{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,10]],"date-time":"2026-09-10T04:05:21Z","timestamp":1789013121019,"version":"build-2803163510"},"reference-count":5,"publisher":"Wiley","issue":"9","license":[{"start":{"date-parts":[[2018,2,20]],"date-time":"2018-02-20T00:00:00Z","timestamp":1519084800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"},{"start":{"date-parts":[[2018,2,20]],"date-time":"2018-02-20T00:00:00Z","timestamp":1519084800000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/www.springer.com\/tdm"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["World j. surg."],"published-print":{"date-parts":[[2018,9]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Background<\/jats:title><jats:p>In recent decades, there have been enthusiastic discussions of, and active proposals for, new approaches to dissection around the superior mesenteric artery during pancreaticoduodenectomy (PD). In contrast, dissection along the celiac axis (CA) and hepatic artery (HA) and in the hepatoduodenal ligament has rarely been systematically discussed. In this report, we propose and describe a three\u2010level classification of dissection along the CA\u2010HA system which is applicable to a variety of diseases for which PD is indicated.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>The extent of dissection is classified into three levels. With the first level (LV\u20101), neither LN nor plexus dissection is required. The second level (LV\u20102) includes en bloc resection of LNs along the CA, HA, and in the hepatoduodenal ligament, preserving the nerve plexus around the artery. The third level (LV\u20103) includes en bloc dissection of LNs and the nerve plexus close to cancer invasion, for example, being accompanied by half circumferential dissection of the nerve plexus around the CA or circumferential dissection of that of HA. LV\u20101 dissection is indicated for benign lesions, low grade malignancy, pancreatic metastasis, or intraductal papillary mucinous neoplasm. LV\u20102 is indicated for periampullary malignancies requiring dissection of regional LNs, including ampullary, distal bile duct, duodenal cancers, and pancreatic cancers without evidence of invasion around the CA\u2010HA system. LV\u20103 is indicated for malignancies with evidence of perineural invasion in the CA\u2010HA system, such as pancreatic cancer at the pancreatic neck or advanced bile duct cancer.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>In combination with classified superior mesenteric artery dissection, a variety of PD procedures would be systematically classified, understood, and reproduced regardless of nature of disease, surgeon, or approach.<\/jats:p><\/jats:sec>","DOI":"10.1007\/s00268-018-4550-9","type":"journal-article","created":{"date-parts":[[2018,2,20]],"date-time":"2018-02-20T19:51:54Z","timestamp":1519156314000},"page":"2963-2967","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":16,"title":["A Novel Classification and Staged Approach for Dissection Along the Celiac and Hepatic Artery During Pancreaticoduodenectomy"],"prefix":"10.1002","volume":"42","author":[{"given":"Yosuke","family":"Inoue","sequence":"first","affiliation":[{"name":"Department of Gastroenterological Surgery, Cancer Institute Hospital Japanese Foundation for Cancer Research 3\u20108\u201031 Ariake, Koto\u2010ku 135\u20108550 Tokyo Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Akio","family":"Saiura","sequence":"additional","affiliation":[{"name":"Department of Gastroenterological Surgery, Cancer Institute Hospital Japanese Foundation for Cancer Research 3\u20108\u201031 Ariake, Koto\u2010ku 135\u20108550 Tokyo Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yu","family":"Takahashi","sequence":"additional","affiliation":[{"name":"Department of Gastroenterological Surgery, Cancer Institute Hospital Japanese Foundation for Cancer Research 3\u20108\u201031 Ariake, Koto\u2010ku 135\u20108550 Tokyo Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2018,2,20]]},"reference":[{"key":"e_1_2_9_2_2","doi-asserted-by":"publisher","DOI":"10.1097\/SLA.0000000000001065"},{"key":"e_1_2_9_3_2","doi-asserted-by":"publisher","DOI":"10.1002\/bjs.8763"},{"key":"e_1_2_9_4_2","doi-asserted-by":"publisher","DOI":"10.1007\/s11605\u2010012\u20101841\u20106"},{"key":"e_1_2_9_5_2","volume-title":"The Third English edition of the General Rules for the Study of Pancreatic Cancer by the Japan Pancreas Society","author":"Japan\u2010Pancreas\u2010Society","year":"2011"},{"key":"e_1_2_9_6_2","doi-asserted-by":"publisher","DOI":"10.1007\/BF02468883"}],"updated-by":[{"DOI":"10.1007\/s00268-018-4557-2","type":"correction","label":"Correction","source":"publisher","updated":{"date-parts":[[2018,3,1]],"date-time":"2018-03-01T00:00:00Z","timestamp":1519862400000}}],"container-title":["World Journal of Surgery"],"original-title":[],"language":"en","link":[{"URL":"http:\/\/link.springer.com\/article\/10.1007\/s00268-018-4550-9\/fulltext.html","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"http:\/\/link.springer.com\/content\/pdf\/10.1007\/s00268-018-4550-9.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"http:\/\/link.springer.com\/content\/pdf\/10.1007\/s00268-018-4550-9.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1007\/s00268-018-4550-9","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,12,26]],"date-time":"2023-12-26T23:34:14Z","timestamp":1703633654000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1007\/s00268-018-4550-9"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2018,2,20]]},"references-count":5,"journal-issue":{"issue":"9","published-print":{"date-parts":[[2018,9]]}},"alternative-id":["10.1007\/s00268-018-4550-9"],"URL":"https:\/\/doi.org\/10.1007\/s00268-018-4550-9","archive":["Portico"],"relation":{"correction":[{"id-type":"doi","id":"10.1007\/s00268-018-4557-2","asserted-by":"object"}]},"ISSN":["0364-2313","1432-2323"],"issn-type":[{"value":"0364-2313","type":"print"},{"value":"1432-2323","type":"electronic"}],"subject":[],"published":{"date-parts":[[2018,2,20]]},"assertion":[{"value":"20 February 2018","order":1,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"1 March 2018","order":2,"name":"change_date","label":"Change Date","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"Correction","order":3,"name":"change_type","label":"Change Type","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"In the original article, the captions for Figs.\u00a02 and 3 were erroneously interchanged. The original article has been corrected.","order":4,"name":"change_details","label":"Change Details","group":{"name":"ArticleHistory","label":"Article History"}},{"order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Compliance with ethical standards"}},{"value":"None.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Conflict of interest"}}]}}