Reconsideration of the Appropriate Dissection Range Based on Japanese Anatomical Classification for Resectable Pancreatic Head Cancer in the Era of Multimodal Treatment

Patients with resectable pancreatic cancer are considered to already have micro-distant metastasis, because most of the recurrence patterns postoperatively are distant metastases. Multimodal treatment dramatically improves prognosis; thus, micro-distant metastasis is considered to be controlled by c...

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Veröffentlicht in:Cancers 2021-07, Vol.13 (14), p.3605
Hauptverfasser: Nagakawa, Yuichi, Nakagawa, Naoya, Takishita, Chie, Uyama, Ichiro, Kozono, Shingo, Osakabe, Hiroaki, Suzuki, Kenta, Nakagawa, Nobuhiko, Hosokawa, Yuichi, Shirota, Tomoki, Honda, Masayuki, Yamada, Tesshi, Katsumata, Kenji, Tsuchida, Akihiko
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container_issue 14
container_start_page 3605
container_title Cancers
container_volume 13
creator Nagakawa, Yuichi
Nakagawa, Naoya
Takishita, Chie
Uyama, Ichiro
Kozono, Shingo
Osakabe, Hiroaki
Suzuki, Kenta
Nakagawa, Nobuhiko
Hosokawa, Yuichi
Shirota, Tomoki
Honda, Masayuki
Yamada, Tesshi
Katsumata, Kenji
Tsuchida, Akihiko
description Patients with resectable pancreatic cancer are considered to already have micro-distant metastasis, because most of the recurrence patterns postoperatively are distant metastases. Multimodal treatment dramatically improves prognosis; thus, micro-distant metastasis is considered to be controlled by chemotherapy. The survival benefit of “regional lymph node dissection” for pancreatic head cancer remains unclear. We reviewed the literature that could be helpful in determining the appropriate resection range. Regional lymph nodes with no suspected metastases on preoperative imaging may become areas treated with preoperative and postoperative adjuvant chemotherapy. Many studies have reported that the R0 resection rate is associated with prognosis. Thus, “dissection to achieve R0 resection” is required. The recent development of high-quality computed tomography has made it possible to evaluate the extent of cancer infiltration. Therefore, it is possible to simulate the dissection range to achieve R0 resection preoperatively. However, it is often difficult to distinguish between areas of inflammatory changes and cancer infiltration during resection. Even if the “dissection to achieve R0 resection” range is simulated based on the computed tomography evaluation, it is difficult to identify the range intraoperatively. It is necessary to be aware of anatomical landmarks to determine the appropriate dissection range during surgery.
doi_str_mv 10.3390/cancers13143605
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source MDPI - Multidisciplinary Digital Publishing Institute; Elektronische Zeitschriftenbibliothek - Frei zugängliche E-Journals; PubMed Central; PubMed Central Open Access
subjects Cancer therapies
Chemotherapy
Classification
Clinical trials
Computed tomography
Connective tissue
Dissection
Infiltration
Inflammation
Lymph nodes
Lymphatic system
Medical prognosis
Mesentery
Metastases
Metastasis
Pancreatic cancer
Pancreaticoduodenectomy
Prognosis
Review
Surgery
Survival
title Reconsideration of the Appropriate Dissection Range Based on Japanese Anatomical Classification for Resectable Pancreatic Head Cancer in the Era of Multimodal Treatment
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