Surgical Treatment of Pancreatic Ductal Adenocarcinoma
Abstract
:Simple Summary
Abstract
1. Introduction
1.1. Definition of Resectability
1.2. Neoadjuvant and Adjuvant Therapy
2. Surgery
2.1. Standard Resection
2.2. Specific Techniques
2.2.1. Artery First Approach
2.2.2. Uncinate Process First
2.2.3. The TRIANGLE Operation
2.2.4. Venous Bypass First
2.2.5. Periarterial Divestment
2.3. Vascular (Venous and Arterial) Resection
2.3.1. Venous Resection
2.3.2. Artery Resection
2.4. Multivisceral Resection
2.5. MIS/Robotic Surgery
2.5.1. Laparoscopic and Robotic Distal Pancreatectomy
2.5.2. Laparoscopic and Robotic Pancreatoduodenectomy
3. Conclusions and Future Perspective
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Conflicts of Interest
Abbreviations
AHPBA | American Hepato-Pancreato-Biliary Association |
SSO | Society of Surgical Oncology |
SSAT | Society for Surgery of the Alimentary Tract |
ECOG | Eastern Cooperative Oncology Group |
BACAP | The National Anatomo-Clinical Database on Pancreatic Adenocarcinoma |
SMV | superior mesenteric vein |
PV | portal vein |
SMA | superior mesenteric artery |
CA | celiac artery |
CHA | common hepatic artery |
PHA | proper hepatic artery |
LAPC | locally advanced pancreatic cancer |
WMD | weighted mean difference |
OR | odds ratio |
CI | confidence interval |
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Category | Anatomical Feature |
---|---|
Resectable: R | SMV/PV: no tumor contact or unilateral narrowing |
SMA, CA, CHA: no tumor contact | |
Borderline resectable: BR | Subclassified according to SMV/PV involvement alone or arterial invasion |
BR-PV (SMV/PV involvement alone) | SMV/PV: tumor contact 180 or greater or bilateral narrowing/occlusion, not exceeding the inferior border of the duodenum. |
SMA, CA, CHA: no tumor contact/invasion | |
BR-A (arterial involvement) | SMA, CA: tumor contact of less than 180 without showing deformity/stenosis |
CHA: tumor contact without showing tumor contact of the PHA and/or CA. | |
Unresectable: UR | Subclassified according to the status of distant metastasis |
Locally advanced: LA | SMV/PV: bilateral narrowing/occlusion, exceeding the inferior border of the duodenum |
SMA, CA: tumor contact/invasion of 180 or more degree #. | |
CHA: tumor contact/invasion showing tumor contact/invasion of the PHA and/or CA. | |
AO: tumor contact or invasion. | |
Metastatic: M | Distant metastasis $. |
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Wei, K.; Hackert, T. Surgical Treatment of Pancreatic Ductal Adenocarcinoma. Cancers 2021, 13, 1971. https://doi.org/10.3390/cancers13081971
Wei K, Hackert T. Surgical Treatment of Pancreatic Ductal Adenocarcinoma. Cancers. 2021; 13(8):1971. https://doi.org/10.3390/cancers13081971
Chicago/Turabian StyleWei, Kongyuan, and Thilo Hackert. 2021. "Surgical Treatment of Pancreatic Ductal Adenocarcinoma" Cancers 13, no. 8: 1971. https://doi.org/10.3390/cancers13081971