Extended distal pancreatectomy for pancreatic adenocarcinoma with splenic vein thrombosis and/or adjacent organ invasion

Roch, Alexandra M.; Singh, Harjot; Turner, Alexandra P.; Ceppa, Eugene P.; House, Michael G.; Zyromski, Nicholas J.; Nakeeb, Attila; Schmidt, C. Max

doi:10.1016/j.amjsurg.2014.10.017

Cited by 16 publications

(8 citation statements)

References 9 publications

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“…Patients with tumors located in the pancreatic body and tail benefit from the fact that technically, distal pancreatectomies can be easily performed together with en bloc gastric or colon resections. Without the involvement of vital structures as in the case of the pancreatic head with its anatomical proximity to important vessels, this extended, or multivisceral resection is not only feasible but also safe and justified [ 25 – 27 ]. Our pooled data for PD and DP demonstrate that survival after portal vein (PVR) and especially multivisceral (MVR) resection is worse in contrast to the standard procedure.…”

Section: Discussionmentioning

confidence: 99%

The prognostic influence of intrapancreatic tumor location on survival after resection of pancreatic ductal adenocarcinoma

et al. 2015

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BackgroundThe prognosis of pancreatic ductal adenocarcinoma (PDAC) is worse when the tumor is located in the pancreatic body or tail, compared to being located in the pancreatic head. However, for localized, resectable tumors survival seems to be at least similar.MethodsWe analyzed and compared the outcome after pancreatoduodenectomy (PD) and distal pancreatectomy (DP) for PDAC at our institution. Clinical, pathological and survival data from patients undergoing pancreatic resection for PDAC 1994–2014 were explored retrospectively, accessing a prospective pancreatic database. Patients receiving primary total pancreatectomy were excluded.ResultsFour hundred and thirteen patients were treated for PDAC: 347 (84 %) underwent PD and 66 (16 %) DP. Tumors located in the pancreatic body and tail were significantly larger than their counterparts located in the head (30.6 mm vs. 41.2 mm; p < 0.001). However, distal tumors had significantly less nodal involvement (71 % vs. 57 %; p = 0.03). Portal-vein resection (PVR) was performed more often in PD, multivisceral resection (MVR) was more frequent in DP (37 % vs. 14 % and 4 % vs. 29 %; p < 0.001). Rates for negative resection margins and tumor grading were similar. Postoperative complication rates including morbidity, rates of re-operation and mortality were comparable. Long-term outcome revealed no significant difference between PD and DP with 5-year survival rates of 17.8 and 22 % respectively (p = 0.284). Multivariate analysis confirmed positive resection margin, positive nodal status, extended resection (PVR, MVR) and lack of adjuvant/additive chemotherapy as independent risk factors for poor survival after pancreatic resection.ConclusionPatients with resectable pancreatic ductal adenocarcinoma located in the body and tail of the pancreas display a similar postoperative oncological outcome despite larger tumors when compared to patients with resectable tumors located in the pancreatic head.

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Section: Discussionmentioning

confidence: 99%

The prognostic influence of intrapancreatic tumor location on survival after resection of pancreatic ductal adenocarcinoma

et al. 2015

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“…There were no randomized controlled studies. Table 2 shows the characteristics of the included studies; five studies were case reports (70-74), and seven were retrospective studies (14,35,68,69,75-77). All articles, were published after 2007 and were published in the English language.…”

Section: Resultsmentioning

confidence: 99%

Visceral Thromboses in Pancreas Adenocarcinoma: Systematic Review

Hicks

DeRosa

Raj

et al. 2018

Clinical Colorectal Cancer

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Within gastrointestinal malignancies, primary hepatocellular carcinoma and pancreatic ductal adenocarcinoma (PDAC) are frequently associated with visceral thromboses (VT). Thrombus formation in the portal (PVT), mesenteric (MVT), or splenic vein (SVT) system leads to portal hypertension and intestinal ischemia. VT in PDAC may convey a risk of increased distal thrombosis and poses therapeutic uncertainty regarding the role of anticoagulation. An increasing number of reports describe VT associated with PDAC. It is possible that early diagnosis of these events may help reduce morbidity and speculatively improve oncologic outcomes. To perform a systematic review to study PVT, MVT, and SVT associated with PDAC, and to provide a comprehensive review. Medline/PubMed, Embase, Web of Science, Scopus, and the Cochrane Library. Data Extraction and Assessment: Two blinded independent observers extracted and assessed the studies for diagnosis of PVT, MVT, and SVT in PDAC. Studies were restricted to English-language literature published between 2007 and 2016. Eleven articles were identified. Five case reports and 7 retrospective studies were found, with a total of 127 patients meeting the inclusion criteria. The mean age at diagnosis was 64 years. PVT was found in 35% (n = 46), SVT in 52% (n = 65), and MVT in 13% (n = 15). Mean follow-up time was 26 months. Only 3 of the selected articles studied the impact of anticoagulation in VT. All patients with nonvisceral thrombosis (eg, deep-vein thrombosis, pulmonary emboli) were therapeutically treated; in contrast, patients with VT only rarely received treatment. VT in PDAC is a frequent finding at diagnosis or during disease progression. Evidence to guide treatment choices is limited, and current management is based on inferred experience from nononcologic settings. Anticoagulation appears to be safe in VT, with most of the large studies recommending a careful assessment for patients at a high risk of bleeding.

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“…Moreover, it could be correlated with intervention differences. The resection of distal pancreatic tumours is safer and more feasible [ 44 ]. Body or tail location does not lead to malignant biliary obstruction and thus is not associated with potential biliary drainage and further complications delaying appropriate surgery [ 45 ].…”

Section: Discussionmentioning

confidence: 99%

Diabetes Mellitus and Pancreatic Ductal Adenocarcinoma—Prevalence, Clinicopathological Variables, and Clinical Outcomes

Badowska-Kozakiewicz

Fudalej

Kwaśniewska

et al. 2022

Cancers

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Background: pancreatic ductal adenocarcinoma (PDAC) is the seventh leading cause of cancer-related deaths with increasing incidence and link to the onset of diabetes mellitus (DM). The aim of this study is to describe the prevalence of DM among patients with the diagnosis of PDAC, analyse the association between the occurrence of DM and clinicopathological factors, and detect variables influencing overall survival. Methods: a retrospective analysis of medical records was performed. The patients were divided into non-DM (n = 101) and DM (n = 74) groups. Statistical analysis with the usage of appropriate tests was conducted. Results: Patients in the groups of DM and NODM had significantly longer median OS than the non-DM group. Nodal involvement, tumour location, level of CEA, CRP and CRP/lymphocytes ratio were significantly associated with OS among patients with any type of DM. Neutropenia was less frequently observed in the DM group. Conclusions: DM is prevalent among patients with pancreatic cancer. In our study, patients with DM receiving palliative chemotherapy had significantly higher median OS than those without DM. The increased comprehension of the mechanisms of the relationship between DM and pancreatic cancer needs further research, which might provide avenues for the development of novel preventive and therapeutic strategies.

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Extended distal pancreatectomy for pancreatic adenocarcinoma with splenic vein thrombosis and/or adjacent organ invasion

Cited by 16 publications

References 9 publications

The prognostic influence of intrapancreatic tumor location on survival after resection of pancreatic ductal adenocarcinoma

The prognostic influence of intrapancreatic tumor location on survival after resection of pancreatic ductal adenocarcinoma

Visceral Thromboses in Pancreas Adenocarcinoma: Systematic Review

Diabetes Mellitus and Pancreatic Ductal Adenocarcinoma—Prevalence, Clinicopathological Variables, and Clinical Outcomes

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