scholarly journals A New Surgical Technique of Pancreaticoduodenectomy with Splenic Artery Resection for Ductal Adenocarcinoma of the Pancreatic Head and/or Body Invading Splenic Artery: Impact of the Balance between Surgical Radicality and QOL to Avoid Total Pancreatectomy

2014 ◽  
Vol 2014 ◽  
pp. 1-14 ◽  
Author(s):  
Ryosuke Desaki ◽  
Shugo Mizuno ◽  
Akihiro Tanemura ◽  
Masashi Kishiwada ◽  
Yasuhiro Murata ◽  
...  
Keyword(s):  
Surgical Technique ◽  
Splenic Artery ◽  
Insulin Dose ◽  
Survival Rates ◽  
Pancreatic Head ◽  
Ductal Adenocarcinoma ◽  
Curative Intent ◽  
Remnant Pancreas ◽  
Artery Resection ◽  
New Surgical Technique

For pancreatic ductal adenocarcinoma (PDAC) of the head and/or body invading the splenic artery (SA), we developed a new surgical technique of proximal subtotal pancreatectomy with splenic artery and vein resection, so-called pancreaticoduodenectomy with splenic artery resection (PD-SAR). We retrospectively reviewed a total of 84 patients with curative intent pancreaticoduodenectomy (PD) for PDAC of the head and/or body. These 84 patients were classified into the two groups: conventional PD (n=66) and PD-SAR (n=18). Most patients were treated by preoperative chemoradiotherapy (CRT). Postoperative MDCT clearly demonstrated enhancement of the remnant pancreas at 1 and 6 months in all patients examined. Overall survival rates were very similar between PD and PD-SAR (3-year OS: 23.7% versus 23.1%,P=0.538), despite the fact that the tumor size and the percentages of UICC-T4 determined before treatment were higher in PD-SAR. Total daily insulin dose was significantly higher in PD-SAR than in PD at 1 month, while showing no significant differences between the two groups thereafter. PD-SAR with preoperative CRT seems to be promising surgical strategy for PDAC of head and/or body with invasion of the splenic artery, in regard to the balance between operative radicality and postoperative QOL.

scholarly journals Factors affecting overall survival in ductal adenocarcinoma of the pancreatic head. Experience of one center

2021 ◽  
Vol 11 (1) ◽  
pp. 20-28
Author(s):  
D.  M. Kuchin ◽  
Ya.  I. Kolesnik ◽  
H.  G. Torgomyan ◽  
V.  E. Zagainov
Keyword(s):  
Overall Survival ◽  
Adjuvant Chemotherapy ◽  
Vascular Invasion ◽  
Survival Rates ◽  
Pancreatic Head ◽  
Ductal Adenocarcinoma ◽  
Factors Affecting ◽  
Poorly Differentiated ◽  
Well Differentiated ◽  
Major Factors

Purpose. To identify major factors affecting the overall survival (OS). To select the cohort of patients with the best prognosis.Materials and methods. A retrospective analysis included data of 268 patients, 128 men and 140 women, with median age of 59±10,53 (30 to 83) years. For multivariate analysis of survival, patients were selected who underwent pancreaticoduodenectomy (PD) for ductal adenocarcinoma of the pancreatic head.Results. Our study demonstrated that histologically verified vascular invasion (detected only in 30 % of patients who underwent PD with resection of the major vessels) statistically significantly affected the OS. The increased CA19-9 level over 500 U / L (detected in 32,3 % of cases) is the factor that significantly worsens the OS. Patients with high grade adenocarcinoma have significantly better survival rates compared with patients who have moderately or poorly differentiated adenocarcinoma (p = 0.014; median 26 months, 95 % CI 4.4–47.6 versus median 17 months, 95 % CI 15–19, an median: 13 months, 95 % CI 5–21, respectively). Also, the use of adjuvant chemotherapy has a positive effect on long-term outcomes (p = 0.0001; median 26 months, 95 % CI 21.7–30.3 versus median 13 months, 95 % CI 11.3–14.7).Conclusion. A well-differentiated tumor and the use of adjuvant chemotherapy significantly increase the OS of patients. Poorly differentiated tumor, CA19-9 level over 500 U / mL and the histologically confirmed vascular invasion significantly worsen the prognosis of these patients.

Survival after pancreaticoduodenectomy for pancreatic ductal adenocarcinoma

2020 ◽  
Vol 21 (4) ◽  
pp. 127-130
Author(s):  
V. U. Rayn ◽  
◽  
A. A. Chernov ◽  
S. O. Zabotkin ◽  
◽  
...  
Keyword(s):  
Surgical Treatment ◽  
Pancreatic Ductal Adenocarcinoma ◽  
Soft Tissues ◽  
Abdominal Cavity ◽  
Survival Rates ◽  
Pancreatic Head ◽  
Ductal Adenocarcinoma ◽  
En Bloc ◽  
Free Survival ◽  
Pancreatic Head Cancer

Aim. To access overall and event-free survival rates in patients after surgical treatment of localized and locally spread pancreatic head cancer. Materials and methods. A single center observational trial was conducted at a low-volume pancreatic surgery center in Khanty-Mansiysk. Data were collected retrospectively from 2007 to 2019. Patients with resectable tumors were included into the study whose final histology showed pancreatic ductal adenocarcinoma and en-bloc resection. According to the technical facilities and actual clinical protocols all patients received surgical treatment only and were then monitored. Data on progression patterns and survival rates were collected and calculated using Kaplan-Meier survival analysis. Results. Median overall survival (OS) after R0 pancreaticoduodenectomy was 16,8 months (IQR 10,9-23,5). Median progression-free survival was 10,6 mo. (IQR 8,0-20,7). OS in jaundiced patients was 4,9 mo. shorter than in patients without jaundice at the diagnosis (р = 0,011). Patients with serum bilirubin level < 100 μmol/l lived on average 7.2 months longer (p = 0.014). Most frequent sites of primary progression were liver and peritoneum, lungs, bones, lymph nodes of the abdominal cavity / retroperitoneal space, less often metastases were found in the skin and soft tissues. In 21.4% of cases metastases were found in several organs simultaneously with most frequent combination of liver and peritoneum, liver and lungs, lungs and bones. The median survival after progression was 7.1 ± 4.8 months Conclusion. Pancreatic duct adenocarcinoma has a high potential for progression and has therefore poor prognosis. To improve long-term outcomes, it is advisable to apply additional therapeutic options perioperatively.

LONG-TERM RESULTS OF COMBINED TREATMENT FOR DUCTAL PANCREATIC HEAD ADENOCARCINOMA BY MEANS OF INTRAARTERIAL PERIOPERATIVE CHEMOTHERAPY WITH OXALIPLATIN AND GEMCITABINE

2018 ◽  
Vol 64 (1) ◽  
pp. 116-120
Author(s):  
Aleksandr Pavlovskiy ◽  
Aleksey Polikarpov ◽  
Viktor Moiseenko ◽  
Sergey Popov ◽  
Dmitriy Granov ◽  
...  
Keyword(s):  
Operative Treatment ◽  
Combined Treatment ◽  
Survival Rates ◽  
Pancreatic Head ◽  
Celiac Trunk ◽  
Regional Chemotherapy ◽  
Long Term Results ◽  
Ductal Adenocarcinoma ◽  
Perioperative Chemotherapy

Aim. Evaluation of long-term results of perioperative regional chemotherapy with gemcitabine and oxaliplatin in combined treatment of ductal adenocarcinoma of the pancreatic head. Material and methods. The first group consisted of 52 patients who received combined treatment: neoadjuvant chemoembolization (CE) with gemcitabine (400 mg / m2) and oxaliplatin (50 mg / m2) (GemOx), operative treatment, as well as up to 6 courses of chemoinfusion (CI) in the celiac trunk of gemcitabine (1000 mg / m2) and oxaliplatin (75 mg / m2) in the adjuvant regime. In the second group of 51 patients, perioperative regional chemotherapy (neoadjuvant CE and adjuvant CI) with gemcitabine (1000 mg / m 2) (Gem) was performed. 54 patients of the third group performed only operative intervention. Results. No complications associated with medical-diagnostic angiography and catheterization were observed. The median of life expectancy in the group of patients who received only operative treatment was 8.4 ±1.2 months, in the group of perioperative chemotherapy Gem-22.3 ± 1.5, in the group of patients who underwent perioperative regional chemotherapy GemOx-26 ± 1.1 months. Five-year survival rates in the groups were 0%, 10% and 13% and respectively Conclusions. A use of regional chemotherapy with gemcitabine and oxaliplatin can be regarded as a useful and effective step in combined treatment of pancreatic head adenocarcinoma.

Usefulness of pancreaticoduodenectomy with splenic artery resection (PDSAR) for borderline resectable/locally unresectable pancreatic head carcinoma

Pancreatology ◽  
2016 ◽  
Vol 16 (4) ◽  
pp. S59
Author(s):  
Shugo Mizuno ◽  
Masashi Kishiwada ◽  
Akihiro Tanemura ◽  
Yasuhiro Murata ◽  
Hiroyuki Kato ◽  
...  
Keyword(s):  
Splenic Artery ◽  
Pancreatic Head ◽  
Borderline Resectable ◽  
Pancreatic Head Carcinoma ◽  
Artery Resection

Metachronous pancreatic cancer originating from disseminated founder pancreatic intraductal neoplasias.

2015 ◽  
Vol 33 (3_suppl) ◽  
pp. 330-330
Author(s):  
Yusuke Ono ◽  
Hidenori Karasaki ◽  
Koji Imai ◽  
Junpei Sasajima ◽  
Shin-ichi Chiba ◽  
...  
Keyword(s):  
Somatic Mutations ◽  
Pancreatic Head ◽  
Digital Pcr ◽  
Ductal Adenocarcinoma ◽  
Tumor Evolution ◽  
Low Grade ◽  
Kras Mutations ◽  
Current Case ◽  
Remnant Pancreas ◽  
Intraepithelial Lesions

330 Background: Clonal populations originated from benign-looking “founder cells” may spread widely within pancreas instead of being localized in situ before frank pancreatic ductal adenocarcinoma (PDA) can be detected. Metachronous PDA is not common event, and we here sought to define potent origin of multiple PDAs developed in a woman by using advanced genetics technologies. Methods: In addition to precise pathological assessment, genetic approaches such as deep sequencing of multiplex PCR amplicons of cancer-associated genes (Ion Torrent PGM platform) and digital PCR were employed. Results: Curative resection of pancreatic head tumor was performed; however, “recurrent” lesions in the remnant pancreas were found 3.5-years later and total pancreatectomy was subsequently performed. The metachronous lesions were morphologically similar to the primary PDA. All 3 PDAs were shown to possess rare somatic mutations in KRAS (p.T58I and p.Q61H). Curiously, identical KRAS mutations were found in low-grade “intraepithelial” lesions, which localized in normal area of the pancreas and one of them possessed p53mutation, which was also found in the PDAs. Conclusions: Rare KRAS haplotype was identified in the metachronous PDAs in the current case. Surprisingly, the identical somatic mutations were also found in independent low-grade “intraepithelial” lesions with and without additional mutation in p53. The footprint of the tumor evolution marked by mutational profiling supports a human correlate to the mouse models of “dissemination” occurring at the earliest stages of pancreatic neoplasia.

Primary squamous cell carcinoma of the ampulla of Vater: management and review of the literature

2021 ◽  
Vol 14 (1) ◽  
pp. e236477
Author(s):  
Subhash Soni ◽  
Poonam Elhence ◽  
Vaibhav Kumar Varshney ◽  
Sunita Suman
Keyword(s):  
Squamous Cell Carcinoma ◽  
Cell Carcinoma ◽  
Squamous Cell ◽  
Survival Rates ◽  
Ampulla Of Vater ◽  
Metallic Stent ◽  
Biological Behaviour ◽  
Curative Intent ◽  
Term Survival ◽  
History Of

Squamous cell carcinoma (SCC) of the ampulla of Vater is a rare pathology and only few cases are reported in the literature. With limited experience of primary SCC in the ampulla of Vater, its biological behaviour, prognosis and long-term survival rates are not well known. A 38-year-old woman presented with a history of painless progressive jaundice for which self-expending metallic stent was placed 3 years back. She was evaluated and initially diagnosed as probably periampullary adenocarcinoma. She underwent pancreaticoduodenectomy and histopathology with immunohistochemistry was suggestive of SCC of ampulla of Vater. She received adjuvant chemotherapy and doing well with no recurrence after 1 year of follow-up. In conclusion, SCC of the ampulla is an unusual pathology that should be kept as a differential diagnosis for periampullary tumours. Surgical treatment with curative intent should be performed whenever feasible even in the setting of bulky tumour to improve the outcome.

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