Recurrence patterns of pancreatic cancer after pancreatoduodenectomy: systematic review and a single-centre retrospective study

Kalisvaart, Marit; Broadhurst, D.; Marcon, Francesca; Pandé, Rupaly; Schlegel, Andrea; Sutcliffe, Robert P.; Marudanayagam, R.; Mirza, Darius F.; Chatzizacharias, N.; Abradelo, M.; Muiesan, Paolo; Isaac, John; T., Yuk; McConville, Christopher; Roberts, Keith

doi:10.1016/j.hpb.2020.01.005

Cited by 24 publications

(16 citation statements)

References 47 publications

(68 reference statements)

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“…With the growing research interest in pancreatic cancer, more and more surgeons are realizing the importance of the meso-pancreas [ 33 , 34 , 35 , 36 ], which refers to the complete resection of perineural and lymphatic tissues, in addition to structures surrounding the pancreatic head/uncinate. This approach may decrease the recurrence rate and improve survival due to the complete clearance of the region [ 37 ].…”

Section: Discussionmentioning

confidence: 99%

Stage II Pancreatic Adenocarcinoma after Endovascular Repair of Abdominal Aortic Aneurysm: A Case Report and Literature Review

Zhang

Wang

et al. 2023

JCM

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Backgrounds: Concomitant abdominal aortic aneurysms (AAA) and gastrointestinal malignancies are uncommon. Endovascular repair (EVAR) is widely used to treat AAA. However, no consensus exists on the optimal strategy for treating AAA when associated with pancreatic adenocarcinoma. In addition, only few reports of pancreaticoduodenectomy (PD) after EVAR exist. Presentation of case: A pancreatic tumor was detected during follow-up after EVAR for AAA in an 83-year-old female patient. The diagnosis was high-grade intraepithelial neoplasia. Modified pylorus-preserving pancreaticoduodenectomy was safely performed. The patient recovered moderately and was discharged two weeks after surgery. The pathological diagnosis was middle-grade pancreatic ductal adenocarcinoma. The patient survived for 24 months with no recurrence or cardiovascular complications. Conclusions: Conducting periodic follow-ups after AAA surgery is helpful for the early discovery of gastrointestinal tumors. EVAR surgery is safe and feasible and thus recommended for AAA patients with pancreatic cancer, although it may increase the risk of cancer. The stage of malignancy and post-EVAR medical history can be valuable in evaluating the benefits of pancreatic surgery for such cases.

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Section: Discussionmentioning

confidence: 99%

Stage II Pancreatic Adenocarcinoma after Endovascular Repair of Abdominal Aortic Aneurysm: A Case Report and Literature Review

Zhang

Wang

et al. 2023

JCM

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“…However, An R0 resection is usually difficult to achieve, and local recurrence is related to a positive SMA margin. Kalisvaart et al (18) retrospectively reviewed 23/617 evaluated studies (n=3,815); local recurrence was observed in 7-69% of the studies and the SMA margin (six studies) was positive in 15-35% of the studies. Moreover, local recurrence was more frequently observed with a positive SMA margin (66 vs. 45%; P=0.005).…”

Section: Discussionmentioning

confidence: 99%

Superior mesenteric artery‑first approach for resectable pancreatic head cancer

et al. 2022

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Superior mesenteric artery-first approach has been proposed for the surgical treatment of pancreatic head cancer. However, little is known about its effects on resectable pancreatic head cancer. In the present study, data from patients with resectable pancreatic head cancer, who underwent radical pancreatoduodenectomy with or without the superior mesenteric artery-first approach at from January, 2014 to December, 2019, were retrospectively collected and analyzed. A total of 204 patients were included in the study. The blood loss and blood transfusion of the arterial approach group (n=94) were less than those of the conventional approach group (n=110). Diarrhea occurred in 31 cases (15.2%) of the arterial approach group and in 18 cases (8.8%) of the conventional approach group (P<0.05). A higher rate of R0 resection and a higher number of lymph nodes harvested were achieved in the arterial approach group (P<0.05). The 1-, 2-and 3-year tumor-free survival rates of the patients in the arterial approach group were 60.9, 43.2 and 37.9%, respectively, and those of the patients in the conventional approach group were 64.2, 24.9 and 15.6%, respectively (P<0.05). Moreover, the 1-, 2-, and 3-year overall survival rates of the patients in the arterial approach group were 79.5, 49.7 and 36.7%, and those of the patients in the conventional approach group were and 75.9, 38.6 and 18.7%, respectively (P<0.05). On the whole, the present study demonstrates that the superior mesenteric artery-first approach can reduce intraoperative blood loss and consequent blood transfusion, facilitate the achievement of an R0 resection, and thus prolong the survival of patients, despite resulting in a higher rate of diarrhea.

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“…For pancreatoduodenectomy specimens, it has been suggested that tumour involvement of some resection margins, in particular of the margin facing the superior mesenteric artery, has a stronger negative impact on patient outcome than that of other margins [ 28 , 38 , 40 , 41 ]. A possible explanation for this claim could be that margin involvement is a proxy for tumour invasion of a microanatomic compartment that is particularly rich in blood vessels, lymphatic channels, or nerves, which is the case for the peripancreatic fat facing the superior mesenteric artery [ 42 ].…”

Section: Prognostic Impact Of Resection Margin Status In Distal Pancr...mentioning

confidence: 99%

Prognostic Impact of Resection Margin Status on Distal Pancreatectomy for Ductal Adenocarcinoma

Holm

Verbeke

2022

Current Oncology

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Pancreatic cancer is associated with a poor prognosis. While surgical resection is the only treatment option with curative intent, most patients die of locoregional and/or distant recurrence. The prognostic impact of the resection margin status has received much attention. However, the evidence is almost exclusively related to pancreatoduodenectomies, while corresponding data for distal pancreatectomy specimens are limited. The key data, such as the rate of microscopic margin involvement (“R1”), the site of margin involvement, and the impact of R1 on patient outcome, are divergent between studies and do not currently allow any general conclusions. The main reasons for the variability in the published data are the small size of the study cohorts and their heterogeneity, as well as the marked divergence in pathology examination practices. The latter is a consequence of the lack of concrete guidance, both for grossing and microscopic examination. The increasing administration of neoadjuvant chemo(radio)therapy introduces a further factor of uncertainty as the conventional definition of a tumour-free margin (“R0”) based on 1 mm clearance is inadequate for these specimens. This review discusses the published data regarding the prognostic impact of margin status in distal pancreatectomy specimens along with the challenges and uncertainties that are related to the assessment of the margins.

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Recurrence patterns of pancreatic cancer after pancreatoduodenectomy: systematic review and a single-centre retrospective study

Cited by 24 publications

References 47 publications

Stage II Pancreatic Adenocarcinoma after Endovascular Repair of Abdominal Aortic Aneurysm: A Case Report and Literature Review

Stage II Pancreatic Adenocarcinoma after Endovascular Repair of Abdominal Aortic Aneurysm: A Case Report and Literature Review

Superior mesenteric artery‑first approach for resectable pancreatic head cancer

Prognostic Impact of Resection Margin Status on Distal Pancreatectomy for Ductal Adenocarcinoma

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