Is pancreatectomy with arterial reconstruction a safe and useful procedure for locally advanced pancreatic cancer?

Amano, Hodaka; Miura, Fumihiko; Toyota, Naoyuki; Wada, Keita; Katoh, Ken-ichirou; Hayano, Kouichi; Kadowaki, Susumu; Shibuya, Makoto; Maeno, Sawako; Eguchi, Tohru; Takada, Tadahiro; Asano, Tomohiko

doi:10.1007/s00534-009-0190-7

Cited by 93 publications

(60 citation statements)

References 29 publications

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“…Eighteen patients with R0 resections had a one-year survival rate of 67 % and 13 months median survival, as opposed to R1/R2 patients who had a 6 month survival rate. The paper concluded that arterial resection is useful only when an R0 resection can be done in a patient with M0 disease [26]. Median operating time in this series was 686 min, and median blood loss was 2,830 mL, clearly illustrating that pancreatectomies with arterial resections are technically demanding cases.…”

Section: Oncologic Controversy: Pancreaticoduodenectomy and Arterial mentioning

confidence: 84%

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Beyond the Whipple Operation: Radical Resections for Cancers of the Head of the Pancreas

Schoellhammer

Goldner

Kim

et al. 2013

Indian J Surg Oncol

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Pancreatic adenocarcinoma is the most common pancreatic malignancy, and it occurs most commonly in the pancreatic head. It has a relatively low incidence; however it is a deadly disease and is the fourth most common cause of cancer deaths for males and females in the United States. Surgical resection in the form of pancreaticoduodenectomy is the mainstay of treatment and can lead to improved overall survival as well as the possibility of a cure, although only 10 % of patients are resectable at presentation. In an attempt to improve outcomes and survival, surgeons over the decades have employed various aggressive resectional strategies to combat this disease. In this paper we review the development of pancreaticoduodenectomy and touch on the role played by the American surgeon Allan Whipple in this development. We review modern data regarding radical pancreaticoduodenectomy and extended lymphadenectomy for pancreatic head cancers, as well as data and controversies regarding arterial and venous resection performed during the course of pancreaticoduodenectomy. The role of extended and vascular resections in the treatment of pancreatic neuroendocrine tumors in contrast to adenocarcinomas is also examined. We summarize the current state of data regarding radical pancreaticoduodenectomy and discuss pushing the boundaries of surgical resection to help improve outcomes for select groups of patients.

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Section: Oncologic Controversy: Pancreaticoduodenectomy and Arterial mentioning

confidence: 84%

“…Amano and colleagues from Tokyo recently published their experience with arterial resections and pancreaticoduodenectomy [26]. In this series, 23 patients with pancreatic adenocarcinoma who underwent arterial resections with pancreatectomies were retrospectively reviewed.…”

Section: Oncologic Controversy: Pancreaticoduodenectomy and Arterial mentioning

confidence: 99%

Beyond the Whipple Operation: Radical Resections for Cancers of the Head of the Pancreas

Schoellhammer

Goldner

Kim

et al. 2013

Indian J Surg Oncol

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“…The author believes that PVR should become a standard procedure during PD. Furthermore, there are many publications describing more aggressive types of resections in selected groups of patients including arterial resection, but are not considered routine and thus cannot yet be recommended (11,12,13).…”

Section: Scope Of Current Opinionsmentioning

confidence: 99%

Portal Vein Resection During Pancreatectomy for Pancreatic Head Adenocarcinoma. Scope of Current Opinions and own Experiences

Łaski¹,

Hać²,

Śledziński³

2014

Polish Journal of Surgery

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“…Current oncological guidelines suggest that pancreatic tumours invading arterial structures render these cancers inoperable [10] . Nevertheless, attempts at resection involving reconstruction of the main arteries such as the coeliac axis, hepatic artery and superior mesenteric artery (SMA) have been reported, albeit in small case series [8,[11][12][13][14][15][16] . The study population for the meta-analysis is the largest in the published literature despite the unsurprising heterogeneity of the 26 studies that met inclusion criteria; a limitation acknowledged by the authors.…”

Section: Commentary On Hot Topicsmentioning

confidence: 99%

Is there a role for arterial reconstruction in surgery for pancreatic cancer?

Ravikumar

Holroyd²,

Fusai³

2013

WJGS

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Surgery remains the only potentially curative treatment for patients with pancreatic cancer. Locally advanced pancreatic cancer with vascular involvement remains a surgical challenge because high perioperative risk and the uncertainty of a survival benefit. Whilst portal vein resection has started to gather momentum because the perioperative morbidity and long term survival is comparable to standard pancreatectomy, there isn't yet a consensus on arterial resections. There have been various reports and case series of arterial resections in pancreatic cancer, with mixed survival results. Mollberg et al have appraised the heterogeneous published literature available on arterial resection in pancreatic cancer in an attempt to compare this to standard pancreatectomy. In this article, we discuss the results of this systematic review and meta-analysis, and the limitations associated with analysing results from heterogenous data. We have outlined the important features in surgery for pancreatic cancer and specifically to arterial resections, and compared arterial resections to the published literature on venous resections.

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Is pancreatectomy with arterial reconstruction a safe and useful procedure for locally advanced pancreatic cancer?

Abstract: Further discussion is required concerning surgical indications and significance. However, it is thought that resection is useful only when surgery of R0 has taken place for selected locally advanced pancreatic cancer (M0).

Cited by 93 publications

References 29 publications

Beyond the Whipple Operation: Radical Resections for Cancers of the Head of the Pancreas

Beyond the Whipple Operation: Radical Resections for Cancers of the Head of the Pancreas

Portal Vein Resection During Pancreatectomy for Pancreatic Head Adenocarcinoma. Scope of Current Opinions and own Experiences

Is there a role for arterial reconstruction in surgery for pancreatic cancer?

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