Total pancreatectomy (R0 resection) improves survival over subtotal pancreatectomy in isolated neck margin positive pancreatic adenocarcinoma

Schmidt, C. Max; Glant, Jeffrey A.; Winter, Jordan M.; Kennard, Jason; Dixon, Jennifer A.; Zhao, Qianqian; Howard, Thomas J.; Madura, James A.; Nakeeb, Atilla; Pitt, Henry A.; Cameron, John L.; Yeo, Charles J.; Lillemoe, Keith D.

doi:10.1016/j.surg.2007.07.016

Cited by 120 publications

(117 citation statements)

References 16 publications

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“…The rates of other clinically significant complications were similar between the 2 groups [41] . While 3 reports showed no differences in morbidity between TP and PD [4,9,42] , 3 showed significant differences between these procedures [16,40,41] . While the perioperative mortality rates for TP have decreased in recent years, perioperative morbidity after TP did not decrease significantly (1970-1989: 70.0%; 1990-1999: 70.3%; 2000-2007: 66.0%; p = 1.0) [40] .…”

Section: The Comparison Of Tp and Pdmentioning

confidence: 95%

“…In patients undergoing pancreatectomy for PDAC, TP improved survival in isolated neck margin-positive patients and was associated with a survival benefit because peri-and postoperative complication rates are comparable to those for pancreatectomy, TP is recommended for patients having cancer spread to the left part of the pancreas [4] . IPMNs involving brunch duct multifocal IPMNs and main duct IPMNs, which are associated with high malignancy rates, and the presence of a positive surgical margin for high-grade dysplasia or carcinoma, might require extended resection to TP [31,32] .…”

Section: The Indications For Tpmentioning

confidence: 99%

“…The comparison of the mortality and morbidity rates associated with TP and PD is demonstrated in table 1 [4,9,16,[38][39][40][41][42] based on published reports from the last 10 years. In these papers, the morbidity rates were 31-87% and included delayed gastric emptying, bleeding, infections, and problems with glycemic control.…”

Section: The Comparison Of Tp and Pdmentioning

confidence: 99%

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The Clinical Outcomes after Total Pancreatectomy

et al. 2016

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Background: Total pancreatectomy (TP) is not more beneficial than less aggressive resection techniques for the treatment of pancreatic neoplasms and is associated with high morbidity and mortality. However, with advances in surgical techniques and glycemic monitoring, and the development of synthetic insulin and pancreatic enzymes for postoperative treatment, TP has been increasingly indicated. This is a review of the recent literature reporting the clinical outcomes after TP. Methods: We reviewed the publications reporting the use of TP starting 2007. The clinicophysiological and survival data were analyzed. Results: Few studies evaluated the differences in clinical outcomes between TP and pancreaticoduodenectomy (PD) with inconsistent results. It was reported that while the perioperative morbidity did not decrease, the mortality decreased compared to previous literature. All patients who underwent TP required insulin and high dose of pancreatic enzyme supplements. The 5-year survival rates after TP and PD for pancreatic cancer were similar. Conclusion: The perioperative mortality decreased in patients who underwent TP with advances in the operative procedures and perioperative care. The long-term survival rates were similar for TP and PD. Therefore, treating pancreatic neoplasms using TP is feasible. Patients undergoing TP should receive adequate treatment with synthetic insulin and pancreatic enzyme supplements.

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Section: The Comparison Of Tp and Pdmentioning

confidence: 95%

Section: The Indications For Tpmentioning

confidence: 99%

Section: The Comparison Of Tp and Pdmentioning

confidence: 99%

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The Clinical Outcomes after Total Pancreatectomy

et al. 2016

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“…Though the postoperative mortality had decreased from 20 % to 5 % in most of the centers, the 5 year survival varied from 5 to 20 % [22,27]. R0 resection varied from 20 % to 90 % depending on the method of histopathological examination [28][29][30][31][32]. The most commonly involved margins were the medial margins (60-80 %) and the posterior margins [22].…”

Section: Review Of Literaturementioning

confidence: 99%

Mesopancreas in Pancreatic Cancer: Where do We Stand – Review of Literature

Ramachandra

Challa

2014

Indian J Surg Oncol

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Pancreatic cancer is associated with poor prognosis and surgery remains the main modality of treatment. Negative resection margin is an important prognostic factor for survival. Retropancreatic margin or the medial margin is the most common site of positive resection margin. Mesopancreas was proposed in analogy with mesorectum, which is considered as a fusion fascia formed embryologically during the development of pancreas. This mesopancreas lies posterior to the pancreas and contains pancreaticoduodenal vessels, lymphatics, nerve plexus and loose areolar tissue. Various technical modifications were proposed for better dissection of mesopancreas like posterior approach and artery first approach. There is an increased rate of R0 resection by these technical modifications but whether this will turn to increase in survival rates is yet to be established.

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“…However in the last two decades the management of patients undergoing TP has improved. Insulin-dependent diabetes and malabsorption are better controlled with new drugs and, in recent series, mortality and morbidity after TP are 5% and 30%-40% respectively, with acceptable quality of life [28][29][30][31] . At the University of Verona, total pancreatectomy was performed in 65 patients with no mortality and morbidity of 38.5%; plannedelective total pancreatectomy was performed in 14 (21.5%) patients with IPMNs, while other nine (14%) underwent total pancreatectomy after an initial partial pancreatectomy for a positive resection margin.…”

Section: Type Of Surgical Resectionmentioning

confidence: 99%

Extent of surgical resections for intraductal papillary mucinous neoplasms

Crippa

Partelli²,

Falconi³

2010

WJGS

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Intraductal papillary mucinous neoplasms (IPMNs) can involve the main pancreatic duct (MD-IPMNs) or its secondary branches (BD-IPMNs) in a segmental of multifocal/diffuse fashion. Growing evidence indicates that BDIPMNs are less likely to harbour cancer and in selected cases these lesions can be managed non operatively. For surgery, clarification is required on: (1) when to resect an IPMN; (2) which type of resection should be performed; and (3) how much pancreas should be resected. In recent years parenchyma-sparing resections as well as laparoscopic procedures have being performed more frequently by pancreatic surgeons in order to decrease the rate of postoperative pancreatic insufficiency and to minimize the surgical impact of these operations. However, oncological radicality is of paramount importance, and extended resections up to total pancreatectomy may be necessary in the setting of IPMNs. In this article the type and extension of surgical resections in patients with MD-IPMNs and BD-IPMNs are analyzed, evaluating perioperative and long-term outcomes. The role of standard and parenchyma-sparing resections is discussed as well as different strategies in the case of multifocal neoplasms.

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Total pancreatectomy (R0 resection) improves survival over subtotal pancreatectomy in isolated neck margin positive pancreatic adenocarcinoma

Cited by 120 publications

References 16 publications

The Clinical Outcomes after Total Pancreatectomy

The Clinical Outcomes after Total Pancreatectomy

Mesopancreas in Pancreatic Cancer: Where do We Stand – Review of Literature

Extent of surgical resections for intraductal papillary mucinous neoplasms

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