Extensive multiarterial resection attending total duodenopancreatectomy and adrenalectomy for MEN-1-associated neuroendocrine carcinomas

Figure 5 Schematic sketch of procedure with omission of right adrenal tumor. А: Before surgery. Tumors of pancreatic head, body and tail (pancreatic neuroendocrine tumors, PNTs). Pancreatic head tumor involving site of hepatomesenteric trunk division into superior mesenteric artery (SMA) and common hepatic artery (CHA) together with all of CHA, proper hepatic artery (PHA), gastroduodenal artery (GDA) (omitted) and right and left hepatic arteries (RHA and LHA) bifurcation; B: After total duodenopancreatectomy, splenectomy with SMA, LHA and RHA resection, excision of CHA and PHA and right adrenalectomy. SMA is sutured to the root of resected hepatomesenteric trunk. Splenic artery (SA) resected, U-turned and sutured to newly reconstructed LHA and RHA union. LGA: Left gastric artery; PV: Portal vein; SMV: Superior mesenteric vein.