Background: The most significant prognostic factors for pancreatic head carcinoma (PHC) with pancreaticoduodenectomy (PD) are the resection margin and lymph node status. The curative surgical margin (R0) and complete clearance of regional lymph nodes contribute to the improvement of survival. To reduce microscopic residual tumor resection (R1) and achieve a complete lymphadenectomy around the superior mesenteric artery (SMA) when performing a PD for PHC, we propose a new concept of a total excision of the "meso-pancreatoduodenum." which consists of a cluster of the soft connective tissue along the inferior pancreaticoduodenal artery and the first jejunal artery.Methods: A total of 39 consecutive patients underwent a PD for PHC between May 2006 and August 2011 at Shimane University Hospital. Twenty-five patients received a standard PD (sPD), while 14 cases underwent a total meso-pancreatoduodenum excision (tMPDe) with PD.Results: The tMPDe procedure was performed safely without any intraoperative complications. The total number of lymph nodes dissected was 18 (median, range: 5-40) in the sPD and 26 (median, range: 13-50) in the tMPDe (p = 0.027). R0 resection was accomplished in 60% and 93% of patients with the sPD and tMPDe, respectively, resulting in a significant decrease in the R1 rate in the tMPDe (7%) compared to that in the sPD (40%) (p = 0.019). No loco-regional recurrence was found around the SMA in the tMPDe patients.Conclusion: Our surgical technique, tMPDe, is safe and more radical when performing a PD and should be adopted when performing pancreatic surgery as a pathological cure for pancreatic head carcinoma. (c) 2012 Elsevier Ltd. All rights reserved.

Deep-sea biological communities associated with cold venting were located within the eastern portion of the Nankai Trough using a deep-towed TV system. Five continuous lines (approximately 200 km long) were observed. Bivalve communities were found both in the Tenryu Canyon outlet region and at the outcrop of the frontal thrusts of the accretionary wedge off Cape Omaezaki. The former is a site at which biological communities had been found during the KAIKO dives in 1985. However, the second site appears to be associated with larger scale venting and was chosen for the 1989 KAIKO.Nankai submersible cruise. Three small mud volcanoes with diameters of several hundred meters and heights of several tens of meters are found in the Seabeam topography map, but the present survey showed neither evidence of recent venting nor biological communities.