Pancreatectomy with resection and reconstruction of the superior mesenteric artery

Boggi, Ugo; Napoli, Niccolò; Kauffmann, Emanuele Federico; Iacopi, Sara; Ginesini, Michael; Gianfaldoni, Cesare; Campani, Daniela; Amorese, G; Vistoli, Fabio

doi:10.1093/bjs/znac363

Cited by 9 publications

(5 citation statements)

References 20 publications

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“…The REDISCOVER guidelines permit the prudent pursuit of arterial resections in highly selected patients (showing involvement of the celiac trunk and/or hepatic artery, but not of the superior mesenteric artery), operated upon by skilled pancreatic surgeons in centers of excellence, provided that a multidisciplinary tumor board decides to proceed with surgery and that the results are documented in a prospective database, and from now in the registry This is based on some pilot studies that demonstrate improved outcomes. 35,36,50,51 Reviews of the literature and meeting discussions brought to light a few shortcomings in the BR-PDAC and LA-PDAC definitions as they stand. First, there is just 1 category of LA-PDAC (anatomic) compared to 3 categories of BR-PDAC (A-B-C: anatomic, biological, and conditional).…”

Section: Discussionmentioning

confidence: 99%

“…Resection of BR-PDAC and, especially of LA-PDAC, requires the pancreatic surgeon to have the extra technical skill not usually encountered in routine pancreatic resections. The planning of the procedure based on imaging after neoadjuvant treatments, 34 safe vascular control, 35 portal hypertension management, 36 preservation of blood supply to essential organs, 35 workflow adaptation to patient’s anatomy, 35 and patient management both before and after surgery 35 are some of these specific technical challenges. Thus, a comprehensive reevaluation of the professional profile of pancreatic surgeons is necessary.…”

Section: Discussionmentioning

confidence: 99%

“…Unanticipated arterial resection accounts for some of these pancreatectomies performed beyond the current guidelines, further underscoring the need for careful patient selection and inclusion in the registry. The REDISCOVER guidelines permit the prudent pursuit of arterial resections in highly selected patients (showing involvement of the celiac trunk and/or hepatic artery, but not of the superior mesenteric artery), operated upon by skilled pancreatic surgeons in centers of excellence, provided that a multidisciplinary tumor board decides to proceed with surgery and that the results are documented in a prospective database, and from now in the registry This is based on some pilot studies that demonstrate improved outcomes 35,36,50,51 …”

Section: Discussionmentioning

confidence: 99%

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REDISCOVER International Guidelines on the Perioperative Care of Surgical Patients With Borderline-resectable and Locally Advanced Pancreatic Cancer

Boggi,

Kauffmann,

Napoli

et al. 2024

Annals of Surgery

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Objective: The REDISCOVER consensus conference aimed at developing and validate guidelines on the perioperative care of patients with borderline resectable (BR-) and locally advanced (LA) pancreatic ductal adenocarcinoma (PDAC). Summary Background Data: Coupled with improvements in chemotherapy and radiation, the contemporary approach to pancreatic surgery supports resection of BR-PDAC and, to a lesser extent, LA-PDAC. Guidelines outlining the selection and perioperative care for these patients are lacking. Methods: The Scottish Intercollegiate Guidelines Network (SIGN) methodology was used to develop the REDISCOVER guidelines and create recommendations. The Delphi approach was used to reach consensus (agreement ≥80%) among experts. Recommendations were approved after a debate and vote among international experts in pancreatic surgery and pancreatic cancer management. A Validation Committee used the AGREE II-GRS tool to assess the methodological quality of the guidelines. Moreover, an independent multidisciplinary advisory group revised the statements to ensure adherence to non-surgical guidelines. Results: Overall, 34 recommendations were created targeting centralization, training, staging, patient selection for surgery, possibility of surgery in uncommon scenarios, timing of surgery, avoidance of vascular reconstruction, details of vascular resection/reconstruction, arterial divestment, frozen section histology of perivascular tissue, extent of lymphadenectomy, anticoagulation prophylaxis and role of minimally invasive surgery. The level of evidence was however low for 29 of 34 clinical questions. Participants agreed that the most conducive mean to promptly advance our understanding in this field is to establish an international registry addressing this patient population (https://rediscover.unipi.it/) Conclusions: The REDISCOVER guidelines provide clinical recommendations pertaining to pancreatectomy with vascular resection for patients with BR- and LA-PDAC, and serve as the basis of a new international registry for this patient population.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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REDISCOVER International Guidelines on the Perioperative Care of Surgical Patients With Borderline-resectable and Locally Advanced Pancreatic Cancer

Boggi,

Kauffmann,

Napoli

et al. 2024

Annals of Surgery

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“…Published experiences in this procedure for RPSs are mostly based on single case reports or small patient series. The strongest experience comes from surgery for pancreas cancer, reporting major perioperative morbidity of 28%, and 90-day postoperative mortality of 15% [ 41 , 42 ].…”

Section: Areas Of Doom—a Possible Role For Autotransplantation In Rpss?mentioning

confidence: 99%

Complex Vascular Resections for Retroperitoneal Soft Tissue Sarcoma

et al. 2023

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Retroperitoneal sarcomas (RPSs) are locally aggressive tumors that can compromise major vessels of the retroperitoneum including the inferior vena cava, aorta, or main tributary vessels. Vascular involvement can be secondary to the tumor’s infiltrating growth pattern or primary vascular origin. Surgery is still the mainstay for curing this disease, and resection of RPSs may include major vascular resections to secure adequate oncologic results. Our improved knowledge in the tumor biology of RPSs, in conjunction with the growing surgical expertise in both sarcoma and vascular surgical techniques, has allowed for major vascular reconstructions within multi-visceral resections for RPSs with good perioperative results. This complex surgical approach may include the combined work of various surgical subspecialties.

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“…Our group pioneered open PD-VR, with the first procedures performed more than 40 years ago. We reported on open PD-VR, 13 robotic PD-VR, 12 , 14 pancreatectomy with arterial resection, 15 , 16 pancreatectomy with resection of the superior mesenteric artery, 17 and robotic PD with arterial resection. 18 Herein, we provide a propensity score-matched analysis of robotic versus open PD-VR.…”

Section: Introductionmentioning

confidence: 99%

Robotic Versus Open Pancreatoduodenectomy With Vein Resection and Reconstruction: A Propensity Score-Matched Analysis

Napoli,

Kauffmann,

Ginesini

et al. 2024

Annals of Surgery Open

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Objective: This study aimed to compare robotic pancreatoduodenectomy with vein resection (PD-VR) based on the incidence of severe postoperative complications (SPC). Background: Robotic pancreatoduodenectomy has been gaining momentum in recent years. Vein resection is frequently required in this operation, but no study has compared robotic and open PD-VR using a matched analysis. Methods: This was an intention-to-treat study designed to demonstrate the noninferiority of robotic to open PD-VR (2011–2021) based on SPC. To achieve a power of 80% (noninferiority margin:10%; α error: 0.05; ß error: 0.20), a 1:1 propensity score-matched analysis required 35 pairs. Results: Of the 151 patients with PD-VR (open = 115, robotic = 36), 35 procedures per group were compared. Elective conversion to open surgery was required in 1 patient with robotic PD-VR (2.9%). One patient in both groups experienced partial vein thrombosis. SPC occurred in 7 (20.0%) and 6 patients (17.1%) in the robotic and open PD-VR groups, respectively (P = 0.759; OR: 1.21 [0.36–4.04]). Three patients died after robotic PD-VR (8.6%) and none died after open PD-VR (P = 0.239). Robotic PD-VR was associated with longer operative time (611.1 ± 13.9 minutes vs 529.0 ± 13.0 minutes; P < 0.0001), more type 2 vein resection (28.6% vs 5.7%; P = 0.0234) and less type 3 vein resection (31.4% vs 71.4%; P = 0.0008), longer vein occlusion time (30 [25.3–78.3] minutes vs 15 [8–19.5] minutes; P = 0.0098), less blood loss (450 [200–750] mL vs 733 [500–1070.3] mL; P = 0.0075), and fewer blood transfusions (intraoperative: 14.3% vs 48.6%; P = 0.0041) (perioperative: 14.3% vs 60.0%; P = 0.0001). Conclusions: In this study, robotic PD-VR was noninferior to open PD-VR for SPC. Robotic and open PD-VR need to be compared in randomized controlled trials.

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Pancreatectomy with resection and reconstruction of the superior mesenteric artery

Cited by 9 publications

References 20 publications

REDISCOVER International Guidelines on the Perioperative Care of Surgical Patients With Borderline-resectable and Locally Advanced Pancreatic Cancer

REDISCOVER International Guidelines on the Perioperative Care of Surgical Patients With Borderline-resectable and Locally Advanced Pancreatic Cancer

Complex Vascular Resections for Retroperitoneal Soft Tissue Sarcoma

Robotic Versus Open Pancreatoduodenectomy With Vein Resection and Reconstruction: A Propensity Score-Matched Analysis

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