Abstract：
When pancreatic head cancer invades the superior mesenteric artery (SMA), attempts at curative resection are aborted. Preoperative imaging diagnostics to determine the surgical curability have yet to surpass the intraoperative information acquired via inspection, palpation, and trial dissection. Pancreatoduodenectomy (PD) is a standard measure for treating periampullary cancers. In conventional PD, SMA invasion is usually identified by dissecting the retroportal lamina, which connects the uncinate process and SMA nerve plexus after dividing the neck of the pancreas. During PD for pancreatic head cancer, this retroperitoneal margin frequently vitiates surgical curability. SMA-first approaches during PD are methods where the SMA is dissected first by severing the posterior pancreatic capsule to assess the SMA involvement of pancreatic cancer early in the operation. The first report of such an approach prompted subsequent reports of various maneuvers that are now known collectively as \"artery-first\" approaches. We herein review those approaches by classifying them according to (1) the side of the mesocolon from where the SMA approach occurs (supracolic or infracolic) and (2) the direction of access (right or left and anterior or posterior). The steps of the reported PD procedures are numbered according to a timeline and summarized using anatomical division of the SMA.
摘要：
当胰头癌侵入肠系膜上动脉（SMA）时，治愈性切除的尝试被中止。术前影像诊断以确定手术可治愈性尚未超过通过检查获得的术中信息。触诊,和审判解剖。胰十二指肠切除术（PD）是治疗壶腹周围癌的标准措施。在传统的PD中，SMA侵入通常通过解剖门后椎板来识别，在划分胰腺颈部后，连接钩突和SMA神经丛。在胰头癌的PD期间，腹膜后边缘经常损害手术的可固化性。PD期间的SMA优先方法是首先通过切断胰腺后囊来解剖SMA以评估手术早期胰腺癌的SMA受累的方法。这种方法的第一份报告引发了随后的各种演习报告，这些演习现在统称为“动脉优先”方法。我们在此通过根据以下方法对这些方法进行分类来回顾：（1）发生SMA方法的中结肠侧（上结肠或下结肠）和（2）进入方向（右或左，前或后）。报告的PD程序的步骤根据时间线进行编号，并使用SMA的解剖划分进行总结。
