Intraportal Endovascular Ultrasonography in the Diagnosis of Portal Vein Invasion by Pancreatobiliary Carcinoma

Kaneko, Tetsuya; Nakao, Akimasa; Inoue, Soichiroh; Harada, Akio; Nonami, Toshiaki; Itoh, Shigeki; Endo, Tokiko

doi:10.1097/00000658-199512000-00004

Cited by 56 publications

(37 citation statements)

References 10 publications

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“…The current study revealed that PV was more susceptible to narrowing in cases involving grade B or C PF or intra-abdominal infection than in cases that did not involve complications or in which grade A PF occurred after pancreatobiliary surgery. The features of the PV; i.e., its normal thickness and pressure values range from 0.5 -1.0 mm and from 5 -10 mmHg, respectively, might partly explain our findings [13] [14]. Specifically, it is suggested that the PV is more susceptible to the effects of periportal inflammation and PF-associated fibrosis than the arteries in the same region.…”

Section: Discussionmentioning

confidence: 63%

Portal Vein Stenosis Caused by Postoperative Complications after Pancreatobiliary Surgery

Kinoshita¹,

Tsubakihara²,

Yamazoe³

et al. 2017

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Background: Portal vein (PV) stenosis or obstruction is sometimes observed in patients who were performed pancreatobiliary surgery. These conditions such as pancreatic fistulas (PF) and intra-abdominal infections after pancreatobiliary surgery still represent significant clinical issues. In addition, insufficient attention is paid to the fact that severe stenosis of the PV can result in life-threatening complications. Material and Methods: At our institution, lymph node dissection within the hepatoduodenal ligament was performed for biliary or pancreatic neoplasms in 68 patients between October 2005 and April 2017. The diameter of the PV was measured on computed tomography scans obtained before and after the operation. PV stenosis was defined as a >50% reduction in the diameter of the PV. The degree of PF (Pancreatic Fistula) was defined by the International Study Group of Pancreatic Fistula after pancreaticoduodenectomy. Furthermore, the Clavien-Dindo (CD) classification was used to assess the complications that occurred in cases in which pancreatojejunostomy was not performed. The relationship between the degree of PV stenosis and the occurrence of postoperative complications was analyzed. Results: The overall frequency of PF was 56.3% (18 patients). Grade B or C PF occurred in 5 patients (15.6%). In the present small series, a correlation was detected between the degree of PV stenosis and the occurrence of postoperative complications after pancreatobiliary surgery (p < 0.05). Conclusions: Clinicians should keep in mind that the PV can narrow in cases in which grade B or C PF or intra-abdominal abscesses occur after pancreatobiliary surgery.

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Section: Discussionmentioning

confidence: 63%

Portal Vein Stenosis Caused by Postoperative Complications after Pancreatobiliary Surgery

Kinoshita¹,

Tsubakihara²,

Yamazoe³

et al. 2017

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“…The effectiveness of endoluminal ultrasonography in the diagnosis of pancreatic cancer gave a sensitivity of 95%, and a specificity of 80%, and negative predictive value of 80% [17]. Kaneko et al [18] reported similar results with a slightly higher sensitivity of 96.9%, specificity of 91.2% and overall accuracy of 93.9% in the diagnosis of portal invasion. On the other hand, CT analysis resulted in a sensitivity of 83.9%, specificity of 74.3% and overall accuracy of 78.9%.…”

Section: Diagnosis and Assessment Of Resectabilitymentioning

confidence: 98%

“…However, it has been reported that the diagnostic accuracy of CT imaging of nodal metastases varies from 42 to 58%, sensitivity 19–37%, specificity 60–92%, positive predictive value 47–83%, and negative predictive value 34–67% [13,14,15,16]. According to recent studies on ultrasonographic diagnosis, endoluminal ultrasonography is highly sensitive to detect invasion of major vascular strictures [17, 18]. The effectiveness of endoluminal ultrasonography in the diagnosis of pancreatic cancer gave a sensitivity of 95%, and a specificity of 80%, and negative predictive value of 80% [17].…”

Section: Diagnosis and Assessment Of Resectabilitymentioning

confidence: 99%

Current Status of Surgery for Pancreatic Cancer

et al. 2007

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Background: In Japan the annual incidence of pancreatic cancer has increased over the last decade, but no advancement has been made in the long-term prognosis after resection. The significant differences in the surgical procedures between Western countries and Japan have been discussed. Therefore, an adequate comparison and analysis of the data from Japan, Europe and the USA is required. This review evaluates many important published reports from Japan which influence surgical procedure. Methods: Several important highlights and controversies regarding the concept of surgical treatment and surgical procedure are discussed comparing the results in Japan with those in Western countries. Results: No significant difference in diagnostic strategy using various imaging methods was observed between Japan and Europe. The stage classification for pancreatic cancer by the Japanese Pancreatic Society (JPS) seems to be superior to others, because the results on long-term prognosis after pancreatectomy of cases with pancreatic head cancer, diagnosed as tubular adenocarcinoma, has been arranged logically. Pancreatectomy with extended radical dissection is recommended in Japan, but several clinical studies from Europe and the USA suggest that this is ineffective. The basic concepts of this controversy have recently come closer altogether. Scientific clinical trials for instance on the necessity of adjuvant treatment, etc., are now on-going. Conclusion: The characteristics on diagnosis and treatment of pancreatic cancer in Japan are described. The JPS registration system for pancreatic cancer can provide much more information, i.e. dependency on diagnostic methods, highly frequent sites of lymph node and of distant metastases, the prognosis of small pancreatic cancers, etc. The indication for any surgical treatments should be limited to cases with the possibility of cancer free margins.

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“…According to Ishikawa et al and Nakao and coworker, the indications are limited to unilateral (<180°) segmental vascular involvement [19,20]. Attention was especially paid to the exclusion of the cases with deep retroperitoneal invasion, defined by the absence of intact connective tissue between the tumor and the right lateral side of the superior mesenteric artery.…”

Section: Indications For Vascular Resectionmentioning

confidence: 99%

The Role of Vascular Resection in Pancreatic Cancer Treatment

Vladov¹,

Takorov²,

Lukanova³

2017

Challenges in Pancreatic Pathology

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Currently, porto-mesenteric vein resection is a standard procedure at high-volume pancreatic centers. Experience in vascular surgery is indispensable for a modern pancreatic surgeon. Nowadays, only arterial resections still are a controversial issue. Nevertheless, attempts at resection involving reconstruction of the main arteries such as the coeliac axis, hepatic artery, and superior mesenteric artery (SMA) have been reported, although in small case series. An overview of the historical and contemporary methods for surgical management of superior mesenteric/portal vein involvement as well as arterial involvement by pancreatic cancer is presented. We compare the data from the literature with our data based on the examination and long-term follow-up of more than 300 radical pancreatic resections. Seventy-two of the presented patients underwent pancreatic resection with simultaneous vascular resection-SMPV in 65 cases (44 with resection of the portal vein, 15 with resection of the superior mesenteric vein, 6 with resection of the portomesenterial confluence), arterial in 2 and partial resections of IVC in 5 cases. Combined vascular resections were done in three cases. Both groups PVR and PR showed similarly close results in complication rates, mortality, and morbidity. Three and 5 years survival rates were 42 and 38% in PD group and 28 and 19% in the PVR group. The vascular resection must be performed only upon carefully selected patients with data for presence of resectable tumors or tumors with borderline resectability from the preoperative imaging studies. The prompt management of pancreatic cancer with vascular involvement should involve multidisciplinary consultation in high-volume centers.

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Intraportal Endovascular Ultrasonography in the Diagnosis of Portal Vein Invasion by Pancreatobiliary Carcinoma

Cited by 56 publications

References 10 publications

Portal Vein Stenosis Caused by Postoperative Complications after Pancreatobiliary Surgery

Portal Vein Stenosis Caused by Postoperative Complications after Pancreatobiliary Surgery

Current Status of Surgery for Pancreatic Cancer

The Role of Vascular Resection in Pancreatic Cancer Treatment

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