Stapled Arterial Divestment in Surgery for Locally Advanced Pancreatic Cancer

BackgroundPancreatic adenocarcinoma has a predisposition to invade the neural tissue surrounding the superior mesenteric artery (SMA). Before the advent of neoadjuvant chemotherapy (NAC), any invasion of this tissue was often considered as unresectable disease. Currently, patients who respond favourably to NAC have potentially resectable disease. There is debate over the exact technique of removing this shell of tumour tissue surrounding the SMA, and whether it is comparable to arterial resection and reconstruction.MethodsWe describe a technique of en bloc arterial divestment in which an endovascular stapler combined with sharp dissection is used to divide the shell of periadventitial SMA tissue.ConclusionsIn patients with locally advanced disease, the technique of arterial divestment can be safely performed where the tumour is not invading below the external elastic lamina. This allows complete tumour resection without incurring the higher morbidity and mortality associated with SMA resection.