Periadventitial dissection of the superior mesenteric artery for locally advanced pancreatic cancer: Surgical planning with the “halo sign” and “string sign”

Kinny‐Köster, Benedict; Oosten, Floortje van; Javed, Ammar A.; Cameron, John L.; Lafaro, Kelly J.; Burkhart, Richard A.; Burns, William R.; He, Jin; Thompson, Elizabeth D.; Fishman, Elliot K.; Wolfgang, Christopher L.

doi:10.1016/j.surg.2020.08.031

Cited by 41 publications

(30 citation statements)

References 25 publications

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“…These procedures were proposed to acquire complete tumor resection and to preserve the tumor-encasing major arteries. [3–5] Here we reported our very first surgical experience of sub-adventitial divestment technique. Together with other reported cohorts, the superiority of histological tumor invasion to radiographic encasement in ai-PC resectability evaluation was then emphasized.…”

Section: Discussionmentioning

confidence: 99%

Artery encasement on preoperative CT scan does not preclude radical surgery: a case report utilizing sub-adventitial divestment for artery-involving pancreatic cancer

Cai

Miao

2022

Journal of Pancreatology

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Pancreatic cancer was most lethal malignancy and artery involvement was the most common clinic scenario that hindered radical resection for non-metastatic lesions. While artery resection and reconstruction combined pancreatectomies were significantly complicated, artery-sparing techniques were of interest. A patient was reported with pancreatic cancer encasing major abdominal arteries. Sub-adventitial divestment technique was performed to achieve curative-intend resection, indicating that artery encasement did not preclude radical surgery. Surgical maneuver as well as the rationale of this technique were presented and discussed in detail. In conclusion, technical resectability of artery-involving pancreatic cancer was determined by invasion depth of the lesion to tumor rather than the involving circumference. Surgical innovations were to increase the chance of curative resection.

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Section: Discussionmentioning

confidence: 99%

Artery encasement on preoperative CT scan does not preclude radical surgery: a case report utilizing sub-adventitial divestment for artery-involving pancreatic cancer

Cai

Miao

2022

Journal of Pancreatology

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“…Therefore it is imperative that patient selection should be based not only on the feasibility of a successful oncological resection, but also on tumor biology. Currently, limited tools are available to predict patient's specific tumor biology (12,13).…”

Section: Review Articlementioning

confidence: 99%

Favorable tumor biology in locally advanced pancreatic cancer—beyond CA19-9

Kinny‐Köster¹,

Wolfgang²,

He³

et al. 2021

J Gastrointest Oncol

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Patients with pancreatic ductal adenocarcinoma (PDAC) are frequently staged as unresectable locally advanced pancreatic cancer (LAPC) at the time of diagnosis. Recently, the administration of multi-agent induction chemotherapy has resulted in treatment response in up to 60% of these patients rendering their tumors technically resectable. Operative strategies have evolved to allow for successful oncologic resection of LAPC. These technically complex procedures involving vascular resections and reconstructions are now being performed with increasing safety at high-volume centers. However, even after induction therapy and successful resection, disease recurrence sometimes occurs early on, limiting the benefit of resecting the local tumor.Therefore, selection of surgical candidates should factor in each patient's tumor biology which could result in accurate treatment guidance to improve patient outcomes while avoiding overtreatment. Well-informed patient selection is critical to improve outcomes in LAPC. Multidisciplinary teams have to determine the appropriate care for LAPC patients at the time of reevaluation after administration of induction chemotherapy. At this point the concept of favorable vs. unfavorable tumor biology becomes highly relevant and having access to biomarkers that are predictive of tumor behavior are of paramount importance. Currently, CA19-9 remains the only clinically utilized biomarker for PDAC, however, its use is limited by factors discussed in this review.While CA19-9 holds value in patient assessment, additional biomarkers are required that could supplement and improve the current ability to classify tumor biology and predict behavior in individual patients. Recent investigations on the use of circulating tumor DNA (ctDNA) and circulating tumor cells (CTCs) using liquid biopsies, as well as patient-derived organoids to characterize tumor biology have shown promise in achieving precise tumor biology-based patient stratification. Serial assessment of these biomarkers throughout therapy could supplement or even replace the anatomic criteria for resectability in the future.

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“…Survival and perioperative outcomes of patients undergoing vein resection during pancreatectomy are similar to patients undergoing standard pancreatectomy. Porto-mesenteric vein resection has been accepted as a standard of care in surgery for BRPC [ 70 , 84 ]. Tumour encasement resulting in complete collateralisation and cavernous transformation of porto-mesenteric vein complex and absence of reconstructible venous stumps are the only venous criteria for inoperability [ 85 ].…”

Section: Introductionmentioning

confidence: 99%

Systemic therapy in pancreatic ductal adenocarcinomas (PDACs)—basis and current status

Ramaswamy¹,

Srinivas²,

Chaudhari³

et al. 2022

ecancer

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A major shift in the approach to the management of pancreatic ductal adenocarcinomas (PDACs) has been the recognition of the systemic nature of the disease even in clinically and radiologically limited disease stages. The recalcitrant nature of PDAC is intrinsically related to the lack of therapeutic targets and dense surrounding stroma that limits the activity of currently available chemotherapeutic options. However, research is increasingly focusing on intensifying systemic management options in PDAC, resulting in gradual improvements in survival. Currently effective chemotherapeutic regimens like modified 5-fluorouracil-leucovorin-irinotecan-oxaliplatin and gemcitabine-nab-paclitaxel have improved outcomes in resectable and advanced PDAC. An increasing use of these regimens has also resulted in greater conversion of borderline resectable and locally advanced cancers to resection, though the most effective approach in this subgroup is yet to be identified. The current review presents an outline of the basic systemic nature of PDAC and current options of systemic therapy, predominantly chemotherapy .

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Periadventitial dissection of the superior mesenteric artery for locally advanced pancreatic cancer: Surgical planning with the “halo sign” and “string sign”

Cited by 41 publications

References 25 publications

Artery encasement on preoperative CT scan does not preclude radical surgery: a case report utilizing sub-adventitial divestment for artery-involving pancreatic cancer

Artery encasement on preoperative CT scan does not preclude radical surgery: a case report utilizing sub-adventitial divestment for artery-involving pancreatic cancer

Favorable tumor biology in locally advanced pancreatic cancer—beyond CA19-9

Systemic therapy in pancreatic ductal adenocarcinomas (PDACs)—basis and current status

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