Regional Pancreatectomy

Fortner, Joseph G.; Kim, Dong K.; Cubilla, Antonio L.; Turnbull, A. D.; Pahnke, Lyle D.; Shils, Maurice E.

doi:10.1097/00000658-197707000-00007

Cited by 220 publications

(37 citation statements)

References 12 publications

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“…Portal vein resection represents therefore the last option for patients with locally advanced disease to receive potential curative surgery [1–5, 10–12] after diagnosis of PDAC.…”

Section: Discussionmentioning

confidence: 99%

Portal vein resection in advanced pancreatic adenocarcinoma: is it worth the risk?

Marsoner

Langeder

Csengeri

et al. 2016

Wien Klin Wochenschr

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SummaryIntroduction Portal vein resection represents a viable add-on option in standard pancreaticoduodenectomy for locally advanced ductal pancreatic adenocarcinoma, but is often underused as it may set patients at additional risk for perioperative and postoperative morbidity and mortality. We aimed to review our long-term experience to determine the additive value of this intervention for locally advanced pancreatic adenocarcinoma. Patients and methods Single, university surgical center audit over a 13-year period; cohort comprised 221 consecutive patients undergoing pancreatic resection; in 47 (21 %) including portal vein resection. Predictors for short-and long-term survival were assessed via multivariate logistic and Cox regression. Results Baseline and perioperative characteristics were similar between the two groups. However, overall skin-to-skin times, intraoperative transfusion requirements as the need for medical inotropic support were higher in patients undergoing additional portal vein resection (p < 0.0001; p = 0.001 and p = 0.03). Postoperative complication rates were 34 vs. 35 % (p = 0.89), 14 patients (5 % vs. 11 %; p = 0.18) died in-hospital. An American Society of Anesthesiologists Score >2 was the only independent predictor for in-hospital mortality (OR 10.66 was complete in 99.5 %, one-year survival was 59 % vs. 70 % and five-year overall survival 15 % vs. 12 % with and without portal vein resection, respectively (Log rank: p = 0.25). For long-term outcome, microvascular invasion (HR 2.03, 95 % CI 1.10-3.76) and preoperative weight loss (HR 2.17, 95 % CI 1.31-3.58) were independent predictors. Conclusion Despite locally advanced disease, patients who underwent portal vein resection had no worse perioperative and overall survival than patients with lower staging and standard pancreaticoduodenectomy only. Therefore, the feasibility of portal vein resection should be evaluated in every potential candidate at risk.

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“…Portal vein resection represents therefore the last option for patients with locally advanced disease to receive potential curative surgery [1–5, 10–12] after diagnosis of PDAC.…”

Section: Discussionmentioning

confidence: 99%

Portal vein resection in advanced pancreatic adenocarcinoma: is it worth the risk?

Marsoner

Langeder

Csengeri

et al. 2016

Wien Klin Wochenschr

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“…One of the major controversies regarding radical resection is the role of total pancreatectomy for ductal adenocarcinomas. As the results of Whipple procedures were disappointing, some surgeons converted to total pan createctomy [3][4][5], When the study commenced in 1973, we advocated total pancreatectomy as the treatment of choice for cancer of the pancreas. This seemed justified because of the pos sible spread to the left of the mesenteric vessels by cancer situated in the head of the pancreas; the procedure achieved a wider lymphadenectomy as well as ensuring removal of multicentric malignant foci.…”

Section: Discussionmentioning

confidence: 99%

Total Pancreatectomy and Subtotal Duodenopancreatectomy for the Management of Carcinoma of the Head of the Pancreas: An Institutional Experience and Evolving Trends

Bardaxoglou¹,

Landen²,

Maddern³

et al. 1996

Dig Surg

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This retrospective study includes 88 consecutive patients treated by surgical resection for adenocarcinoma of the head of the pancreas between January 1973 and December 1992. Initially in 1973 total pancreatectomy was the treatment of choice. Our policy changed after a review of 47 consecutive total pancreatectomies in 1986 which showed no benefit. From 1986 the Whipple procedure became our standard operation. In the following 41 patients, a Whipple procedure was performed in 19 patients, and a total pancreatectomy was still performed in 22 patients because of positive resection margins or a friable pancreatic remnant. After total pancreatectomy, the 5-year survival rate was 7.8%. For lymph-node-negative patients, the 1-, 3-, and 5-year survival rates were 54, 24, and 15%, respectively. For node-positive patients, the 1-and 3-year survival rates were 46 and 4%, respectively, and there were no survivors at 54 months. This difference was statistically not significant. After the Whipple procedure, the 5-year survival rate was 12.5%. For node-negative patients, the 1-, 3- and 5-year survival rates were 50, 59, and 25%, respectively. For node-positive patients, the 1-year survival rate was 21%. This difference was significant (p = 0.007). This study highlights the fact that extended radical surgery does not improve overall survival, but stage II and III disease (Hermreck classification) was associated with a prolonged survival.

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“…Nakao et al [19]found histopathological extrapancreatic nerve plexus invasion in 14 of 30 patients with carcinoma of the body and tail of the pancreas. Pancreatic cancer is also characterized by the high frequency of intrapancreatic neural invasion (75–100%) [14, 15, 17, 18, 20]. Therefore to erradicate pancreatic cancer a complete plexus dissection must be performed around the superior mesenteric artery, common hepatic artery and coeliac axis including soft tissue removal.…”

Section: Neural and Soft Tissue Invasion:vascular Involvementmentioning

confidence: 99%

Locoregional Dissemination and Extended Lymphadenectomy in Pancreatic Cancer

1999

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Carcinoma of the pancreas is characterized by the high frequency of intrapancreatic (from 75 to 100%) and extrapancreatic neural invasion (from 64 to 69%). Even small-sized tumors (T₁) show plexus invasion. Carcinoma of the pancreas is also associated with a high incidence (76%) of lymph node metastasis. The knowledge of local and regional tumor spread is mandatory in the planning of rational surgical treatment with the intention to cure. At present, it does not seem possible to predict the direction of lymph drainage leading to nodal involvement in different anatomical areas. However, the anterior and posterior pancreaticoduodenal areas are generally involved at first and nodes farther away from the primary tumor mostly show metastases only after involvement of the nearer nodes. We believe, radical pancreatoduodenectomy should be based on three aspects: wide lymph node dissection; radical retroperitoneal dissection, and pancreatectomy with an extirpation line left of the coeliac axis for tumors of the head and left pancreatectomy for tumors of the body and tail of the pancreas. Conclusions: Cure or long-term palliation of pancreatic cancer is generally possible only after complete erradication of the primary tumor, including its local and regional extensions.

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Regional Pancreatectomy

Cited by 220 publications

References 12 publications

Portal vein resection in advanced pancreatic adenocarcinoma: is it worth the risk?

Portal vein resection in advanced pancreatic adenocarcinoma: is it worth the risk?

Total Pancreatectomy and Subtotal Duodenopancreatectomy for the Management of Carcinoma of the Head of the Pancreas: An Institutional Experience and Evolving Trends

Locoregional Dissemination and Extended Lymphadenectomy in Pancreatic Cancer

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