To evaluate the application value of "total arterial devascularization first" (TADF) in radical resection of type Ⅱ pancreatic head carcinoma.

Clinical data of 86 patients with type Ⅱ pancreatic head carcinoma undergoing radical pancreatoduodenectomy by TADF in Tongji Hospital, Tongji Medical College of Huazhong University of Science and Technology from May 2012 to January 2014 were analyzed retrospectively. There were 51 males and 35 females with the age ranging from 42 to 78 years and median age of 65 years. The informed consents of all patients were obtained and the ethical committee approval was received. The pancreatic vessels in all the patients were treated by TADF. Occluding bands of the superior mesenteric vein (SMV)/portal vein (PV) and superior mesenteric artery (SMA) were preset. Pancreatic neck was cut off. Along the anterior, right, posterior surfaces of SMA, vessels and neural connective tissues between pancreatic head and SMA, celiac aorta were totally dissected and cut off. The involved SMV/PV were stripped or resected, and reconstructed. Then the en-bloc tumor was removed. The perioperative situation was observed including operative completion, surgical procedures, intraoperative blood loss and postoperative complications.

Radical pancreatoduodenectomy was performed successfully in all 86 cases. The operation duration was 4.6-8.3 h, intraoperative blood loss was 200-600 ml. The operation included SMV sidewall resection and repair (n=26), SMV resection and end to end anastomosis (n=12). No death case was observed during the perioperative period. The incidences of postoperative hemorrhage, pancreatic fistula were 6% (5/86), 8% (7/86) respectively.

Applying TADF in radical resection of type Ⅱ pancreatic head carcinoma can ensure the safety of operation, reduce the intraoperative blood loss, improve the general and radical resection rates, and decrease the SMV/PV accidental cutting rate.