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This consequently results in postoperative refractory diarrhea. This study aimed to evaluate the clinical impact of extended nerve plexus dissection around major arteries on postoperative diarrhea.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>Patients who underwent pancreatoduodenectomy (PD) for PDAC between January 2013 and December 2016 were included. The frequency of diarrhea (defined as a condition requiring opioid antidiarrheal drug for at least 6\u00a0months after surgery) and its short\u2010 and long\u2010term outcomes were reviewed.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Of 200 consecutive patients who underwent PD, 78 (39.0%) developed postoperative refractory diarrhea (diarrhea group), and 73 of them (93.6%) underwent hemi\u2010circumferential or more nerve dissection for SMA or CA; both plSMA and plCA dissection were associated with diarrhea. Borderline resectable artery (BR\u2010A) PDAC was included more in the diarrhea group (32.0% vs. 13.1%, <jats:italic>P<\/jats:italic>\u2009=\u20090.001); however, the local recurrence rate in the diarrhea group was significantly lower than that in the non\u2010diarrhea group (14.1% vs. 26.2%, <jats:italic>P<\/jats:italic>\u2009=\u20090.036). The completion of adjuvant chemotherapy and overall survival were comparable between the two groups. The pre\u2010albumin level improved in 2 years, and 61.3% of patients with diarrhea could stop opioid antidiarrheal drugs within 3 years of surgery.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>Although the frequency of diarrhea increased following nerve plexus dissection around arteries, diarrhea was controllable and resulted in a reduced local recurrence rate. Aggressive dissection of the nerve plexus may be justified for local disease control in BR\u2010A PDAC.<\/jats:p><\/jats:sec>","DOI":"10.1007\/s00268-022-06457-5","type":"journal-article","created":{"date-parts":[[2022,2,4]],"date-time":"2022-02-04T16:02:37Z","timestamp":1643990557000},"page":"1172-1182","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":37,"title":["Long\u2010Term Outcome of Patients with Postoperative Refractory Diarrhea After Tailored Nerve Plexus Dissection Around the Major Visceral Arteries During Pancreatoduodenectomy for Pancreatic Cancer"],"prefix":"10.1002","volume":"46","author":[{"given":"Naomi","family":"Kuroki","sequence":"first","affiliation":[{"name":"Division of Hepatobiliary and Pancreatic Surgery Cancer Institute Hospital, Japanese Foundation for Cancer Research 3\u20108\u201031 Ariake, Koto\u2010ku 135\u20108550 Tokyo 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