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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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. |
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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.</description><identifier>ISSN: 2072-6694</identifier><identifier>EISSN: 2072-6694</identifier><identifier>DOI: 10.3390/cancers13143605</identifier><identifier>PMID: 34298818</identifier><language>eng</language><publisher>Basel: MDPI AG</publisher><subject>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</subject><ispartof>Cancers, 2021-07, Vol.13 (14), p.3605</ispartof><rights>2021 by the authors. Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https://creativecommons.org/licenses/by/4.0/). 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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.</description><subject>Cancer therapies</subject><subject>Chemotherapy</subject><subject>Classification</subject><subject>Clinical trials</subject><subject>Computed tomography</subject><subject>Connective tissue</subject><subject>Dissection</subject><subject>Infiltration</subject><subject>Inflammation</subject><subject>Lymph nodes</subject><subject>Lymphatic system</subject><subject>Medical prognosis</subject><subject>Mesentery</subject><subject>Metastases</subject><subject>Metastasis</subject><subject>Pancreatic cancer</subject><subject>Pancreaticoduodenectomy</subject><subject>Prognosis</subject><subject>Review</subject><subject>Surgery</subject><subject>Survival</subject><issn>2072-6694</issn><issn>2072-6694</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2021</creationdate><recordtype>article</recordtype><sourceid>8G5</sourceid><sourceid>BENPR</sourceid><sourceid>GUQSH</sourceid><sourceid>M2O</sourceid><recordid>eNpdUsFu1DAQtRCIVkvPXC1x4bLUjh3HviCVpaWgItCqnKOJPWldJXawEyT-qJ-Js60Q1BeP9d68mXkeQl5z9k4Iw04tBIspc8GlUKx-Ro4r1lRbpYx8_k98RE5yvmPlCMEb1bwkR0JWRmuuj8n9Hm0M2TtMMPsYaOzpfIv0bJpSnJKHGelHnzPaA7qHcIP0A2R0tDy_wAQBc6EHmOPoLQx0N0DOvi_xIaOPie5xzYduQPq99JywQJZeIji6O8xAfThUPU-wNvB1GWY_RlfUrlfyiGF-RV70MGQ8ebw35MfF-fXucnv17dPn3dnV1kol563VDSD22jROVZ01xpmq76yzDTrOFHZCI3S6RtFJVJ2omTTSQF9xqXuJVmzI-wfdaelGdLaUTjC0xYoR0u82gm__R4K_bW_ir1YLJornReDto0CKPxfMczv6bHEYilNxyW1V1zVnoimftiFvnlDv4pJCGW9lSak4r1fB0weWTTHnhP3fZjhr10VonyyC-AOCv6qE</recordid><startdate>20210719</startdate><enddate>20210719</enddate><creator>Nagakawa, Yuichi</creator><creator>Nakagawa, Naoya</creator><creator>Takishita, Chie</creator><creator>Uyama, Ichiro</creator><creator>Kozono, Shingo</creator><creator>Osakabe, Hiroaki</creator><creator>Suzuki, Kenta</creator><creator>Nakagawa, Nobuhiko</creator><creator>Hosokawa, Yuichi</creator><creator>Shirota, Tomoki</creator><creator>Honda, Masayuki</creator><creator>Yamada, Tesshi</creator><creator>Katsumata, Kenji</creator><creator>Tsuchida, Akihiko</creator><general>MDPI AG</general><general>MDPI</general><scope>AAYXX</scope><scope>CITATION</scope><scope>3V.</scope><scope>7T5</scope><scope>7TO</scope><scope>7XB</scope><scope>8FE</scope><scope>8FH</scope><scope>8FK</scope><scope>8G5</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>AZQEC</scope><scope>BBNVY</scope><scope>BENPR</scope><scope>BHPHI</scope><scope>CCPQU</scope><scope>DWQXO</scope><scope>GNUQQ</scope><scope>GUQSH</scope><scope>H94</scope><scope>HCIFZ</scope><scope>LK8</scope><scope>M2O</scope><scope>M7P</scope><scope>MBDVC</scope><scope>PHGZM</scope><scope>PHGZT</scope><scope>PIMPY</scope><scope>PKEHL</scope><scope>PQEST</scope><scope>PQGLB</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>PRINS</scope><scope>Q9U</scope><scope>7X8</scope><scope>5PM</scope><orcidid>https://orcid.org/0000-0003-2095-1308</orcidid><orcidid>https://orcid.org/0000-0003-1169-8160</orcidid><orcidid>https://orcid.org/0000-0002-6843-7482</orcidid></search><sort><creationdate>20210719</creationdate><title>Reconsideration of the Appropriate Dissection Range Based on Japanese Anatomical Classification for Resectable Pancreatic Head Cancer in the Era of Multimodal Treatment</title><author>Nagakawa, Yuichi ; 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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. 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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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