Combined resection of the pancreas and portal vein for pancreatic cancer

Takahashi, Shuji; Ogata, Yasuhide; Tsuzuki, Toshiharu

doi:10.1002/bjs.1800810837

Cited by 130 publications

(91 citation statements)

References 5 publications

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“…There are no prospective randomized trials comparing pancreatectomy with and without VnR. Most retrospective studies demonstrate that while VnR is associated with longer operative times and larger blood loss, the morbidity and mortality of pancreatectomy with VnR is similar to those of pancreatectomy alone (Table 3) [42][43][44][45][46][47][48][49][50][51][52][53][54]. There was a high incidence of venous invasion (50%-82%) among patients who underwent VnR.…”

Section: Portal/mesenteric Vascular Resectionmentioning

confidence: 99%

Extended Resection for Pancreatic Adenocarcinoma

et al. 2007

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LEARNING OBJECTIVESAfter completing this course, the reader will be able to:1. Discuss the evidence in favor of and against the role of surgical resection in the management of pancreatic adenocarcinoma.2. Explain how the components of an extended pancreatectomy, including total pancreatectomy, extended lymph node dissection, and major intestinal arterial resection, do not improve survival above what is provided after pancreaticoduodenectomy and are associated with substantial morbidity.3. Discuss how portal/mesenteric vein resection to achieve negative resection margins does not add to the morbidity of pancreaticoduodenectomy, does not worsen survival after resection, and is most often performed because of tumor location.Access and take the CME test online and receive 1 AMA PRA Category 1 Credit ™ at CME.TheOncologist.com CME CME ABSTRACTAdenocarcinoma of the pancreas presents a number of therapeutic challenges. Given the poor long-term outcomes after pancreaticoduodenectomy (PD), many surgeons have sought to improve survival via a radical or "extended" pancreatectomy which may include (a) total pancreatectomy (TP), (b) extended lymph node dissection (ELND), and (c) portal/mesenteric vascular resections. These themes of "extended" resection are addressed in this review. TP should not be performed for most cases of adenocarcinoma of the pancreatic head because of the nominal incidence of lymph node involvement along the body and tail of the pancreas, the scarcity of multicentric disease, and the better management of pancreatic leaks after PD. Most studies show no difference in long-term survival and demonstrate greater postoperative morbidity after TP than after PD. Performing ELND in addition to PD is not worthwhile because most studies do not demonstrate any long-term benefits from ELND and the circumferential dissection around the mesenteric vessels required to harvest distant lymph nodes increases postoperative morbidity. Major arterial resection increases postoperative morbidity after PD and worsens long-term survival as the need for arterial resection to achieve negative resection margins indicates more aggressive disease. In contrast, portal and/or mesenteric venous resection does not increase the morbidity after PD or impact long-term survival as venous resection is often performed because of tumor location and not extent of disease. The disappointing experience with extended resections underscores the need for better adjuvant systemic strategies and the interdisciplinary care of patients with pancreatic adenocarcinoma.

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Section: Portal/mesenteric Vascular Resectionmentioning

confidence: 99%

Extended Resection for Pancreatic Adenocarcinoma

et al. 2007

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“…The purpose of such an aggressive approach was to achieve curative resection. According to the Japan Pancreas Society (JPS), a curative resection is defined as complete removal of the tumor with a histologically clear surgical margin, removal of the peripancreatic connective tissue including extrapancreatic nerve plexuses, and removal of metastases from the first- and second-station lymph node groups [10, 19]. Curability was shown to be closely related to postoperative prognosis; thus, the postoperative survival rate was significantly greater in patients who underwent a curative resection than in those who underwent a noncurative resection [20].…”

Section: Extended Surgery For Pancreatic Cancermentioning

confidence: 99%

“…Nagakawa et al [21]emphasized that extended pancreaticoduodenectomy might be preferable for the treatment of pancreatic cancer because standard pancreatoduodenectomy might miss tumors that have spread to the retroperitoneum and extrapancreatic nerve plexuses. Takahashi et al [10]also noted the importance of curative resection for long-term survival and recommended extended pancreatoduodenectomy for such curative surgery. The results of Manabe et al [8]further supported the importance of radical surgery by showing that the 5-year survival rate of 32 patients who underwent a radical pancreatectomy (33.4%) was significantly higher than that of 42 patients who underwent nonradical surgery pancreatectomy (0%).…”

Section: Extended Surgery For Pancreatic Cancermentioning

confidence: 99%

“…In the 1980s, aggressive operational strategies to treat pancreatic cancer were approved in Japan. Most pancreatic surgeons applied extended lymphadenectomy and connective tissue dissection, and with portal vein resection, whereas some tried more aggressive surgery combined with arterial resection [5, 6, 7, 8, 9, 10, 11]. Although such extended operations prolonged postoperative survival, they reduced the quality of life of the patients [7].…”

Section: Introductionmentioning

confidence: 99%

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Surgery for Carcinoma of the Pancreas in Japan

Takada

1999

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Pancreatic cancer surgery was first performed in Japan in the 1940s, although it was not until the 1970s that pancreatic resectional surgery became widely available. In the late 1970s, influenced by the application of regional pancreatectomy by Fortner and colleagues, several institutions in Japan introduced radical pancreatic cancer surgery. Aggressive strategies in pancreatic cancer surgery were approved in Japan in the 1980s. Japanese surgeons introduced additional modifications to pancreatic cancer surgery, including radical pancreatoduodenectomy with extended lymph node and connective tissue dissection and portal vein resection. However, it became clear that such extended operations impair the quality of life of the patient, even though the resectability of cancer increased to up to about 50%. Improvements to radical pancreatoduodenectomy were therefore introduced. Pylorus-preserving pancreatoduodenectomy with extended lymphadenectomy, connective tissue dissection, and portal vein resection is a Japanese modification to radical pancreatectomy that improves the quality of life of the patient and does not reduce the survival rate. Another modification applicable to low-grade malignancies is organ-preserving pancreatectomy, such as duodenum-preserving total pancreatic head resection, ventral pancreatectomy, and medial or segmental pancreatectomy. Although aggressive Japanese surgical strategies have provided important data, most studies have been retrospective. In the near future, Japanese surgeons will need to reevaluate their strategies in term of the importance of extended lymphadenectomy with connective tissue dissection and its influence on long-term survival of patients. Such reevaluation will require randomized controlled trials performed according to a detailed and strict protocol.

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“…In recent years, there has been an increasing number of authors who recommend more actively resecting the SMPVC when it is judged as positive in cancer invasion. However, we anticipate a better prognosis by concomitant SMPVC resection when the SMPVC invasion is less extensive as follows: hemicircular or less and less than 2.0 cm in length (1.4 cm in the angiographic film) [8]; limited to the tunica adventitia or media of the SMPVC wall [9, 10]; or isolated type [11]. On the other hand, it raised a question that a microscopic level of SMPVC invasion might have sometimes been overlooked when judged by macroscopic inspection alone.…”

Section: Why and When Is An Extended Pancreatectomy Justified In Resementioning

confidence: 99%

Extended Pancreatectomy and Liver Perfusion Chemotherapy for Resectable Adenocarcinoma of the Pancreas

Ishikawa

Ohhigashi²,

Sasaki³

et al. 1999

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In order to increase the long-term survival after resection of pancreatic adenocarcinoma, it is essential to eradicate both locoregional recurrence and hepatic metastasis. We have added a wide range of lymphatic and connective tissue clearance to conventional pancreatectomy (extended pancreatectomy) and succeeded in improving the 5-year survival rate from 8 to 25% via decreasing the incidence of local failure. Among many procedures which together compose an extended pancreatectomy, connective tissue clearance seems to have played a more important role on patients’ prognosis rather than wide range lymphadenectomy. Concomitant resection of the portal vein is recommended for selected patients, and it is important not to overlook a minute invasion even though it appears macroscopically intact. With regard to adjuvant therapy in combination with our extended pancreatectomy, the addition of preoperative irradiation failed to further improve the long-term survival rate because the cause of cancer deaths shifted from local recurrence to hepatic metastasis. When liver perfusion chemotherapy was added to this operation (without radiation), the 5-year survival rate was improved to 39% by decreasing the incidence of hepatic metastasis. In the future, a combination of extended pancreatectomy with chemoradiation plus liver perfusion chemotherapy is one of the promising approaches for this cancer.

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Combined resection of the pancreas and portal vein for pancreatic cancer

Cited by 130 publications

References 5 publications

Extended Resection for Pancreatic Adenocarcinoma

Extended Resection for Pancreatic Adenocarcinoma

Surgery for Carcinoma of the Pancreas in Japan

Extended Pancreatectomy and Liver Perfusion Chemotherapy for Resectable Adenocarcinoma of the Pancreas

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