Abstract
There are still many controversial issues on the technical aspect of pancreatoduodenectomy (PD). Surgical decision should be made on the basis of principles of oncologic surgery and evidences – evidence-based surgery. Clinically randomized controlled trial (RCT) is considered providing the highest level of evidence. However, even similarly designed RCTs sometimes show different results, so that many systematic review and meta-analysis studies are performed. Pancreatic surgeons cannot simply choose one of the two types of surgery following the result of RCT, and they tend to customize PD according to tumor factor and patient factors. Tumor factors include nature, origin, location, and extent of tumor. According to the tumor origin, the area that should be focused during PD could be different. Extent of resection sometimes should be customized according to the location of the tumor. According to the extent of tumor, sometimes resections of other organs or major vessels are needed. Different reconstruction techniques can be applied according to the parenchymal condition and ductal diameter of the pancreas. Host factors including old age and operative risk are the factors that might affect surgical decision also. In this chapter, potential procedures that can be customized are introduced. Some have evidences and others need evidence. In conclusion, PD should be customized according to the disease and host factors. Pancreatic surgeons should be familiar with every type of resection and reconstruction method so as to be able to customize PD for each patient.
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Kim, SW. (2017). The Concept of Customized Pancreatoduodenectomy. In: Kim, SW., Yamaue, H. (eds) Pancreatic Cancer. Springer, Berlin, Heidelberg. https://doi.org/10.1007/978-3-662-47181-4_23
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DOI: https://doi.org/10.1007/978-3-662-47181-4_23
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