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Surgical management of adenocarcinoma of the pancreatic uncinate process in a cancer hospital in egypt.

Roshdy S, Hussein O, Abdallah A, Abdel-Wahab K, Senbel A - Clin Med Insights Gastroenterol (2015)

Bottom Line: Median DFS was 19.2 months.Survival was superior in the Whipple procedure group than in the total pancreatectomy group (median survival 19 months vs 4 months, respectively).Vascular resection and retroperitoneal safety margin status did not affect disease relapse.

View Article: PubMed Central - PubMed

Affiliation: Surgical Oncology Department, Mansoura University Cancer Center, Mansoura, Egypt.

ABSTRACT

Introduction: Pancreatic carcinoma affecting the uncinate process is a challenging surgical condition. Several considerations affect the management plan, including the need for vascular resection and the ability to achieve a clear margin.

Methods: The data of 19 patients who had curative resection for pancreatic adenocarcinoma of the uncinate process were reviewed. Operative mortality and morbidity, and disease-free survival (DFS) were calculated.

Results: The study population included 13 male and 6 female patients with a mean age of 55 years. Nine patients (47.4%) had stage I disease, seven patients (36.8%) had stage II disease, and three patients (15.8%) had stage III disease. A total of 12 patients had Whipple procedure and 7 patients had total pancreatectomy. In total, there were 9 R0 and 10 R1 resections. Operative mortality rate was 10.5% (2/19), postoperative leakage rate was 21.1% (4/19), and wound sepsis rate was 21.1%. Median DFS was 19.2 months. Survival was superior in the Whipple procedure group than in the total pancreatectomy group (median survival 19 months vs 4 months, respectively). Vascular resection and retroperitoneal safety margin status did not affect disease relapse.

Conclusion: Non-metastatic pancreatic adenocarcinoma of the uncinate process should be offered R0 or R1 resection whenever technically feasible.

No MeSH data available.


Related in: MedlinePlus

Operative photograph of Patient 3. Left panel: operative bed of the mobilized pancreas showing the portal vein, the superior mesenteric vein infiltrated with the tumor, and the superior mesenteric vein stump. Right panel: completed synthetic graft anastomosis. Inset panel: operative specimen photograph showing the posterior aspect of the pancreas and cannulated superior mesenteric vein segment.Abbreviations: LIV, liver; SMV, superior mesenteric vein stump; SV, splenic vein.
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f4-cgast-8-2015-001: Operative photograph of Patient 3. Left panel: operative bed of the mobilized pancreas showing the portal vein, the superior mesenteric vein infiltrated with the tumor, and the superior mesenteric vein stump. Right panel: completed synthetic graft anastomosis. Inset panel: operative specimen photograph showing the posterior aspect of the pancreas and cannulated superior mesenteric vein segment.Abbreviations: LIV, liver; SMV, superior mesenteric vein stump; SV, splenic vein.

Mentions: Patient 3 was a male in his 60s presenting with mild pain without jaundice. A preoperative CT scan reported a 5.5-cm mass in the head and uncinate process of the pancreas infiltrating at least 1/4 of the circumference of a 3-cm segment of the SMV. Whipple pancreaticoduodenectomy with vascular resection and synthetic graft repair was done (Fig. 4). Postoperative pathology revealed a 4-cm GII adenocarcinoma with invaded 1/9 lymph nodes, invaded SMV, and infiltrated retroperitoneal margin. The pancreatic resection margin was free of tumor invasion. The patient was disease-free on follow-up at nine months.


Surgical management of adenocarcinoma of the pancreatic uncinate process in a cancer hospital in egypt.

Roshdy S, Hussein O, Abdallah A, Abdel-Wahab K, Senbel A - Clin Med Insights Gastroenterol (2015)

Operative photograph of Patient 3. Left panel: operative bed of the mobilized pancreas showing the portal vein, the superior mesenteric vein infiltrated with the tumor, and the superior mesenteric vein stump. Right panel: completed synthetic graft anastomosis. Inset panel: operative specimen photograph showing the posterior aspect of the pancreas and cannulated superior mesenteric vein segment.Abbreviations: LIV, liver; SMV, superior mesenteric vein stump; SV, splenic vein.
© Copyright Policy - open-access
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC4295910&req=5

f4-cgast-8-2015-001: Operative photograph of Patient 3. Left panel: operative bed of the mobilized pancreas showing the portal vein, the superior mesenteric vein infiltrated with the tumor, and the superior mesenteric vein stump. Right panel: completed synthetic graft anastomosis. Inset panel: operative specimen photograph showing the posterior aspect of the pancreas and cannulated superior mesenteric vein segment.Abbreviations: LIV, liver; SMV, superior mesenteric vein stump; SV, splenic vein.
Mentions: Patient 3 was a male in his 60s presenting with mild pain without jaundice. A preoperative CT scan reported a 5.5-cm mass in the head and uncinate process of the pancreas infiltrating at least 1/4 of the circumference of a 3-cm segment of the SMV. Whipple pancreaticoduodenectomy with vascular resection and synthetic graft repair was done (Fig. 4). Postoperative pathology revealed a 4-cm GII adenocarcinoma with invaded 1/9 lymph nodes, invaded SMV, and infiltrated retroperitoneal margin. The pancreatic resection margin was free of tumor invasion. The patient was disease-free on follow-up at nine months.

Bottom Line: Median DFS was 19.2 months.Survival was superior in the Whipple procedure group than in the total pancreatectomy group (median survival 19 months vs 4 months, respectively).Vascular resection and retroperitoneal safety margin status did not affect disease relapse.

View Article: PubMed Central - PubMed

Affiliation: Surgical Oncology Department, Mansoura University Cancer Center, Mansoura, Egypt.

ABSTRACT

Introduction: Pancreatic carcinoma affecting the uncinate process is a challenging surgical condition. Several considerations affect the management plan, including the need for vascular resection and the ability to achieve a clear margin.

Methods: The data of 19 patients who had curative resection for pancreatic adenocarcinoma of the uncinate process were reviewed. Operative mortality and morbidity, and disease-free survival (DFS) were calculated.

Results: The study population included 13 male and 6 female patients with a mean age of 55 years. Nine patients (47.4%) had stage I disease, seven patients (36.8%) had stage II disease, and three patients (15.8%) had stage III disease. A total of 12 patients had Whipple procedure and 7 patients had total pancreatectomy. In total, there were 9 R0 and 10 R1 resections. Operative mortality rate was 10.5% (2/19), postoperative leakage rate was 21.1% (4/19), and wound sepsis rate was 21.1%. Median DFS was 19.2 months. Survival was superior in the Whipple procedure group than in the total pancreatectomy group (median survival 19 months vs 4 months, respectively). Vascular resection and retroperitoneal safety margin status did not affect disease relapse.

Conclusion: Non-metastatic pancreatic adenocarcinoma of the uncinate process should be offered R0 or R1 resection whenever technically feasible.

No MeSH data available.


Related in: MedlinePlus