Pancreatectomy is the cornerstone of local therapy for localized pancreatic adenocarcinoma. At M. D. Anderson, we use a standard form of pancre-aticoduodenectomy for resection of tumors that arise in the right pancreas. A recent review of our experience demonstrated that our mortality rate for pancreaticoduodenectomy in a series of 300 patients was 1.4% (Pisters et al, 2001a). This rate compares quite favorably with those in other highvolume centers, which have been reported to range from 2% to 5%, and is considerably lower than those reported in comprehensive analyses of surgical outcome in institutions that perform a relatively low number of complex pancreatic surgeries (10% or higher).
The relatively low operative mortality rate at M. D. Anderson is a consequence of a standardized approach to the technical aspects of pancre-aticoduodenectomy (Figure 12-2) and is also most likely related to the concentration of pancreatic tumor surgery in the hands of 4 surgeons. This reflects a departmental policy of using an organ-specific approach to
3. Portal dissection
1. Extended Kocher
!. Cattell-Braasch \ maneuver exposing SMV
4. Transect stomach
5, Transcct jejunum and dissect Ligament of Treitz rotating duodenum under mesenteric vessels
6, Transect pancreas and complete retroperitoneal dissection by removing specimen from SMA
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