Implementation of Leeds Protocol in Duodenopancreatectomies for Pancreatic Adenocarcinoma and Impact of Resection Margins in the Survival

Abstract

have occult metastases or local vessel involvement at attempted resection and undergo a palliative bypass. Recent guidelines have suggested that Staging Laparoscopy (SL) should be undertaken in selected cases prior to resection. We studied the effectiveness of SL in detecting metastatic disease and avoiding non-therapeutic laparotomy. Methods: This retrospective study reviewed patients who underwent SL between January 2009 and September 2014. Cases were reviewed at the regional pancreaticobiliary multidisciplinary team (MDT) meeting and were thought to be amenable to resection. Patients had raised carbohydrate antigen 19-9 (CA 19-9) levels and/or suspicious clinicoradiological features and were therefore put forward for laparoscopic staging. Results: 105 patients (53 Female, Mean age = 69 years, Median American Society of Anaesthesiologists (ASA) grade = 2) underwent SL of which 23 (21.9%) had metastases. 66 patients underwent attempted resection, however 13 were found to have metastases or locally advanced disease. This resulted in 12 palliative bypasses and 1 open and close laparotomy being performed. The resection rate for this cohort was 50.5% with 42 pylorus preserving pancreaticoduodenectomies (PPPD), 4 distal pancreatectomies with splenectomy, 3 total pancreatectomies, 3 pancreaticoduodenectomies and 1 bile duct excision performed. SL failed to detect metastatic disease in 10 patients resulting in an overall false negative rate of 9.5%. Conclusions: SL is useful in the staging of periampullary neoplasms enabling a significant number of patients to avoid the attendant morbidity of a non-therapeutic laparotomy. There is room for improvement with the use of this technique to reduce the near 10% false negative rate. Therefore factors affecting the diagnostic yield of SL clearly warrant exploration. Aims: Cystic neoplasms of the pancreas (CNP) have been raising a growing interest in the world scientific community. They represent 10% of the pancreatic tumors, resulting in a diagnostic and therapeutic challenge.This study presents the profile of patients with CPN submitted to surgery and evaluates possible predictive factors of malignancy. Methods: Retrospective analysis of the patients with CPN submitted to surgery between 2000 and 2014.Results: A total of 56 patients were submitted to surgery (75% female, mean age: 55,2 years old). The lesions consisted in incidental findings in 53,6% of the cases. In the symptomatic patients, pain was the main complaint (17,9%). Suspicion about the nature of the lesion was the main indication for surgery. The procedure performed more often was cephalic duodenopancreatectomy (17). The histological characterization revealed a higher frequency of serous and mucinous cystic neoplasms (30,4% in both groups); 21,4% of the lesions were intraductal papillary mucinous neoplasms. The morbidity was 19,6% and there was no surgical mortality. Dimensional progression, cephalic location, age and weight loss appeared as predictive factors of malignancy (p < 0,05). Conclusions: Even in very ex...