Locally advanced pancreatic duct adenocarcinoma: pancreatectomy with planned arterial resection based on axial arterial encasement
Summary Pancreatectomy with arterial resection for locally advanced pancreatic duct adenocarcinoma (PDA) is associated with high morbidity and is thus considered as a contraindication. The aim of our study was to report our experience of pancreatectomy with planned arterial resection for locally adv...
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| Veröffentlicht in: | Langenbeck's archives of surgery 2016-12, Vol.401 (8), p.1131-1142 |
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| creator | Perinel, J. Nappo, G. El Bechwaty, M. Walter, T. Hervieu, V. Valette, P. J. Feugier, P. Adham, M. |
| description | Summary
Pancreatectomy with arterial resection for locally advanced pancreatic duct adenocarcinoma (PDA) is associated with high morbidity and is thus considered as a contraindication. The aim of our study was to report our experience of pancreatectomy with planned arterial resection for locally advanced PDA based on specific selection criteria.
Material and methods
All patients receiving pancreatectomy for PDA between October 2008 and July 2014 were reviewed. The patients were classified into group 1, pancreatectomy without vascular resection (66 patients); group 2, pancreatectomy with isolated venous resection (31 patients), and group 3, pancreatectomy with arterial resection for locally advanced PDA (14 patients). The primary selection criteria for arterial resection was the possibility of achieving a complete resection based on the extent of axial encasement, the absence of tumor invasion at the origin of celiac trunk (CT) and superior mesenteric artery (SMA), and a free distal arterial segment allowing reconstruction. Patient outcomes and survival were analyzed.
Results
Six SMA, two CT, four common hepatic artery, and two replaced right hepatic artery resections were undertaken. The preferred arterial reconstruction was splenic artery transposition. Group 3 had a higher preoperative weight loss, a longer operative time, and a higher incidence of intraoperative blood transfusion. Ninety-day mortality occurred in three patients in groups 1 and 2. There were no statistically significant differences in the incidence, grade, and type of complications in the three groups. Postoperative pancreatic fistula and postpancreatectomy hemorrhage were also comparable. In group 3, none had arterial wall invasion and nine patients had recurrence (seven metastatic and two loco-regional). Survival and disease-free survival were comparable between groups.
Conclusion
Planned arterial resection for PDA can be performed safely with a good outcome in highly selected patients. Key elements for defining the resectability is based on the extent of the axial arterial encasement with two criteria: the origin of the CT and SMA are free from tumor invasion and the possibility of distal reconstruction. |
| doi_str_mv | 10.1007/s00423-016-1488-y |
| format | Article |
| fullrecord | <record><control><sourceid>proquest_hal_p</sourceid><recordid>TN_cdi_hal_primary_oai_HAL_hal_04496006v1</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><sourcerecordid>1826738236</sourcerecordid><originalsourceid>FETCH-LOGICAL-c378t-b9c651b195664d7322566f42576214fa20e112857f29eeaacad999914a0101fb3</originalsourceid><addsrcrecordid>eNp9kc1u1TAQhSMEoj_wAGxQlrAIeBzHTthVFVCkK7GBtTVxJjRVYl_spG22PDlzlZIl3szI55sjzZwsewPiAwhhPiYhlCwLAboAVdfF-iw7B1VWhVQVPN97VZ5lFyndCSG0adTL7EwaZTQofZ79OQSH47jm2N2jd9TlRy6RcB5c3i1uZoE8M9ENPkz4adfJzWFa84dhvs2PI3rPsxhnigOOeaTE-hB83mJigRt8PAk7Qd6xMpGfX2UvehwTvX6ql9nPL59_XN8Uh-9fv11fHQpXmnou2sbpClpoKq1VZ0opuemVrIyWoHqUggBkXZleNkSIDruGHygUIKBvy8vs_eZ7i6M9xmHCuNqAg725OtjTn1Cq0Xyje2D23cYeY_i9UJrtNCRHI-9JYUkWaqlNWctSMwob6mJIKVK_e4Owp5jsFpPlmOwpJrvyzNsn-6WdqNsn_uXCgNyAxJL_RdHehSV6Ps9_XP8CdBqfDg</addsrcrecordid><sourcetype>Open Access Repository</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>1826738236</pqid></control><display><type>article</type><title>Locally advanced pancreatic duct adenocarcinoma: pancreatectomy with planned arterial resection based on axial arterial encasement</title><source>MEDLINE</source><source>SpringerNature Journals</source><creator>Perinel, J. ; Nappo, G. ; El Bechwaty, M. ; Walter, T. ; Hervieu, V. ; Valette, P. J. ; Feugier, P. ; Adham, M.</creator><creatorcontrib>Perinel, J. ; Nappo, G. ; El Bechwaty, M. ; Walter, T. ; Hervieu, V. ; Valette, P. J. ; Feugier, P. ; Adham, M.</creatorcontrib><description>Summary
Pancreatectomy with arterial resection for locally advanced pancreatic duct adenocarcinoma (PDA) is associated with high morbidity and is thus considered as a contraindication. The aim of our study was to report our experience of pancreatectomy with planned arterial resection for locally advanced PDA based on specific selection criteria.
Material and methods
All patients receiving pancreatectomy for PDA between October 2008 and July 2014 were reviewed. The patients were classified into group 1, pancreatectomy without vascular resection (66 patients); group 2, pancreatectomy with isolated venous resection (31 patients), and group 3, pancreatectomy with arterial resection for locally advanced PDA (14 patients). The primary selection criteria for arterial resection was the possibility of achieving a complete resection based on the extent of axial encasement, the absence of tumor invasion at the origin of celiac trunk (CT) and superior mesenteric artery (SMA), and a free distal arterial segment allowing reconstruction. Patient outcomes and survival were analyzed.
Results
Six SMA, two CT, four common hepatic artery, and two replaced right hepatic artery resections were undertaken. The preferred arterial reconstruction was splenic artery transposition. Group 3 had a higher preoperative weight loss, a longer operative time, and a higher incidence of intraoperative blood transfusion. Ninety-day mortality occurred in three patients in groups 1 and 2. There were no statistically significant differences in the incidence, grade, and type of complications in the three groups. Postoperative pancreatic fistula and postpancreatectomy hemorrhage were also comparable. In group 3, none had arterial wall invasion and nine patients had recurrence (seven metastatic and two loco-regional). Survival and disease-free survival were comparable between groups.
Conclusion
Planned arterial resection for PDA can be performed safely with a good outcome in highly selected patients. Key elements for defining the resectability is based on the extent of the axial arterial encasement with two criteria: the origin of the CT and SMA are free from tumor invasion and the possibility of distal reconstruction.</description><identifier>ISSN: 1435-2443</identifier><identifier>EISSN: 1435-2451</identifier><identifier>DOI: 10.1007/s00423-016-1488-y</identifier><identifier>PMID: 27476146</identifier><language>eng</language><publisher>Berlin/Heidelberg: Springer Berlin Heidelberg</publisher><subject>Abdominal Surgery ; Adenocarcinoma - mortality ; Adenocarcinoma - pathology ; Adenocarcinoma - surgery ; Aged ; Arteries - surgery ; Cancer ; Cardiac Surgery ; Disease-Free Survival ; Female ; General Surgery ; Human health and pathology ; Humans ; Hépatology and Gastroenterology ; Life Sciences ; Male ; Medicine ; Medicine & Public Health ; Middle Aged ; Operative Time ; Original Article ; Pancreatectomy - methods ; Pancreatic Ducts - blood supply ; Pancreatic Neoplasms - mortality ; Pancreatic Neoplasms - pathology ; Pancreatic Neoplasms - surgery ; Retrospective Studies ; Survival Rate ; Thoracic Surgery ; Traumatic Surgery ; Treatment Outcome ; Vascular Surgery</subject><ispartof>Langenbeck's archives of surgery, 2016-12, Vol.401 (8), p.1131-1142</ispartof><rights>Springer-Verlag Berlin Heidelberg 2016</rights><rights>Attribution - NonCommercial - NoDerivatives</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c378t-b9c651b195664d7322566f42576214fa20e112857f29eeaacad999914a0101fb3</citedby><cites>FETCH-LOGICAL-c378t-b9c651b195664d7322566f42576214fa20e112857f29eeaacad999914a0101fb3</cites><orcidid>0000-0002-4199-4561</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://link.springer.com/content/pdf/10.1007/s00423-016-1488-y$$EPDF$$P50$$Gspringer$$H</linktopdf><linktohtml>$$Uhttps://link.springer.com/10.1007/s00423-016-1488-y$$EHTML$$P50$$Gspringer$$H</linktohtml><link.rule.ids>230,314,780,784,885,27924,27925,41488,42557,51319</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/27476146$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink><backlink>$$Uhttps://hal.science/hal-04496006$$DView record in HAL$$Hfree_for_read</backlink></links><search><creatorcontrib>Perinel, J.</creatorcontrib><creatorcontrib>Nappo, G.</creatorcontrib><creatorcontrib>El Bechwaty, M.</creatorcontrib><creatorcontrib>Walter, T.</creatorcontrib><creatorcontrib>Hervieu, V.</creatorcontrib><creatorcontrib>Valette, P. J.</creatorcontrib><creatorcontrib>Feugier, P.</creatorcontrib><creatorcontrib>Adham, M.</creatorcontrib><title>Locally advanced pancreatic duct adenocarcinoma: pancreatectomy with planned arterial resection based on axial arterial encasement</title><title>Langenbeck's archives of surgery</title><addtitle>Langenbecks Arch Surg</addtitle><addtitle>Langenbecks Arch Surg</addtitle><description>Summary
Pancreatectomy with arterial resection for locally advanced pancreatic duct adenocarcinoma (PDA) is associated with high morbidity and is thus considered as a contraindication. The aim of our study was to report our experience of pancreatectomy with planned arterial resection for locally advanced PDA based on specific selection criteria.
Material and methods
All patients receiving pancreatectomy for PDA between October 2008 and July 2014 were reviewed. The patients were classified into group 1, pancreatectomy without vascular resection (66 patients); group 2, pancreatectomy with isolated venous resection (31 patients), and group 3, pancreatectomy with arterial resection for locally advanced PDA (14 patients). The primary selection criteria for arterial resection was the possibility of achieving a complete resection based on the extent of axial encasement, the absence of tumor invasion at the origin of celiac trunk (CT) and superior mesenteric artery (SMA), and a free distal arterial segment allowing reconstruction. Patient outcomes and survival were analyzed.
Results
Six SMA, two CT, four common hepatic artery, and two replaced right hepatic artery resections were undertaken. The preferred arterial reconstruction was splenic artery transposition. Group 3 had a higher preoperative weight loss, a longer operative time, and a higher incidence of intraoperative blood transfusion. Ninety-day mortality occurred in three patients in groups 1 and 2. There were no statistically significant differences in the incidence, grade, and type of complications in the three groups. Postoperative pancreatic fistula and postpancreatectomy hemorrhage were also comparable. In group 3, none had arterial wall invasion and nine patients had recurrence (seven metastatic and two loco-regional). Survival and disease-free survival were comparable between groups.
Conclusion
Planned arterial resection for PDA can be performed safely with a good outcome in highly selected patients. Key elements for defining the resectability is based on the extent of the axial arterial encasement with two criteria: the origin of the CT and SMA are free from tumor invasion and the possibility of distal reconstruction.</description><subject>Abdominal Surgery</subject><subject>Adenocarcinoma - mortality</subject><subject>Adenocarcinoma - pathology</subject><subject>Adenocarcinoma - surgery</subject><subject>Aged</subject><subject>Arteries - surgery</subject><subject>Cancer</subject><subject>Cardiac Surgery</subject><subject>Disease-Free Survival</subject><subject>Female</subject><subject>General Surgery</subject><subject>Human health and pathology</subject><subject>Humans</subject><subject>Hépatology and Gastroenterology</subject><subject>Life Sciences</subject><subject>Male</subject><subject>Medicine</subject><subject>Medicine & Public Health</subject><subject>Middle Aged</subject><subject>Operative Time</subject><subject>Original Article</subject><subject>Pancreatectomy - methods</subject><subject>Pancreatic Ducts - blood supply</subject><subject>Pancreatic Neoplasms - mortality</subject><subject>Pancreatic Neoplasms - pathology</subject><subject>Pancreatic Neoplasms - surgery</subject><subject>Retrospective Studies</subject><subject>Survival Rate</subject><subject>Thoracic Surgery</subject><subject>Traumatic Surgery</subject><subject>Treatment Outcome</subject><subject>Vascular Surgery</subject><issn>1435-2443</issn><issn>1435-2451</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2016</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNp9kc1u1TAQhSMEoj_wAGxQlrAIeBzHTthVFVCkK7GBtTVxJjRVYl_spG22PDlzlZIl3szI55sjzZwsewPiAwhhPiYhlCwLAboAVdfF-iw7B1VWhVQVPN97VZ5lFyndCSG0adTL7EwaZTQofZ79OQSH47jm2N2jd9TlRy6RcB5c3i1uZoE8M9ENPkz4adfJzWFa84dhvs2PI3rPsxhnigOOeaTE-hB83mJigRt8PAk7Qd6xMpGfX2UvehwTvX6ql9nPL59_XN8Uh-9fv11fHQpXmnou2sbpClpoKq1VZ0opuemVrIyWoHqUggBkXZleNkSIDruGHygUIKBvy8vs_eZ7i6M9xmHCuNqAg725OtjTn1Cq0Xyje2D23cYeY_i9UJrtNCRHI-9JYUkWaqlNWctSMwob6mJIKVK_e4Owp5jsFpPlmOwpJrvyzNsn-6WdqNsn_uXCgNyAxJL_RdHehSV6Ps9_XP8CdBqfDg</recordid><startdate>20161201</startdate><enddate>20161201</enddate><creator>Perinel, J.</creator><creator>Nappo, G.</creator><creator>El Bechwaty, M.</creator><creator>Walter, T.</creator><creator>Hervieu, V.</creator><creator>Valette, P. J.</creator><creator>Feugier, P.</creator><creator>Adham, M.</creator><general>Springer Berlin Heidelberg</general><general>Springer Verlag</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope><scope>1XC</scope><orcidid>https://orcid.org/0000-0002-4199-4561</orcidid></search><sort><creationdate>20161201</creationdate><title>Locally advanced pancreatic duct adenocarcinoma: pancreatectomy with planned arterial resection based on axial arterial encasement</title><author>Perinel, J. ; Nappo, G. ; El Bechwaty, M. ; Walter, T. ; Hervieu, V. ; Valette, P. J. ; Feugier, P. ; Adham, M.</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c378t-b9c651b195664d7322566f42576214fa20e112857f29eeaacad999914a0101fb3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2016</creationdate><topic>Abdominal Surgery</topic><topic>Adenocarcinoma - mortality</topic><topic>Adenocarcinoma - pathology</topic><topic>Adenocarcinoma - surgery</topic><topic>Aged</topic><topic>Arteries - surgery</topic><topic>Cancer</topic><topic>Cardiac Surgery</topic><topic>Disease-Free Survival</topic><topic>Female</topic><topic>General Surgery</topic><topic>Human health and pathology</topic><topic>Humans</topic><topic>Hépatology and Gastroenterology</topic><topic>Life Sciences</topic><topic>Male</topic><topic>Medicine</topic><topic>Medicine & Public Health</topic><topic>Middle Aged</topic><topic>Operative Time</topic><topic>Original Article</topic><topic>Pancreatectomy - methods</topic><topic>Pancreatic Ducts - blood supply</topic><topic>Pancreatic Neoplasms - mortality</topic><topic>Pancreatic Neoplasms - pathology</topic><topic>Pancreatic Neoplasms - surgery</topic><topic>Retrospective Studies</topic><topic>Survival Rate</topic><topic>Thoracic Surgery</topic><topic>Traumatic Surgery</topic><topic>Treatment Outcome</topic><topic>Vascular Surgery</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Perinel, J.</creatorcontrib><creatorcontrib>Nappo, G.</creatorcontrib><creatorcontrib>El Bechwaty, M.</creatorcontrib><creatorcontrib>Walter, T.</creatorcontrib><creatorcontrib>Hervieu, V.</creatorcontrib><creatorcontrib>Valette, P. J.</creatorcontrib><creatorcontrib>Feugier, P.</creatorcontrib><creatorcontrib>Adham, M.</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><collection>Hyper Article en Ligne (HAL)</collection><jtitle>Langenbeck's archives of surgery</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Perinel, J.</au><au>Nappo, G.</au><au>El Bechwaty, M.</au><au>Walter, T.</au><au>Hervieu, V.</au><au>Valette, P. J.</au><au>Feugier, P.</au><au>Adham, M.</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Locally advanced pancreatic duct adenocarcinoma: pancreatectomy with planned arterial resection based on axial arterial encasement</atitle><jtitle>Langenbeck's archives of surgery</jtitle><stitle>Langenbecks Arch Surg</stitle><addtitle>Langenbecks Arch Surg</addtitle><date>2016-12-01</date><risdate>2016</risdate><volume>401</volume><issue>8</issue><spage>1131</spage><epage>1142</epage><pages>1131-1142</pages><issn>1435-2443</issn><eissn>1435-2451</eissn><abstract>Summary
Pancreatectomy with arterial resection for locally advanced pancreatic duct adenocarcinoma (PDA) is associated with high morbidity and is thus considered as a contraindication. The aim of our study was to report our experience of pancreatectomy with planned arterial resection for locally advanced PDA based on specific selection criteria.
Material and methods
All patients receiving pancreatectomy for PDA between October 2008 and July 2014 were reviewed. The patients were classified into group 1, pancreatectomy without vascular resection (66 patients); group 2, pancreatectomy with isolated venous resection (31 patients), and group 3, pancreatectomy with arterial resection for locally advanced PDA (14 patients). The primary selection criteria for arterial resection was the possibility of achieving a complete resection based on the extent of axial encasement, the absence of tumor invasion at the origin of celiac trunk (CT) and superior mesenteric artery (SMA), and a free distal arterial segment allowing reconstruction. Patient outcomes and survival were analyzed.
Results
Six SMA, two CT, four common hepatic artery, and two replaced right hepatic artery resections were undertaken. The preferred arterial reconstruction was splenic artery transposition. Group 3 had a higher preoperative weight loss, a longer operative time, and a higher incidence of intraoperative blood transfusion. Ninety-day mortality occurred in three patients in groups 1 and 2. There were no statistically significant differences in the incidence, grade, and type of complications in the three groups. Postoperative pancreatic fistula and postpancreatectomy hemorrhage were also comparable. In group 3, none had arterial wall invasion and nine patients had recurrence (seven metastatic and two loco-regional). Survival and disease-free survival were comparable between groups.
Conclusion
Planned arterial resection for PDA can be performed safely with a good outcome in highly selected patients. Key elements for defining the resectability is based on the extent of the axial arterial encasement with two criteria: the origin of the CT and SMA are free from tumor invasion and the possibility of distal reconstruction.</abstract><cop>Berlin/Heidelberg</cop><pub>Springer Berlin Heidelberg</pub><pmid>27476146</pmid><doi>10.1007/s00423-016-1488-y</doi><tpages>12</tpages><orcidid>https://orcid.org/0000-0002-4199-4561</orcidid></addata></record> |
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| subjects | Abdominal Surgery Adenocarcinoma - mortality Adenocarcinoma - pathology Adenocarcinoma - surgery Aged Arteries - surgery Cancer Cardiac Surgery Disease-Free Survival Female General Surgery Human health and pathology Humans Hépatology and Gastroenterology Life Sciences Male Medicine Medicine & Public Health Middle Aged Operative Time Original Article Pancreatectomy - methods Pancreatic Ducts - blood supply Pancreatic Neoplasms - mortality Pancreatic Neoplasms - pathology Pancreatic Neoplasms - surgery Retrospective Studies Survival Rate Thoracic Surgery Traumatic Surgery Treatment Outcome Vascular Surgery |
| title | Locally advanced pancreatic duct adenocarcinoma: pancreatectomy with planned arterial resection based on axial arterial encasement |
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