Are There Indications for Palliative Resection in Pancreatic Cancer?

Gouma, Dirk J.; Dijkum, Els J. M. Nieveen van; Geenen, Rutger C. I. van; Gulik, Thomas M. van; Obertop, H.

doi:10.1007/s002689900606

Cited by 33 publications

(26 citation statements)

References 31 publications

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“…These findings are in contrast to other authors [18,16] who could not find a difference in perioperative morbidity between bypass surgery and resection, however, as previously mentioned, in these analyses, so-called palliative resections included patients with microscopical tumor remnants (R1).…”

Section: Discussioncontrasting

confidence: 80%

“…In our opinion, tumor debulking it is not an option in the treatment of pancreatic cancer; however, there is an ongoing debate about palliative pancreaticoduodenectomy since this procedure is associated with limited mortality in experienced centers and may lead to better pain control [16,18]. Nieveen van Dijkum et al compared quality of life after bypass surgery and pancreaticoduodenectomy in patients with potentially resectable tumors and found that quality of life does not differ significantly after bypass and resection [21].…”

Section: Discussionmentioning

confidence: 96%

“…According to current surgical literature, reduction of tumor mass (debulking) is not an option in the surgical treatment of pancreatic cancer [16]. Therefore, surgical exploration should not be performed if clear non-resectability criteria are present, such as tumor infiltration of the celiac trunk, common hepatic, or superior mesenteric artery.…”

Section: Discussionmentioning

confidence: 98%

“…The resectability of pancreatic tumors depends, to a great extent, on the experience of the individual surgeon and the case load of the institution [9,16]. Johnstone et al reported on 29 patients in whom resectability of pancreatic cancer was excluded in other institutions by explorative laparotomy [10].…”

Section: Discussionmentioning

confidence: 99%

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R2 resection in pancreatic cancer—does it make sense?

Köninger

Wente

Müller‐Stich

et al. 2008

Langenbecks Arch Surg

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Section: Discussioncontrasting

confidence: 80%

Section: Discussionmentioning

confidence: 96%

Section: Discussionmentioning

confidence: 98%

Section: Discussionmentioning

confidence: 99%

See 2 more Smart Citations

R2 resection in pancreatic cancer—does it make sense?

Köninger

Wente

Müller‐Stich

et al. 2008

Langenbecks Arch Surg

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“…Die vorliegenden Studien zeigen, dass eine palliative Resektion mit vergleichbarer Morbidität und Mortalität wie eine Bypass-Operation durchgeführt werden kann und unter Umständen zu einer verlängerten Überlebenszeit führt [14,24,26,28,35]. Aufgrund der niedrigen Mortalität bei Pankreasresektion in spezialisierten Zentren sollte die Frage, ob Patienten von einer palliativen Pankreatikoduodenektomie profitieren, in randomisierten kontrollierten Studien beantwortet werden.…”

Section: Pankreaschirurgieder Chirurg Als Wesentlicher Prognostischerunclassified

Chirurgische Standardtherapie beim Pankreaskarzinom

Frieß

Kleeff

Fischer

et al. 2003

Chirurg

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Approximately 150,000 people worldwide and 40,000 people in Europe die each year of pancreatic cancer,making it one of the five leading causes of cancer-related death and one of the most aggressive human tumors. Resection is still the only option that offers a chance of cure for pancreatic cancer patients. Recent studies have highlighted the correlation between the number of pancreatic resections per year and postoperative mortality. Thus, large centers of pancreatic surgery have mortality rates below 5%, whereas centers with lower caseloads have mortality rates exceeding 10%. Standards have been established for the surgical treatment of pancreatic cancer;however, these are often not based on evidence derived from randomized, controlled studies. Resection for pancreatic cancer is carried out if there are no metastases present and if the tumor is locally resectable; i.e., if there is no complex vessel invasion. However, an isolated infiltration of the portal vein is not considered a contraindication for surgery. At present, there are no evidenced-based data available on palliative (R2) resections,which might be a therapeutic option in centers with low morbidity/mortality. Three randomized controlled trials clearly show that the pylorus-preserving Whipple is equal to the classical Whipple in terms of oncological effectiveness, morbidity, and quality of life. Therefore, the pylorus-preserving Whipple is increasingly considered the standard operation for tumors of the pancreatic head. Based on randomized trials, extended lymph node dissection cannot generally be recommended for pancreatic cancer. Further prospective, randomized, multicenter trials have to be carried out in the upcoming years to find new approaches in the therapy of pancreatic cancer and to establish evidence-based treatment strategies for this disease.

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How Should Surgeons Communicate About Palliative and Curative Intentions, Purposes, and Outcomes?

Binkley

2021

AMA Journal of Ethics

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How surgeons describe procedures should be accurate, precise, and concordant with patients' values. By focusing on intention rather than realistic goals, terms like curative and palliative, when applied to highstakes operations, such as a Whipple pancreaticoduodenectomy, can be confusing to patients. This case commentary argues that surgeons' language choices can influence patients' decisions and experiences.The American Medical Association designates this journal-based CME activity for a maximum of 1 AMA PRA Category 1 Credit™ available through the AMA Ed Hub TM . Physicians should claim only the credit commensurate with the extent of their participation in the activity.Case LL is a 66-year-old patient with a pancreatic head adenocarcinoma. In consultation, Dr B recommended that LL undergo a Whipple pancreaticoduodenectomy and indicated that his "intention in doing this procedure is to cure your cancer." There were no postoperative complications, and LL completed adjuvant chemotherapy. But 18 months later, surveillance computed tomography imaging revealed a 3 cm mass in LL's right liver. Metastatic pancreatic cancer was confirmed by biopsy.LL returned to see Dr B and asked why her operation wasn't curative. Dr B explained that most often pancreatic cancer recurs and that the operation was palliative. CommentaryIn 1978, C. Gardner Child, former chairman of surgery at the University of Michigan, published a summary of 55 Whipple pancreaticoduodenectomies (PDs) he had performed from 1960 to 1978, mostly for malignancy. Child observed that the operation was "primarily a palliative surgical procedure." 1 More than 40 years later, the same operation is still being referred to in many cases as palliative. 2 However, the basis of the current designation is much different than what Child meant by palliative. Given advances in addressing major symptoms of malignancies treated by a PD, the role of true surgical palliation is significantly limited. 3,4 Palliative Whipple is thus a description that should be used with precision, as imprecise usage can compromise patient autonomy, informed consent, and physician truthfulness.

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Are There Indications for Palliative Resection in Pancreatic Cancer?

Abstract: Obertop, H. (1999). Are there indications for palliative resection in pancreatic cancer ? World journal of surgery, 23, 954-959.

Cited by 33 publications

References 31 publications

R2 resection in pancreatic cancer—does it make sense?

R2 resection in pancreatic cancer—does it make sense?

Chirurgische Standardtherapie beim Pankreaskarzinom

How Should Surgeons Communicate About Palliative and Curative Intentions, Purposes, and Outcomes?

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