Resection Criteria in Pancreatic Surgery: Lymphadenectomy and Vascular Resections
Pancreatic carcinoma is generally considered a systemic disease; at diagnosis the disease is often metastatic , 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 . 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) . In the early 1970s, Fortner  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.
KeywordsPancreatic Cancer Superior Mesenteric Artery Pancreatic Carcinoma Superior Mesenteric Vein Pancreatic Surgery
Unable to display preview. Download preview PDF.
- 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 366–368CrossRefPubMedGoogle 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; 228:508–517CrossRefPubMedGoogle 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
- 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):60Google 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 111–122Google Scholar