Selective Radical Resection for Unresectable Pancreatic Cancer

Changku Jia,Hanzhang Zhu,Ling Liu,Chunfeng Yang,Weimin Shen

doi:10.51441/biomedica/5-88

Changku Jia, Hanzhang Zhu + Show 3 more

Open Access

https://doi.org/10.51441/biomedica/5-88

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Abstract

Background and Objective: For inefficiency of chemotherapy and radiation against pancreatic cancer, resection rate for primary unresectable pancreatic cancer remains very low. This study was carried out to evaluate the safety and value of radical resection for unresectable pancreatic cancer (UPC). Methods: Clinical data were analyzed retrospectively. In unresectable group, 360° resection of the involved artery sheath, resection and reconstruction of the involved artery, resection and reconstruction of the involved vein as well as resection and reconstruction of combined organs were performed. Operation time, intraoperative blood loss, ICU transitional treatment, pancreatic fistula, bleeding, reoperation and survival time were analyzed for two groups. Results: Operation time and intraoperative blood loss were greatly increased in the unresectable group. The incidence of intractable diarrhea and abdominal hemorrhage in the unresectable group were higher. However, the rate of ICU transitional therapy, delayed gastric emptying and reoperation were lower. Grade-C pancreatic fistula occurred in neither group. Conclusion: Surgical treatment through stringent selection for patients with unresectable pancreatic cancer is a safer technique and median post-operative survival time is similar to patients with resectable pancreatic cancer.

Highlights

Because pancreas is closely related to the blood vessel and pancreatic cancer grows infiltratively, it is prone to invade portal vein, superior mesenteric vein (SMV) and superior mesenteric artery (SMA) that makes its surgical resection more difficult
If (1) superior mesenteric artery is encapsulated by the tumor more than 180° and the tumor is close to celiac artery trunk; or if (2) superior mesenteric vein or portal vein is involved
Inclusion criteria were the patients being diagnosed as pancreatic cancer before operation through enhanced CT and/or enhanced MRI, together with tumor markers; no distant metastasis; with resectable tumor according to preoperative imaging and intraoperative judgment, vascular invasion and possible arterial sheath resection or vascular segmental resection and reconstruction

Summary

Introduction

Patients with pancreatic cancer generally have poor prognoses.[1,2] Because pancreas is closely related to the blood vessel and pancreatic cancer grows infiltratively, it is prone to invade portal vein, superior mesenteric vein (SMV) and superior mesenteric artery (SMA) that makes its surgical resection more difficult. To make resection or reconstruction impossible; for pancreatic carcinoma of body and tail, if (1) superior mesenteric artery or celiac artery trunk is encapsulated more than 180°; or if (2) superior mesenteric vein and portal vein is involved to make resection or reconstruction impossible, the tumor is considered to be unresectable.[3,4] in addition to preoperative imaging evaluation, the resectability of pancreatic cancer is closely related to the experience and ability of surgeons.[5,6] There is no identical standard for clinical application in unresectable pancreatic cancer.[7,8] We selectively carried out radical surgery upon some patients with unresectable pancreatic cancer and explored its safety and significance compared with the surgery for resectable pancreatic cancer. This study was carried out to evaluate the safety and value of radical resection for unresectable pancreatic cancer (UPC)

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