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Annals of Surgical Oncology
Published in: Annals of Surgical Oncology 7/2009

01-07-2009 | CONSENSUS REPORT: RESECTABLE AND BORDERLINE RESECTABLE PANCREAS CANCER

Surgical Treatment of Resectable and Borderline Resectable Pancreas Cancer: Expert Consensus Statement

Authors: Douglas B. Evans, MD, Michael B. Farnell, MD, Keith D. Lillemoe, MD, Charles Vollmer Jr, MD, Steven M. Strasberg, MD, Richard D. Schulick, MD

Published in: Annals of Surgical Oncology | Issue 7/2009

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Excerpt

The regional pancreatectomy first described by Fortner in 1973 was complex and not adopted by Western pancreatic surgeons.1 In contrast, Japanese surgeons were influenced by Fortner’s concept of extended lymph node dissection and soft-tissue clearance for resectable pancreatic head cancer. The rationale for a more extensive procedure was based on the observation that standard Whipple resection does not encompass nodal groups often involved with microscopic disease,2‐7 and that many patients frequently experienced local recurrence after resection.8 …
Literature
1.
Fortner JG. Regional resection of cancer of the pancreas: a new surgical approach. Surgery. 1973;73:307–20.PubMed
2.
Takahashi S, Ogata Y, Miyazaki H, Maeda D, Murai S, Yamataka K, et al. Aggressive surgery for pancreatic duct cell cancer: feasibility, validity, limitations. World J Surg. 1995;19:653–9; discussion 60.PubMedCrossRef
3.
Cubilla AL, Fortner J, Fitzgerald PJ. Lymph node involvement in carcinoma of the head of the pancreas area. Cancer. 1978;41:880–7.PubMedCrossRef
4.
Reber HA, Ashley SW, McFadden D. Curative treatment for pancreatic neoplasms. Radical resection. Surg Clin North Am. 1995;75 905–12.PubMed
5.
Satake K, Nishiwaki H, Yokomatsu H, Kawazoe Y, Kim K, Haku A, et al. Surgical curability and prognosis for standard versus extended resection for T1 carcinoma of the pancreas. Surg Gynecol Obstet. 1992;175:259–65.PubMed
6.
Kayahara M, Nagakawa T, Ueno K, Ohta T, Tsukioka Y, Miyazaki I. Surgical strategy for carcinoma of the pancreas head area based on clinicopathologic analysis of nodal involvement and plexus invasion. Surgery. 1995;117:616–23.PubMedCrossRef
7.
Liu CD, Slice LW, Balasubramaniam A, Walsh JH, Newton TR, Saxton RE, et al. Y2 receptors decrease human pancreatic cancer growth and intracellular cyclic adenosine monophosphate levels. Surgery. 1995;118: 229–35; discussion 35–6.PubMedCrossRef
8.
Ishikawa O, Ohhigashi H, Sasaki Y, Kabuto T, Fukuda I, Furukawa H, et al. Practical usefulness of lymphatic and connective tissue clearance for the carcinoma of the pancreas head. Ann Surg. 1988;208:215–20.PubMedCrossRef
9.
Manabe T, Ohshio G, Baba N, Miyashita T, Asano N, Tamura K, et al. Radical pancreatectomy for ductal cell carcinoma of the head of the pancreas. Cancer. 1989;64:1132–7.PubMedCrossRef
10.
Tsuchiya R, Oribe T, Noda T. Size of the tumor and other factors influencing prognosis of carcinoma of the head of the pancreas. Am J Gastroenterol. 1985;80:459–62.PubMed
11.
Tsuchiya R, Eto T, Tsunoda T. Radical resection of pancreatic and periampullary neoplasms. Pancreatoduodenectomy. In: Braasch J, Tompkins R, eds. Surgical disease of the biliary tract and pancreas. Multidisciplinary management. St. Louis: Mosby, 1994:570–87.
12.
Hirata K, Sato T, Mukaiya M, Yamashiro K, Kimura M, Sasaki K, et al. Results of 1001 pancreatic resections for invasive ductal adenocarcinoma of the pancreas. Arch Surg. 1997;132:771–6; discussion 7.PubMed
13.
Ishikawa O, Ohigashi H, Sasaki Y, Kabuto T, Furukawa H, Nakamori S, et al. Practical grouping of positive lymph nodes in pancreatic head cancer treated by an extended pancreatectomy. Surgery. 1997;121:244–9.PubMedCrossRef
14.
Pedrazzoli S, DiCarlo V, Dionigi R, Mosca F, Pederzoli P, Pasquali C, et al. Standard versus extended lymphadenectomy associated with pancreatoduodenectomy in the surgical treatment of adenocarcinoma of the head of the pancreas: a multicenter, prospective, randomized study. Lymphadenectomy Study Group. Ann Surg. 1998;228:508–17.PubMedCrossRef
15.
Nimura Y, Nagino M, Kato H, Miyagawa S, Yamaguchi A, Kinoshita T, et al. Regional vs extended lymph node dissection in radical pancreaticoduodenectomy for pancreatic cancer. A multicenter randomized controlled trial. HPB. 2004;6:2 (abstract).
16.
Yeo CJ, Cameron JL, Sohn TA, Coleman J, Sauter PK, Hruban RH, et al. Pancreaticoduodenectomy with or without extended retroperitoneal lymphadenectomy for periampullary adenocarcinoma: comparison of morbidity and mortality and short-term outcome. Ann Surg. 1999;229:613–22; discussion 22–4.PubMedCrossRef
17.
Yeo CJ, Cameron JL, Lillemoe KD, Sohn TA, Campbell KA, Sauter PK, et al. Pancreaticoduodenectomy with or without distal gastrectomy and extended retroperitoneal lymphadenectomy for periampullary adenocarcinoma, part 2: randomized controlled trial evaluating survival, morbidity, and mortality. Ann Surg. 2002;236:355–66; discussion 66–8.PubMedCrossRef
18.
Nguyen TC, Sohn TA, Cameron JL, Lillemoe KD, Campbell KA, Coleman J, et al. Standard vs. radical pancreaticoduodenectomy for periampullary adenocarcinoma: a prospective, randomized trial evaluating quality of life in pancreaticoduodenectomy survivors. J Gastrointest Surg. 2003;7:1–9; discussion 11.PubMedCrossRef
19.
Riall TS, Cameron JL, Lillemoe KD, Campbell KA, Sauter PK, Coleman J, et al. Pancreaticoduodenectomy with or without distal gastrectomy and extended retroperitoneal lymphadenectomy for periampullary adenocarcinoma—part 3: update on 5-year survival. J Gastrointest Surg. 2005;9:1191–204; discussion 204–6.PubMedCrossRef
20.
Farnell MB, Pearson RK, Sarr MG, DiMagno EP, Burgart LJ, Dahl TR, et al. A prospective randomized trial comparing standard pancreatoduodenectomy with pancreatoduodenectomy with extended lymphadenectomy in resectable pancreatic head adenocarcinoma. Surgery. 2005;138:618–28; discussion 28–30.PubMedCrossRef
21.
Pawlik TM, Abdalla EK, Barnett CC, Ahmad SA, Cleary KR, Vauthey JN, et al. Feasibility of a randomized trial of extended lymphadenectomy for pancreatic cancer. Arch Surg. 2005;140:584–9; discussion 9–91.PubMedCrossRef
22.
Tomlinson JS, Jain S, Bentrem DJ, Sekeris EG, Maggard MA, Hines OJ, et al. Accuracy of staging node-negative pancreas cancer: a potential quality measure. Arch Surg. 2007;142:767–23; discussion 73–4.
23.
Asada S, Itaya H, Nakamura K, Isohashi T, Masuoka S. Radical pancreatoduodenectomy and portal vein resection. Report of two successful cases with transplantation of portal vein. Arch Surg. 1963;87:609–13.PubMed
24.
Wolff R, Crane C, Li D, Abbruzzese J, Evans D. Neoplasms of the exocrine pancreas. In: Kufe D, Bast R, Hait W, Hong WK, Pollock RE, Weichselbaum RR, et al., eds. Holland-Frei Cancer Medicine. Ontario: B.C. Decker, Inc., 2006:1331–58.
25.
Tseng JF, Raut CP, Lee JE, Pisters PW, Vauthey JN, Abdalla EK, et al. Pancreaticoduodenectomy with vascular resection: margin status and survival duration. J Gastrointest Surg. 2004;8:935–49; discussion 49–50.
26.
Raut CP, Tseng JF, Sun CC, Wang H, Wolff RA, Crane CH, et al. Impact of resection status on pattern of failure and survival after pancreaticoduodenectomy for pancreatic adenocarcinoma. Ann Surg. 2007;246:52–60.PubMedCrossRef
27.
Al-Haddad M, Martin JK, Nguyen J, Pungpapong S, Raimondo M, Woodward T, et al. Vascular resection and reconstruction for pancreatic malignancy: a single center survival study. J Gastrointest Surg. 2007;11:1168–74.PubMedCrossRef
28.
Riediger H, Makowiec F, Fischer E, Adam U, Hopt UT. Postoperative morbidity and long-term survival after pancreaticoduodenectomy with superior mesenterico-portal vein resection. J Gastrointest Surg. 2006;10:1106–15.PubMedCrossRef
29.
Carrere N, Sauvanet A, Goere D, Kianmanesh R, Vullierme MP, Couvelard A, et al. Pancreaticoduodenectomy with mesentericoportal vein resection for adenocarcinoma of the pancreatic head. World J Surg. 2006;30:1526–35.PubMedCrossRef
30.
Poon RT, Fan ST, Lo CM, Liu CL, Lam CM, Yuen WK, et al. Pancreaticoduodenectomy with en bloc portal vein resection for pancreatic carcinoma with suspected portal vein involvement. World J Surg. 2004;28:602–8.PubMedCrossRef
31.
Capussotti L, Massucco P, Ribero D, Vigano L, Muratore A, Calgaro M. Extended lymphadenectomy and vein resection for pancreatic head cancer: outcomes and implications for therapy. Arch Surg. 2003;138:1316–22.PubMedCrossRef
32.
Howard TJ, Villanustre N, Moore SA, DeWitt J, LeBlanc J, Maglinte D, et al. Efficacy of venous reconstruction in patients with adenocarcinoma of the pancreatic head. J Gastrointest Surg. 2003;7:1089–95.PubMedCrossRef
33.
Shibata C, Kobari M, Tsuchiya T, Arai K, Anzai R, Takahashi M, et al. Pancreatectomy combined with superior mesenteric-portal vein resection for adenocarcinoma in pancreas. World J Surg. 2001;25:1002–5.PubMedCrossRef
34.
van Geenen RC, ten Kate FJ, de Wit LT, van Gulik TM, Obertop H, Gouma DJ. Segmental resection and wedge excision of the portal or superior mesenteric vein during pancreatoduodenectomy. Surgery. 2001;129:158–63.PubMedCrossRef
35.
Bachellier P, Nakano H, Oussoultzoglou PD, Weber JC, Boudjema K, Wolf PD, et al. Is pancreaticoduodenectomy with mesentericoportal venous resection safe and worthwhile? Am J Surg. 2001;182:120–9.PubMedCrossRef
36.
Launois B, Stasik C, Bardaxoglou E, Meunier B, Campion JP, Greco L, et al. Who benefits from portal vein resection during pancreaticoduodenectomy for pancreatic cancer? World J Surg. 1999;23:926–9.PubMedCrossRef
37.
Roder JD, Stein HJ, Siewert JR. Carcinoma of the periampullary region: who benefits from portal vein resection? Am J Surg. 1996;171:170–4; discussion 4–5.PubMedCrossRef
38.
Harrison LE, Klimstra DS, Brennan MF. Isolated portal vein involvement in pancreatic adenocarcinoma. A contraindication for resection? Ann Surg. 1996;224:342–7; discussion 7–9.PubMedCrossRef
39.
Yeo CJ, Cameron JL, Lillemoe KD, Sitzmann JV, Hruban RH, Goodman SN, et al. Pancreaticoduodenectomy for cancer of the head of the pancreas. 201 patients. Ann Surg. 1995;221:721–31; discussion 31–3.PubMedCrossRef
40.
Trede M, Schwall G, Saeger HD. Survival after pancreatoduodenectomy. 118 consecutive resections without an operative mortality. Ann Surg. 1990;211:447–58.PubMedCrossRef
41.
Sindelar WF. Clinical experience with regional pancreatectomy for adenocarcinoma of the pancreas. Arch Surg. 1989;124:127–32.PubMed
42.
Exocrine Pancreas. In: Greene F, Page D, Fleming I, Fritz AG, Balch CM, Haller DG, et al., eds. AJCC Cancer Staging Manual. New York: Springer-Verlag, 2002:157–64.
43.
Tempero M, Arnoletti JP, Ben-Josef E, Bhargava P, Casper ES, Kim P, et al. Pancreatic adenocarcinoma. Clinical Practice Guidelines in Oncology. J Natl Compr Cancer Netw. 2007;5:998–1033.
44.
Howard TJ, Krug JE, Yu J, Zyromski NJ, Schmidt CM, Jacobson LE, et al. A margin-negative R0 resection accomplished with minimal postoperative complications is the surgeon’s contribution to long-term survival in pancreatic cancer. J Gastrointest Surg. 2006;10:1338–45; discussion 45–6.PubMedCrossRef
45.
Wagner M, Redaelli C, Lietz M, Seiler CA, Friess H, Buchler MW. Curative resection is the single most important factor determining outcome in patients with pancreatic adenocarcinoma. Br J Surg. 2004;91:586–94.PubMedCrossRef
46.
Forrest JF, Longmire WP, Jr. Carcinoma of the pancreas and periampullary region. Ann Surg. 1979;189:129–38.PubMedCrossRef
47.
Pingpank JF, Hoffman JP, Ross EA, Cooper HS, Meropol NJ, Freedman G, et al. Effect of preoperative chemoradiotherapy on surgical margin status of resected adenocarcinoma of the head of the pancreas. J Gastrointest Surg. 2001;5:121–30.PubMedCrossRef
48.
Sohn TA, Yeo CJ, Cameron JL, Koniaris L, Kaushal S, Abrams RA, et al. Resected adenocarcinoma of the pancreas-616 patients: results, outcomes, and prognostic indicators. J Gastrointest Surg. 2000;4:567–79.PubMedCrossRef
49.
Strasberg SM, Drebin JA, Linehan D. Radical antegrade modular pancreatosplenectomy. Surgery. 2003;133:521–7.PubMedCrossRef
50.
Christein JD, Kendrick ML, Iqbal CW, Nagorney DM, Farnell MB. Distal pancreatectomy for resectable adenocarcinoma of the body and tail of the pancreas. J Gastrointest Surg. 2005;9:922–7.PubMedCrossRef
51.
Cioc AM, Ellison EC, Proca DM, Lucas JG, Frankel WL. Frozen section diagnosis of pancreatic lesions. Arch Pathol Lab Med. 2002;126:1169–73.PubMed
52.
Raut CP, Cleary KR, Staerkel GA, Abbruzzese JL, Wolff RA, Lee JH, et al. Intraductal papillary mucinous neoplasms of the pancreas: effect of invasion and pancreatic margin status on recurrence and survival. Ann Surg Oncol. 2006;13:582–94.PubMedCrossRef
53.
Tran KT, Smeenk HG, van Eijck CH, Kazemier G, Hop WC, Greve JW, et al. Pylorus preserving pancreaticoduodenectomy versus standard Whipple procedure: a prospective, randomized, multicenter analysis of 170 patients with pancreatic and periampullary tumors. Ann Surg. 2004;240:738–45.PubMedCrossRef
54.
Tseng JF, Pisters PW, Lee JE, Wang H, Gomez HF, Sun CC, et al. The learning curve in pancreatic surgery. Surgery. 2007;141:456–63. Corrected and republished in: Surgery 2007;141:694–701.
55.
Butturini G, Stocken DD, Wente MN, Jeekel H, Klinkenbijl JH, Bakkevold KE, et al. Influence of resection margins and treatment on survival in patients with pancreatic cancer: meta-analysis of randomized controlled trials. Arch Surg. 2008;143:75–83; discussion.PubMedCrossRef
56.
Winter JM, Cameron JL, Campbell KA, Arnold MA, Chang DC, Coleman J, et al. 1423 pancreaticoduodenectomies for pancreatic cancer: a single-institution experience. J Gastrointest Surg. 2006;10:1199–210; discussion 210–1.PubMedCrossRef
57.
Lillemoe KD, Cameron JL, Yeo CJ, Sohn TA, Nakeeb A, Sauter PK, et al. Pancreaticoduodenectomy. Does it have a role in the palliation of pancreatic cancer? Ann Surg. 1996;223:718–25; discussion 25–8.PubMedCrossRef
58.
Reinders ME, Allema JH, van Gulik TM, Karsten TM, de Wit LT, Verbeek PC, et al. Outcome of microscopically nonradical, subtotal pancreaticoduodenectomy (Whipple’s resection) for treatment of pancreatic head tumors. World J Surg. 1995;19:410–5; discussion 4–5.PubMedCrossRef
59.
Kuhlmann K, de Castro S, van Heek T, Busch O, van Gulik T, Obertop H, et al. Microscopically incomplete resection offers acceptable palliation in pancreatic cancer. Surgery. 2006;139:188–96.PubMedCrossRef
60.
Schniewind B, Bestmann B, Kurdow R, Tepel J, Henne-Bruns D, Faendrich F, et al. Bypass surgery versus palliative pancreaticoduodenectomy in patients with advanced ductal adenocarcinoma of the pancreatic head, with an emphasis on quality of life analyses. Ann Surg Oncol. 2006;13:1403–11.PubMedCrossRef
61.
Imamura M, Doi R, Imaizumi T, Funakoshi A, Wakasugi H, Sunamura M, et al. A randomized multicenter trial comparing resection and radiochemotherapy for resectable locally invasive pancreatic cancer. Surgery. 2004;136:1003–11.PubMedCrossRef
Metadata
Title
Surgical Treatment of Resectable and Borderline Resectable Pancreas Cancer: Expert Consensus Statement
Authors
Douglas B. Evans, MD
Michael B. Farnell, MD
Keith D. Lillemoe, MD
Charles Vollmer Jr, MD
Steven M. Strasberg, MD
Richard D. Schulick, MD
Publication date
01-07-2009
Publisher
Springer-Verlag
Published in
Annals of Surgical Oncology / Issue 7/2009
Print ISSN: 1068-9265
Electronic ISSN: 1534-4681
DOI
https://doi.org/10.1245/s10434-009-0416-6

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