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Surgical Management of Pancreatic Adenocarcinoma

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Hepato-Pancreato-Biliary Malignancies

Abstract

Globally, pancreatic cancer accounts for 4% of all cancer-related deaths and will become the second largest cause of cancer-related deaths by 2030. The most important intervention in the multimodal therapy for pancreatic cancer remains surgical intervention. The operation depends on the anatomical location of the tumor with tumors in the head of the pancreas necessitating a pancreaticoduodenectomy (Whipple procedure). The success of surgery depends on the thorough evaluation of patients and preoperative optimization. Minimally invasive diagnostic laparoscopy has improved patient selection. Increasing familiarity with the disease and improvement of adjuvant and neoadjuvant therapies have allowed the broader inclusion of surgical candidates to include vascular resection. While the operation remains, technically challenging outcomes continue to improve.

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References

  1. Are C, Chowdhury S, Ahmad H, Ravipati A, Song T, Shrikandhe S, Smith L. Predictive global trends in the incidence and mortality of pancreatic cancer based on geographic location, socio-economic status, and demographic shift. J Surg Oncol. 2016;114:736–42.

    Article  Google Scholar 

  2. ASCO. Pancreatic cancer. Statistics. Available online: https://www.cancer.net/cancer-types/pancreatic-cancer/statistics. Accessed on 1 Jan 2021

  3. Stefanidis D, Grove KD, Schwesinger WH, Thomas CR Jr. The current role of staging laparoscopy for adenocarcinoma of the pancreas: a review. Ann Oncol. 2006;17(2):189–99. https://doi.org/10.1093/annonc/mdj013.

    Article  CAS  PubMed  Google Scholar 

  4. Cuschieri A, Hall AW, Clark J, et al. Value of laparoscopy in the diagnosis and management of pancreatic carcinoma. Gut. 1978;19:672–7.

    Article  CAS  Google Scholar 

  5. Ta R, O’Connor DB, Sulistijo A, Chung B, Conlon KC. The role of staging laparoscopy in resectable and borderline resectable pancreatic cancer: a systematic review and meta-analysis. Dig Surg. 2019;36(3):251–60. https://doi.org/10.1159/000488372.

    Article  PubMed  Google Scholar 

  6. De Rosa A, Cameron IC, Gomez D. Indications for staging laparoscopy in pancreatic cancer. HPB (Oxford). 2016;18(1):13–20. https://doi.org/10.1016/j.hpb.2015.10.004.

    Article  Google Scholar 

  7. Satoi S, Yanagimoto H, Toyokawa H, Inoue K, Wada K, Yamamoto T, Hirooka S, Yamaki S, Yui R, Mergental H, Kwon A-H. Selective use of staging laparoscopy based on carbohydrate antigen 19-9 level and tumor size in patients with radiographically defined potentially or borderline resectable pancreatic cancer. Pancreas. 2011;40(3):426–32. https://doi.org/10.1097/MPA.0b013e3182056b1c.

    Article  CAS  PubMed  Google Scholar 

  8. DiMagno EP. Cancer of the pancreas and biliary tract. In: Winawer SJ, editor. Management of gastrointestinal diseases. New York: Gower Medical Publishing; 1992.

    Google Scholar 

  9. Obstructive jaundice: history and current status. J Gastrointest Surg. 2009;13:814–20. https://doi.org/10.1007/s11605-008-0618-4.

  10. Gouma DJ, Roughneen PT, Kumar S, et al. Changes in nutritional status associated with obstructive jaundice and biliary drainage in rats. Am J Clin Nutr. 1986;44:362–9.

    Article  CAS  Google Scholar 

  11. Greve JW, Gouma DJ, Soeters PB, Buurman WA. Suppression of cellular immunity in obstructive jaundice is caused by endotoxins: a study with germ-free rats. Gastroenterology. 1990;98:478–85.

    Article  CAS  Google Scholar 

  12. Smith RC, Pooley M, George CR, Faithful GR. Preoperative percutaneous transhepatic internal drainage in obstructive jaundice: a randomized controlled trial examining renal function. Surgery. 1985;97(6):641–9.

    CAS  PubMed  Google Scholar 

  13. Van der Gaag NA, Rauws EA, van Eijck CH, et al. Preoperative biliary drainage for cancer of the head of the pancreas. N Engl J Med. 2010;362(2):129–37.

    Article  Google Scholar 

  14. Sewnath ME, Karsten TM, Prins MH, Rauws EJ, Obertop H, Gouma DJ. A meta-analysis on the efficacy of preoperative biliary drainage for tumors causing obstructive jaundice. Ann Surg. 2002;236:17–27.

    Article  Google Scholar 

  15. Chu LC, Goggins MG, Fishman EK. Diagnosis and detection of pancreatic cancer. Cancer J. 2017;23(6):333–42. https://doi.org/10.1097/PPO.0000000000000290.

    Article  PubMed  Google Scholar 

  16. Wang W, Shpaner A, Krishna SG, et al. Use of EUS-FNA in diagnosing pancreatic neoplasm without a definitive mass on CT. Gastrointest Endosc. 2013;78:73–80.

    Article  Google Scholar 

  17. Goel N, Nadler A, Reddy S, Hoffman JP, Pitt HA. Biliary microbiome in pancreatic cancer: alterations with neoadjuvant therapy. HPB (Oxford). 2019;21(12):1753–60. https://doi.org/10.1016/j.hpb.2019.04.005.

    Article  Google Scholar 

  18. Negoi I, Beuran M, Hostiuc S, Negoi RI, Inoue Y. Surgical anatomy of the superior mesenteric vessels related to pancreaticoduodenectomy: a systematic review and meta-analysis. J Gastrointest Surg. 2018;22(5):802–17.

    Article  Google Scholar 

  19. Blumgart LH, Fong Y. Surgery of the liver and biliary tract. 3rd ed. New York: Saunders Co Ltd; 2000.

    Google Scholar 

  20. Van der Wilt AA, Coolsen MM, de Hingh IH, et al. To drain or not to drain: a cumulative meta-analysis of the use of routine abdominal drains after pancreatic resection. HPB. 2013;15:337–44.

    Article  Google Scholar 

  21. Addison P, Nauka PC, Fatakhova K, Amodu L, Kohn N, Rodriguez Rilo HL. Impact of drain placement and duration on outcomes after pancreaticoduodenectomy: a national surgical quality improvement program analysis. J Surg Res. 2019;243:100–7.

    Article  Google Scholar 

  22. Zaghal A, Tamim H, Habib S, Jaafar R, Mukherji D, Khalife M, Mailhac A, Faraj W. Drain or no drain following pancreaticoduodenectomy: the unsolved dilemma. Scand J Surg. 2020;109(3):228–37. https://doi.org/10.1177/1457496919840960.

    Article  CAS  PubMed  Google Scholar 

  23. Beane JD, House MG, Ceppa EP, Dolejs SC, Pitt HA. Variation in drain management after pancreatoduodenectomy: early versus delayed removal. Ann Surg. 2019;269(4):718–24.

    Article  Google Scholar 

  24. Bassi C, Molinari E, Malleo G, Crippa S, Butturini G, Salvia R, Talamini G, Pederzoli P. Early versus late drain removal after standard pancreatic resections: results of a prospective randomized trial. Ann Surg. 2010;252(2):207–14.

    Article  Google Scholar 

  25. Villafane-Ferriol N, Baugh KA, McElhany AL, et al. Evidence versus practice in early drain removal after pancreatectomy. J Surg Res. 2019;236:332–9. https://doi.org/10.1016/j.jss.2018.11.048.

    Article  PubMed  PubMed Central  Google Scholar 

  26. Hüttner FJ, Fitzmaurice C, Schwarzer G, Seiler CM, Antes G, Büchler MW, Diener MK. Pylorus-preserving pancreaticoduodenectomy (pp Whipple) versus pancreaticoduodenectomy (classic Whipple) for surgical treatment of periampullary and pancreatic carcinoma. Cochrane Database Syst Rev. 2016;2:CD006053. https://doi.org/10.1002/14651858.CD006053.pub6.

    Article  PubMed  Google Scholar 

  27. Seiler CA, Wagner M, Sadowski C, Kulli C, Buchler MW. Randomized prospective trial of pylorus-preserving vs. classic duodenopancreatectomy (Whipple procedure): initial clinical results. J Gastrointest Surg. 2000;4(5):443–52.

    Article  CAS  Google Scholar 

  28. Williamson RC, Bliouras N, Cooper MJ, Davies ER. Gastric emptying and enterogastric reflux after conservative and conventional pancreatoduodenectomy. Surgery. 1993;114(1):82–6.

    CAS  PubMed  Google Scholar 

  29. Tran KT, Smeenk HG, 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(5):738–45.

    Article  Google Scholar 

  30. Mosca F, Giulianotti PC, Balestracci T, et al. Long-term survival in pancreatic cancer: pylorus-preserving versus Whipple pancreatoduodenectomy. Surgery. 1997;122:553–66.

    Article  CAS  Google Scholar 

  31. Hackert T, Strobel O, Michalski C, et al. The TRIANGLE operation – radical surgery after neoadjuvant treatment for advanced pancreatic cancer – a single arm observational study. HPB. 2017;19:1001–7.

    Article  Google Scholar 

  32. Dua MM, Tran TB, Klausner J, et al. Pancreatectomy with vein reconstruction: technique matters. HPB (Oxford). 2015;17(9):824–31. https://doi.org/10.1111/hpb.12463.

    Article  PubMed Central  Google Scholar 

  33. Kim PT, Wei AC, Atenafu EG, Cavallucci D, Cleary SP, Moulton CA. Planned versus unplanned portal vein resections during pancreaticoduodenectomy for adenocarcinoma. Br J Surg. 2013;100:1349–56.

    Article  CAS  Google Scholar 

  34. Suzuki T, Yoshidome H, Kimura F, Shimizu H, Ohtsuka M, Kato A, et al. Renal function is well maintained after use of left renal vein graft for vascular reconstruction in hepatobiliary-pancreatic surgery. J Am CollSurg. 2006;202:87–92.

    Google Scholar 

  35. Liao K, Wang H, Chen Q, Wu Z, Zhang L. Prosthetic graft for superior mesenteric-portal vein reconstruction in pancreaticoduodenectomy: a retrospective, multicenter study. J Gastrointest Surg. 2014;18:1452–61.

    Article  Google Scholar 

  36. Panwar R, Pal S. The International Study Group of Pancreatic Surgery definition of delayed gastric emptying and the effects of various surgical modifications on the occurrence of delayed gastric emptying after pancreatoduodenectomy. Hepatobiliary Pancreat Dis Int. 2017;16(4):353–63.

    Article  Google Scholar 

  37. Karim SAM, Abdulla KS, Abdulkarim QH, Rahim FH. The outcomes and complications of pancreaticoduodenectomy (Whipple procedure): Cross sectional study. Int J Surg. 2018;52:383–7. https://doi.org/10.1016/j.ijsu.2018.01.041.

    Article  PubMed  Google Scholar 

  38. Duarte Garcés AA, Andrianello S, Marchegiani G, Piccolo R, Secchettin E, Paiella S, Malleo G, Salvia R, Bassi C. Reappraisal of post-pancreatectomy hemorrhage (PPH) classifications: do we need to redefine grades A and B? HPB (Oxford). 2018;20(8):702–7.

    Article  Google Scholar 

  39. Ke Z, Cui J, Hu N, Yang Z, Chen H, Hu J, Wang C, Wu H, Nie X, Xiong J. Risk factors for postoperative pancreatic fistula: analysis of 170 consecutive cases of pancreaticoduodenectomy based on the updated ISGPS classification and grading system. Medicine (Baltimore). 2018;97(35)

    Google Scholar 

  40. Allen PJ, Gönen M, Brennan MF, Bucknor AA, Robinson LM, Pappas MM, Carlucci KE, D'Angelica MI, DeMatteo RP, Kingham TP, Fong Y, Jarnagin WR. Pasireotide for postoperative pancreatic fistula. N Engl J Med. 2014;370(21):2014–22.

    Article  Google Scholar 

  41. Malleo G, Crippa S, Butturini G, Salvia R, Partelli S, Rossini R, Bacchion M, Pederzoli P, Bassi C. Delayed gastric emptying after pylorus-preserving pancreaticoduodenectomy: validation of International Study Group of Pancreatic Surgery classification and analysis of risk factors. HPB (Oxford). 2010;12(9):610–8.

    Article  Google Scholar 

  42. Miura F, Asano T, Amano H, Yoshida M, Toyota N, Wada K, Kato K, Yamazaki E, Kadowaki S, Shibuya M, Maeno S, Furui S, Takeshita K, Kotake Y, Takada T. Management of postoperative arterial hemorrhage after pancreato-biliary surgery according to the site of bleeding: re-laparotomy or interventional radiology. J Hepatobiliary Pancreat Surg. 2009;16(1):56–63.

    Article  Google Scholar 

  43. Validation of postresection pancreatic adenocarcinoma nomogram for disease specific survival

    Google Scholar 

  44. Ciambella CC, Beard RE, Miner TJ. Current role of palliative interventions in advanced pancreatic cancer. World J Gastrointest Surg. 2018;10(7):75–83. https://doi.org/10.4240/wjgs.v10.i7.75.

    Article  PubMed  PubMed Central  Google Scholar 

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Di Carlo, A., Gunder, M., Doria, C. (2021). Surgical Management of Pancreatic Adenocarcinoma. In: Doria, C., Rogart, J.N. (eds) Hepato-Pancreato-Biliary Malignancies. Springer, Cham. https://doi.org/10.1007/978-3-030-37482-2_32-1

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  • DOI: https://doi.org/10.1007/978-3-030-37482-2_32-1

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  • Print ISBN: 978-3-030-37482-2

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