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Resection Criteria in Pancreatic Surgery: Lymphadenectomy and Vascular Resections

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Book cover Surgical Treatment of Pancreatic Diseases

Part of the book series: Updates in Surgery ((UPDATESSURG))

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Abstract

Pancreatic carcinoma is generally considered a systemic disease; at diagnosis the disease is often metastatic [1], and its early spread via the lymphatic and blood circulation is well documented by the identification of tumor cells at the level of the cardiovascular system in around 28% of cases and of the marrow in around 24% of cases [2]. However, the poor resectability of pancreatic cancer is also due to local progression, which is also often detected at diagnosis. Approximately 30% of patients diagnosed as having pancreatic carcinoma are excluded from resective surgery owing to suspected involvement of the large vessels of the retropancreatic region (portal mesenteric venous axis, superior mesenteric artery, celiac trunk) [3]. In the early 1970s, Fortner [4] introduced the concept of regional pancreatectomy as a way to achieve higher surgical resection for improved local control of the disease and better lymphatic clearance. Fortner’s experience has been reproduced by various authors with different results and sometimes controversial conclusions.

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References

  1. Pawlik TM, Abdalla EK, Barnett CC et al (2005) Feasibility of a randomized trial of extended lymphadenectomy for pancreatic cancer. Arch Surg 140:584–589; discussion 589–591

    Article  PubMed  Google Scholar 

  2. Picozzi VJ, Kozarek RA, Traverso LW (2003) Interferon-based adjuvant chemoradiation therapy after pancreaticoduodenectomy for pancreatic adenocarcinoma. Am J Surg 185:476–480

    Article  PubMed  Google Scholar 

  3. Tseng JF, Raut CP, Lee JE et al (2004) Pancreaticoduodenectomy with vascular resection: margin status and survival duration. J Gastrointest Surgery 8:935–949

    Article  Google Scholar 

  4. Fortner JG (1973) Regional resection and pancreatic carcinoma. Surgery 73:799–800

    CAS  PubMed  Google Scholar 

  5. Ishikawa O, Ohhigashi H, Sasaki Y et al (1988) Practical usefulness of lymphatic and connective tissue clearance for the carcinoma of the pancreas head. Ann Surg 208:215–220

    Article  CAS  PubMed  Google Scholar 

  6. Manabe T, Ohshio G, Baba N et al (1989) Radical pancreatectomy for ductal cell carcinoma of the head of the pancreas. Cancer 64:1132–1137

    Article  CAS  PubMed  Google Scholar 

  7. Farnell MB, Pearson RK, Sarr MG et al (2005) A prospective randomized trial comparing standard pancreatoduodenectomy with pancreatoduodenectomy with extended lymphadenectomy in resectable pancreatic head adenocarcinoma. Surgery 138:618–628; discussion 628–630

    Article  PubMed  Google Scholar 

  8. Yeo CJ, Cameron JL, Lillemoe KD et al (2002) Pancreaticoduodenectomy with or without distal gastrectomy and extended retroperitoneal lymphadenectomy for periampullary adenocarcinoma, part 2: randomized controlled trial evaluating survival, morbidity, and mortality. Ann Surg; 236:355–366; discussion 366–368

    Article  PubMed  Google Scholar 

  9. Pedrazzoli S, DiCarlo V, Dionigi R et al (1998) Standard versus extended lymphadenectomy associated with pancreatoduodenectomy in the surgical treatment of adenocarcinoma of the head of the pancreas: a multicenter, prospective, randomized study. Lymphadenectomy Study Group. Ann Surg; 228:508–517

    Article  CAS  PubMed  Google Scholar 

  10. Nimura Y, Nagino M, Kato H et al (2004) Regional versus extended lymph node dissection in radical pancreaticoduodenectomy for pancreatic cancer: a multicenter, randomized controlled trial. HPB 6(Suppl 1):2 (abstract)

    Google Scholar 

  11. Michalski CW, Kleeff J, Wente MN et al (2007) Systematic review and meta-analysis of standard and extended lymphadenectomy in pancreaticoduodenectomy for pancreatic cancer. Br J Surg 94:265–273

    Article  CAS  PubMed  Google Scholar 

  12. Pisters PWT, Evans DB, Leung DHY et al (2001) Re: Surgery for ductal adenocarcinoma of the pancreatic head. World J Surg 25:533–534

    Article  CAS  PubMed  Google Scholar 

  13. Fortner JG (1973) Regional resection and pancreatic carcinoma. Surgery 73:799–800

    CAS  PubMed  Google Scholar 

  14. Mosca F, Boggi U, Del Chiaro M (2008) Management of tumor invasion/adhesion to the superior mesenteric-portal vein during pancreatectomy. In: Disease of the pancreas. Springer, Berlin Heidelberg, pp 593–610

    Chapter  Google Scholar 

  15. Cusack JC, Fuhrman GM, Lee JE et al (1994) Managing unsuspected tumor invasion of the superior mesenteric-portal venous confluence during pancreaticoduodenectomy. Am J Surg 168:352–354

    Article  PubMed  Google Scholar 

  16. Carrere N, Sauvanet A, Goere D et al (2006) Pancreaticoduodenectomy with mesentericoportal vein resection for adenocarcinoma of the pancreatic head. World J Surg 30:1–10

    Article  Google Scholar 

  17. Zhou GW, Wu WD, Xiao WD et al (2005) Pancreatectomy combined with superior mesenteric-portal vein resection: report of 32 cases. Hepatobiliary Pancreat Dis Int 4:130–134

    PubMed  Google Scholar 

  18. Poon RT, Fan ST, Lo CM et al (2004) Pancreaticoduodenectomy with en bloc portal vein resection for pancreatic carcinoma with suspected portal vein involvement. World J Surg 28:602–608

    Article  PubMed  Google Scholar 

  19. Tseng JF, Raut CP, Lee JE et al (2004) Pancreaticoduodenectomy with vascular resection: margin status and survival duration. J Gastrointest Surg 8:935–950

    Article  PubMed  Google Scholar 

  20. Howard TJ, Villanustre N, Moore SA et al (2003) Efficacy of venous reconstruction in patients with adenocarcinoma of the pancreatic head. J Gastrointest Surg 7:1089–1095

    Article  PubMed  Google Scholar 

  21. Sasson AR, Hoffman JP, Ross EA et al (2002) En bloc resection for locally advanced cancer of the pancreas: is it worthwhile? J Gastrointest Surg 6:147–158

    Article  PubMed  Google Scholar 

  22. Al-Haddad M, Martin JK, Nguyen J et al (2007) Vascular resection and reconstruction for pancreatic malignancy: a single center survival study. J Gastrointest Surg 11:1168–1174

    Article  PubMed  Google Scholar 

  23. Ishikawa O, Ohigashi H, Imaoka S et al (1992) Preoperative indications for extended pancreatectomy for locally advanced pancreas cancer involving the portal vein. Ann Surg 215:231–236

    Article  CAS  PubMed  Google Scholar 

  24. Nakao A, Harada A, Nonami T et al (1995) Clinical significance of portal invasion by pancreatic head carcinoma. Surgery 117:50–55

    Article  CAS  PubMed  Google Scholar 

  25. Mehta VK, Fisher G, Ford JA et al (2001) Preoperative chemoradiation for marginally respectable adenocarcinoma of the pancreas. J Gastrointest Surg 5:27–35

    Article  CAS  PubMed  Google Scholar 

  26. Boggi U, Del Chiaro M, Mosca I et al (2007) En-bloc resection of superior mesenteric vessels and mesenteric root followed by intestinal auto-transplantation for locally advanced pancreatic cancer: a pilot study. HPB 9(Suppl 2):60

    Google Scholar 

  27. Hirano S, Kondo S, Hara T et al (2007) Distal pancreatectomy with en bloc celiac axis resection for locally advanced pancreatic body cancer: long-term results. Ann Surg 246:46–51

    Article  PubMed  Google Scholar 

  28. Pietrabissa A, Caramella D, Di Candio G et al (1999) Laparoscopy and laparoscopic ultrasonography for staging pancreatic cancer: critical appraisal. World J Surg 23:998–1002; discussion 1003

    Article  CAS  PubMed  Google Scholar 

  29. Mazzeo S, Cappelli C, Caramella D et al (2007) Evaluation of vascular infiltration in resected patients for pancreatic cancer: comparison among multidetector CT, intraoperative findings and histopathology. Abdom Imaging Mar 27 [Epub ahead of print]

    Google Scholar 

  30. Boggi U, Del Chiaro M et al (2006) Le resezioni vascolari in chirurgia pancreatica. In: Trattato di tecnica chirurgica. Volume pancreas, surrene, milza, peritoneo, retroperitoneo. UTET, Turin, pp 111–122

    Google Scholar 

  31. Varty PP, Yamamoto H, Farges O et al (2005) Early retropancreatic dissection during pancreatectomy. Am J Surg 189:488–491

    Article  PubMed  Google Scholar 

  32. Machado MC, Penteado S, Cunha JE et al (2001) Pancreatic head tumors with portal vein involvement: an alternative surgical approach. Hepatogastroenterology 48:1486–1487

    CAS  PubMed  Google Scholar 

  33. Leach SD, Davidson BS, Ames FC et al (1996) Alternative method for exposure of retropancreatic mesenteric vasculature during total pancreatectomy. J Surg Oncol 61:163–165

    Article  CAS  PubMed  Google Scholar 

  34. Tseng JF, Tamm EP, Lee JE et al (2006) Venous resection in pancreatic cancer surgery. Best Pract Res Clin Gastroenterol 20:349–364

    Article  PubMed  Google Scholar 

  35. Makary MA, Fishman EK, Cameron JL (2005) Resection of the celiac axis for invasive pancreatic cancer. J Gastrointest Surg 9:503–507

    Article  PubMed  Google Scholar 

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© 2009 Springer-Verlag Italia

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Del Chiaro, M., Boggi, U., Mosca, F. (2009). Resection Criteria in Pancreatic Surgery: Lymphadenectomy and Vascular Resections. In: Surgical Treatment of Pancreatic Diseases. Updates in Surgery. Springer, Milano. https://doi.org/10.1007/978-88-470-0856-4_22

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  • DOI: https://doi.org/10.1007/978-88-470-0856-4_22

  • Publisher Name: Springer, Milano

  • Print ISBN: 978-88-470-0855-7

  • Online ISBN: 978-88-470-0856-4

  • eBook Packages: MedicineMedicine (R0)

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