Results of venous resections in cancer of the pancreatic head.

2020 ◽  
Vol 38 (15_suppl) ◽  
pp. e16785-e16785
Author(s):  
Oleg I. Kit ◽  
Oksana V. Katelnitskaya ◽  
Andrey A. Maslov ◽  
Aleksey Yu. Maksimov ◽  
Evgeniy N. Kolesnikov ◽  
...  
Keyword(s):  
Pancreatic Head ◽  
Pathological Examination ◽  
Additional Risk Factor ◽  
Incomplete Resection ◽  
Sleeve Resection ◽  
Venous Resection ◽  
Advantages And Disadvantages ◽  
Ductal Pancreatic Adenocarcinoma ◽  
Direct Anastomosis ◽  
Venous Segment

e16785 Background: Studies have shown that pancreaticoduodenal resection (PDR) with resection and reconstruction of the venous segment does not interfere with surgical treatment for ductal pancreatic adenocarcinoma with suspected venous invasion. Venous resection improves survival compared to palliative interventions. However, the advantages and disadvantages of marginal resection, segmental resection with direct anastomosis, and venous segment prosthetics are not reflected. Methods: The study included 52 patients (23 women, 29 men) undergoing PDR with venous resection and reconstruction for cancer of the pancreatic head in 2015-2019. The average tumor size was 3.8 cm. Results: Superior mesenteric vein reconstruction (PTFE grafts) was performed in 17 patients (32.7%), sleeve resection with direct anastomosis - 24 (46.2%), marginal resection - 11 (21.1%). Venous reconstruction was planned in 78.8% of patients before the surgery. In the early postoperative period, thrombosis of the reconstructed zone was developed in two patients (3.8%), bleeding from the pancreatic bed - in one case (1.9%). Postoperative mortality was 5.8% (3 patients). After the final pathological examination, macroscopically incomplete resection was diagnosed only in the group with marginal resection and amounted to 3.8%. Microscopically incomplete resection was diagnosed in 9.6% of the studied preparations (in marginal resection of the vein wall - 3.8%, with direct anastomosis - 1.9%, SMV prosthetics - 3.8%). Most often, R1 resection was detected in the retroperitoneal resection margin (80%). The lowest 1-year survival was observed in the group with marginal resection (36.4%). No significant differences in survival rates were found in patients with direct venous anastomosis (62.5%) and venous prosthetics (64.7%) (RR 1.69; 95% CI 0.69-4.12, p > 0.05). Microscopically complete resection R0 improved the survival (RR 2.7; 95% CI 1.45-5.04, p < 0.05). Planning the venous resection was an additional risk factor affecting the completeness of resection (RR 4.6; CI 95% 1.5-14.5, p > 0.05). Conclusions: Expanding the surgery volume in PDR due to venous resection and reconstruction shows acceptable rates of postoperative morbidity and mortality. Planning the venous resection enhances the results of radical surgery.

A matched cohort study of en bloc venous resection during pancreaticoduodenectomy for adenocarcinoma of the pancreatic head

2005 ◽  
Vol 9 (4) ◽  
pp. 607-607
Author(s):  
J CHRISTEIN ◽  
D NAGORNEY ◽  
J SARMIENTO ◽  
S BARNES ◽  
B CROWNHART ◽  
...  
Keyword(s):  
Cohort Study ◽  
Pancreatic Head ◽  
Matched Cohort ◽  
En Bloc ◽  
Venous Resection ◽  
Matched Cohort Study

Portal venous resection in cancer of the pancreatic head: What are the relevant predictors of survival?

Pancreatology ◽  
2014 ◽  
Vol 14 (3) ◽  
pp. S106
Author(s):  
Hryhoriy Lapshyn ◽  
Ulrich F. Wellner ◽  
Peter Bronsert ◽  
Birte Kulemann ◽  
Jens Hoeppner ◽  
...  
Keyword(s):  
Pancreatic Head ◽  
Venous Resection

EUS combined with CT in predicting SMV/PV resection in patients with borderline resectable pancreatic carcinoma.

2016 ◽  
Vol 34 (4_suppl) ◽  
pp. 432-432
Author(s):  
Evan Scott Glazer ◽  
Omar Maen Rashid ◽  
Jason Klapman ◽  
Cynthia L. Harris ◽  
Pamela Joy Hodul ◽  
...  
Keyword(s):  
Ct Scan ◽  
Multivariate Logistic Regression Analysis ◽  
Pancreatic Head ◽  
Pet Scan ◽  
Vascular Involvement ◽  
Borderline Resectable ◽  
Curative Intent ◽  
Venous Resection ◽  
Tumor Involvement ◽  
Vein Resection

432 Background: Guidelines recommend pancreatic protocol CT scan (CT) for staging vascular involvement in patients with pancreatic cancer (PC). While endoscopic ultrasound (EUS) has been demonstrated to be effective in venous staging of PC, its role when combined with CT is poorly defined. We evaluated the utility of EUS in addition to CT in staging PC. We hypothesized that EUS complements CT in identifying SMV/PV tumor involvement as measured by the requirement for vein resection. Methods: We reviewed our database of patients with borderline resectable PC who went to surgery with curative intent. Inclusion criteria were pre-operative staging with CT scan, EUS, PET scan, and CA 19-9 levels, as well as completion of neoadjuvant chemotherapy and radiation. Results: We identified 62 patients with 74% of tumors in the pancreatic head. 97% of resections were R0. The average age was 65 ± 9 years; 60% were male. Patients were classified as borderline resectable by EUS alone in 29%, CT alone in 23%, and both modalities in 48% of patients, respectively. 34 patients required vein resection; EUS identified 88% of these patients pre-operatively while CT identified 68%. EUS identified 11 patients who required vein resection that CT did not identify while CT identified 4 patients that EUS did not identify. EUS had higher sensitivity and specificity than CT in identifying patients requiring venous resection (Table). On multivariate logistic regression analysis, EUS was predictive of vein resection (P < 0.02) but CT scan findings, PET scan findings, tumor size, and CA19-9 values were not predictive (each P > 0.1). In margin negative resected patients, median survival was longer when both CT and EUS identified borderline status compared to only 1 modality (43 vs 23 months, P < 0.05). Conclusions: EUS complemented CT in identifying patients with borderline resectable PC requiring vein resection- 29% of patients were identified with EUS alone. This observation supports the use of EUS in addition to CT scan for the vascular staging of patients with PC. [Table: see text]

scholarly journals Radiomics Signatures of Computed Tomography Imaging for Predicting Resection Margin Status in Pancreatic Head Adenocarcinoma

2020 ◽  
Author(s):  
Jinheng Liu ◽  
Xubao Liu ◽  
Jiajun Qiu ◽  
Yanting Wang ◽  
Wei Huang ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Wavelet Transform ◽  
Resection Margin ◽  
Pancreatic Head ◽  
Texture Features ◽  
Margin Status ◽  
Pathological Examination ◽  
Gray Level ◽  
Survival Prognosis ◽  
Resection Margin Status

Abstract Background: To identify preoperative computed tomography radiomics texture features which correlate with resection margin status and prognosis in resected pancreatic head adenocarcinoma. Methods: Improved prognostication methods utilizing novel non-invasive radiomic techniques may accurately predict resection margin status preoperatively. In an ongoing concerning pancreatic head adenocarcinoma, the venous enhanced CT images of 86 patients who underwent pancreaticoduodenectomy were selected, and the resection margin (>1 mm or ≤1 mm) was identified by pathological examination. Three regions of interests (ROIs) were then taken from superior to inferior facing the superior mesenteric vein and artery. Subsequent Laplacian-Dirichlet based texture analysis methods extracting algorithm flows of texture features within ROIs were analyzed and assessed in relation to patient prognosis.Results: Patients with >1 mm resection margin had an overall improved survival compared to ≤1 mm (P < 0.05). Distance 1 and 2 of Gray level co-occurrence matrix, high Gray-level run emphasis of run-length matrix and average filter of wavelet transform (all P < 0.05) were correlated with resection margin status (Area under the curve was 0.784, sensitivity was 75% and specificity was 79%). The energy of wavelet transform, the measure of smoothness of histogram and the variance in 2 direction of Gabor transform are independent predictors of overall survival prognosis, independent of resection margin.Conclusions: Resection margin status (>1 mm vs ≤1 mm) is a key prognostic factor in pancreatic adenocarcinoma and CT radiomic analysis have the potential to predict resection margin status preoperatively, and the radiomic labels may improve selection neoadjucant therapy. Trial registration: Clinicaltrials.gov/ct2/show/NCT02928081.

Benefit of venous resection for ductal adenocarcinoma of the pancreatic head

2002 ◽  
Vol 168 (12) ◽  
pp. 707-712 ◽  
Author(s):  
Mark Hartel ◽  
Marco Niedergethmann ◽  
Michael Farag-Soliman ◽  
Jörg Sturm ◽  
Axel Richter ◽  
...  
Keyword(s):  
Pancreatic Head ◽  
Ductal Adenocarcinoma ◽  
Venous Resection

scholarly journals Extramedullary melanotic schwannoma recurrence in the cervical vertebral arch: a case report and review of the literature

2020 ◽  
Vol 48 (8) ◽  
pp. 030006052094791
Author(s):  
Zongbin Hou ◽  
Teng Shi ◽  
Guangrun Li ◽  
Lin Tian ◽  
Xinna Li ◽  
...  
Keyword(s):  
Neck Pain ◽  
Upper Extremity ◽  
Tumor Resection ◽  
Pathological Examination ◽  
Radical Excision ◽  
Incomplete Resection ◽  
Nerve Sheath Tumor ◽  
Melanotic Schwannoma ◽  
Nerve Sheath ◽  
History Of

Melanotic schwannoma (MS), a slowly growing nerve sheath tumor, is not a purely benign tumor. MS accounts for less than 1% of all nerve sheath tumors. We herein describe a rare case of MS and present a literature review focusing on the treatment of this disease. Twelve years before presentation at our hospital, a 41-year-old woman was examined because of an 8-month history of neck pain and 6-month history of upper extremity numbness and weakness. She underwent surgery to remove a tumor, and the pathological examination confirmed a diagnosis of MS. Twelve years later, at 53 years of age, the patient presented to our hospital with a 2-year history of neck pain and upper extremity numbness and weakness. Posterior cervical tumor resection was performed along with posterior cervical laminectomy, decompression and intraspinal space-occupying internal fixation, and radiotherapy. MS recurrence was confirmed. No tumor recurrence or metastasis was found after 7 months of follow-up. Recurrence of MS is rare, and its diagnosis depends on pathological features. Radical excision is the primary treatment for MS. Incomplete resection of MS is a risk factor for postoperative recurrence and metastasis. Furthermore, postoperative adjuvant radiotherapy should be performed to prevent recurrence and metastasis of MS.

Tu1622 Portal Venous Resection in Cancer of the Pancreatic Head: What Are the Relevant Predictors of Survival?

2014 ◽  
Vol 146 (5) ◽  
pp. S-1091
Author(s):  
Hryhoriy Lapshyn ◽  
Ulrich F. Wellner ◽  
Birte Kulemann ◽  
Jens Hoeppner ◽  
Peter Bronsert ◽  
...  
Keyword(s):  
Pancreatic Head ◽  
Venous Resection

Primary Spinal Epidural Mantle Cell Lymphoma: Case Report

Neurosurgery ◽  
2000 ◽  
Vol 47 (5) ◽  
pp. 1239-1242 ◽  
Author(s):  
Maja Barnard ◽  
Bayardo Perez-Ordoñez ◽  
David W. Rowed ◽  
Lee Cyn Ang
Keyword(s):  
Mantle Cell Lymphoma ◽  
Hodgkin’S Lymphoma ◽  
Cell Lymphoma ◽  
Hodgkin's Lymphoma ◽  
Pathological Examination ◽  
Incomplete Resection ◽  
Non Hodgkin’S Lymphoma ◽  
Non Hodgkin's Lymphoma ◽  
Mantle Cell ◽  
Spinal Epidural

Abstract OBJECTIVE AND IMPORTANCE Mantle cell lymphoma is a distinct clinicopathological type of non-Hodgkin's lymphoma that often presents at an advanced stage, with systemic spread. Spinal involvement is uncommon and generally occurs as part of advanced disease or generalized relapses. Primary spinal epidural lymphoma is a rare initial manifestation of non-Hodgkin's lymphoma, and mantle cell lymphoma with initial presentation in the spinal epidural space is extremely rare, having been previously reported in only two cases. CLINICAL PRESENTATION We report a case of a 71-year-old man who presented with increasing weakness and numbness of the legs. Magnetic resonance imaging revealed a spinal epidural mass in the lumbosacral region. INTERVENTION The patient underwent a partial L4 and L5–S1 laminectomy, with incomplete resection of the mass for spinal decompression and tissue diagnosis. Mantle cell lymphoma was diagnosed in the pathological examination. CONCLUSION After radiotherapy, the disease recurred with a soft-tissue mass in the anterior maxillary area of the face. The patient underwent restaging and was treated with chemotherapy, with only a partial response. Mantle cell lymphoma with primary spinal epidural presentation is rare. This diagnosis can be established and other causes of spinal cord compression can be ruled out by obtaining tissue for proper histopathological examinations. Because of its aggressive behavior and poor prognosis, mantle cell lymphoma should be treated using a combined-modality approach.

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