Concepts in Isolated Pancreatectomy for Pancreatic Cancer Using the Nakao Mesenteric Approach and Catheter Bypass of the Portal Vein

The ideal surgery for pancreatic head cancer is isolated pancreatoduodenectomy (PD). “Isolated” means non-touch isolation techniques. Before manipulating pancreatic head cancer, all arteries supplying the pancreatic head region and all drainage veins for this region are ligated and divided, followed by pancreatectomy. The first step in isolated PD is a mesenteric approach. The inferior pancreaticoduodenal artery from the superior mesenteric artery is ligated and divided using the mesenteric approach. If the time to resect and reconstruct the portal venous system is expected to be prolonged, the congested portal venous blood is bypassed from a branch of the superior mesenteric vein to the femoral vein or umbilical vein using an antithrombogenic catheter. The concepts, intention, and precise surgical techniques of isolated PD are discussed in this paper.