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Published in: Clinical and Translational Oncology 11/2017

01-11-2017 | Review article

Surgery for pancreatic ductal adenocarcinoma

Authors: R. Vera, L. Díez, E. Martín Pérez, J. C. Plaza, A. Sanjuanbenito, A. Carrato

Published in: Clinical and Translational Oncology | Issue 11/2017

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Abstract

Surgical resection is the only potentially curative option in the treatment of pancreatic ductal adenocarcinoma. Preoperative radiological imaging allows to rule out the presence of metastases. Three resectability categories are established based on the radiological findings depending on the degree of contact between the tumor and the blood vessels. Histological confirmation of malignancy is only required in cases of borderline or non-resectable tumors, prior to neoadjuvant treatment initiation. Diagnostic laparoscopy is recommended in the presence of large tumors of the body or tail and in borderline tumors to explore the possibility of resection and to apply treatment with curative intent, as well as in those cases with high level of biomarkers to rule out peritoneal involvement. Prior to surgery preoperative nutritional measures as well as endoscopic biliary drainage can be applied to optimize patient’s conditions. Cephalic pancreaticoduodenectomy is the recommended surgical technique in tumors located in the head of the pancreas. The benefits from pyloric preservation, type or reconstruction (one vs. two loops), type of anastomosis (pancreaticojejunostomy vs. pancreaticogastrostomy), intraoperative biopsy of the pancreatic resection margin or the use of intraperitoneal drainages are inconclusive. Total pancreatectomy and/or portal resection should only be performed in particular cases; however, arterial resections have shown no benefits. Radical antegrade modular pancreaticosplenectomy, that can be performed laparoscopically, is the technique used for those tumors located in the pancreatic body-tail.
Literature
1.
go back to reference Jemal A, Bray F, Center MM, Ferlay J, Ward E, Forman D. Global cancer statistics. CA Cancer J Clin. 2011;61:69–90.CrossRefPubMed Jemal A, Bray F, Center MM, Ferlay J, Ward E, Forman D. Global cancer statistics. CA Cancer J Clin. 2011;61:69–90.CrossRefPubMed
2.
go back to reference Rahib L, Smith BD, Aizenberg R, Rosenzweig AB, Fleshman JM, Matrisian LM. Projecting cancer incidence and deaths to 2030: the unexpected burden of thyroid, liver, and pancreas cancers in the United States. Cancer Res. 2014;74:2913–21.CrossRefPubMed Rahib L, Smith BD, Aizenberg R, Rosenzweig AB, Fleshman JM, Matrisian LM. Projecting cancer incidence and deaths to 2030: the unexpected burden of thyroid, liver, and pancreas cancers in the United States. Cancer Res. 2014;74:2913–21.CrossRefPubMed
3.
go back to reference Hidalgo M, Cascinu S, Kleeff J, Labianca R, Löhr JM, Neoptolomeus J, et al. Addressing the challenges of pancreatic cancer: future directions for improving outcomes. Pancreatology. 2015;15:8–18.CrossRefPubMed Hidalgo M, Cascinu S, Kleeff J, Labianca R, Löhr JM, Neoptolomeus J, et al. Addressing the challenges of pancreatic cancer: future directions for improving outcomes. Pancreatology. 2015;15:8–18.CrossRefPubMed
4.
go back to reference Dykewicz CA. Summary of the guidelines for preventing opportunistic infections among hematopoietic stem cell transplant recipients. Clin Infect Dis. 2001;33:139–44.CrossRefPubMed Dykewicz CA. Summary of the guidelines for preventing opportunistic infections among hematopoietic stem cell transplant recipients. Clin Infect Dis. 2001;33:139–44.CrossRefPubMed
5.
go back to reference Tamm EP, Bhosale PR, Vikram R, de Almeida Marcal LP, Balachandran A, et al. Imaging of pancreatic adenocarcinoma: update on staging/resectability. Radiol Clin North Am. 2012;50:407–28.CrossRefPubMed Tamm EP, Bhosale PR, Vikram R, de Almeida Marcal LP, Balachandran A, et al. Imaging of pancreatic adenocarcinoma: update on staging/resectability. Radiol Clin North Am. 2012;50:407–28.CrossRefPubMed
6.
go back to reference Al-Hawary MM, Francis IR, Chari ST, Fishman EK, Hough DM, Lu DS, et al. Pancreatic ductal adenocarcinoma radiology reporting template: consensus statement of the society of abdominal radiology and the American pancreatic association. Radiology. 2014;270:248–60.CrossRefPubMed Al-Hawary MM, Francis IR, Chari ST, Fishman EK, Hough DM, Lu DS, et al. Pancreatic ductal adenocarcinoma radiology reporting template: consensus statement of the society of abdominal radiology and the American pancreatic association. Radiology. 2014;270:248–60.CrossRefPubMed
8.
go back to reference Bockhorn M, Uzunoglu FG, Adham M, Imrie C, Milicevic M, Sandberg AA, et al. Borderline resectable pancreatic cancer: a consensus statement by the international study group of pancreatic surgery (ISGPS). Surgery. 2014;155:977–88.CrossRefPubMed Bockhorn M, Uzunoglu FG, Adham M, Imrie C, Milicevic M, Sandberg AA, et al. Borderline resectable pancreatic cancer: a consensus statement by the international study group of pancreatic surgery (ISGPS). Surgery. 2014;155:977–88.CrossRefPubMed
9.
go back to reference Callery MP, Chang KJ, Fishman EK, Talamonti MS, William TL, Linehan DC, et al. Pretreatment assessment of resectable and borderline resectable pancreatic cancer: expert consensus statement. Ann Surg Oncol. 2009;16:1727–33.CrossRefPubMed Callery MP, Chang KJ, Fishman EK, Talamonti MS, William TL, Linehan DC, et al. Pretreatment assessment of resectable and borderline resectable pancreatic cancer: expert consensus statement. Ann Surg Oncol. 2009;16:1727–33.CrossRefPubMed
10.
go back to reference Varadhachary GR, Tamm EP, Abbruzzese JL, Xiong HQ, Crane CH, Wang H, et al. Borderline resectable pancreatic cancer: definitions, management, and role of preoperative therapy. Ann Surg Oncol. 2006;13:1035–46.CrossRefPubMed Varadhachary GR, Tamm EP, Abbruzzese JL, Xiong HQ, Crane CH, Wang H, et al. Borderline resectable pancreatic cancer: definitions, management, and role of preoperative therapy. Ann Surg Oncol. 2006;13:1035–46.CrossRefPubMed
11.
go back to reference Katz MH, Marsh R, Herman JM, Shi Q, Collision E, Venook AP, Kindler HL, et al. Borderline resectable pancreatic cancer: need for standardization and methods for optimal clinical trial design. Ann Surg Oncol. 2013;20:2787–7895.CrossRefPubMedPubMedCentral Katz MH, Marsh R, Herman JM, Shi Q, Collision E, Venook AP, Kindler HL, et al. Borderline resectable pancreatic cancer: need for standardization and methods for optimal clinical trial design. Ann Surg Oncol. 2013;20:2787–7895.CrossRefPubMedPubMedCentral
12.
go back to reference Evans DB, Farnell MB, Lillemoe KD, Vollmer C Jr, Strasberg SM, Schulick RD. Surgical treatment of resectable and borderline resectable pancreas cancer: expert consensus statement. Ann Surg Oncol. 2009;16:1736–44.CrossRefPubMed Evans DB, Farnell MB, Lillemoe KD, Vollmer C Jr, Strasberg SM, Schulick RD. Surgical treatment of resectable and borderline resectable pancreas cancer: expert consensus statement. Ann Surg Oncol. 2009;16:1736–44.CrossRefPubMed
13.
go back to reference Uzunoglu FG, Reeh M, Vettorazzi E, Ruschke T, Hannah P, Nentwich MF, et al. preoperative pancreatic resection (PREPARE) score: a prospective multicenter-based morbidity risk score. Ann Surg. 2014;260:857–64.CrossRefPubMed Uzunoglu FG, Reeh M, Vettorazzi E, Ruschke T, Hannah P, Nentwich MF, et al. preoperative pancreatic resection (PREPARE) score: a prospective multicenter-based morbidity risk score. Ann Surg. 2014;260:857–64.CrossRefPubMed
14.
go back to reference Asbun HJ, Conlon K, Fernandez-Cruz L, Friess H, Shrikhande SV, Adham M, et al. When to perform a pancreatoduodenectomy in the absence of positive histology? A consensus statement by the international study group of pancreatic surgery. Surgery. 2014;155:887–92.CrossRefPubMed Asbun HJ, Conlon K, Fernandez-Cruz L, Friess H, Shrikhande SV, Adham M, et al. When to perform a pancreatoduodenectomy in the absence of positive histology? A consensus statement by the international study group of pancreatic surgery. Surgery. 2014;155:887–92.CrossRefPubMed
15.
go back to reference Braga M, Capretti G, Pecorelli N, Balzano G, Doglioni C, Ariotti R, et al. A prognostic score to predict major complications after pancreaticoduodenectomy. Ann Surg. 2011;254:702–8.CrossRefPubMed Braga M, Capretti G, Pecorelli N, Balzano G, Doglioni C, Ariotti R, et al. A prognostic score to predict major complications after pancreaticoduodenectomy. Ann Surg. 2011;254:702–8.CrossRefPubMed
16.
go back to reference Ragulin-Coyne E, Carroll JE, Smith JK, Witowsky ER, Ng SC, Shah SA, et al. Perioperative mortality after pancreatectomy: a risk score to aid decision- making. Surgery. 2012;152:S120–7.CrossRefPubMed Ragulin-Coyne E, Carroll JE, Smith JK, Witowsky ER, Ng SC, Shah SA, et al. Perioperative mortality after pancreatectomy: a risk score to aid decision- making. Surgery. 2012;152:S120–7.CrossRefPubMed
18.
go back to reference Tol JA, Gouma DJ, Bassi C, Dervenis C, Montorsi M, Adham M, et al. Definition of a standard lymphadenectomy in surgery for pancreatic ductal adenocarcinoma: a consensus statement by the international study group on pancreatic surgery (ISGPS). Surgery. 2014;156:591–600.CrossRefPubMed Tol JA, Gouma DJ, Bassi C, Dervenis C, Montorsi M, Adham M, et al. Definition of a standard lymphadenectomy in surgery for pancreatic ductal adenocarcinoma: a consensus statement by the international study group on pancreatic surgery (ISGPS). Surgery. 2014;156:591–600.CrossRefPubMed
19.
go back to reference Diener MK, Heukaufer C, Schwarzer G, Seiler CM, Antes G, Buchler M, Knaebel HP. Pancreaticoduodenectomy (classic Whipple) versus pylorus-preserving pancreaticoduodenectomy (pp Whipple) for surgical treatment of periampullary and pancreatic carcinoma. Cochrane Database Syst Rev. 2008;16(2):CD006053. Diener MK, Heukaufer C, Schwarzer G, Seiler CM, Antes G, Buchler M, Knaebel HP. Pancreaticoduodenectomy (classic Whipple) versus pylorus-preserving pancreaticoduodenectomy (pp Whipple) for surgical treatment of periampullary and pancreatic carcinoma. Cochrane Database Syst Rev. 2008;16(2):CD006053.
20.
go back to reference Strasberg SM, Drebin JA, Linehan D. Radical antegrade modular pancreatosplenectomy. Surgery. 2003;133:521–7.CrossRefPubMed Strasberg SM, Drebin JA, Linehan D. Radical antegrade modular pancreatosplenectomy. Surgery. 2003;133:521–7.CrossRefPubMed
21.
go back to reference Mitchem JB, Hamilton N, Gao F, Hawkins WG, Linehan DC, Strasberg SM. Long-term results of resection of adenocarcinoma of the body and tail of the pancreas using radical antegrade modular pancreatosplenectomy procedure. J Am Coll Surg. 2012;214:46–52.CrossRefPubMed Mitchem JB, Hamilton N, Gao F, Hawkins WG, Linehan DC, Strasberg SM. Long-term results of resection of adenocarcinoma of the body and tail of the pancreas using radical antegrade modular pancreatosplenectomy procedure. J Am Coll Surg. 2012;214:46–52.CrossRefPubMed
22.
go back to reference Boggi U, Amorese G, Vistoli F, Caniglia F, de Lio N, Perrone V, et al. Laparoscopic pancreaticoduodenectomy: a systematic literature review. Surg Endosc. 2015;29:9–23.CrossRefPubMed Boggi U, Amorese G, Vistoli F, Caniglia F, de Lio N, Perrone V, et al. Laparoscopic pancreaticoduodenectomy: a systematic literature review. Surg Endosc. 2015;29:9–23.CrossRefPubMed
23.
go back to reference Stafford AT, Walsh M. robotic surgery of the pancreas: the current state of the art. J Surg Oncol. 2015;112:289–94.CrossRefPubMed Stafford AT, Walsh M. robotic surgery of the pancreas: the current state of the art. J Surg Oncol. 2015;112:289–94.CrossRefPubMed
24.
go back to reference Roder JD, Stein HJ, Siewert JR. Carcinoma of the periampullary region: who benefits from portal vein resection. Am J Surg. 1996;171:170–4.CrossRefPubMed Roder JD, Stein HJ, Siewert JR. Carcinoma of the periampullary region: who benefits from portal vein resection. Am J Surg. 1996;171:170–4.CrossRefPubMed
25.
go back to reference Siriwardana HP, Siriwardena AK. Systematic review of outcome of synchronous portal-superior mesenteric vein resection during pancreatectomy for cancer. Br J Surg. 2006;93:662–73.CrossRefPubMed Siriwardana HP, Siriwardena AK. Systematic review of outcome of synchronous portal-superior mesenteric vein resection during pancreatectomy for cancer. Br J Surg. 2006;93:662–73.CrossRefPubMed
28.
go back to reference Ryan R, Gibbons D, Hyland JMP, Treanor D, White A, et al. Pathological response following long-course neoadjuvant chemoradiotherapy for locally advanced rectal cancer. Histopahology. 2005;47:141–6.CrossRef Ryan R, Gibbons D, Hyland JMP, Treanor D, White A, et al. Pathological response following long-course neoadjuvant chemoradiotherapy for locally advanced rectal cancer. Histopahology. 2005;47:141–6.CrossRef
Metadata
Title
Surgery for pancreatic ductal adenocarcinoma
Authors
R. Vera
L. Díez
E. Martín Pérez
J. C. Plaza
A. Sanjuanbenito
A. Carrato
Publication date
01-11-2017
Publisher
Springer International Publishing
Published in
Clinical and Translational Oncology / Issue 11/2017
Print ISSN: 1699-048X
Electronic ISSN: 1699-3055
DOI
https://doi.org/10.1007/s12094-017-1688-0

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