Pancreatic resection for cancer-the Heidelberg technique.

Published on Nov 14, 2019in Langenbeck's Archives of Surgery3.445
路 DOI :10.1007/S00423-019-01839-1
Martin Schneider26
Estimated H-index: 26
(Heidelberg University),
Oliver Strobel53
Estimated H-index: 53
(Heidelberg University)
+ 1 AuthorsMarkus W. B眉chler177
Estimated H-index: 177
(Heidelberg University)
Sources
Abstract
Background Pancreatic cancer is associated with high recurrence rates, and any surgery should aim to prevent local recurrence. However, systematic resection of putatively tumor-infiltrated soft tissue adjacent to the celiac branches and superior mesenteric artery has not regularly been applied in pancreatic head resection.
馃摉 Papers frequently viewed together
References32
Newest
#1Robert P. Jones (RLUH: Royal Liverpool University Hospital)H-Index: 23
#2Eftychia-Eirini Psarelli (University of Liverpool)H-Index: 3
Last. John P. Neoptolemos (Heidelberg University)H-Index: 127
view all 40 authors...
Importance The patterns of disease recurrence after resection of pancreatic ductal adenocarcinoma with adjuvant chemotherapy remain unclear. Objective To define patterns of recurrence after adjuvant chemotherapy and the association with survival. Design, Setting, and Participants Prospectively collected data from the phase 3 European Study Group for Pancreatic Cancer 4 adjuvant clinical trial, an international multicenter study. The study included 730 patients who had resection and adjuvant chem...
Source
#1W. S. Tummers (LEI: Leiden University)H-Index: 1
#2Jesse V. Groen (LEI: Leiden University)H-Index: 5
Last. Rutger-Jan Swijnenburg (LEI: Leiden University)H-Index: 27
view all 11 authors...
Background: The prognosis of patients with pancreatic ductal adenocarcinoma (PDAC) is poor and selection of patients for surgery is challenging. This study examined the impact of a positive resection margin (R1) on locoregional recurrence (LRR) and overall survival (OS); and also aimed to identified tumour characteristics and/or technical factors associated with a positive resection margin in patients with PDAC. Methods: Patients scheduled for pancreatic resection for PDAC between 2006 and 2016 ...
Source
#1Giulia GaspariniH-Index: 6
#2Marta PellegattaH-Index: 7
Last. Massimo FalconiH-Index: 106
view all 8 authors...
Perineural invasion (PNI) is defined as the presence of neoplastic cells along nerves and/or within the different layers of nervous fibers: epineural, perineural and endoneural spaces. In pancreatic cancer鈥攑articularly in pancreatic ductal adenocarcinoma (PDAC)鈥擯NI has a prevalence between 70 and 100%, surpassing any other solid tumor. PNI has been detected in the early stages of pancreatic cancer and has been associated with pain, increased tumor recurrence and diminished overall survival. Such...
Source
#1Oliver Strobel (University Hospital Heidelberg)H-Index: 53
#2John P. Neoptolemos (University Hospital Heidelberg)H-Index: 127
Last. Markus W. B眉chler (University Hospital Heidelberg)H-Index: 177
view all 4 authors...
Pancreatic cancer is likely to become the second most frequent cause of cancer-associated mortality within the next decade. Surgical resection with adjuvant systemic chemotherapy currently provides the only chance of long-term survival. However, only 10鈥20% of patients with pancreatic cancer are diagnosed with localized, surgically resectable disease. The majority of patients present with metastatic disease and are not candidates for surgery, while surgery remains underused even in those with re...
Source
#1Seiko Hirono (Wakayama Medical University)H-Index: 33
#2Manabu Kawai (Wakayama Medical University)H-Index: 36
Last. Hiroki Yamaue (Wakayama Medical University)H-Index: 69
view all 19 authors...
Background The mesenteric approach is an artery-first approach to pancreaticoduodenectomy for pancreatic cancer, which starts with the dissection of connective tissues around the superior mesenteric artery. The procedure aims for early confirmation of resectability by checking the surgical margin around the superior mesenteric artery first during the operation. It also aims to decrease intraoperative blood loss by early ligation of the inferior pancreaticoduodenal artery and to increase R0 rate ...
Source
#1Ulla Klaiber (Heidelberg University)H-Index: 18
#2Carl-Stephan Leonhardt (Heidelberg University)H-Index: 1
Last. John P. Neoptolemos (Heidelberg University)H-Index: 127
view all 6 authors...
Background Only 15鈥20% of patients with pancreatic ductal adenocarcinoma (PDAC) have a resectable tumor at the time of diagnosis. Effective multimodal treatment concepts including neoadjuvant chemotherapy are therefore needed. Following upfront resection, adjuvant chemotherapy has become mandatory to prevent early tumor recurrence.
Source
#1Ujjwal M. Mahajan (LMU: Ludwig Maximilian University of Munich)H-Index: 10
#2Eno LanghoffH-Index: 1
Last. Julia Mayerle (LMU: Ludwig Maximilian University of Munich)H-Index: 70
view all 29 authors...
Background & Aims Changes to the microenvironment of聽pancreatic ductal adenocarcinomas (PDACs) have been associated with poor outcomes of patients. We studied the associations between composition of the pancreatic stroma (fibrogenic, inert, dormant, or fibrolytic stroma) and infiltration by inflammatory cells and times of progression-free survival (PFS) of patients with PDACs after resection. Methods We obtained 1824 tissue microarray specimens from 385 patients included in the European Study Gr...
Source
#1Thomas Hank (University Hospital Heidelberg)H-Index: 11
#2Ulf Hinz (University Hospital Heidelberg)H-Index: 19
Last. Oliver Strobel (University Hospital Heidelberg)H-Index: 53
view all 9 authors...
BACKGROUND: The definition of resection margin (R) status in pancreatic cancer is under debate. Although a margin of at least 1 mm is an independent predictor of survival after resection for pancreatic head cancer, its relevance to pancreatic body and tail cancers remains unclear. This study aimed to validate R status based on a 1-mm tumour-free margin as a prognostic factor for resected adenocarcinoma involving the pancreatic body and tail. METHODS: Patients who underwent distal or total pancre...
Source
#1Natasha Ironside (University of Auckland)H-Index: 13
#2Savio G. Barreto (Flinders University)H-Index: 22
Last. Sanjay Pandanaboyana (University of Auckland)H-Index: 17
view all 6 authors...
BACKGROUND: The aim of this systematic review and meta-analysis was to evaluate perioperative outcomes and survival in patients undergoing an artery-first approach to pancreatoduodenectomy in comparison with those having standard pancreatoduodenectomy. METHODS: A systematic search of PubMed, MEDLINE, Embase and the Cochrane Database of Systematic Reviews was performed in accordance with PRISMA guidelines. Comparative studies including patients who underwent artery-first pancreatoduodenectomy and...
Source
#1Abhishek Mitra (ACTREC: Tata Memorial Hospital)H-Index: 4
#2Esha Pai (ACTREC: Tata Memorial Hospital)H-Index: 1
Last. Shailesh V. Shrikhande (ACTREC: Tata Memorial Hospital)H-Index: 31
view all 7 authors...
Purpose Extended pancreatectomy aimed at R0 resection of pancreatic tumors with adjacent vessel and organ involvement may be the only option for cure. This study was done with an objective to analyze the short- and long-term outcomes of extended pancreatic resections.
Source
Cited By22
Newest
#1Mohammed Al-Saeedi (University Hospital Heidelberg)H-Index: 10
#2Leonie Frank-Moldzio (University Hospital Heidelberg)
Last. Arianeb Mehrabi (University Hospital Heidelberg)H-Index: 40
view all 13 authors...
Resection of the portal venous confluence is frequently necessary for radical resection during pancreatoduodenectomy for cancer. However, ligation of the splenic vein can cause serious postoperative complications such as gastric/splenic venous congestion and left-sided portal hypertension. A splenorenal shunt (SRS) can maintain gastric and splenic venous drainage and mitigate these complications. This study describes the surgical technique, postoperative course, and surgical outcomes of SRS afte...
Source
#1J.W.C. Kung (CUHK: The Chinese University of Hong Kong)
#2Rowan W. Parks (Edin.: University of Edinburgh)H-Index: 54
Abstract null null Pancreatic ductal adenocarcinoma (PDAC) is characterised by poor oncological outcome and is the seventh cause of cancer-related deaths worldwide. With the advances in surgical technology, oncological treatment, and critical care, extended pancreatic resections including vascular resections have become more frequently performed in specialised centres. Furthermore, the boundaries of resectability continue to be pushed in order to achieve a potentially curative approach in select...
Source
The "artery-first" approach pancreaticoduodenectomy, with maximal mesopancreas excision and central vascular ligation, represents the current principal determinants of radicality in pancreatic head cancer resection. However, these modifications at the resection stage of pancreaticoduodenectomy constitute extremely demanding and technically complicated procedures. Among the most critical contributing factors in the difficulty of artery-first approaches is the spiral configuration of the mesoduode...
Source
#1Sami-Alexander Safi (HHU: University of D眉sseldorf)
#2Lena Haeberle (HHU: University of D眉sseldorf)H-Index: 6
Last. Irene Esposito (HHU: University of D眉sseldorf)H-Index: 71
view all 14 authors...
Summary: The rates of microscopic incomplete resections (R1/R0CRM+) in patients receiving standard pancreaticoduodenectomy for PDAC remain very high. One reason may be the reported high rates of mesopancreatic fat infiltration. In this large cohort study, we used available histopathological specimens of the retropancreatic fat and correlated high resolution CT-scans with the microscopic tumor infiltration of this area. We found that preoperative MDCT scans are suitable to detect cancerous infilt...
Source
#1Martin Schneider (Heidelberg University)H-Index: 26
#2T. Hackert (Heidelberg University)H-Index: 17
Last. M.W. B眉chler (Heidelberg University)H-Index: 79
view all 4 authors...
BACKGROUND Multimodal treatment concepts enhance options for surgery in locally advanced pancreatic ductal adenocarcinoma (PDAC). This review provides an overview of technical advances to facilitate curative-intent resection in PDAC. METHODS A review of the literature addressing current technical advances in surgery for PDAC was performed, and current state-of-the-art surgical techniques summarized. RESULTS Artery-first and uncinate-first approaches, dissection of the anatomical triangle between...
Source
#1Andr茅 L. Mihaljevic (Heidelberg University)H-Index: 21
#2Thilo Hackert (Heidelberg University)H-Index: 57
Last. Markus W. B眉chler (Heidelberg University)H-Index: 177
view all 12 authors...
Abstract Background Pancreatoduodenectomy is the standard treatment for pathologies of the pancreatic head and is performed routinely worldwide. The aim of the study was to analyze this procedure in terms of extent of surgery, technical difficulty, and clinical outcomes and thereby provide a standardized surgical categorization of pancreatoduodenectomies for future reference. Methods For this cohort study, all patients who underwent pancreatoduodenectomy at a single center within an 18-year peri...
Source
Purpose This study aims to investigate the positivity rate of the nerve plexus (NPL) around the common hepatic artery (CHA), as well as the impact of dissecting the NPL-CHA, during surgical resection of pancreatic cancer. Methods Clinicopathological factors, including hematoxylin and eosin (H&E) staining and immunohistochemistry, were compared between the resectable pancreatic cancer (RPC) and borderline resectable PC (BRPC) groups. Moreover, the relationship between the NPL-CHA status and overa...
Source
#1Markus K. Diener (Heidelberg University)H-Index: 51
#2Andr茅 L. Mihaljevic (Heidelberg University)H-Index: 21
Last. Markus W. B眉chler (Heidelberg University)H-Index: 177
view all 14 authors...
Abstract Background Modern pancreatic cancer surgery changed with the introduction of effective neoadjuvant therapies. Complete tumor resection is the mainstay for long-term, disease-free, and overall survival and has been a prerequisite for decreasing local recurrence. The medial resection margin in the area of the superior mesenteric vessels limits the radicalness of the resection, especially in borderline and locally advanced cases. Therefore, the periarterial soft tissue around the peripancr...
Source
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...
Source
#1SA Safi (HHU: University of D眉sseldorf)H-Index: 3
#2Nadja Lehwald-Tywuschik (HHU: University of D眉sseldorf)H-Index: 4
Last. Wolfram T. Knoefel (HHU: University of D眉sseldorf)H-Index: 60
view all 7 authors...
Ductal adenocarcinoma of the pancreas (PDAC) remains one of the most lethal malignancies. To date, no guidelines exists for isolated resectable metachronous disease. It is still unknown, which patients may benefit from relapse surgery. The aim of our study was to compare disease free survival (DFS) and post relapse survival (PRS) in patients with isolated local recurrence, metachronous hepatic or pulmonary metastases. Patients with isolated resectable local recurrence, metachronous hepatic or pu...
Source
This website uses cookies.
We use cookies to improve your online experience. By continuing to use our website we assume you agree to the placement of these cookies.
To learn more, you can find in our Privacy Policy.