Generalized obesity is associated with postoperative wound infections after pancreaticoduodenectomy. The degree of visceral fat on preoperative cross-sectional imaging is associated with significantly higher rates of overall complications and pancreatic fistula.

Objective The role for neoadjuvant systemic therapy in resectable pancreas adenocarcinoma remains undefined. We evaluated the efficacy of gemcitabine and oxaliplatin administered as preoperative therapy in patients with resectable pancreas adenocarcinoma. Methods Eligible patients were screened using CT pancreas angiography, laparoscopy, endoscopic ultrasound and fine needle aspiration cytology, to identify 38 patients who received four cycles of neoadjuvant gemcitabine 1000mg/m2 IV over 100 minutes and oxaliplatin 80 mg/m2 IV over 2 hours, every 2 weeks. Patients whose tumors remained resectable at re-staging proceeded to operation and subsequently received 5 cycles of adjuvant gemcitabine (1000 mg/m2 IV over 30 minutes day 1, 8, 15 every 4 weeks). The primary endpoint was 18-month overall survival and secondary endpoints included radiologic, tumor marker and pathologic response to neoadjuvant therapy, time to recurrence, patterns of failure and feasibility of obtaining pre-operative core biopsies. Results Thirty-five of 38 (92%) patients completed neoadjuvant therapy. Twenty-seven patients underwent tumor resection (resectability rate 71%) of which 26 initiated adjuvant therapy for a total of 23 patients (60.5%) who completed all planned therapy. The 18-month survival was 63% (24 patients alive). The median overall survival for all 38 patients was 27.2 months (95% CI 17- NA) and the median disease-specific survival was 30.6 months (95% CI 19 - NA). Conclusion This study met its endpoint and provided a signal suggesting that exploration of neoadjuvant systemic therapy is worthy of further investigation in resectable pancreas adenocarcinoma. Improved patient selection and more active systemic regimens are key. NCT00536874.

Variant hepatic and celiac arterial anatomy is common. CTA can be used to identify common and uncommon variants that are important for the surgical management of patients with pancreatic and hepatobiliary neoplasms.

MRI and MRCP can provide information relevant to preoperative staging of gallbladder carcinoma.