Resection For Pancreatic Head Carcinoma Research Articles

Impact of Different Surgical Approaches on Morbidity and Mortality in Patients with Borderline Resectable Pancreatic Head Carcinoma.

Radical surgical resection for pancreatic head carcinoma offers a chance for cure but unfortunately is only available to a limited number of patients. For a significant number of patients, palliative surgery remains the only option. The question of the most effective approach for patients with borderline resectable pancreatic head carcinoma (BRPHC) remains unresolved. Objective: The aim of the study was to compare the morbidity and mortality following R1 duodenocephalic pancreatectomy and double palliative bypass to explore the most optimal surgical treatment for patients with BRPHC. Our retrospective cohort study included 64 patients with BRPHC who underwent surgery from 2012 to 2019, with postoperative follow-up for three years. Morbidity and mortality parameters were examined based on the type of surgical treatment: R1 duodenocephalic pancreatectomy or palliative double bypass. Chi-square test, univariate regression, and Kaplan-Meier analysis were used as basic statistical methods in the analysis of the results. Patients undergoing R1 duodenocephalic pancreatectomy had a 3.69 times higher risk of developing biliary leak (p=0.039; 95%CI:1.066, 1.181) and shorter survival compared to those undergoing palliative double bypass (p=0.022). No statistically significant association was found between the type of surgical procedure and other postoperative complications. Our study suggests that the double palliative bypass procedure may be a better option than R1 resection for patients with BRPHC.

Optimized Drainage of Pancreatic-Digestive Anastomosis in Patients with Pancreatoduodenal Resection

Summary The study compared early post-surgical complications between two groups of patients with pancreatoduodenal resection for pancreatic head carcinoma: patients with pancreatic-gastric anastomosis with mixed drainage and controls with pancreatic jejunal anastomosis with external drainage. The present study was a cohort study. The patient group was selected prospectively, and the control group – retrospectively. Patients were randomized by sex, age, primary tumor location, pancreatic parenchyma density, clinical symptoms, tumor–node–metastasis (TNM), and grade (G). We used the IBM SPSS Statistics software with the following tests: Fisher’s exact test, Pearson’s chi-squared test, Mann–Whitney U test. The optimized reconstruction approach with mixed drainage reduced early complications: early mortality - by 2.5%, overall morbidity - by 7.5%; pancreatic-digestive anastomosis insufficiency - by 2.5%; intra-abdominal bleeding - by 2.5%; intra-abdominal infection - by 2.5%; gastroparesis - by 5.0%; wound infection - by 2.5%; biliary leakage -by 2.5%. There were no cases of clinically significant pancreatic fistula. The control group was associated with an average of 9-fold higher relative risk of early complications. The passage was restored between the 4th and 7th day. Patients had a shorter average hospital stay (11 days) compared to controls (22 days). Digestive anastomoses reconstruction on a single loop and mixed intraluminal drainage through a modified nasogastric tube led to a 7-fold reduction in early post-surgical complications and a 2-fold shorter hospital stay.

Successful radical resection of pancreatic head carcinoma in a patient with replaced right hepatic artery originating from posterior inferior pancreaticoduodenal artery: a case report

Anatomical variations of hepatic arteries may be problematic in pancreaticoduodenectomy (PD). We experienced pancreatic head cancer in a patient with rare variation of hepatic artery and performed PD successfully with the resection of this artery. A 75-year-old woman showed pancreatic head tumor on CT. Preoperative CT detected rare variation of hepatic artery; posterior segmental branch of right hepatic artery (RHA-PB) originating from posterior inferior pancreaticoduodenal artery. The image also demonstrated that there was a junction between RHA-PB and anterior branch of right hepatic artery (RHA-AB). We performed PD for suspected pancreatic head cancer. We divided RHA-PB for complete resection of cancer because we preoperatively knew that there was the junction between RHA-PB and RHA-AB. She was discharged uneventfully, and there was no evidence of local recurrence throughout the whole course. Careful preoperative assessment of hepatic blood supply is the key to perform successful PD even in this troublesome situation.

R0 resection of pancreatic head carcinoma: Definition of surgical margins and influencing factors

R0 resection of pancreatic head carcinoma: Definition of surgical margins and influencing factors

Extent and disputes about radical resection for pancreatic head carcinoma

Pancreatic carcinoma is a high malignancy, as radical resection is the only cure for long-term survival. In an attempt to improve outcomes and prognosis, surgeons over the decades have employed various active surgical strategies to combat this disease. Through document analyses of radical pancreaticoduodenectomy for pancreatic head carcinoma, regional lymphadenectomy, retroperitoneal nerve dissection, and combined vessel resection, the extent and disputes about radical resection for pancreatic head carcinoma are investigated. Total mesopancreas excision appears to be a novel and promising surgical procedure for the improvement of prognosis of patients with pancreatic head carcinoma. However, further studies based on the data of larger number of patients are mandatory to raise the evidence for this surgical procedure. Key words: Pancreatic neoplasms; Radical resection; Total mesopancreas excision

Gallbladder abnormalities in carcinoma of pancreatic head: findings on MR imaging

Our objective is to study the gallbladder abnormalities on MR images associated with carcinoma of the pancreatic head. Thirty-six patients who had surgical resection of pancreatic head carcinoma were retrospectively analyzed regarding the appearance of the tumor and gallbladder on MR imaging performed within one month before surgery. The changes of the gallbladder wall, and the dimension of the gallbladder, cystic duct, pericholecystic region, and common bile duct (CBD) on MR imaging were noted. About 92% (33/36) of patients had at least one gallbladder abnormality on MR imaging, including thickened gallbladder wall (58%), gallbladder wall striation (19%), gallbladder wall severe enhancement (44%), enlarged gallbladder (33%), gallbladder stone (19%), dilatation of cystic duct (67%), focally increased liver parenchymal enhancement adjacent to the gallbladder (19%), and pericholecystic fluid (11%). 64% of patients had dilated CBD. The diameter of the cystic duct was correlated with those of the CBD (r = 0.45, P < 0.01) and gallbladder (r = 0.56, P < 0.0001). Enlarged gallbladder, dilatation of the cystic duct, and CBD were correlated with chronic cholecystitis. Most patients with pancreatic head carcinoma show gallbladder abnormalities on MR imaging. Cystic duct dilatation follows CBD dilatation and is the primary cause for dilated gallbladder and chronic cholecystitis in carcinoma of pancreatic head.

Postoperative adjuvant gemcitabine and concurrent radiation after curative resection of pancreatic head carcinoma: a phase II study

Purpose: The addition of radiation to adjuvant 5-fluorouracil for the treatment of pancreatic cancer has not yet shown any definite benefit. Gemcitabine (GEM) has potential activity in advanced pancreatic cancer and is a powerful radiosensitizer. We evaluated the feasibility of postoperative administration of GEM alone, followed by concurrent GEM and irradiation (RT) after curative resection for pancreatic adenocarcinoma. Methods and materials GEM 1000 mg/m 2 on Days 1 and 8 every 21 days for three courses was given within 8 weeks after surgery and was followed by GEM 300 mg/m 2 weekly +40 Gy in a split course. Twenty-two patients (median age 59 years, range 39–74, Performance Status 0–1) with Stage II and III curatively resected pancreatic head adenocarcinoma were included. Results For GEM alone, all patients received the three planned courses, with dose reductions in 7 (32%) of 22 patients. All patients, except two, completed full chemoradiation; one received only 20 Gy because of both World Health Organization Grade 4 vomiting and thrombopenia and the other stopped RT after 32 Gy because of early disease progression. No reduction in GEM during RT was necessary; no toxic death was noted; and World Health Organization Grade 3–4 hematologic and nonhematologic toxicities occurred in 8 (36%) and 7 (nausea, vomiting) (32%) of 22 patients respectively. No late toxicity developed. After a median follow-up of 15 months, 11 patients were alive, and 2 patients had died of causes unrelated to their disease or toxicity, The median disease-free survival and overall survival was 6 and 15 months, respectively. Conclusion This adjuvant regimen was well tolerated and can be easily administered after curative surgery for pancreatic cancer. Its intensification with continuous RT is currently being investigated.

Ductal adenocarcinoma of the body and tail of the pancreas

Background: Carcinoma arising from the body and tail of the pancreas is less frequent than pancreatic head cancer, and its prognosis is known to be worse. This aggressive behavior is reported by few large clinical studies. Study Design: We retrospectively reviewed our 24 years experience on adenocarcinoma of the body and tail of the pancreas and analyzed survival and longterm results after resection. Recent large series on cancer of the distal pancreas were also reviewed. Results: Among 148 patients observed, 109 were surgically treated. Resectability rate was 16%; ductal adenocarcinoma in 22% of patients who underwent surgery was resectable. Macroscopic radical resection was achieved in only 16 cases. Overall 5-year survival rate was 2%. In resected cancers the actual 5-year survival rate was 12.5%. Patients with unresectable cancers did not survive more than 17 months. All three patients who survived more than 5 years had a small tumor (T1 according to TNM staging). In the literature, among 360 evaluable resected patients, only 7 survived at 5 years (2%). Conclusions: The prognosis for patients with adenocarcinoma of the distal pancreas is poor, even after resection of the tumor; however, the results are not substantially different for those reported after resection for pancreatic head carcinoma. Surgical resection can offer longterm survival for patients with localized cancer.

Ductal adenocarcinoma of the body and tail of the pancreas.

Carcinoma arising from the body and tail of the pancreas is less frequent than pancreatic head cancer, and its prognosis is known to be worse. This aggressive behavior is reported by few large clinical studies. We retrospectively reviewed our 24 years experience on adenocarcinoma of the body and tail of the pancreas and analyzed survival and longterm results after resection. Recent large series on cancer of the distal pancreas were also reviewed. Among 148 patients observed, 109 were surgically treated. Resectability rate was 16%; ductal adenocarcinoma in 22% of patients who underwent surgery was resectable. Macroscopic radical resection was achieved in only 16 cases. Overall 5-year survival rate was 2%. In resected cancers the actual 5-year survival rate was 12.5%. Patients with unresectable cancers did not survive more than 17 months. All three patients who survived more than 5 years had a small tumor (T1 according to TNM staging). In the literature, among 360 evaluable resected patients, only 7 survived at 5 years (2%). The prognosis for patients with adenocarcinoma of the distal pancreas is poor, even after resection of the tumor; however, the results are not substantially different for those reported after resection for pancreatic head carcinoma. Surgical resection can offer longterm survival for patients with localized cancer.