Six Hundred Fifty Consecutive Pancreaticoduodenectomies in the 1990s

Yeo, Charles J.; Cameron, John L.; Sohn, Taylor A.; Lillemoe, Keith D.; Pitt, Henry A.; Talamini, Mark A.; Hruban, Ralph H.; Ord, Sarah E.; Sauter, Patricia K.; Coleman, Jo Ann; Zahurak, Marianna; Grochow, Louise B.; Abrams, Ross A.

doi:10.1097/00000658-199709000-00004

Cited by 1,720 publications

(1,338 citation statements)

References 37 publications

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“…About 30% of the patients underwent a palliative resection, a percentage not different from the previous period in this institution and from the literature [1,5,6,10,11]. In a recent series of 650 consecutive resections from Johns Hopkins positive margins were found in 29% of the 282 patients with a pancreatic carcinoma [12]. As shown in Table 3, the postoperative complications, mortality, and hospital stay after palliative resection were no higher than after radical resection.…”

Section: Postoperative Complications and Mortality After Palliative Smentioning

confidence: 59%

Are There Indications for Palliative Resection in Pancreatic Cancer?

et al. 1999

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Section: Postoperative Complications and Mortality After Palliative Smentioning

confidence: 59%

Are There Indications for Palliative Resection in Pancreatic Cancer?

et al. 1999

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“…However, cancer‐free resection margins at the bile duct stump are difficult to achieve because of longitudinal extension, which is one of the prominent characteristics of extrahepatic cholangiocarcinoma 11, 12. Ductal resection margin status is an established prognostic indicator,13, 14 and survival following resection in patients with positive ductal margins has generally been deemed unsatisfactory 10, 15, 16, 17, 18, 19, 20, 21, 22, 23, 24, 25. In 2005, Wakai et al26 reported that invasive carcinoma at the ductal resection margins had a strong adverse effect on survival in patients with extrahepatic cholangiocarcinoma, whereas residual carcinoma in situ did not.…”

Section: Introductionmentioning

confidence: 99%

Surgical management of carcinoma in situ at ductal resection margins in patients with extrahepatic cholangiocarcinoma

Wakai

Sakata

Katada

et al. 2018

Annals of Gastroent Surgery

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Recent advances in dimensional imaging, surgical technique, and perioperative patient care have resulted in increased rates of complete resection with histopathologically negative margins and improved surgical outcomes in patients with extrahepatic cholangiocarcinoma. However, achieving cancer‐free resection margins at ductal stumps in surgery for this disease remains challenging because of longitudinal extension, which is one of the hallmarks of extrahepatic cholangiocarcinoma. When the ductal resection margins are shown to be positive on examination of frozen sections, discrimination between carcinoma in situ and invasive carcinoma is clinically important because residual carcinoma in situ may lead to late local recurrence whereas residual invasive carcinoma is associated with early local recurrence. Residual invasive carcinoma at the ductal margins should be avoided whenever technically feasible. Residual “carcinoma in situ” at the ductal margins appears to be allowed in resection for the advanced disease because it has less effect on survival than other adverse prognostic factors (pN1 and/ or pM1). However, in surgery for early‐stage (pTis‐2N0M0) extrahepatic cholangiocarcinoma, residual carcinoma in situ at the ductal margins may have an adverse effect on long‐term survival, so should be avoided whenever possible. In this review, we focus on the histopathological term “carcinoma in situ,” the biological behavior of residual carcinoma in situ at ductal resection margins, intraoperative histological examination of the ductal resection margins, outcome of additional resection for positive ductal margins, and adjuvant therapy for patients with positive margins.

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“…However, many patients with pancreatic cancer present with advanced disease due to early lymphatic and hematogenous spread and the tendency toward infiltrative growth; therefore, only 10 -30% of pancreatic cancers are considered to be resectable at the time of diagnosis (4,6 -9). Pancreaticoduodenectomy, even with an expert surgeon's hands, carries a 5% mortality and postoperative morbidity approaching 50% (2,5,7,9). Therefore, early diagnosis and an accurate assessment of tumor resectability are an essential step in the treatment planning so that unnecessary surgical procedures can be avoided (8,10 -15).…”

mentioning

confidence: 99%

Preoperative evaluation of pancreatic cancer: Comparison of gadolinium‐enhanced dynamic MRI with MR cholangiopancreatography versus MDCT

Park

Lee

Choi

et al. 2009

Magnetic Resonance Imaging

138

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Purpose:To determine the accuracy of magnetic resonance imaging (MRI) including dynamic imaging using three-dimensional gradient-echo (3D-GRE) sequences and MR cholangiopancreatograpy (MRCP) compared with that of multidetector row CT (MDCT) with regard to resectability in pancreas cancer. Materials and Methods:From February 2004 to July 2008, 54 patients (32 men, 22 women: age range, 28 -83 years; mean age, 63.1 years old) with surgically proven pancreatic carcinoma, who had undergone preoperative gadolinium-enhanced 3D-GRE MRI with MRCP and triplephase MDCT, were included in this retrospective study. Two, clinically experienced attending radiologists independently reviewed the two image sets. These readers evaluated the tumor conspicuity, presence of vascular invasion, choledochal and duodenal invasion, lymph node metastases, distant metastasis, and tumor resectability. The results were compared with the surgical and histopathologic findings using receiver operating characteristic analysis (Az) and kappa statistics. Results:Curative resections were performed on 42 patients. Regarding the tumor conspicuity, MRI had a significantly higher Az value compared with MDCT according to both reviewers (P Ͻ 0.05). The accuracy of resectability was Az ϭ 0.753 and 0.768 on MRI and Az ϭ 0.829 and 0.762 on MDCT for each reviewer, and the difference in the accuracy of resectability was not significant between MRI and MDCT for either reviewer (P Ͼ 0.05). Two imaging sets showed a similar diagnostic performance in the evaluation of vascular involvement, lymph node metastasis, and distant metastasis.Conclusion: Dynamic 3D-GRE MRI with MRCP shows superior tumor conspicuity and similar diagnostic performance compared with MDCT in evaluating the resectability of pancreatic cancer.

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Six Hundred Fifty Consecutive Pancreaticoduodenectomies in the 1990s

Abstract: This single institution, high-volume experience indicates that pancreaticoduodenectomy can be performed safely for a variety of malignant and benign disorders of the pancreas and periampullary region. Overall survival is determined largely by the pathology within the resection specimen.

Cited by 1,720 publications

References 37 publications

Are There Indications for Palliative Resection in Pancreatic Cancer?

Are There Indications for Palliative Resection in Pancreatic Cancer?

Surgical management of carcinoma in situ at ductal resection margins in patients with extrahepatic cholangiocarcinoma

Preoperative evaluation of pancreatic cancer: Comparison of gadolinium‐enhanced dynamic MRI with MR cholangiopancreatography versus MDCT

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