Pancreatic Adenocarcinoma in the Head of the Pancreas with Portal Vein Involvement

2017 ◽  
pp. 277-288
Author(s):  
Gyulnara G. Kasumova ◽  
Jennifer F. Tseng
Keyword(s):  
Portal Vein ◽  
Pancreatic Adenocarcinoma ◽  
Head Of The Pancreas

scholarly journals Hepatic Artery Embolization prior to En Bloc Resection of an Encased Common Hepatic Artery in Adenocarcinoma of the Head of the Pancreas

2013 ◽  
Vol 2013 ◽  
pp. 1-4 ◽  
Author(s):  
Gregory Sergeant ◽  
Erik Schadde ◽  
Geert Maleux ◽  
Raymond Aerts
Keyword(s):  
Portal Vein ◽  
Hepatic Artery ◽  
Balloon Dilation ◽  
En Bloc Resection ◽  
Common Hepatic Artery ◽  
Pathological Examination ◽  
Periampullary Cancer ◽  
En Bloc ◽  
Head Of The Pancreas ◽  
The Common

A 64-year-old female patient with adenocarcinoma of the head of the pancreas with encasement of the common hepatic artery and portal vein stenosis was reexplored after six cycles of gemcitabine (1000 mg/m2). Prior to surgery, the patient underwent balloon dilation and stenting of the portal vein in addition to successful coil embolisation of the common hepatic artery, proper hepatic artery, and proximal gastroduodenal artery. After embolisation, a pylorus-preserving pancreaticoduodenectomy was performed with resection of the common hepatic artery and portal vein confluens. Pathological examination showed a moderately differentiated pT3N0 (Stage IIa, TNM 7th edition) tumor with negative section margins. We show with this case that in selected cases of periampullary cancer with encasement of the common hepatic artery, it is technically feasible to perform pancreaticoduodenectomy with hepatic artery resection and negative surgical margins. Nevertheless, the oncological benefit of extended arterial resections remains controversial.

scholarly journals Multidisciplinary approach for Borderline pancreatic adenocarcinoma of the head of the pancreas

HPB ◽  
2020 ◽  
Vol 22 ◽  
pp. S318
Author(s):  
R. Rhaiem ◽  
O. Delchet ◽  
A. Tashkandi ◽  
S. Deguelte ◽  
M. Brasseur ◽  
...  
Keyword(s):  
Pancreatic Adenocarcinoma ◽  
Multidisciplinary Approach ◽  
Head Of The Pancreas

scholarly journals Superior Mesenteric-Portal Vein Resection in Patients With Pancreatic Adenocarcinoma Is Safe and May Increase Survival

2017 ◽  
Vol 102 (7-8) ◽  
pp. 356-361
Author(s):  
Wei-Ding Wu ◽  
Hong-Guo Yang ◽  
Jia Wu ◽  
Kai Jiang ◽  
Kun Guo ◽  
...  
Keyword(s):  
Portal Vein ◽  
Pancreatic Adenocarcinoma ◽  
Survival Rates ◽  
Vein Wall ◽  
Venous Resection ◽  
Group A ◽  
Tumor Involvement ◽  
Artery First ◽  
Vein Resection ◽  
Group B

Extension of pancreatic adenocarcinoma into adjacent vasculature often necessitates resection of the portal vein (PV) and or superior mesenteric vein (SMV) during pancreaticoduodenectomy (PD). Our study describes the surgical technique and results of PV/SMV resection in pancreatic adenocarcinoma patients. Between January 2008 and October 2013, 252 patients underwent PD for pancreatic malignancy. A total of 42 PV/SMV resections were performed (28 men, 14 women). Patients were categorized into 2 groups according to the degree of invasion into the portal vein wall: Group A (n = 16), extended compression of the portal vein wall by the surrounding carcinoma without true invasion, and Group B (n = 26), true invasion including intramural and transmural invasion. Morbidity of the 42 patients was 35%; there was no operative mortality, and overall 1-, 3-, and 5-year survival rates were 60%, 21%, and 12%, respectively. No differences in tumor size, margin positivity, nodal positivity, or survival rates were observed between groups. Resection of the PV/SMV is safe and does not increase morbidity or mortality. Tumor involvement of the PV/SMV is not associated with histopathologic signs that are predictive of a poor prognosis. The “artery first” approach should be considered as a means to facilitate safe venous resection and reconstruction.

scholarly journals Injuries of the Portal Vein in Patients With Blunt Abdominal Trauma

HPB Surgery ◽  
1993 ◽  
Vol 6 (3) ◽  
pp. 163-168 ◽  
Author(s):  
D. Henne-Bruns ◽  
B. Kremer ◽  
D. M. Lloyd ◽  
U. Meyer-Pannwitt
Keyword(s):  
Portal Vein ◽  
Abdominal Trauma ◽  
Blunt Abdominal Trauma ◽  
Vena Cava ◽  
Prosthetic Graft ◽  
Emergency Laparotomy ◽  
Distal Pancreatic Resection ◽  
Major Injury ◽  
Mesenteric Root ◽  
Head Of The Pancreas

Between January 1987 and September 1991, 68 severely traumatized patients underwent emergency laparotomy because of blunt abdominal trauma. Intraoperatively, 54.4% of the patients had a major injury to one organ, 23.5% had injuries to two organs, 16.2% had injuries to three organs and 5.9% to four or more organs. Additionally, in 11.8% of these cases (n = 8) a major vascular injury (portal vein n = 5, vena cava n = 2, mesenteric root n = 1) was found. Injuries to the portal vein were always associated with complete rupture of the pancreas, requiring distal pancreatic resection in four cases and a duodenum preserving resection of the head of the pancreas in one. In two of these patients the portal vein had to be reconstructed with a Goretex prosthetic graft. Mortality was 14.7% for the whole group (n = 68) and 0% for patients with additional portal venous injuries.

scholarly journals Portal Vein Stenting for Jejunal Variceal Bleeding after Recurrence of Pancreatic Adenocarcinoma: A Case Report and Review of the Literature

2021 ◽  
Vol 6 (2) ◽  
pp. 44-50
Author(s):  
Seiichiro Takao ◽  
Masakazu Hirakawa ◽  
Kazuki Takeishi ◽  
Yushi Motomura ◽  
Katsumi Sakamoto ◽  
...  
Keyword(s):  
Case Report ◽  
Portal Vein ◽  
Pancreatic Adenocarcinoma ◽  
Variceal Bleeding ◽  
Review Of The Literature

Safety and efficacy of modified dose-attenuated FOLFIRINOX chemotherapy in patients over 65 years with advanced pancreatic adenocarcinoma.

2013 ◽  
Vol 31 (15_suppl) ◽  
pp. e15176-e15176 ◽  
Author(s):  
Matheus Bongers Alessandretti ◽  
Erika Pereira Brandao ◽  
Carina Meira Abrahão ◽  
Aline Rocha Lino ◽  
Rodnei Macambira Junior ◽  
...  
Keyword(s):  
Pancreatic Adenocarcinoma ◽  
Therapeutic Option ◽  
Progression Free Survival ◽  
Complete Response ◽  
Tumor Location ◽  
Ethical Committee Approval ◽  
Head Of The Pancreas ◽  
Grade 3 ◽  
Few Data ◽  
Advanced Pancreatic Adenocarcinoma

e15176 Background: Few data regard efficacy and safety of FOLFIRINOX (oxaliplatin 85 mg/m2, irinotecan 180 mg/m2, fluorouracil bolus of 400 mg/m2 and continuous infusion of 2400 mg/m2 over 46 hours and leucovorin 400 mg/m2) in patients over 65 years with advanced pancreatic adenocarcinoma. Methods: After Ethical Committee approval, consecutive patients age over 65 with biopsy proven pancreatic adenocarcinoma that received at least one cycle of modified dose-attenuated FOLFIRINOX (no bolus FU and reduced dose of at least one agent since first cycle) were selected (São José Hospital database) for a retrospective review for safety, response, and survival. Results: Nineteen consecutive patients were selected from our database. Patients characteristics included 12 (63,1%) males, 7 (36,9 %) females, median age 72,7 (range 66-79). Tumor location was 11 (57,8 %) head of the pancreas, 6 (31,57 %) body and 2 (11 %) in other sites. Grade 3/4 toxicities were reported in 10 patients (52,6 %): nausea/vomiting 1 (5,2 %), diarrhea 1 (5,2 %), fatigue 3 (15,7%), neutropenia 4 (21 %), thrombocytopenia 1 (5,2%) and febrile neutropenia 3 (15,6 %). Elevations in AST and ALT above the upper limit of normality were identified in 5 (26,31%). No deaths reported due to toxicity. Prophylactic granulocyte colony stimulator factor (G-CSF) was given to 14 (73 %). Seventeen patients completed at least four cycles; disease control was obtained in 15 (83, 3 %) with 1 complete response, 5 partial response and 9 stable diseases. Median reductions in doses in the first cycle of chemotherapy by drugs were: oxaliplatin 23,3 % (10%-30%), irinotecan 24,6 % (0%-60%), fluorouracil 20,6% (0%-40%). Median reductions in doses in the fourth cycle of chemotherapy by drugs were: oxaliplatin 20,8 % (0%-42%), irinotecan 24,9 % (0%-75%), fluorouracil 17,6% (0%-40%).With a median follow up of 4.5 months, median overall or progression free survival is not reached. Conclusions: Modified dose-attenuated FOLFIRINOX is a therapeutic option to elderly with advanced pancreatic adenocarcinoma. Although grade 3 and 4 toxicities were reported, they were manageable. Modified attenuated-dose of FOLFIRINOX needs further investigated.

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