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Extended distal pancreatectomy for advanced pancreatic neck cancer.

Park SY, Shin WY, Choe YM, Lee KY, Ahn SI - Korean J Hepatobiliary Pancreat Surg (2014)

Bottom Line: The results were compared with those after standard pancreatectomy.All three patients presented with jaundice, and the ratio of pancreatic duct to parenchymal thickness of the pancreatic body was greater than 0.5.Also, the procedure is technically feasible, and further refinement is necessary to improve patient survival.

View Article: PubMed Central - PubMed

Affiliation: Department of Surgery, Inha University School of Medicine, Incheon, Korea.

ABSTRACT

Backgrounds/aims: We investigated the clinical application of extended distal pancreatectomy in patients with pancreatic neck cancer accompanied by distal pancreatic atrophy. In this study, we have emphasized on the technical aspects of using the linear stapling device for a bulky target organ.

Methods: From March 2010 to September 2013, 46 patients with pancreatic adenocarcinoma, who underwent pancreatic resection with radical intent at our institute, were reviewed retrospectively. Among them, three patients (6.5%) underwent extended distal pancreatectomy. A linear stapling device and vise-grip locking pliers were used for en bloc resection of the distal pancreas, first duodenal portion, and distal common bile duct. The results were compared with those after standard pancreatectomy.

Results: All three patients presented with jaundice, and the ratio of pancreatic duct to parenchymal thickness of the pancreatic body was greater than 0.5. Grade A pancreatic fistula developed in all of the cases, but none of these fistulae were lethal. Pathological staging was T3N1M0 in all of the patients. The postoperative daily serum glucose fluctuations and insulin requirements were comparable to those in patients who received pancreaticoduodenectomy or distal pancreatectomy. At the last follow-up, two patients were alive with liver metastasis at 4 and 10 months postoperatively, respectively, and one patient died of liver metastasis at 5 months postoperatively.

Conclusions: While the prognosis of advanced pancreatic neck adenocarcinoma is still dismal, extended distal pancreatectomy is a valid treatment option, especially when there is atrophy of the distal pancreas. Also, the procedure is technically feasible, and further refinement is necessary to improve patient survival.

No MeSH data available.


Related in: MedlinePlus

Preoperative computed tomography of a representative patient. (A) Pancreatic neck cancer (arrow) with distal pancreatic atrophy shows dilated pancreatic duct (arrow head). (B) The uncinate process of the pancreas is intact (arrow).
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Figure 1: Preoperative computed tomography of a representative patient. (A) Pancreatic neck cancer (arrow) with distal pancreatic atrophy shows dilated pancreatic duct (arrow head). (B) The uncinate process of the pancreas is intact (arrow).

Mentions: EDP was indicated for the following conditions: adenocarcinoma in the neck of the pancreas, with distal pancreatic atrophy, and no extension or invasion of the ampulla of Vater and the uncinate process. Pancreatic atrophy was defined when the ratio of the diameter of the main pancreatic duct to the width of the pancreatic parenchyma, measured at the body of the pancreas anterior to the aorta, was larger than 0.5 on computed tomography (Fig. 1).3


Extended distal pancreatectomy for advanced pancreatic neck cancer.

Park SY, Shin WY, Choe YM, Lee KY, Ahn SI - Korean J Hepatobiliary Pancreat Surg (2014)

Preoperative computed tomography of a representative patient. (A) Pancreatic neck cancer (arrow) with distal pancreatic atrophy shows dilated pancreatic duct (arrow head). (B) The uncinate process of the pancreas is intact (arrow).
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4492328&req=5

Figure 1: Preoperative computed tomography of a representative patient. (A) Pancreatic neck cancer (arrow) with distal pancreatic atrophy shows dilated pancreatic duct (arrow head). (B) The uncinate process of the pancreas is intact (arrow).
Mentions: EDP was indicated for the following conditions: adenocarcinoma in the neck of the pancreas, with distal pancreatic atrophy, and no extension or invasion of the ampulla of Vater and the uncinate process. Pancreatic atrophy was defined when the ratio of the diameter of the main pancreatic duct to the width of the pancreatic parenchyma, measured at the body of the pancreas anterior to the aorta, was larger than 0.5 on computed tomography (Fig. 1).3

Bottom Line: The results were compared with those after standard pancreatectomy.All three patients presented with jaundice, and the ratio of pancreatic duct to parenchymal thickness of the pancreatic body was greater than 0.5.Also, the procedure is technically feasible, and further refinement is necessary to improve patient survival.

View Article: PubMed Central - PubMed

Affiliation: Department of Surgery, Inha University School of Medicine, Incheon, Korea.

ABSTRACT

Backgrounds/aims: We investigated the clinical application of extended distal pancreatectomy in patients with pancreatic neck cancer accompanied by distal pancreatic atrophy. In this study, we have emphasized on the technical aspects of using the linear stapling device for a bulky target organ.

Methods: From March 2010 to September 2013, 46 patients with pancreatic adenocarcinoma, who underwent pancreatic resection with radical intent at our institute, were reviewed retrospectively. Among them, three patients (6.5%) underwent extended distal pancreatectomy. A linear stapling device and vise-grip locking pliers were used for en bloc resection of the distal pancreas, first duodenal portion, and distal common bile duct. The results were compared with those after standard pancreatectomy.

Results: All three patients presented with jaundice, and the ratio of pancreatic duct to parenchymal thickness of the pancreatic body was greater than 0.5. Grade A pancreatic fistula developed in all of the cases, but none of these fistulae were lethal. Pathological staging was T3N1M0 in all of the patients. The postoperative daily serum glucose fluctuations and insulin requirements were comparable to those in patients who received pancreaticoduodenectomy or distal pancreatectomy. At the last follow-up, two patients were alive with liver metastasis at 4 and 10 months postoperatively, respectively, and one patient died of liver metastasis at 5 months postoperatively.

Conclusions: While the prognosis of advanced pancreatic neck adenocarcinoma is still dismal, extended distal pancreatectomy is a valid treatment option, especially when there is atrophy of the distal pancreas. Also, the procedure is technically feasible, and further refinement is necessary to improve patient survival.

No MeSH data available.


Related in: MedlinePlus