Interventional Radiology for Pancreatic Cancer

Reference work entry

Abstract

Pancreatic adenocarcinoma is the 12th most common malignancy globally, holding joint position with renal cancer, and is the seventh leading cause of cancer-related mortality and second most common cause of cancer deaths for all gastrointestinal-related carcinomas. Most patients present late in their course and have either locally extensive or metastatic disease with a median survival of only 4–6 months. At the time of diagnosis, unfortunately only 10–20% of patients are candidates for curative resection. The late presentation, aggressive nature, and lack of effective therapies all contribute to the poor prognosis. It is typical that these patients with more advanced disease will undergo either interventional radiology (IR)- or endoscopic ultrasound (EUS)-guided interventions to deliver either preoperative or palliative care. The objective of this chapter is to highlight currently available and emerging IR- and EUS-guided interventions as they apply to the care of patients with pancreatic carcinoma.

Keywords

Endoscopic ultrasound Endoscopic retrograde cholangiography-guided drainage Endoscopic ultrasound-guided bile duct drainage Duodenal stenting Celiac plexus and ganglia neurolysis Ablative antitumor therapies 

References

  1. 1.
    Rösch J, Dotter CT, Brown MN. Selective arterial embolization: new method for control of acute gastrointestinal bleeding. Radiology. 1972;102:303–6.PubMedCrossRefGoogle Scholar
  2. 2.
    Ardengh JC, Lopes CV, de Lima LF, de Oliveira JR, Venco F, Santo GC, Modena JL. Diagnosis of pancreatic tumors by endoscopic ultrasound-guided fine-needle aspiration. World J Gastroenterol. 2007;13(22):3112–6.PubMedPubMedCentralCrossRefGoogle Scholar
  3. 3.
    Bhutani MS, Hawes RH, Baron PL, Sanders-Cliette A, van Velse A, Osborne JF, Hoffman BJ. Endoscopic ultrasound guided fine needle aspiration of malignant pancreatic lesions. Endoscopy. 1997;29(9):854–8.PubMedCrossRefGoogle Scholar
  4. 4.
    Chang KJ, Nguyen P, Erickson RA, Durbin TE, Katz KD. The clinical utility of endoscopic ultrasound-guided fine-needle aspiration in the diagnosis and staging of pancreatic carcinoma. Gastrointest Endosc. 1997;45(5):387–93.PubMedCrossRefGoogle Scholar
  5. 5.
    Eloubeidi MA, Jhala D, Chhieng DC, Chen VK, Eltoum I, Vickers S, Mel Wilcox C, Jhala N. Yield of endoscopic ultrasound-guided fine-needle aspiration biopsy in patients with suspected pancreatic carcinoma. Cancer. 2003;99(5):285–92.CrossRefPubMedGoogle Scholar
  6. 6.
    Wilson JL, Kalade A, Prasad S, Cade R, Thomson B, Banting S, Mackay S, Desmond PV, Chen RY. Diagnosis of solid pancreatic masses by endoscopic ultrasound-guided fine-needle aspiration. Intern Med J. 2008;39:32–7.PubMedCrossRefGoogle Scholar
  7. 7.
    Kulesza P, Eltoum IA. Endoscopic ultrasound-guided fine-needle aspiration: sampling, pitfalls, and quality management. Clin Gastroenterol Hepatol. 2007;5(11):1248–54.PubMedCrossRefGoogle Scholar
  8. 8.
    Levy MJ, Wiersema MJ. EUS-guided trucut biopsy. Gastrointest Endosc. 2005;62(3):417–26.PubMedCrossRefGoogle Scholar
  9. 9.
    Warshaw AL, Fernandez-del Castillo C. Pancreatic carcinoma. N Engl J Med. 1992;326(7):455–65.PubMedCrossRefGoogle Scholar
  10. 10.
    Smith AC, Dowsett JF, Russell RC, Hatfield AR, Cotton PB. Randomised trial of endoscopic stenting versus surgical bypass in malignant low bile duct obstruction. Lancet. 1994;344(8938):1655–60.PubMedPubMedCentralCrossRefGoogle Scholar
  11. 11.
    Lichtenstein DR, Carr-Locke DL. Endoscopic palliation for unresectable pancreatic carcinoma. Surg Clin North Am. 1995;75(5):969–88.PubMedCrossRefGoogle Scholar
  12. 12.
    Leung JW, Emery R, Cotton PB, Russell RC, Vallon AG, Mason RR. Management of malignant obstructive jaundice at The Middlesex Hospital. Br J Surg. 1983;70(10):584–6.PubMedCrossRefGoogle Scholar
  13. 13.
    Speer AG, Cotton PB, Russell RC, et al. Randomised trial of endoscopic versus percutaneous stent insertion in malignant obstructive jaundice. Lancet. 1987;2(8550):57–62.PubMedCrossRefGoogle Scholar
  14. 14.
    Brandabur JJ, Kozarek RA, Ball TJ, et al. Nonoperative versus operative treatment of obstructive jaundice in pancreatic cancer: cost and survival analysis. Am J Gastroenterol. 1988;83(10):1132–9.PubMedGoogle Scholar
  15. 15.
    Shepherd HA, Royle G, Ross AP, Diba A, Arthur M, Colin-Jones D. Endoscopic biliary endoprosthesis in the palliation of malignant obstruction of the distal common bile duct: a randomized trial. Br J Surg. 1988;75(12):1166–8.PubMedCrossRefGoogle Scholar
  16. 16.
    Andersen JR, Sorensen SM, Kruse A, Rokkjaer M, Matzen P. Randomised trial of endoscopic endoprosthesis versus operative bypass in malignant obstructive jaundice. Gut. 1989;30(8):1132–5.PubMedPubMedCentralCrossRefGoogle Scholar
  17. 17.
    van den Bosch RP, van der Schelling GP, Klinkenbijl JH, Mulder PG, van Blankenstein M, Jeekel J. Guidelines for the application of surgery and endoprostheses in the palliation of obstructive jaundice in advanced cancer of the pancreas. Ann Surg. 1994;219(1):18–24.PubMedPubMedCentralCrossRefGoogle Scholar
  18. 18.
    Mitty R, Cave DR. Randomized trial of endoscopic stenting versus surgical bypass in malignant low bile duct obstruction. Gastrointest Endosc. 1995;42(3):281–2.PubMedGoogle Scholar
  19. 19.
    Raikar GV, Melin MM, Ress A, et al. Cost-effective analysis of surgical palliation versus endoscopic stenting in the management of unresectable pancreatic cancer. Ann Surg Oncol. 1996;3(5):470–5.PubMedCrossRefGoogle Scholar
  20. 20.
    Ballinger AB, McHugh M, Catnach SM, Alstead EM, Clark ML. Symptom relief and quality of life after stenting for malignant bile duct obstruction. Gut. 1994;35(4):467–70.PubMedPubMedCentralCrossRefGoogle Scholar
  21. 21.
    Luman W, Cull A, Palmer KR. Quality of life in patients stented for malignant biliary obstructions. Eur J Gastroenterol Hepatol. 1997;9(5):481–4.PubMedCrossRefGoogle Scholar
  22. 22.
    Abraham NS, Barkun JS, Barkun AN. Palliation of malignant biliary obstruction: a prospective trial examining impact on quality of life. Gastrointest Endosc. 2002;56(6):835–41.CrossRefPubMedGoogle Scholar
  23. 23.
    Davids PH, Groen AK, Rauws EA, Tytgat GN, Huibregtse K. Randomised trial of self-expanding metal stents versus polyethylene stents for distal malignant biliary obstruction (comment). Lancet. 1992;340(8834–8835):1488–92.PubMedCrossRefGoogle Scholar
  24. 24.
    Carr-Locke DL, Ball TJ, Connors PJ, et al. Multicenter, randomized, controlled trial of metal stents for malignant obstruction of the common bile duct. Gastrointest Endosc. 1993;39:A310.Google Scholar
  25. 25.
    Knyrim K, Wagner HJ, Pausch J, Vakil N. A prospective, randomized, controlled trial of metal stents for malignant obstruction of the common bile duct. Endoscopy. 1993;25(3):207–12.PubMedCrossRefGoogle Scholar
  26. 26.
    Prat F, Chapat O, Ducot B, et al. A randomized trial of endoscopic drainage methods for inoperable malignant strictures of the common bile duct (comment). Gastrointest Endosc. 1998;47(1):1–7.PubMedCrossRefGoogle Scholar
  27. 27.
    Kaassis M, Boyer J, Dumas R, et al. Plastic or metal stents for malignant stricture of the common bile duct? Results of a randomized prospective study. Gastrointest Endosc. 2003;57:178–82.PubMedCrossRefGoogle Scholar
  28. 28.
    Schmassmann A, von Gunten E, Knuchel J, Scheurer U, Fehr HF, Halter F. Wallstents versus plastic stents in malignant biliary obstruction: effects of stent patency of the first and second stent on patient compliance and survival (comment). Am J Gastroenterol. 1996;91(4):654–9.PubMedGoogle Scholar
  29. 29.
    England RE, Martin DF, Morris J, et al. A prospective randomised multicentre trial comparing 10 Fr Teflon Tannenbaum stents with 10 Fr polyethylene Cotton-Leung stents in patients with malignant common duct strictures (comment). Gut. 2000;46(3):395–400.PubMedPubMedCentralCrossRefGoogle Scholar
  30. 30.
    Libby ED, Leung JW. Ultrasmooth plastic to prevent stent clogging (comment). Gastrointest Endosc. 1994;40(3):386–7.PubMedCrossRefGoogle Scholar
  31. 31.
    Sung JY, Shaffer EA, Costerton JW. Antibacterial activity of bile salts against common biliary pathogens. Effects of hydrophobicity of the molecule and in the presence of phospholipids. Dig Dis Sci. 1993;38(11):2104–12.PubMedCrossRefGoogle Scholar
  32. 32.
    Ghosh S, Palmer KR. Prevention of biliary stent occlusion using cyclical antibiotics and ursodeoxycholic acid. Gut. 1994;35(12):1757–9.PubMedPubMedCentralCrossRefGoogle Scholar
  33. 33.
    Levy MJ, Baron TH, Gostout CJ, Petersen BT, Farnell MB. Palliation of malignant extrahepatic biliary obstruction with plastic versus expandable metal stents: an evidence-based approach. Clin Gastroenterol Hepatol. 2004;2(4):273–85.PubMedCrossRefGoogle Scholar
  34. 34.
    Takada T, Hanyu F, Kobayashi S, Uchida Y. Percutaneous transhepatic cholangial drainage: direct approach under fluoroscopic control. J Surg Oncol. 1976;8:83–97.PubMedCrossRefGoogle Scholar
  35. 35.
    Saltzstein EC, Peacock JB, Mercer LC. Early operation for acute biliary tract stone disease. Surgery. 1983;94:704–8.PubMedGoogle Scholar
  36. 36.
    Lameris JS, Stoker J, Nijs HG, et al. Malignant biliary obstruction: percutaneous use of self-expandable stents. Radiology. 1991;179:703–7.PubMedCrossRefGoogle Scholar
  37. 37.
    Beissert M, Wittenberg G, Sandstede J, et al. Metallic stents and plastic endoprostheses in percutaneous treatment of biliary obstruction. Z Gastroenterol. 2002;40:503–10.PubMedCrossRefGoogle Scholar
  38. 38.
    Chiou YY, Tseng HS, Chiang JH, Hwang JI, Chou YH, Chang CY. Percutaneous placement of metallic stents in the management of malignant biliary obstruction. J Formos Med Assoc. 2005;104(10):738–43.PubMedGoogle Scholar
  39. 39.
    Mallery S, Matlock J, Freeman M. EUS-guided rendezvous drainage of obstructed biliary and pancreatic ducts: report of 6 cases. Gastrointest Endosc. 2004;59(1):100–7.PubMedCrossRefGoogle Scholar
  40. 40.
    Bories E, Pesenti C, Caillol F, Lopes C, Giovannini M. Transgastric endoscopic ultrasonography-guided biliary drainage: results of a pilot study. Endoscopy. 2007;39(4):287–91.PubMedCrossRefGoogle Scholar
  41. 41.
    Wiersema MJ, Sandusky D, Carr R, Wiersema LM, Erdel WC, Frederick PK. Endosonography-guided cholangiopancreatography. Gastrointest Endosc. 1996;43(2 Pt 1):102–6.PubMedCrossRefGoogle Scholar
  42. 42.
    Giovannini M, Moutardier V, Presenti C, et al. Endoscopic ultrasound-guided bilioduodenal anastomosis: a new technique for biliary drainage. Endoscopy. 2001;33(10):898–900.PubMedCrossRefGoogle Scholar
  43. 43.
    Burmester E, Niehaus J, Leineweber T, et al. EUS-cholangiodrainage of the bile duct: report of 4 cases. Gastrointest Endosc. 2003;57(2):246–50.PubMedCrossRefGoogle Scholar
  44. 44.
    Kahaleh M, Yoshida C, Kane L, Yeaton P. Interventional EUS cholangiography: a report of five cases. Gastrointest Endosc. 2004;60:138–42.PubMedCrossRefGoogle Scholar
  45. 45.
    Lai R, Freeman ML. Endoscopic ultrasound-guided bile duct access for rendezvous ERCP drainage in the setting of intradiverticular papilla. Endoscopy. 2005;37(5):487–9.PubMedCrossRefGoogle Scholar
  46. 46.
    Puspok A, Lomoschitz F, Dejaco C, et al. Endoscopic ultrasound guided therapy of benign and malignant biliary obstruction: a case series. Am J Gastroenterol. 2005;100:1743–7.PubMedCrossRefGoogle Scholar
  47. 47.
    Kahaleh M, Hernandez AJ, Tokar J, Adams RB, Shami VM, Yeaton P. Interventional EUS-guided cholangiography: evaluation of a technique in evolution. Gastrointest Endosc. 2006;64(1):52–9.PubMedCrossRefGoogle Scholar
  48. 48.
    Yamao K, Sawaki A, Takahashi K, Imaoka H, Ashida R, Mizuno N. EUS-guided choledochoduodenostomy for palliative biliary drainage in case of papillary obstruction: report of 2 cases. Gastrointest Endosc. 2006;64(4):663–7.PubMedCrossRefGoogle Scholar
  49. 49.
    Will U, Thieme A, Fueldner F, Gerlach R, Wanzar I, Meyer F. Treatment of biliary obstruction in selected patients by endoscopic ultrasonography (EUS)-guided transluminal biliary drainage. Endoscopy. 2007;39(4):292–5.PubMedCrossRefGoogle Scholar
  50. 50.
    Ang TL, Teo EK, Fock KM. EUS-guided transduodenal biliary drainage in unresectable pancreatic cancer with obstructive jaundice. JOP. 2007;8(4):438–43.PubMedGoogle Scholar
  51. 51.
    Fujita N, Noda Y, Kobayashi G, Ito K, Obana T, Horaguchi J, Takasawa O, Nakahara K. Histological changes at an endosonography-guided biliary drainage site: a case report. World J Gastroenterol. 2007;13(41):5512–5.PubMedPubMedCentralCrossRefGoogle Scholar
  52. 52.
    Yamao K, Bhatia V, Mizuno N, Sawaki A, Ishikawa H, Tajika M, Hoki N, Shimizu Y, Ashida R, Fukami N. EUS-guided choledochoduodenostomy for palliative biliary drainage in patients with malignant biliary obstruction: results of long-term follow-up. Endoscopy. 2008;40(4):340–2.PubMedCrossRefGoogle Scholar
  53. 53.
    Moon JH, Choi HJ, Kim DC, et al. A newly designed fully covered metal stent for lumen apposition in EUS-guided drainage and access: a feasibility study (with videos). Gastrointest Endosc. 2014;79(6):990–5.PubMedCrossRefGoogle Scholar
  54. 54.
    Itoi T, Binmoeller KF, Shah J, et al. Clinical evaluation of a novel lumen-apposing metal stent for endosonography-guided pancreatic pseudocyst and gallbladder drainage (with videos). Gastrointest Endosc. 2012;75(4):870–6.PubMedCrossRefGoogle Scholar
  55. 55.
    Law R, Grimm IS, Stavas JM, Baron TH. Conversion of percutaneous cholecystostomy to internal transmural gallbladder drainage using an endoscopic ultrasound-guided, lumen-apposing metal stent. Clin Gastroenterol Hepatol. 2016;14(3):476–80.PubMedCrossRefGoogle Scholar
  56. 56.
    Tarantino I, Barresi L, Repici A, Traina M. EUS-guided biliary drainage: a case series. Endoscopy. 2008;40(4):336–9.PubMedCrossRefGoogle Scholar
  57. 57.
    Adler DG, Baron TH. Endoscopic palliation of malignant gastric outlet obstruction using self-expanding metal stents: experience in 36 patients. Am J Gastroenterol. 2002;97(1):72–8.PubMedCrossRefGoogle Scholar
  58. 58.
    Dormann A, Meisner S, Verin N, Wenk Lang A. Self-expanding metal stents for gastroduodenal malignancies: systematic review of their clinical effectiveness. Endoscopy. 2004;36(6):543–50.PubMedCrossRefGoogle Scholar
  59. 59.
    Graber I, Dumas R, Filoche B, Boyer J, Coumaros D, Lamouliatte H, Legoux JL, Napoléon B, Ponchon T, Société Française d’Endoscopie Digestive (SFED). The efficacy and safety of duodenal stenting: a prospective multicenter study. Endoscopy. 2007;39(9):784–7.PubMedCrossRefGoogle Scholar
  60. 60.
    Mutignani M, Tringali A, Shah SG, Perri V, Familiari P, Iacopini F, Spada C, Costamagna G. Combined endoscopic stent insertion in malignant biliary and duodenal obstruction. Endoscopy. 2007;39(5):440–7.PubMedCrossRefGoogle Scholar
  61. 61.
    Ventafridda GV, Caraceni AT, Sbanotto AM, Barletta L, De Conno F. Pain treatment in cancer of the pancreas. Eur J Surg Oncol. 1990;16(1):1–6.PubMedGoogle Scholar
  62. 62.
    Lankisch PG. Natural course of chronic pancreatitis. Pancreatology. 2001;1(1):3–14.PubMedCrossRefGoogle Scholar
  63. 63.
    Ventafridda V, Tamburini M, Caraceni A, De Conno F, Naldi F. A validation study of the WHO method for cancer pain relief. Cancer. 1987;59(4):850–6.PubMedCrossRefGoogle Scholar
  64. 64.
    Yeager MP, Colacchio TA, Yu CT, et al. Morphine inhibits spontaneous and cytokine-enhanced natural killer cell cytotoxicity in volunteers. Anesthesiology. 1995;83(3):500–8.PubMedCrossRefGoogle Scholar
  65. 65.
    Ward EM, Rorie DK, Nauss LA, Bahn RC. The celiac ganglia in man: normal anatomic variations. Anesth Analg. 1979;58(6):461–5.PubMedCrossRefGoogle Scholar
  66. 66.
    Ischia S, Ischia A, Polati E, Finco G. Three posterior percutaneous celiac plexus block techniques. A prospective, randomized study in 61 patients with pancreatic cancer pain. Anesthesiology. 1992;76(4):534–40.PubMedCrossRefGoogle Scholar
  67. 67.
    Brown DL, Moore DC. The use of neurolytic celiac plexus block for pancreatic cancer: anatomy and technique. J Pain Symptom Manag. 1988;3(4):206–9.CrossRefGoogle Scholar
  68. 68.
    Plancarte R, Velasquez R, Patt R. Neurolytic blocks of the sympathetic axis. In: Patt RB, editor. Cancer pain. Philadelphia: Lippincott; 1993. p. 377–425.Google Scholar
  69. 69.
    Nagakawa T, Mori K, Nakano T, et al. Perineural invasion of carcinoma of the pancreas and biliary tract. Br J Surg. 1993;80(5):619–21.PubMedCrossRefGoogle Scholar
  70. 70.
    Gebhardt GF. Visceral pain mechanisms. In: Chapman CR, Foley KM, editors. Current and emerging issues in cancer pain. New York: Raven Press; 1993. p. 99–111.Google Scholar
  71. 71.
    Kappis M. Erfahrungen mit local anasthesie bie bauchoperationen. Vehr Dtsch Gesellsch Chir. 1914;43:87–9.Google Scholar
  72. 72.
    Mercadante S, Nicosia F. Celiac plexus block: a reappraisal (comment). Reg Anesth Pain Med. 1998;23(1):37–48.PubMedGoogle Scholar
  73. 73.
    Lebovits AH, Lefkowitz M. Pain management of pancreatic carcinoma: a review. Pain. 1989;36(1):1–11.PubMedCrossRefGoogle Scholar
  74. 74.
    Sharfman WH, Walsh TD. Has the analgesic efficacy of neurolytic celiac plexus block been demonstrated in pancreatic cancer pain? Pain. 1990;41(3):267–71.PubMedCrossRefGoogle Scholar
  75. 75.
    Eisenberg E, Carr DB, Chalmers TC. Neurolytic celiac plexus block for treatment of cancer pain: a meta-analysis (erratum appears in Anesth Analg 1995 Jul;(81)1:213). Anesth Analg. 1995;80(2):290–5.PubMedGoogle Scholar
  76. 76.
    Polati E, Finco G, Gottin L, Bassi C, Pederzoli P, Ischia S. Prospective randomized double-blind trial of neurolytic coeliac plexus block in patients with pancreatic cancer. Br J Surg. 1998;85(2):199–201.PubMedCrossRefGoogle Scholar
  77. 77.
    Kawamata M, Ishitani K, Ishikawa K, et al. Comparison between celiac plexus block and morphine treatment on quality of life in patients with pancreatic cancer pain. Pain. 1996;64(3):597–602.PubMedCrossRefGoogle Scholar
  78. 78.
    Wong GY, Schroeder DR, Carns PE, Wilson JL, Martin DP, Kinney MO, Mantilla CB, Warner DO. Effect of neurolytic celiac plexus block on pain relief, quality of life, and survival in patients with unresectable pancreatic cancer: a randomized controlled trial. JAMA. 2004;291(9):1092–9.PubMedPubMedCentralCrossRefGoogle Scholar
  79. 79.
    Davies DD. Incidence of major complications of neurolytic coeliac plexus block. J R Soc Med. 1993;86(5):264–6.PubMedPubMedCentralGoogle Scholar
  80. 80.
    De Conno F, Caraceni A, Aldrighetti L, et al. Paraplegia following coeliac plexus block (comment). Pain. 1993;55(3):383–5.PubMedCrossRefGoogle Scholar
  81. 81.
    van Dongen RT, Crul BJ. Paraplegia following coeliac plexus block. Anaesthesia. 1991;46(10):862–3.PubMedCrossRefGoogle Scholar
  82. 82.
    Hayakawa J, Kobayashi O, Murayama H. Paraplegia after intraoperative celiac plexus block. Anesth Analg. 1997;84(2):447–8.PubMedCrossRefGoogle Scholar
  83. 83.
    Wiersema MJ, Wiersema LM. Endosonography-guided celiac plexus neurolysis. Gastrointest Endosc. 1996;44(6):656–62.PubMedCrossRefGoogle Scholar
  84. 84.
    Gunaratnam NT, Sarma AV, Norton ID, Wiersema MJ. A prospective study of EUS-guided celiac plexus neurolysis for pancreatic cancer pain. Gastrointest Endosc. 2001;54(3):316–24.PubMedCrossRefGoogle Scholar
  85. 85.
    Levy MJ, Wiersema MJ. EUS-guided celiac plexus neurolysis and celiac plexus block. Gastrointest Endosc. 2003;57(7):923–30.PubMedCrossRefGoogle Scholar
  86. 86.
    Levy MJ, Topazian MD, Wiersema MJ, Clain JE, Rajan E, Wang KK, de la Mora JG, Gleeson FC, Pearson RK, Pelaez MC, Petersen BT, Vege SS, Chari ST. Initial evaluation of the efficacy and safety of endoscopic ultrasound-guided direct Ganglia neurolysis and block. Am J Gastroenterol. 2008;103(1):98–103.PubMedPubMedCentralCrossRefGoogle Scholar
  87. 87.
    Fujii-Lau LL, Bamlet WR, Eldrige JS et al. Impact of celiac neurolysis on survival in patients with pancreatic cancer. Gastrointest Endosc. 2015 Jul;82(1):46–56.e2.PubMedCrossRefGoogle Scholar
  88. 88.
    Moertel CG, Childs Jr DS, Reitemeier RJ, Colby Jr MY, Holbrook MA. Combined 5-fluorouracil and supervoltage radiation therapy of locally unresectable gastrointestinal cancer. Lancet. 1969;2(7626):865–7.PubMedCrossRefGoogle Scholar
  89. 89.
    Burris 3rd HA, Moore MJ, Andersen J, et al. Improvements in survival and clinical benefit with gemcitabine as first-line therapy for patients with advanced pancreas cancer: a randomized trial (see comment). J Clin Oncol. 1997;15(6):2403–13.PubMedPubMedCentralCrossRefGoogle Scholar
  90. 90.
    Li CP, Chao Y, Chi KH, et al. Concurrent chemoradiotherapy treatment of locally advanced pancreatic cancer: gemcitabine versus 5-fluorouracil, a randomized controlled study (see comment). Int J Radiat Oncol Biol Phys. 2003;57(1):98–104.PubMedCrossRefGoogle Scholar
  91. 91.
    Conroy T, Desseigne F, Ychou M, et al. FOLFIRINOX versus gemcitabine for metastatic pancreatic cancer. N Engl J Med. 2011;364(19):1817–25.PubMedPubMedCentralCrossRefGoogle Scholar
  92. 92.
    Heinemann V, Hertel LW, Grindey GB, Plunkett W. Comparison of the cellular pharmacokinetics and toxicity of 2′,2′-difluorodeoxycytidine and 1-beta-D-arabinofuranosylcytosine. Cancer Res. 1988;48(14):4024–31.PubMedGoogle Scholar
  93. 93.
    van Moorsel CJ, Bergman AM, Veerman G, et al. Differential effects of gemcitabine on ribonucleotide pools of twenty-one solid tumour and leukaemia cell lines. Biochim Biophys Acta. 2000;1474(1):5–12.PubMedCrossRefGoogle Scholar
  94. 94.
    Huang P, Plunkett W. Fludarabine- and gemcitabine-induced apoptosis: incorporation of analogs into DNA is a critical event. Cancer Chemother Pharmacol. 1995;36(3):181–8.PubMedCrossRefGoogle Scholar
  95. 95.
    Ujiki MB, Talamonti MS. Guidelines for the surgical management of pancreatic adenocarcinoma. Semin Oncol. 2007;34(4):311–20.PubMedCrossRefGoogle Scholar
  96. 96.
    Tanaka T, Sakaguchi H, Anai H, Yamamoto K, Morimoto K, Tamamoto T, Kichikawa K. Arterial infusion of 5-fluorouracil combined with concurrent radiotherapy for unresectable pancreatic cancer: results from a pilot study. AJR Am J Roentgenol. 2007;189(2):421–8.PubMedCrossRefGoogle Scholar
  97. 97.
    Takamori H, Kanemitsu K, Tsuji T, Tanaka H, Chikamoto A, Nakahara O, Hiraoka T, Ikeda O, Kudo K, Imuta M, Yamashita Y. 5-fluorouracil intra-arterial infusion combined with systemic gemcitabine for unresectable pancreatic cancer. Pancreas. 2005;30(3):223–6.PubMedCrossRefGoogle Scholar
  98. 98.
    Miyanishi K, Ishiwatari H, Hayashi T, Takahashi M, Kawano Y, Takada K, Ihara H, Okuda T, Takanashi K, Takahashi S, Sato Y, Matsunaga T, Homma H, Kato J, Niitsu Y. A phase I trial of arterial infusion chemotherapy with gemcitabine and 5-fluorouracil for unresectable advanced pancreatic cancer after vascular supply distribution via superselective embolization. Jpn J Clin Oncol. 2008;38(4):268–74.PubMedCrossRefGoogle Scholar
  99. 99.
    Sasada T, Denno R, Tanaka T, Kanai M, Mizukami Y, Kohno S, Takabayashi A. Intra-arterial infusion chemotherapy with 5-fluorouracil and cisplatin in advanced pancreatic cancer: a feasibility study. Am J Clin Oncol. 2008;31(1):71–8.PubMedCrossRefGoogle Scholar
  100. 100.
    Mambrini A, Bassi C, Pacetti P, Torri T, Iacono C, Ballardini M, Orlandi M, Guadagni S, Fiorentini G, Cantore M. Prognostic factors in patients with advanced pancreatic adenocarcinoma treated with intra-arterial chemotherapy. Pancreas. 2008;36(1):56–60.PubMedCrossRefGoogle Scholar
  101. 101.
    Furuse J, Maru Y, Yoshino M, Mera K, Sumi H, Tajiri H, Satake M, Onaya H, Ishikura S, Ogino T, Kawashima M, Ikeda H. Hepatic arterial infusion of 5-fluorouracil for liver metastases from pancreatic carcinoma: results from a pilot study. Hepatogastroenterology. 2001;48(37):208–11.PubMedGoogle Scholar
  102. 102.
    Ishii H, Furuse J, Nagase M, Yoshino M, Kawashima M, Satake M, Ogino T, Ikeda H. Hepatic arterial infusion of 5-fluorouracil and extrabeam radiotherapy for liver metastases from pancreatic carcinoma. Hepatogastroenterology. 2004;51(58):1175–8.PubMedGoogle Scholar
  103. 103.
    Mulvihill S, Warren R, Venook A, et al. Safety and feasibility of injection with an E1B-55 kDa gene-deleted, replication-selective adenovirus (ONYX-015) into primary carcinomas of the pancreas: a phase I trial. Gene Ther. 2001;8(4):308–15.PubMedCrossRefGoogle Scholar
  104. 104.
    Micames C, Jowell PS, White R, et al. Lower frequency of peritoneal carcinomatosis in patients with pancreatic cancer diagnosed by EUS-guided FNA vs. percutaneous FNA. Gastrointest Endosc. 2003;58(5):690–5.PubMedCrossRefGoogle Scholar
  105. 105.
    Vilmann P, Jacobsen GK, Henriksen FW, Hancke S. Endoscopic ultrasonography with guided fine needle aspiration biopsy in pancreatic disease. Gastrointest Endosc. 1992;38(2):172–3.PubMedCrossRefGoogle Scholar
  106. 106.
    Erickson RA. EUS-guided FNA. Gastrointest Endosc. 2004;60(2):267–79.PubMedCrossRefGoogle Scholar
  107. 107.
    Levy MJ, Alberts SR, Chari ST, et al. EUS guided intra-tumoral gemcitabine therapy for locally advanced and metastatic pancreatic cancer. Gastrointest Endosc. 2014 April;73(4: Supplement):AB144–5.Google Scholar
  108. 108.
    Chang KJ, Nguyen PT, Thompson JA, et al. Phase I clinical trial of allogeneic mixed lymphocyte culture (cytoimplant) delivered by endoscopic ultrasound-guided fine-needle injection in patients with advanced pancreatic carcinoma. Cancer. 2000;88(6):1325–35.PubMedCrossRefGoogle Scholar
  109. 109.
    Hecht JR, et al. A phase I/II trial of intratumoral endoscopic ultrasound injection of ONYX-015 with intravenous gemcitabine in unresectable pancreatic carcinoma. Clin Cancer Res. 2003;9:555–61.PubMedGoogle Scholar
  110. 110.
    Chang KJ, et al. A novel gene transfer therapy against pancreatic cancer (TNFerade) delivered by endoscopic ultrasound (EUS) and percutaneous guided fine needle injection (FNI) (abstract). Gastrointest Endosc. 2004;59:188.Google Scholar
  111. 111.
    Chang KJ, et al. Multi-center clinical trial using endoscopy and endoscopic ultrasound (EUS) guided fine needle injection (FNI) of anti-tumor agent (TNFerade™) in patients with locally advanced esophageal cancer (abstract). Gastrointest Endosc. 2006;63:AB83.Google Scholar
  112. 112.
    Farrell JJ, et al. Long-term data for endoscopic ultrasound (EUS) and percutaneous (PTA) guided intratumoral TNFerade gene delivery combined with chemoradiation in the treatment of locally advanced pancreatic cancer (LAPC) (abstract). Gastrointest Endosc. 2006;63:AB93.Google Scholar
  113. 113.
    Jeong B, Bae YH, Lee DS, Kim SW. Biodegradable block copolymers as injectable drug-delivery systems. Nature. 1997;388(6645):860–2.PubMedCrossRefGoogle Scholar
  114. 114.
    Linghu E, Matthes K, Mino-Kenudson M, Brugge WR. Feasibility of endoscopic ultrasound-guided OncoGel (ReGel/paclitaxel) injection into the pancreas in pigs. Endoscopy. 2005;37(11):1140–2.PubMedCrossRefGoogle Scholar
  115. 115.
    Matthes K, Mino-Kenudson M, Sahani DV, Holalkere N, Fowers KD, Rathi R, Brugge WR. EUS-guided injection of paclitaxel (OncoGel) provides therapeutic drug concentrations in the porcine pancreas (with video). Gastrointest Endosc. 2007;65(3):448–53.PubMedCrossRefGoogle Scholar
  116. 116.
    Sun S, Wang S, Ge N, Lei T, Lu Q, Zhou Z, Yang A, Wang Z, Sun M. Endoscopic ultrasound-guided interstitial chemotherapy in the pancreas: results in a canine model. Endoscopy. 2007;39(6):530–4.PubMedCrossRefGoogle Scholar
  117. 117.
    Irisawa A, Takagi T, Kanazawa M, et al. Endoscopic ultrasound-guided fine-needle injection of immature dendritic cells into advanced pancreatic cancer refractory to gemcitabine: a pilot study. Pancreas. 2007;35(2):189–90.PubMedCrossRefGoogle Scholar
  118. 118.
    Grado GL, Larson TR, Balch CS, Grado MM, Collins JM, Kriegshauser JS, Swanson GP, Navickis RJ, Wilkes MM. Actuarial disease-free survival after prostate cancer brachytherapy using interactive techniques with biplane ultrasound and fluoroscopic guidance. Int J Radiat Oncol Biol Phys. 1998;42(2):289–98.PubMedCrossRefGoogle Scholar
  119. 119.
    Xue J, Waterman F, Handler J, Gressen E. The effect of interobserver variability on transrectal ultrasonography-based postimplant dosimetry. Brachytherapy. 2006;5(3):174–82.PubMedCrossRefGoogle Scholar
  120. 120.
    Firusian N, Dempke W. An early phase II study of intratumoral P-32 chromic phosphate injection therapy for patients with refractory solid tumors and solitary metastases. Cancer. 1999;85(4):980–7.PubMedCrossRefGoogle Scholar
  121. 121.
    Order SE, Siegel JA, Principato R, et al. Selective tumor irradiation by infusional brachytherapy in nonresectable pancreatic cancer: a phase I study. Int J Radiat Oncol Biol Phys. 1996;36(5):1117–26.PubMedCrossRefGoogle Scholar
  122. 122.
    Rosemurgy A, Luzardo G, Cooper J, et al. 32P as an adjunct to standard therapy for locally advanced unresectable pancreatic cancer: a randomized trial. J Gastrointest Surg. 2008;12(4):682–8.PubMedCrossRefGoogle Scholar
  123. 123.
    Peretz T, Nori D, Hilaris B, Manolatos S, Linares L, Harrison L, Anderson LL, Fuks Z, Brennan MF. Treatment of primary unresectable carcinoma of the pancreas with I-125 implantation. Int J Radiat Oncol Biol Phys. 1989;17(5):931–5.PubMedCrossRefGoogle Scholar
  124. 124.
    Joyce F, Burcharth F, Holm HH, Strøyer I. Ultrasonically guided percutaneous implantation of iodine-125 seeds in pancreatic carcinoma. Int J Radiat Oncol Biol Phys. 1990;19(4):1049–52.PubMedCrossRefGoogle Scholar
  125. 125.
    Zhang FJ, Wu PH, Zhao M, Huang JH, Fan WJ, Gu YK, Liu J, Zhang L, Lu MJ. CT guided radioactive seed 125I implantation in treatment of pancreatic cancer. Zhonghua Yi Xue Za Zhi. 2006;86(4):223–7.PubMedGoogle Scholar
  126. 126.
    Xu KC, Niu LZ, Hu YZ, He WB, He YS, Li YF, Zuo JS. A pilot study on combination of cryosurgery and (125)iodine seed implantation for treatment of locally advanced pancreatic cancer. World J Gastroenterol. 2008;14(10):1603–11.PubMedPubMedCentralCrossRefGoogle Scholar
  127. 127.
    Dobelbower RR, Montemaggi P. Brachytherapy for pancreatic cancer: a review. Hepato Gastroenterology. 1996;43:333–7.PubMedGoogle Scholar
  128. 128.
    Shirato H, Harada T, Harabayashi T, Hida K, Endo H, Kitamura K, Onimaru R, Yamazaki K, Kurauchi N, Shimizu T, Shinohara N, Matsushita M, Dosaka-Akita H, Miyasaka K. Feasibility of insertion/implantation of 2.0-mm-diameter gold internal fiducial markers for precise setup and real-time tumor tracking in radiotherapy. Int J Radiat Oncol Biol Phys. 2003;56(1):240–7.PubMedCrossRefGoogle Scholar
  129. 129.
    Murphy MJ, Adler Jr JR, Bodduluri M, Dooley J, Forster K, Hai J, Le Q, Luxton G, Martin D, Poen J. Image-guided radiosurgery for the spine and pancreas. Comput Aided Surg. 2000;5(4):278–88.PubMedCrossRefGoogle Scholar
  130. 130.
    Pishvaian AC, Collins B, Gagnon G, Ahlawat S, Haddad NG. EUS-guided fiducial placement for CyberKnife radiotherapy of mediastinal and abdominal malignancies. Gastrointest Endosc. 2006;64(3):412–7.PubMedCrossRefGoogle Scholar
  131. 131.
    Yan BM, Schellenberg D, Kim J, et al. EUS-guided gold fiducial insertion for image-guided radiation therapy of pancreatic cancer. Gastrointest Endosc. 2008;67:AB225.CrossRefGoogle Scholar
  132. 132.
    Dhadham GC, Hoffe S, Harris CL, Klapman JB. Endoscopic ultrasound-guided fiducial marker placement for image-guided radiation therapy without fluoroscopy: safety and technical feasibility. Endosc Int Open. 2016;4(3):E378–82.PubMedPubMedCentralCrossRefGoogle Scholar
  133. 133.
    Dávila Fajardo R, Lekkerkerker SJ, van der Horst A, et al. EUS-guided fiducial markers placement with a 22-gauge needle for image-guided radiation therapy in pancreatic cancer. Gastrointest Endosc. 2014;79(5):851–5.PubMedCrossRefGoogle Scholar
  134. 134.
    Sun S, Qingjie L, Qiyong G, Mengchun W, Bo Q, Hong X. EUS-guided interstitial brachytherapy of the pancreas: a feasibility study. Gastrointest Endosc. 2005;62(5):775–9.PubMedCrossRefGoogle Scholar
  135. 135.
    Sun S, Xu H, Xin J, Liu J, Guo Q, Li S. Endoscopic ultrasound-guided interstitial brachytherapy of unresectable pancreatic cancer: results of a pilot trial. Endoscopy. 2006;38(4):399–403.PubMedCrossRefGoogle Scholar
  136. 136.
    Jin Z, Du Y, Li Z, Jiang Y, Chen J, Liu Y. Endoscopic ultrasonography-guided interstitial implantation of iodine 125-seeds combined with chemotherapy in the treatment of unresectable pancreatic carcinoma: a prospective pilot study. Endoscopy. 2008;40(4):314–20.PubMedCrossRefGoogle Scholar
  137. 137.
    Wilson BC. Photodynamic therapy for cancer principles. Can J Gastroenterol. 2002;16:393–6.PubMedCrossRefGoogle Scholar
  138. 138.
    Moesta KT, Schlag P, Douglass Jr HO, et al. Evaluating the role of photodynamic therapy in the management of pancreatic cancer. Lasers Surg Med. 1995;16:84–92.PubMedCrossRefGoogle Scholar
  139. 139.
    Fan BG, Andrén-Sandberg A. Photodynamic therapy for pancreatic cancer. Pancreas. 2007;34(4):385–9.PubMedCrossRefGoogle Scholar
  140. 140.
    Bown SG, Rogowska AZ, Whitelaw DE, Lees WR, Lovat LB, Ripley P, Jones L, Wyld P, Gillams A, Hatfield AW. Photodynamic therapy for cancer of the pancreas. Gut. 2002;50(4):549–57.PubMedPubMedCentralCrossRefGoogle Scholar
  141. 141.
    Regula J, Ravi B, Bedwell J, et al. Photodynamic therapy using 5-aminolevulinic acid for experimental pancreatic cancer prolonged animal survival. Br J Cancer. 1994;70:248–54.PubMedPubMedCentralCrossRefGoogle Scholar
  142. 142.
    Chan HH, Nishioka NS, Mino M, Lauwers GY, Puricelli WP, Collier KN, Brugge WR. EUS-guided photodynamic therapy of the pancreas: a pilot study. Gastrointest Endosc. 2004;59(1):95–9.PubMedCrossRefGoogle Scholar
  143. 143.
    Yusuf TE, Matthes K, Brugge WR. EUS-guided photodynamic therapy with verteporfin for ablation of normal pancreatic tissue: a pilot study in a porcine model (with video). Gastrointest Endosc. 2008;67(6):957–61.PubMedCrossRefGoogle Scholar
  144. 144.
    Choi JH, Oh D, Lee JH, et al. Initial human experience of endoscopic ultrasound-guided photodynamic therapy with a novel photosensitizer and a flexible laser-light catheter. Endoscopy. 2015;47(11):1035–8.PubMedCrossRefGoogle Scholar
  145. 145.
    Tang Z, Wu YL, Fang HQ, Xu J, Mo GQ, Chen XM, Gao SL, Li JT, Liu YB, Wang Y. Treatment of unresectable pancreatic carcinoma by radiofrequency ablation with “cool-tip needle”: report of 18 cases. Zhonghua Yi Xue Za Zhi. 2008;88(6):391–4.PubMedGoogle Scholar
  146. 146.
    Spiliotis JD, Datsis AC, Michalopoulos NV, Kekelos SP, Vaxevanidou A, Rogdakis AG, Christopoulou AN. Radiofrequency ablation combined with palliative surgery may prolong survival of patients with advanced cancer of the pancreas. Langenbeck’s Arch Surg. 2007;392(1):55–60.CrossRefGoogle Scholar
  147. 147.
    Varshney S, Sewkani A, Sharma S, Kapoor S, Naik S, Sharma A, Patel K. Radiofrequency ablation of unresectable pancreatic carcinoma: feasibility, efficacy and safety. JOP. 2006;7(1):74–8.PubMedGoogle Scholar
  148. 148.
    Carrafiello G, Laganà D, Recaldini C, Dionigi G, Boni L, Bacuzzi A, Fugazzola C. Radiofrequency ablation of a pancreatic metastasis from renal cell carcinoma: case report. Surg Laparosc Endosc Percutaneous Technol. 2008;18(1):64–6.CrossRefGoogle Scholar
  149. 149.
    Carrafiello G, Laganà D, Ianniello A, Dionigi G, Novario R, Recaldini C, Mangini M, Cuffari S, Fugazzola C. Post-radiofrequency ablation syndrome after percutaneous radiofrequency of abdominal tumours: one centre experience and review of published works. Australas Radiol. 2007;51(6):550–4.PubMedCrossRefGoogle Scholar
  150. 150.
    Date RS, McMahon RF, Siriwardena AK. Radiofrequency ablation of the pancreas. I: definition of optimal thermal kinetic parameters and the effect of simulated portal venous circulation in an ex-vivo porcine model. JOP. 2005;6(6):581–7.PubMedGoogle Scholar
  151. 151.
    Ng KK, Lam CM, Poon RT, Shek TW, Fan ST, Wong J. Delayed portal vein thrombosis after experimental radiofrequency ablation near the main portal vein. Br J Surg. 2004;91(5):632–9.PubMedCrossRefGoogle Scholar
  152. 152.
    Wu Y, Tang Z, Fang H, Gao S, Chen J, Wang Y, Yan H. High operative risk of cool-tip radiofrequency ablation for unresectable pancreatic head cancer. J Surg Oncol. 2006;94(5):392–5.PubMedCrossRefGoogle Scholar
  153. 153.
    Goldberg SN, Mallery S, Gazelle GS, Brugge WR. EUS-guided radiofrequency ablation in the pancreas: results in a porcine model. Gastrointest Endosc. 1999;50(3):392–401.PubMedCrossRefGoogle Scholar
  154. 154.
    Hines-Peralta A, Hollander CY, Solazzo S, Horkan C, Liu ZJ, Goldberg SN. Hybrid radiofrequency and cryoablation device: preliminary results in an animal model. J Vasc Interv Radiol. 2004;15(10):1111–20.PubMedCrossRefGoogle Scholar
  155. 155.
    Pai M, Habib N, Senturk H, et al. Endoscopic ultrasound guided radiofrequency ablation, for pancreatic cystic neoplasms and neuroendocrine tumors. World J Gastrointest Surg. 2015;7(4):52–9.PubMedPubMedCentralCrossRefGoogle Scholar
  156. 156.
    Lakhtakia S, Ramchandani M, Galasso D, et al. EUS-guided radiofrequency ablation for management of pancreatic insulinoma by using a novel needle electrode (with videos). Gastrointest Endosc. 2016;83(1):234–9.PubMedCrossRefGoogle Scholar
  157. 157.
    Song TJ, Seo DW, Lakhtakia S, et al. Initial experience of EUS-guided radiofrequency ablation of unresectable pancreatic cancer. Gastrointest Endosc. 2016;83(2):440–3.PubMedCrossRefGoogle Scholar
  158. 158.
    Carrara S, Arcidiacono PG, Albarello L, Addis A, Enderle MD, Boemo C, Campagnol M, Ambrosi A, Doglioni C, Testoni PA. Endoscopic ultrasound-guided application of a new hybrid cryotherm probe in porcine pancreas: a preliminary study. Endoscopy. 2008;40(4):321–6.PubMedCrossRefGoogle Scholar
  159. 159.
    Giorgio A, Tarantino L, de Stefano G, Perrotta A, Aloisio V, del Viscovo L, Alaia A, Lettieri G. Ultrasound-guided percutaneous ethanol injection under general anesthesia for the treatment of hepatocellular carcinoma on cirrhosis: long-term results in 268 patients. Eur J Ultrasound. 2000;12(2):145–54.PubMedCrossRefGoogle Scholar
  160. 160.
    Barclay RL, Perez-Miranda M, Giovannini M. EUS-guided treatment of a solid hepatic metastasis. Gastrointest Endosc. 2002;55(2):266–70.PubMedCrossRefGoogle Scholar
  161. 161.
    Artifon EL, Lucon AM, Sakai P, Gerhardt R, Srougi M, Takagaki T, Ishioka S, Bhutani MS. EUS-guided alcohol ablation of left adrenal metastasis from non-small-cell lung carcinoma. Gastrointest Endosc. 2007;66(6):1201–5.PubMedCrossRefGoogle Scholar
  162. 162.
    Günter E, Lingenfelser T, Eitelbach F, Müller H, Ell C. EUS-guided ethanol injection for treatment of a GI stromal tumor. Gastrointest Endosc. 2003;57(1):113–5.PubMedCrossRefGoogle Scholar
  163. 163.
    Armellini E, Crinò SF, Ballarè M, Pallio S, Occhipinti P. Endoscopic ultrasound-guided ethanol ablation of pancreatic neuroendocrine tumours: a case study and literature review. World J Gastrointest Endosc. 2016;8(3):192–7.PubMedPubMedCentralCrossRefGoogle Scholar
  164. 164.
    Aslanian H, Salem RR, Marginean C, Robert M, Lee JH, Topazian M. EUS-guided ethanol injection of normal porcine pancreas: a pilot study. Gastrointest Endosc. 2005;62(5):723–7.PubMedCrossRefGoogle Scholar
  165. 165.
    Matthes K, Mino-Kenudson M, Sahani DV, Holalkere N, Brugge WR. Concentration-dependent ablation of pancreatic tissue by EUS-guided ethanol injection. Gastrointest Endosc. 2007;65(2):272–7.PubMedCrossRefGoogle Scholar
  166. 166.
    Giday SA, Magno P, Gabrielson KL, et al. The utility of contrast-enhanced endoscopic ultrasound in monitoring ethanol-induced pancreatic tissue ablation: a pilot study in a porcine model. Endoscopy. 2007;39(6):525–9.PubMedCrossRefGoogle Scholar
  167. 167.
    Jürgensen C, Schuppan D, Neser F, Ernstberger J, Junghans U, Stölzel U. EUS-guided alcohol ablation of an insulinoma. Gastrointest Endosc. 2006;63(7):1059–62.PubMedCrossRefGoogle Scholar
  168. 168.
    Levy MJ, Thompson GB, Topazian MD, Callstrom MR, Grant CS, Vella A. US-guided ethanol ablation of insulinomas: a new treatment option. Gastrointest Endosc. 2012;75(1):200–6.PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2018

Authors and Affiliations

  1. 1.Division of Gastroenterology and HepatologyMayo Clinic College of MedicineRochesterUSA

Section editors and affiliations

  • James L. Abbruzzese
    • 1
  • Raul A. Urrutia
    • 2
  • John Neoptolemos
    • 3
  • Markus W. Büchler
    • 4
  1. 1.Duke University Medical CenterDurhamUSA
  2. 2.Mayo Clinic Cancer CenterMayo ClinicRochesterUSA
  3. 3.Division of Surgery and OncologyUniversity of LiverpoolLiverpoolUK
  4. 4.Department of General, Visceral and Transplantation SurgeryUniversity of HeidelbergHeidelbergGermany

Personalised recommendations