Approaches to Retroperitoneal Dissection During Pancreatoduodenectomy

Because of the infiltrative nature of pancreatic ductal adenocarcinoma (PDAC), as well as the proximity of the superior mesenteric artery (SMA) to the head and uncinate process of the pancreas, cancer cells frequently infiltrate into the surrounding perineural and lymphatic tissues of the retroperitoneum toward the SMA. Thorough clearance of these soft tissues, known as the retroperitoneal or uncinate dissection, is therefore required to enhance the likelihood of a margin-negative resection. In this chapter, we describe and illustrate technical approaches to retroperitoneal dissection during pancreatoduodenectomy for patients with PDAC and discuss important considerations regarding the resection of tumors with vascular involvement.