Reply to: Correspondence reading “Complete circumferential lymphadenectomy around the superior mesenteric artery with preservation of nerve plexus reduces locoregional recurrence after pancreatoduodenectomy for resectable pancreatic ductal adenocarcinoma”

Abstract Background Delayed arterial hemorrhage after pancreaticoduodenectomy is a life-threatening complication. There are no reports about infected aneurysms of the superior mesenteric artery after pancreaticoduodenectomy without clinically relevant pancreatic fistula. Case presentation A 78-year-old woman with borderline resectable pancreatic ductal adenocarcinoma involving the superior mesenteric arterial nerve plexus underwent pancreaticoduodenectomy with en bloc resection of the superior mesenteric vein and the superior mesenteric arterial nerve plexus after neoadjuvant chemotherapy. On postoperative day 14, she had bacteremia and sudden fever with chills. During the postoperative course, macroscopic abscesses or distinct infectious signs, including pancreatic fistula or bile fistula, were not present, but pylephlebitis was observed. After the antimicrobial treatment course, the patient was discharged. After 17 days, she was hospitalized for melena. Contrast-enhanced computed tomography showed a ruptured aneurysm of the superior mesenteric artery into the small intestine without a major intraabdominal abscess. E. coli was isolated from blood cultures. The patient was diagnosed with a ruptured infected aneurysm of the superior mesenteric artery. She was treated successfully with a covered stent by the cardiology team. There was no recurrence of bleeding at the 4-month follow-up, and the stent was patent in all subsequent computed tomography scans. Conclusions Endovascular repair using a covered stent was effective in palliating acute bleeding from an infected aneurysm of the superior mesenteric artery.

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Complete Lymphadenectomy Around the Entire Superior Mesenteric Artery Improves Survival in Artery-First Approach Pancreatoduodenectomy for T3 Pancreatic Ductal Adenocarcinoma

World Journal of Surgery ◽

10.1007/s00268-020-05856-w ◽

2020 ◽

Author(s):

Shinjiro Kobayashi ◽

Takehito Otsubo ◽

Hiroshi Nakano ◽

Satoshi Koizumi ◽

Kazunari Nakahara

Keyword(s):

Superior Mesenteric Artery ◽

Pancreatic Ductal Adenocarcinoma ◽

Mesenteric Artery ◽

Ductal Adenocarcinoma ◽

Artery First

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Pattern of locoregional recurrence after curative resection in pancreatic ductal adenocarcinoma according to the location of the tumor

HPB ◽

10.1016/j.hpb.2018.06.2208 ◽

2018 ◽

Vol 20 ◽

pp. S629

Author(s):

J.R. Kim ◽

W. Kwon ◽

J.-Y. Jang ◽

S.-W. Kim

Keyword(s):

Pancreatic Ductal Adenocarcinoma ◽

Locoregional Recurrence ◽

Curative Resection ◽

Ductal Adenocarcinoma

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Abstract 2847: Tenascin C expression in neural microenvironment enhances perineural invasion and is associated with locoregional recurrence-related poor prognosis in pancreatic ductal adenocarcinoma

10.1158/1538-7445.sabcs18-2847 ◽

2019 ◽

Author(s):

Satoru Furuhashi ◽

Takanori Sakaguchi ◽

Tomohiro Murakami ◽

Mayu Fukushima ◽

Yoshifumi Morita ◽

...

Keyword(s):

Pancreatic Ductal Adenocarcinoma ◽

Poor Prognosis ◽

Locoregional Recurrence ◽

Perineural Invasion ◽

Ductal Adenocarcinoma ◽

Tenascin C

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Recurrence Patterns for Pancreatic Ductal Adenocarcinoma after Upfront Resection Versus Resection Following Neoadjuvant Therapy: A Comprehensive Meta-Analysis

Journal of Clinical Medicine ◽

10.3390/jcm9072132 ◽

2020 ◽

Vol 9 (7) ◽

pp. 2132

Author(s):

Bathiya Ratnayake ◽

Alina Y. Savastyuk ◽

Manu Nayar ◽

Colin H. Wilson ◽

John A. Windsor ◽

...

Keyword(s):

Pancreatic Cancer ◽

Pancreatic Ductal Adenocarcinoma ◽

Neoadjuvant Therapy ◽

Recurrence Rate ◽

Locoregional Recurrence ◽

Ductal Adenocarcinoma ◽

Resectable Pancreatic Cancer ◽

Recurrence Rates ◽

Recurrence Patterns ◽

Patterns Of Recurrence

Background: Neoadjuvant therapy (NAT) represents a paradigm shift in the management of patients with pancreatic ductal adenocarcinoma (PDAC) with perceived benefits including a higher R0 rate. However, it is unclear whether NAT affects the sites and patterns of recurrence after surgery. This review seeks to compare sites and patterns of recurrence after resection between patients undergoing upfront surgery (US) or after NAT. Methods: The EMBASE, SCOPUS, PubMed, and Cochrane library databases were systematically searched to identify eligible studies that compare recurrence patterns between patients who had NAT (followed by resection) with those that had US. The primary outcome included site-specific recurrence. Results: 26 articles were identified including 4986 patients who underwent resection. Borderline resectable pancreatic cancer (BRPC, 47% 1074/2264) was the most common, followed by resectable pancreatic cancer (RPC 42%, 949/2264). The weighted overall recurrence rates were lower among the NAT group, 63.4% vs. 74% (US) (OR 0.67 (CI 0.52–0.87), p = 0.006). The overall weighted locoregional recurrence rate was lower amongst patients who received NAT when compared to US (12% vs. 27% OR 0.39 (CI 0.22–0.70), p = 0.004). In BRPC, locoregional recurrence rates improved with NAT (NAT 25.8% US 37.7% OR 0.62 (CI 0.44–0.87), p = 0.007). NAT was associated with a lower weighted liver recurrence rate (NAT 19.4% US 30.1% OR 0.55 (CI 0.34–0.89), p = 0.023). Lung and peritoneal recurrence rates did not differ between NAT and US cohorts (p = 0.705 and p = 0.549 respectively). NAT was associated with a significantly longer weighted mean time to first recurrence 18.8 months compared to US (15.7 months) (OR 0.18 (CI 0.05–0.32), p = 0.015). Conclusion: NAT was associated with lower overall recurrence rate and improved locoregional disease control particularly for those with BRPC. Although the burden of liver metastases was less, there was no overall effect upon distant metastatic disease.

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