The “Triangle Operation” in Pancreatic Cancer: Toward Optimizing Oncological Radicality After Neoadjuvant Therapy

Abstract

Recent advances in pancreatic cancer management, particularly with the introduction of intensive neoadjuvant chemotherapy regimens, have significantly reshaped surgical indications and objectives. In this context, the “Triangle Operation,” described by Thomas Hackert, has emerged as an innovative approach aimed at improving R0 resection rates without systematically resorting to arterial resections. This technique is based on an extensive dissection of the peri-arterial compartment located between the superior mesenteric artery, the celiac trunk, and the porto-mesenteric axis. Its primary goal is to eradicate areas of potential microscopic tumor spread, particularly after neoadjuvant therapy. Through a detailed analysis of anatomical foundations, technical principles, and clinical outcomes, this article highlights both the benefits and limitations of this strategy in the management of borderline resectable and locally advanced pancreatic tumors.