Minimally invasive pancreatic cancer surgery: What is the current evidence?

Pędziwiatr, Michał; Małczak, Piotr; Major, Piotr; Witowski, Jan; Kuśnierz-Cabała, Beata; Ceranowicz, Piotr; Budzyński, Andrzej

doi:10.1007/s12032-017-0984-4

Cited by 13 publications

(8 citation statements)

References 52 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Literature reviews agree that ERAS may be introduced without compromising patients’ safety, although there is still a need for large-scale, multicenter randomized trials [ 39 , 40 ]. It seems one of the greatest concerns arises around minimally invasive pancreatic surgery because the evidence for its safety in cancer patients is still limited [ 41 , 42 ]. As with hepatic surgery, recent high-quality trials have provided new evidence in regard to the implementation of ERAS in pancreatic surgery.…”

Section: Eras In Different Surgical Disciplinesmentioning

confidence: 99%

Current status of enhanced recovery after surgery (ERAS) protocol in gastrointestinal surgery

et al. 2018

Self Cite

View full text Add to dashboard Cite

Enhanced Recovery After Surgery (ERAS) is an evidence-based paradigm shift in perioperative care, proven to lower both recovery time and postoperative complication rates. The role of ERAS in several surgical disciplines was reviewed. In colorectal surgery, ERAS protocol is currently well established as the best care. In gastric surgery, 2014 saw an establishment of ERAS protocol for gastrectomies with resulting meta-analysis showing ERAS effectiveness. ERAS has also been shown to be beneficial in liver surgery with many centers starting implementation. The advantages of ERAS in pancreatic surgery have been strongly established, but there is still a need for large-scale, multicenter randomized trials. Barriers to implementation were analyzed, with recent studies concluding that successful implementation requires a multidisciplinary team, a willingness to change and a clear understanding of the protocol. Additionally, the difficulty in accomplishing necessary compliance to all protocol items calls for new implementation strategies. ERAS success in different patient populations was analyzed, and it was found that in the elderly population, ERAS shortened the length of hospitalization and did not lead to a higher risk of postoperative complications or readmissions. ERAS utilization in the emergency setting is possible and effective; however, certain changes to the protocol may need to be adapted. Therefore, further research is needed. There remains insufficient evidence on whether ERAS actually improves patients’ course in the long term. However, since most centers started to implement ERAS protocol less than 5 years ago, more data are expected.

show abstract

Section: Eras In Different Surgical Disciplinesmentioning

confidence: 99%

Current status of enhanced recovery after surgery (ERAS) protocol in gastrointestinal surgery

et al. 2018

Self Cite

View full text Add to dashboard Cite

show abstract

“…However, this technique cannot be used for tumors in the head of the pancreas (where PPoma is located). The main concern regarding MIPS relies in blood loss, and although alternative, is a traumatic surgery proceeding [ 90 ].…”

Section: Treatmentmentioning

confidence: 99%

PPoma Review: Epidemiology, Aetiopathogenesis, Prognosis and Treatment

Braga

Santos-Oliveira

2018

Diseases

View full text Add to dashboard Cite

Generally, pancreatic polypeptide-secreting tumor of the distal pancreas (PPoma) is classified as a rare tumor, and may occur sporadically or be associated in families or with multiple endocrine neoplasia type 1 (NEM 1). It grows slowly, reaching large dimensions at the time of diagnosis and the symptomatology is fundamentally due to the mass effect, causing either non-specific abdominal pain or symptoms suggestive of obstruction of the pancreatic or biliary duct. Therefore, when detected, they are usually malignant, with metastases mainly in the liver. The combination of serum analysis of increased levels of chromogranin A and pancreatic polypeptide and pancreastatin is very useful with a sensitivity of up to 95%. However, in addition, scintigraphicexams with somatostatin analogues should be performed to better clarify the diagnosis. Surgical resection is the treatment of choice, despite surgical difficulty and because they are generally palliative due to the metastases. Surgeries for tumor volume reduction are also performed to relieve symptoms. Chemotherapy commonly uses streptozotocin and somatostatin analogues to treat residual disease. Unfortunately, the survival rates are still very low, less than 10%, and if metastases already exist, this percentage drops to 3%.

show abstract

“…Despite therapeutic advances, early metastasis and late tumor detection contribute to the extremely poor prognosis of patients with PC [ 16 ]. Hypoxia is a critical factor promoting communication between PC and stromal cells in the tumor microenvironment [ 17 , 18 ].…”

Section: Discussionmentioning

confidence: 99%

Hypoxic pancreatic stellate cell-derived exosomal mirnas promote proliferation and invasion of pancreatic cancer through the PTEN/AKT pathway

Cao

Zeng

et al. 2021

Aging

View full text Add to dashboard Cite

Pancreatic stellate cells (PSCs) are important components of the tumor microenvironment in pancreatic cancer (PC) and contribute to its development and metastasis through mechanisms that remain incompletely characterized. Tumor hypoxia affects the function and behavior of PC and stromal cells, and can alter exosomal content to modify cell-cell communication. The present study explored the effects of exosomal miRNAs produced by hypoxia-preconditioned PSCs on the growth and metastatic potential of PC cells. Subcutaneous xenografts and liver metastasis mouse models revealed increased tumorigenic potential upon co-implantation of PC cells and PSCs as compared to PC cells alone. Screening miRNA profiles of mouse plasma exosomes and cultured PSCs, followed by miRNA overexpression and inhibition assays, enabled us to identify miR-4465 and miR-616-3p as prominent hypoxia-induced, PSC-derived, exosomal miRNAs promoting PC cell proliferation, migration, and invasion. Proteomics analysis of PC cells incubated with exosomes derived from hypoxic PSCs showed significant downregulation of PTEN. Dual-luciferase reporter assays and western blotting showed that both miR-4465 and miR-616-3p target PTEN and activate AKT signaling in PC cells. We conclude that hypoxia upregulates miR-4465 and miR-616-3p expression in PSC-derived exosomes. Following exosome uptake, these miRNAs promote PC progression and metastasis by suppressing the PTEN/AKT pathway.

show abstract

Minimally invasive pancreatic cancer surgery: What is the current evidence?

Cited by 13 publications

References 52 publications

Current status of enhanced recovery after surgery (ERAS) protocol in gastrointestinal surgery

Current status of enhanced recovery after surgery (ERAS) protocol in gastrointestinal surgery

PPoma Review: Epidemiology, Aetiopathogenesis, Prognosis and Treatment

Hypoxic pancreatic stellate cell-derived exosomal mirnas promote proliferation and invasion of pancreatic cancer through the PTEN/AKT pathway

Contact Info

Product

Resources

About