State-of-the-art surgery for pancreatic cancer

Nießen, Anna; Hackert, Thilo

doi:10.1007/s00423-021-02362-y

Cited by 12 publications

(13 citation statements)

References 55 publications

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“…Therefore, a formal pancreatic resection including lymphadenectomy may not be obligatory in many cases. Contrary, highly suspected malignancy (i.e., PDAC) is a contraindication to perform CP 22 . In our study, postoperative histopathology revealed PDAC in one patient.…”

Section: Discussioncontrasting

confidence: 48%

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Central pancreatectomy prevents postoperative diabetes

Klotz

Schilling

Kuner

et al. 2022

J Hepato Biliary Pancreat

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Background: Central pancreatectomy (CP) can be performed as an alternative surgical approach to distal pancreatectomy (DP) in the treatment of benign or low-grade malignant lesions located in the neck and body of the pancreas, aiming to reduce loss of parenchyma and therefore organ failure. The objective of this study was to evaluate the short-and long-term outcome of CP in comparison to DP. Methods: Patients who received CP in a large tertiary care pancreatic surgery center between 2001 and 2020 were identified from a prospectively maintained database and compared via propensity score matching with patients receiving DP during the same time period. Perioperative rate of complications and long-term outcome of pancreatic endocrine and exocrine function were evaluated. Results: One hundred and seven patients undergoing open CP were compared to 107 patients with open DP. No significant difference in rates or severity of most surgical complications could be found including postoperative pancreatic fistula, intraabdominal fluid collection, delayed gastric emptying and wound infection.However, patients receiving CP had a significantly higher risk of grade C postpancreatectomy hemorrhage (PPH) (CP: 10 patients, 9.3% versus DP: 1 patient, 0.9%; p = .0019). Perioperative mortality was comparable. Long-term follow-up of 60 matched pairs revealed significantly less patients with new-onset diabetes after CP (eight patients, 13.3%) compared to DP (22 patients, 36.7%, p = .0056). Conclusion:CP offers an improved endocrine long-term outcome at the expense of a higher risk of PPH without increased perioperative mortality. As evidence on this parenchyma sparing surgical technique is sparse, more prospective data are needed.

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Section: Discussioncontrasting

confidence: 48%

“…Contrary, highly suspected malignancy (i.e., PDAC) is a contraindication to perform CP. 22 In our study, postoperative histopathology revealed PDAC in one patient. Upon patient request no revision surgery was performed and adjuvant therapy was started.…”

Section: Discussionsupporting

confidence: 47%

Central pancreatectomy prevents postoperative diabetes

Klotz

Schilling

Kuner

et al. 2022

J Hepato Biliary Pancreat

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“…The large-scale use of MIPS for PDAC also remains controversial for now, due to a lack of literature on the long-term outcomes. 91 , 93 , 101 …”

Section: Role Of Minimally-invasive Pancreatic Surgery In the Treatme...mentioning

confidence: 99%

Surgical Treatment of Pancreatic Cancer: Currently Debated Topics on Vascular Resection

Pedrazzoli

2023

Cancer Control

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Vascular resections involving the superior mesenteric and portal veins (SMV-PV), celiac axis (CA), superior mesenteric artery (SMA) and hepatic artery (HA) have multiplied in recent years, raising the resection rate for pancreatic cancer (PDAC) and the related morbidity and mortality rates. While resection is generally accepted for resectable SMV-PV, the usefulness of associated arterial resection in borderline resectable (BRPC) and locally-advanced PDAC (LAPC) is much debated. Careful selection of splenic vein reconstruction is very important to prevent left-sided portal hypertension (LSPH). During distal pancreatectomy (DP), CA and common HA resection is largely accepted, while there is debate on the value of SMA and proper HA resection and reconstruction. Their resection is useless according to several reviews and meta-analyses, and some international societies, although some high-volume centers have reported good results. Short- and long-term reconstructed vessel patency varies with the type of reconstruction, the material used, and the surgeon’s experience. Laparoscopic and robotic pancreaticoduodenectomy and DP are generally accepted if done by surgeons performing at least 10 such procedures annually. The usefulness of associated vascular resection remains highly controversial. Surgeons need to complete numerous minimally-invasive procedures to overcome the learning curve, and prevent an increase in complications and surgical mortality. Higher resectability rates and satisfactory long-term results have been reported after neoadjuvant therapy (NAT) for BRPC and LAPC requiring vascular resection. It is essential to select the most appropriate NAT for a given patient and to assess PDAC resectability preoperatively.

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“…The RFA procedure is an electrocautery-based technique that results in tissue necrosis. It has been used widely for managing unresectable primary as well as secondary liver cancer, where it has been previously reported by Nießen et al [ 8 ]. The local recurrence was primarily dependent on tumor size.…”

Section: Introductionmentioning

confidence: 99%

Impact of endoscopic ultrasound-guided radiofrequency ablation in managing pancreatic malignancy

Lesmana¹

2023

World J Gastrointest Surg

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Pancreatic malignancy is still the most lethal gastrointestinal malignancy. It has a very poor prognosis with low survival rate. Surgery is still the main treatment option for pancreatic malignancy. Most patients already have locally advanced and even late stage disease due to non-specific abdominal symptoms. Even though some cases are still suitable for surgical treatment, due to its aggressiveness adjuvant chemotherapy is becoming the standard treatment for controlling the disease. Radiofrequency ablation (RFA) is a thermal therapy that has been used as one of the standard treatments for liver malignancy. It can also be performed intraoperatively. There are several reports on percutaneous RFA treatment for pancreatic malignancy using transabdominal ultrasound and guided by computed tomography scan. However, due to its anatomical location and the risk of high radiation exposure, these methods seem to be very limited. Endoscopic ultrasound (EUS) has been widely used for pancreatic abnormality evaluation due to its ability to detect more accurately, especially small pancreatic lesions, compared to other imaging modalities. By the EUS approach, it is easier to achieve good visualization of tumor ablation and necrosis as the echoendoscope position is closer to the tumor area. Based on studies and a recent meta-analysis, EUS-guided RFA is a promising treatment approach for most pancreatic malignancy cases, but most studies only collected data from a small sample size. Larger studies are needed before clinical recommendations can be made.

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State-of-the-art surgery for pancreatic cancer

Cited by 12 publications

References 55 publications

Central pancreatectomy prevents postoperative diabetes

Central pancreatectomy prevents postoperative diabetes

Surgical Treatment of Pancreatic Cancer: Currently Debated Topics on Vascular Resection

Impact of endoscopic ultrasound-guided radiofrequency ablation in managing pancreatic malignancy

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