Radical pancreatic cancer surgery-with arterial resection.

Published on Feb 3, 2019in Translational Gastroenterology and Hepatology
· DOI :10.21037/TGH.2019.01.07
Ulla Klaiber18
Estimated H-index: 18
(Heidelberg University),
André L. Mihaljevic21
Estimated H-index: 21
(Heidelberg University),
Thilo Hackert57
Estimated H-index: 57
(Heidelberg University)
Sources
Abstract
Extended surgery with arterial resection in pancreatic cancer remains a controversial topic. Although not recommended as a standard procedure, arterial resection may be feasible in selected patients and with the availability of new multimodal treatment approaches it may gain increasing impact in pancreatic cancer therapy as a complete tumor removal is still the only opportunity to achieve long-term survival for this disease. With regard to the surgical approach, one must differentiate between resection and reconstruction of the celiac axis and the hepatic artery as its most important branch, and resection/reconstruction of the superior mesenteric artery. Both procedures are technically possible and require a distinct level of surgical experience as well as interdisciplinary management for preoperative diagnosis and treatment of postoperative complications to achieve good outcomes. Besides arterial resection followed by reconstruction, there are specific situations when arteries may be resected without reconstruction, e.g., during distal pancreatectomy with celiac axis resection. In addition, in some cases arterial resections can be avoided despite a suspected tumor attachment by sharp dissection on the adventitial layer of the respective artery, especially after neoadjuvant therapy which is increasingly performed for borderline resectable and locally advanced tumor findings. This review summarizes definitions, diagnostics, technical aspects and outcomes of arterial resection in pancreatic cancer surgery in the context of the current literature and evidence.
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2019
1 Author (Chunyu Zhu)
References33
Newest
#1Marco Del Chiaro (Karolinska University Hospital)H-Index: 34
#2Elena Rangelova (Karolinska University Hospital)H-Index: 15
Last. Caroline S. Verbeke (University of Oslo)H-Index: 39
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Abstract Background Few studies have investigated the outcome of pancreatectomy associated with artery resection (PAR). Methods Retrospective analysis of a cohort of operated borderline or locally advanced pancreatic cancer patients with surgically confirmed arterial involvement. Short and long-term outcome were analyzed and compared in patients who underwent PAR (Group 1) and palliative surgery (Group 2). Results Of 73 patients who underwent surgical exploration with intent of resection, 34 und...
Source
#1Louiza Loizou (Karolinska University Hospital)H-Index: 9
#2Carlos Valls Duran (Karolinska University Hospital)H-Index: 1
Last. Nikolaos Kartalis (Karolinska University Hospital)H-Index: 18
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Objectives: To assess the interreader agreement and reader performance in the evaluation of patients with pancreatic cancer (PC) in two classification systems of local resectability status prior to ...
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#1Sjors KlompmakerH-Index: 14
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In the original article, the institutional author the E-AHPBA DP-CAR study group was misspelled. It is correct as reflected here. The original article has also been corrected.
Source
#1Duarte RegoH-Index: 6
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Background Celiac artery (CA) occlusions/stenosis is infrequently associated with liver ischemia due to its unique vascularization, where portal vein provides about 75% of liver's perfusion. Collateral flow from gastroduodenal artery also provides, in most cases, enough blood supply to prevent ischemic hepatitis. In cases where these collateral pathways are compromised, severe liver ischemia can occur. Methods We present a case of acute mesenteric ischemia following gastric surgery that was trea...
Source
#1Shuji Isaji (Mie University)H-Index: 40
#2Shugo Mizuno (Mie University)H-Index: 25
Last. Christopher L. Wolfgang (Johns Hopkins University)H-Index: 105
view all 13 authors...
This statement was developed to promote international consensus on the definition of borderline resectable pancreatic ductal adenocarcinoma (BR-PDAC) which was adopted by the National Comprehensive Cancer Network (NCCN) in 2006, but which has changed yearly and become more complicated. Based on a symposium held during the 20th meeting of the International Association of Pancreatology (IAP) in Sendai, Japan, in 2016, the presenters sought consensus on issues related to BR-PDAC. We defined patient...
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#1Tomohisa Yamamoto (Kansai Medical University)H-Index: 20
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We retrospectively investigated the operative outcomes of patients who underwent distal pancreatectomy (DP) for invasive pancreatic ductal adenocarcinoma (PDAC) located at the body and tail.
Source
#1Warren R. Maley (Thomas Jefferson University)H-Index: 30
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Source
#9Markus W. Büchler (Heidelberg University)H-Index: 177
Abstract Background Neoadjuvant therapy is an important strategy for locally advanced pancreatic cancer (PDAC) as resection rates increase with modern chemotherapy regimens even in patients with arterial tumor encasement. The aim of this study is the description of technique and initial outcomes of a new type of radical and arterial-sparing resection after neoadjuvant treatment for locally advanced PDAC. Methods The surgical technique and perioperative results of a new type of operation are desc...
Source
#1Margaret A. Tempero (UCSF: University of California, San Francisco)H-Index: 59
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Abstract Ductal adenocarcinoma and its variants account for most pancreatic malignancies. High-quality multiphase imaging can help to preoperatively distinguish between patients eligible for resection with curative intent and those with unresectable disease. Systemic therapy is used in the neoadjuvant or adjuvant pancreatic cancer setting, as well as in the management of locally advanced unresectable and metastatic disease. Clinical trials are critical for making progress in treatment of pancrea...
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#1Santhalingam Jegatheeswaran (Manchester Royal Infirmary)H-Index: 7
#2Minas Baltatzis (Manchester Royal Infirmary)H-Index: 7
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Abstract Background Resection of the superior mesenteric artery (SMA) during pancreatectomy is performed infrequently and is undertaken with the aim of removing non-metastatic locally advanced pancreatic tumours. SMA resection reports also encompass resection of other visceral vessels. The consequences of resection of these different arteries are not necessarily equivalent. This is a focused systematic review of the outcome of SMA resection during pancreatectomy for cancer. Methods A computerize...
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#1John A. Windsor (University of Auckland)H-Index: 72
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The aim null of the study was to specify peculiarities of the blood supply to the body and tail of the human pancreas determining topographic variants and vascular bed of the splenic artery. null Material and methods. null The artery basin of the pancreas body and tail was studied in 46 native and 42 organ complexes consisting of the pancreas, duodenum, spleen, retropancreatic tissue, celiac trunk with the main branches, a section of the superior mesenteric artery up to the entrance into the roo...
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The outcomes of pancreatectomy with resection and reconstruction of the involved arteries for locally advanced pancreatic cancer following chemotherapy have improved in recent years. In pancreatic head cancers in which there is contact with the common and proper hepatic arteries, margin-negative resection requires pancreati-coduodenectomy, with the resection of these arteries and the restoration of hepatic arterial flow. Here, we describe a middle colic artery transposition technique in hepatic ...
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We aimed to systematically evaluate the diagnostic accuracy of CT-determined resectability following neoadjuvant treatment for predicting margin-negative resection (R0 resection) in patients with pancreatic ductal adenocarcinoma (PDAC). Original studies with sufficient details to obtain the sensitivity and specificity of CT-determined resectability following neoadjuvant treatment, with a reference on the pathological margin status, were identified in PubMed, EMBASE, and Cochrane databases until ...
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Pancreatic ductal adenocarcinoma (PDAC) represents an aggressive tumor of the digestive system with still low five-year survival of less than 10%. Although there are improvements for multimodal therapy of PDAC, surgery still remains the effective way to treat the disease. Combined with adjuvant and/or neoadjuvant treatment, pancreatic surgery is able to enhance the five-year survival up to around 20%. However, pancreatic resection is always associated with a high risk of complications and regard...
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Purpose Surgical resection is the only curative treatment for pancreatic cancer. Arterial resection and reconstruction during pancreaticoduodenectomy for advanced pancreatic cancer remain controversial due to a high rate of complications. Methods We report two cases of pancreatic cancer with hepatic artery resection and reconstruction using the right gastroepiploic artery during pancreaticoduodenectomy after neoadjuvant therapy. Results The patients underwent pancreaticoduodenectomy with resecti...
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Abstract Introduction Extended pancreatectomy for initially unresectable locally advanced (URLA) pancreatic carcinoma (PC) often requires combined arterial resection/reconstruction. By limiting candidate arterial inflow after combined resection of the celiac arterial system over a long distance, great saphenous vein graft (GSVG) is an alternative conduit for obtaining non-anatomical arbitrary arterial inflow. Presentation of case A 66-year-old woman was diagnosed with URLA pancreatic head carcin...
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