METHODS:All patients undergoing PD between January 2008 and December 2012 were divided into two groups,one with aRHA and the other without.These groups were compared to identify differences in the intraoperative variables,the oncological clearance and the postoperative morbidity,mortality and hospital stay.RESULTS:A total of 225 patients underwent PD,of which 43(19.1%)patients were found to have eitheraccessory or replaced right hepatic arteries(aRHA group).The aRHA was preserved in 79%of the patients.There was no significant difference in the intraoperative blood loss but operative time was prolonged,reflecting the complexity of the procedure[420±44(240-540)min vs 480±45(300-600)min,P<0.05)].There were no differences in the incidence of postoperative complications(pancreatic leak,pancreatic fistula,delayed gastric emptying and mortality)and hospital stay.Oncological clearance in the form of positive resection margins[13(7.1%)vs 3(6.9%)]and lymph node yield were also similar in the two groups.CONCLUSION:An aRHA is found in approximately one fifth of patients undergoing PD.Preservation is technically possible in most patients and can increase the operative complexity but does not negatively affect the safety or oncological outcomes of the procedure.Ashwin Rammohan Ravichandran Palaniappan Anbalagan Pitchaimuthu Kamalakannan Rajendran Senthil Kumar Perumal Kesavan Balaraman Ravi Ramasamy Jeswanth Sathyanesan Manoharan Govindan 2014World Journal of Gastrointestinal Surgery2014,6,1:3
3Extended pancreatic resections and lymphadenectomy:An appraisal of the current evidence显示文摘Surgery remains the mainstay of treatment for pancreatic ductal adenocarcinoma and complete removal of the cancer confers a definite survival advantage,especially in early disease.However,the majority of patients do not present with early disease,thus precluding the chance of a cure by standard pancreatoduodenectomy(PD),distal pancreatectomy or total pancreatectomy.For this reason,pancreatic surgeons have attempted to push the limits of resection over the last three decades.The aim of these resections has been to determine whether obtaining a complete resection by extending the limits of conventional resection in patients with advanced disease will yield the results seen with PD alone in early disease.This article revisits the data from such studies in an attempt to determine if the available literature supports the performance of extended resections for pancreatic cancer in terms of improvement of survival.Shailesh V Shrikhande Savio G Barreto 2010World Journal of Gastrointestinal Surgery2010,2,2:2
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