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Major Vascular Resection in Pancreatic Carcinoma

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Pancreatic Cancer

Abstract

Pancreatic cancer (PDAC) is one of the leading causes of cancer-related death worldwide. The incidence of PDAC is rising and mortality despite the effort to develop and implement new therapeutic strategies is increasing [1] (The Cancer Statistics Review (2009–2013) online). The major problem to improve individual survival rates is the delayed diagnosis of PDAC. Consequently, the majority of patients have to be excluded from surgical resection due to an already distant spread or locally advancement of the disease. Hence, only 10–20% of PDAC patients are primarily eligible for potential curative surgical approach aiming at a complete oncologic resection of the carcinoma with negative margins (R0). Despite controversies in definition of true R0 resection in PDAC and lessons learned in histological workup of the specimen, tumor-free resection margins still remain the goal of radical operation in PDAC with a reported prolonged survival of 5-year survival rates of up to 25% in selected series [2–7].

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References

  1. Bosetti C, Bertuccio P, Malvezzi M, Levi F, Chatenoud L, Negri E, et al. Cancer mortality in Europe, 2005–2009, and an overview of trends since 1980. Ann Oncol. 2013;24(10):2657–71.

    Article  CAS  PubMed  Google Scholar 

  2. Lewis R, Drebin JA, Callery MP, Fraker D, Kent TS, Gates J, et al. A contemporary analysis of survival for resected pancreatic ductal adenocarcinoma. HPB. 2013;15(1):49–60.

    Article  PubMed  Google Scholar 

  3. 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 Off J Soc Surg Aliment Tract. 2000;4(6):567–79.

    Article  CAS  Google Scholar 

  4. 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(1):52–60.

    Article  PubMed  PubMed Central  Google Scholar 

  5. Gebauer F, et al. Resection margin clearance in pancreatic cancer after implementation of the Leeds Pathology Protocol (LEEPP): clinically relevant or just academic? World J Surg. 2015;39(2):493–9.

    Article  PubMed  Google Scholar 

  6. Verbeke CS, Menon KV. Redefining resection margin status in pancreatic cancer. HPB (Oxford). 2009;11(4):282–9.

    Article  Google Scholar 

  7. Wellner UF, et al. Mesopancreatic stromal clearance defines curative resection of pancreatic head cancer and can be predicted preoperatively by radiologic parameters: a retrospective study. Medicine (Baltimore). 2016;95(3):e2529.

    Article  Google Scholar 

  8. Steele GD, Osteen RT, Winchester DP, Murphy GP, Menck HR. Clinical highlights from the National Cancer Data Base: 1994. CA Cancer J Clin. 1994;44(2):71–80.

    Article  PubMed  Google Scholar 

  9. Vollmer CM, Sanchez N, Gondek S, McAuliffe J, Kent TS, Christein JD, et al. A root-cause analysis of mortality following major pancreatectomy. J Gastrointest Surg Off J Soc Surg Aliment Tract. 2012;16(1):89–102; discussion 102–3.

    Google Scholar 

  10. Winter JM, Brennan MF, Tang LH, D’Angelica MI, Dematteo RP, Fong Y, et al. Survival after resection of pancreatic adenocarcinoma: results from a single institution over three decades. Ann Surg Oncol. 2012;19(1):169–75.

    Article  PubMed  Google Scholar 

  11. Ramacciato G, Mercantini P, Petrucciani N, Giaccaglia V, Nigri G, Ravaioli M, et al. Does portal-superior mesenteric vein invasion still indicate irresectability for pancreatic carcinoma? Ann Surg Oncol. 2009;16(4):817–25.

    Article  PubMed  Google Scholar 

  12. Seufferlein T, Porzner M, Becker T, Budach V, Ceyhan G, Esposito I, et al. S3-guideline exocrine pancreatic cancer. Z Gastroenterol. 2013;51(12):1395–440.

    Article  CAS  PubMed  Google Scholar 

  13. Mollberg N, Rahbari NN, Koch M, Hartwig W, Hoeger Y, Büchler MW, et al. Arterial resection during pancreatectomy for pancreatic cancer: a systematic review and meta-analysis. Ann Surg. 2011;254(6):882–93.

    Article  PubMed  Google Scholar 

  14. Buchs NC, Chilcott M, Poletti P-A, Buhler LH, Morel P. Vascular invasion in pancreatic cancer: imaging modalities, preoperative diagnosis and surgical management. World J Gastroenterol. 2010;16(7):818–31.

    PubMed  PubMed Central  Google Scholar 

  15. 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(6):977–88.

    Article  PubMed  Google Scholar 

  16. Zhang Y, Huang J, Chen M, Jiao LR. Preoperative vascular evaluation with computed tomography and magnetic resonance imaging for pancreatic cancer: a meta-analysis. Pancreatol Off J Int Assoc Pancreatol IAP Al. 2012;12(3):227–33.

    Article  Google Scholar 

  17. Treadwell JR, Zafar HMM, Mitchell MD, Tipton K, Teitelbaum U, Jue JM. Imaging tests for the diagnosis and staging of pancreatic adenocarcinoma: a meta-analysis. [Review]. Pancreas. 2016;45:789–95.

    Article  CAS  PubMed  Google Scholar 

  18. Tseng JF, Raut CP, Lee JE, Pisters PWT, Vauthey J-N, Abdalla EK, et al. Pancreaticoduodenectomy with vascular resection: margin status and survival duration. J Gastrointest Surg Off J Soc Surg Aliment Tract. 2004;8(8):935–49; discussion 949–50.

    Google Scholar 

  19. 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(8):1035–46.

    Article  PubMed  Google Scholar 

  20. Katz MHG, Marsh R, Herman JM, Shi Q, Collison E, Venook AP, et al. Borderline resectable pancreatic cancer: need for standardization and methods for optimal clinical trial design. Ann Surg Oncol. 2013;20(8):2787–95.

    Article  PubMed  Google Scholar 

  21. Hartwig W, Vollmer CM, Fingerhut A, Yeo CJ, Neoptolemos JP, Adham M, et al. Extended pancreatectomy in pancreatic ductal adenocarcinoma: definition and consensus of the International Study Group for Pancreatic Surgery (ISGPS). Surgery. 2014 Jul;156(1):1–14.

    Article  PubMed  Google Scholar 

  22. Petrelli F, Coinu A, Borgonovo K, Cabiddu M, Ghilardi M, Lonati V, et al. FOLFIRINOX-based neoadjuvant therapy in borderline resectable or unresectable pancreatic cancer: a meta-analytical review of published studies. Pancreas. 2015;44(4):515–21.

    Article  CAS  PubMed  Google Scholar 

  23. Stein SM, James ES, Deng Y, Cong X, Kortmansky JS, Li J, et al. Final analysis of a phase II study of modified FOLFIRINOX in locally advanced and metastatic pancreatic cancer. Br J Cancer. 2016;114(7):809–12.

    Article  CAS  PubMed Central  Google Scholar 

  24. Kelly KJ, Winslow E, Kooby D, Lad NL, Parikh AA, Scoggins CR, et al. Vein involvement during pancreaticoduodenectomy: is there a need for redefinition of “borderline resectable disease”? J Gastrointest Surg Off J Soc Surg Aliment Tract. 2013;17(7):1209–17; discussion 1217.

    Google Scholar 

  25. Zhou Y, Zhang Z, Liu Y, Li B, Xu D. Pancreatectomy combined with superior mesenteric vein–portal vein resection for pancreatic cancer: a meta -analysis. World J Surg. 2012;36(4):884–91.

    Article  PubMed  Google Scholar 

  26. Katz MHG, Fleming JB, Bhosale P, Varadhachary G, Lee JE, Wolff R, et al. Response of borderline resectable pancreatic cancer to neoadjuvant therapy is not reflected by radiographic indicators. Cancer. 2012;118(23):5749–56.

    Article  PubMed  Google Scholar 

  27. Allendorf JD, Lauerman M, Bill A, DiGiorgi M, Goetz N, Vakiani E, et al. Neoadjuvant chemotherapy and radiation for patients with locally unresectable pancreatic adenocarcinoma: feasibility, efficacy, and survival. J Gastrointest Surg Off J Soc Surg Aliment Tract. 2008;12(1):91–100.

    Article  Google Scholar 

  28. Hirono S, Kawai M, Okada K-I, Miyazawa M, Shimizu A, Kitahata Y, et al. Treatment strategy for borderline resectable pancreatic cancer with radiographic artery involvement. Pancreas. 2016;45:1438–46.

    Article  PubMed  Google Scholar 

  29. Ferrone CR, Marchegiani G, Hong TS, Ryan DP, Deshpande V, McDonnell EI, et al. Radiological and surgical implications of neoadjuvant treatment with FOLFIRINOX for locally advanced and borderline resectable pancreatic cancer. Ann Surg. 2015;261(1):12–7.

    Article  PubMed  PubMed Central  Google Scholar 

  30. Festa V, Andriulli A, Valvano MR, Uomo G, Perri F, Andriulli N, et al. Neoadjuvant chemo-radiotherapy for patients with borderline resectable pancreatic cancer: a meta-analytical evaluation of prospective studies. JOP J Pancreas. 2013;14(6):618–25.

    Google Scholar 

  31. Bang S, Chung HW, Park SW, Chung JB, Yun M, Lee JD, et al. The clinical usefulness of 18-fluorodeoxyglucose positron emission tomography in the differential diagnosis, staging, and response evaluation after concurrent chemoradiotherapy for pancreatic cancer. J Clin Gastroenterol. 2006;40(10):923–9.

    Article  PubMed  Google Scholar 

  32. Appleby LH. The coeliac axis in the expansion of the operation for gastric carcinoma. Cancer. 1953;6(4):704–7.

    Article  CAS  PubMed  Google Scholar 

  33. Bilimoria KY, Talamonti MS, Sener SF, Bilimoria MM, Stewart AK, Winchester DP, et al. Effect of hospital volume on margin status after pancreaticoduodenectomy for cancer. J Am Coll Surg. 2008;207(4):510–9.

    Article  PubMed  Google Scholar 

  34. Mitsunaga S, Hasebe T, Kinoshita T, Konishi M, Takahashi S, Gotohda N, et al. Detail histologic analysis of nerve plexus invasion in invasive ductal carcinoma of the pancreas and its prognostic impact. Am J Surg Pathol. 2007;31(11):1636–44.

    Article  PubMed  Google Scholar 

  35. Butler JR, Ahmad SA, Katz MH, Cioffi JL, Zyromski NJ. A systematic review of the role of periadventitial dissection of the superior mesenteric artery in affecting margin status after pancreatoduodenectomy for pancreatic adenocarcinoma. HPB. 2016;18(4):305–11.

    Article  PubMed  PubMed Central  Google Scholar 

  36. Rehders A, Stoecklein NH, Güray A, Riediger R, Alexander A, Knoefel WT. Vascular invasion in pancreatic cancer: tumor biology or tumor topography? Surgery. 2012;152(3 Supplement):S143–51.

    Article  PubMed  Google Scholar 

  37. Pandanaboyana S, Bell R, Windsor J. Artery first approach to pancreatoduodenectomy: current status. ANZ J Surg. 2016;86(3):127–32.

    Article  PubMed  Google Scholar 

  38. Pessaux P, Varma D, Arnaud J-P. Pancreaticoduodenectomy: superior mesenteric artery first approach. J Gastrointest Surg. 2006;10(4):607–11.

    Article  PubMed  Google Scholar 

  39. Inoue Y, Saiura A, Yoshioka R, Ono Y, Takahashi M, Arita J, et al. Pancreatoduodenectomy with systematic mesopancreas dissection using a supracolic anterior artery-first approach. Ann Surg. 2015;262(6):1092–101.

    Article  PubMed  Google Scholar 

  40. Weitz J, Rahbari N, Koch M, Büchler MW. The “artery first” approach for resection of pancreatic head cancer. J Am Coll Surg. 2010;210(2):e1–4.

    Article  PubMed  Google Scholar 

  41. Rose JB, Rocha F, Alseidi A, Helton S. Posterior “superior mesenteric artery first” approach for resection of locally advanced pancreatic cancer. Ann Surg Oncol. 2014;21(6):1927–8.

    Article  PubMed  Google Scholar 

  42. Gundara JS, Wang F, Alvarado-Bachmann R, Williams N, Choi J, Gananadha S, et al. The clinical impact of early complete pancreatic head devascularisation during pancreatoduodenectomy. Am J Surg. 2013;206(4):518–25.

    Article  CAS  PubMed  Google Scholar 

  43. Nagakawa Y, Hosokawa Y, Sahara Y, Takishita C, Nakajima T, Hijikata Y, et al. A novel “artery first” approach allowing safe resection in laparoscopic pancreaticoduodenectomy: the uncinate process first approach. Hepato-Gastroenterology. 2015;62(140):1037–40.

    PubMed  Google Scholar 

  44. Ugurel MS, Battal B, Bozlar U, Nural MS, Tasar M, Ors F, et al. Anatomical variations of hepatic arterial system, coeliac trunk and renal arteries: an analysis with multidetector CT angiography. Br J Radiol. 2010;83(992):661–7.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  45. Michels NA. Newer anatomy of the liver and its variant blood supply and collateral circulation. Am J Surg. 1966;112(3):337–47.

    Article  CAS  PubMed  Google Scholar 

  46. El Amrani M, Pruvot F-R, Truant S. Management of the right hepatic artery in pancreaticoduodenectomy: a systematic review. J Gastrointest Oncol. 2016;7(2):298–305.

    PubMed  PubMed Central  Google Scholar 

  47. Younan G, Chimukangara M, Tsai S, Evans DB, Christians KK. Replaced gastroduodenal artery: added benefit of the “artery first” approach during pancreaticoduodenectomy-a case report. Int J Surg Case Rep. 2016;23:93–7.

    Article  PubMed  PubMed Central  Google Scholar 

  48. Latona JA, Lamb KM, Pucci MJ, Maley WR, Yeo CJ. Modified appleby procedure with arterial reconstruction for locally advanced pancreatic adenocarcinoma: a literature review and report of three unusual cases. J Gastrointest Surg Off J Soc Surg Aliment Tract. 2016;20(2):300–6.

    Article  Google Scholar 

  49. Smoot RL, Donohue JH. Modified Appleby procedure for resection of tumors of the pancreatic body and tail with celiac axis involvement. J Gastrointest Surg Off J Soc Surg Aliment Tract. 2012;16(11):2167–9.

    Article  Google Scholar 

  50. Chua TC, Saxena A. Extended pancreaticoduodenectomy with vascular resection for pancreatic cancer: a systematic review. J Gastrointest Surg Off J Soc Surg Aliment Tract. 2010;14(9):1442–52.

    Article  Google Scholar 

  51. Hirai I, Kimura W, Kamiga M, Mizutani M, Takeshita A, Watanabe T, et al. The significance of intraoperative Doppler ultrasonography in evaluating hepatic arterial flow when assessing the indications for the Appleby procedure for pancreatic body cancer. J Hepato-Biliary-Pancreat Surg. 2005;12(1):55–60.

    Article  Google Scholar 

  52. Malgras B, Duron S, Gaujoux S, Dokmak S, Aussilhou B, Rebours V, et al. Early biliary complications following pancreaticoduodenectomy: prevalence and risk factors. HPB. 2016;18(4):367–74.

    Article  PubMed  PubMed Central  Google Scholar 

  53. Gong H, Ma R, Gong J, Cai C, Song Z, Xu B. Distal pancreatectomy with en bloc celiac axis resection for locally advanced pancreatic cancer: a systematic review and meta-analysis. Medicine (Baltimore). 2016;95(10):e3061.

    Article  Google Scholar 

  54. Yekebas EF, Bogoevski D, Cataldegirmen G, Kunze C, Marx A, Vashist YK, et al. En bloc vascular resection for locally advanced pancreatic malignancies infiltrating major blood vessels: perioperative outcome and long-term survival in 136 patients. Ann Surg. 2008;247(2):300–9.

    Article  PubMed  Google Scholar 

  55. Del Chiaro M, Segersvärd R, Rangelova E, Coppola A, Scandavini CM, Ansorge C, et al. Cattell-Braasch maneuver combined with artery-first approach for superior mesenteric-portal vein resection during pancreatectomy. J Gastrointest Surg Off J Soc Surg Aliment Tract. 2015;19(12):2264–8.

    Article  Google Scholar 

  56. Martin RCG, Scoggins CR, Egnatashvili V, Staley CA, McMasters KM, Kooby DA. Arterial and venous resection for pancreatic adenocarcinoma: operative and long-term outcomes. Arch Surg Chicago Illinois 1960. 2009;144(2):154–9.

    Google Scholar 

  57. 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(2):120–9.

    Article  CAS  PubMed  Google Scholar 

  58. Müller SA, Hartel M, Mehrabi A, Welsch T, Martin DJ, Hinz U, et al. Vascular resection in pancreatic cancer surgery: survival determinants. J Gastrointest Surg. 2009;13(4):784–92.

    Article  PubMed  Google Scholar 

  59. Siriwardana HPP, Siriwardena AK. Systematic review of outcome of synchronous portal–superior mesenteric vein resection during pancreatectomy for cancer. Br J Surg. 2006;93(6):662–73.

    Article  CAS  PubMed  Google Scholar 

  60. Han S-S, Park S-J, Kim SH, Cho SY, Kim Y-K, Kim TH, et al. Clinical significance of portal-superior mesenteric vein resection in pancreatoduodenectomy for pancreatic head cancer. Pancreas. 2012;41(1):102–6.

    Article  CAS  PubMed  Google Scholar 

  61. Kaneoka Y, Yamaguchi A, Isogai M. Portal or superior mesenteric vein resection for pancreatic head adenocarcinoma: prognostic value of the length of venous resection. Surgery. 2009;145(4):417–25.

    Article  PubMed  Google Scholar 

  62. Pan G, Xie K-L, Wu H. Vascular resection in pancreatic adenocarcinoma with portal or superior mesenteric vein invasion. World J Gastroenterol. 2013;19(46):8740–4.

    Article  PubMed  PubMed Central  Google Scholar 

  63. Murakami Y, Satoi S, Motoi F, Sho M, Kawai M, Matsumoto I, et al. Portal or superior mesenteric vein resection in pancreatoduodenectomy for pancreatic head carcinoma. Br J Surg. 2015;102(7):837–46.

    Article  CAS  PubMed  Google Scholar 

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Correspondence to Jakob R. Izbicki .

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Karstens, KF., Vashist, Y.K., Izbicki, J.R. (2017). Major Vascular Resection in Pancreatic Carcinoma. In: Kim, SW., Yamaue, H. (eds) Pancreatic Cancer. Springer, Berlin, Heidelberg. https://doi.org/10.1007/978-3-662-47181-4_15

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