To investigate the feasibility of resection based on the nerve and fibrous tissue (NFT) structures around the superior mesenteric artery (SMA) for resectable pancreatic adenocarcinoma (R-PDAC) patients.
NFTs around the SMA were classified into four “intensive NTFs area” with spreading the NFTs around the SMA and three SMA nerve-plexus regions without branching nerves according to autopsy findings. Complete dissection of four “intensive NTFs areas” was performed by pre-exposing three SMA nerve-plexus regions without branching nerves as “dissection-guiding points” with SMA nerve-plexus preservation (NFT-based resection). Among 157 R-PDAC patients undergoing pancreaticoduodenectomy, surgical outcomes of 78 patients with NFT-based resection were compared with 59 patients with half-SMA nerve-plexus dissection and 20 patients without NFTs dissection.
In NFT-based resection group, 76.5% had tumor involvement and metastasis in each intensive NTFs-area. Operative time, blood loss, and postoperative diarrhea rate were significantly lower in NFT-based resection than in half-SMA nerve-plexus group (321 vs 390 min; p<0.01, 228 vs 550 ml; p<0.01, 5.1 vs 15.3%; p=0.04, respectively). R0 rate and median overall survival significantly improved in NFT-based resection than in non-NFT dissection group (93.6 vs 65.0%; p<0.01, 49.6 vs 23.6 months, p=0.01).
NFT-based resection may become a novel method for R-PDAC patients.

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