The significance of intraoperative Doppler ultrasonography in evaluating hepatic arterial flow when assessing the indications for the Appleby procedure for pancreatic body cancer

Hirai, Ichiro; Kimura, Wataru; Kamiga, Masahiro; Mizutani, Masaomi; Takeshita, Akira; Fuse, Akira

doi:10.1007/s00534-004-0939-y

Cited by 38 publications

(32 citation statements)

References 12 publications

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“…We performed a tangential resection of the portal vein in one of our 5 patients, as in 31/78 patients (39.7%) reported in the literature [7,8,9,10,11,12,13,14,15,16,18,19,20,21,22,24,25,26,28]. The mortality rate after combined CA and portal vein resection was 2/31 patients (6.5%), while it was 0/47 patients after CA resection alone; thus, associating portal vein resection with DP-CAR increases the related mortality rate.…”

Section: Discussionmentioning

confidence: 99%

“…After the first DP-CAR for body-tail pancreatic cancer performed by Nimura et al [7] in 1976, only 90 patients emerged from a careful literature review [7,8,9,10,11,12,13,14,15,16,17,18,19,20,21,22,23,24,25,26,27,28] (table 2). Since there are no large series of DP-CAR for pancreatic cancer, we pooled our own findings with published reports in an attempt to draw some conclusions about the related surgical risk and long-term results.…”

Section: Discussionmentioning

confidence: 99%

“…If inadequate, the arterial blood flow was reconstructed by reimplantation of the CHA or left gastric artery to celiac trunk [16,25], or by arterial [11,18,27,28] or vein [12,23,27] grafts in one of our patients and 13/74 patients (17.6%) reported in the literature. If the surgical risk related to the DP-CAR is considered excessive, the procedure should be abandoned [15,19]. To prevent ischemia-related complications, Hirano et al [18] routinely performed a preoperative coil embolization of the CHA.…”

Section: Discussionmentioning

confidence: 99%

“…Nimura et al [7] performed the first DP-CAR in a patient with body-tail pancreatic cancer in 1976. To date, DP-CAR for the surgical treatment of body-tail pancreatic cancer has been reported in a limited number of patients, mainly by Far Eastern authors [7,8,9,10,11,12,13,14,15,16,17,18,19,20,21,22], while experience with this operation in Western countries is limited and more recent [23,24,25,26,27,28]. The indication for DP-CAR was recently extended to patients without any direct invasion of the CA to increase the radical resection (R0) rate for advanced body-tail pancreatic cancer [18].…”

Section: Introductionmentioning

confidence: 99%

See 3 more Smart Citations

Distal Pancreatectomy for Body-Tail Pancreatic Cancer: Is There a Role for Celiac Axis Resection?

2010

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Distal Pancreatectomy for Body-Tail Pancreatic Cancer: Is There a Role for Celiac Axis Resection?

2010

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“…Nevertheless, intraoperative Dop-US has been used only for the diagnosis of tumor spread or assessment of blood flow volume in the pancreas to date. 32,33 The Dop-Navi procedure is also a very simple method where the surgeon or surgical assistant only needs to put the probe on the pancreas tissue to directly hear the Doppler sound during the operation. Inflammation due to biliary drainage sometime causes chronic tissue change, which interferes with continuing the operation around bile duct.…”

Section: Discussionmentioning

confidence: 99%

Clinical Impact of Intraoperative Navigation Using a Doppler Ultrasonographic Guided Vessel Tracking Technique for Pancreaticoduodenectomy

Maemura

Mataki

Kurahara

et al. 2014

International Surgery

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During pancreaticoduodenectomy (PD), early ligation of critical vessels such as the inferior pancreaticoduodenal artery (IPDA) has been reported to reduce blood loss. Color Doppler flow imaging has become the useful diagnostic methods for the delineation of the anatomy. In this study, we assessed the utility of the intraoperative Doppler ultrasonography (Dop-US) guided vessel detection and tracking technique (Dop-Navi) for identifying critical arteries in order to reduce operative bleeding. Ninety patients who received PD for periampullary or pancreatic disease were enrolled. After 14 patients were excluded because of combined resection of portal vein or other organs, the remaining were assigned to 1 of 2 groups: patients for whom Dop-Navi was used (n ¼ 37) and those for whom Dop-Navi was not used (n ¼ 39; controls). We compared the ability of Dop-Navi to identify critical vessels to that of preoperative multi-detector computed tomography (MD-CT), using MD-CT data, as well as compared the perioperative status and postoperative outcome between the 2 patient groups. Intraoperative Dop-US was significantly superior to MD-CT in terms of identifying number of vessels and the ability to discriminate the IPDA from the superior mesenteric artery (SMA) based on blood flow velocity. The Dop-Navi patients had shorter operation times (531 min versus 577 min; no significance) and smaller bleeding volumes (1120 mL versus 1590 mL; P , 0.01) than the control patients without increasing postoperative complications. Intraoperative DopNavi method allows surgeons to clearly identify the IPDA during PD and to avoid injuries to major arteries.Key words: Pancreaticoduodenectomy -Doppler ultrasonography -Blood flowmeter P ancreaticoduodenectomy (PD) is a standard treatment for malignant tumor of periampullary and pancreas head. As lymphatics (lymph node and lymph vessels) accompany the arteries and are distributed in the surrounding neural plexuses, complete clearance of peripancreatic tissue, including lymphatics and nerve plexus, is necessary for curative resection of the tumor. [1][2][3][4] As this operation is considered a complex procedure, a surgeon is required to be well trained in this specific surgical technique and to possess sufficient anatomic knowledge.Despite a low mortality rate and improvements in perioperative care and operative management, there is still a relatively high complication rate following PD. 5,6 Several studies showed that intraoperative bleeding and red blood cell (RBC) transfusion are serious risk factors of postoperative complications in PD. 6,7 Recently, several procedures for artery-first approaches such as posterior, uncinated, and mesenteric approach have been introduced for improving perioperative outcomes such as curability and decreasing blood loss and morbidity. [8][9][10][11] Incidentally, it has been well known that early ligation of the inferior pancreaticoduodenal artery (IPDA)-one of the efferent arteries of the pancreas head-considerably reduces intraoperative bleeding and postoperative co...

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Extended Appleby's operation for pancreatic cancer involving celiac axis

Yan

Chen

et al. 2007

Journal of Surgical Oncology

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The significance of intraoperative Doppler ultrasonography in evaluating hepatic arterial flow when assessing the indications for the Appleby procedure for pancreatic body cancer

Cited by 38 publications

References 12 publications

Distal Pancreatectomy for Body-Tail Pancreatic Cancer: Is There a Role for Celiac Axis Resection?

Distal Pancreatectomy for Body-Tail Pancreatic Cancer: Is There a Role for Celiac Axis Resection?

Clinical Impact of Intraoperative Navigation Using a Doppler Ultrasonographic Guided Vessel Tracking Technique for Pancreaticoduodenectomy

Extended Appleby's operation for pancreatic cancer involving celiac axis

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