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Controversies in the Management of Borderline Resectable Proximal Pancreatic Adenocarcinoma with Vascular Involvement
Joint Authors
Source
Issue
Vol. 2008, Issue 2008 (31 Dec. 2008), pp.1-8, 8 p.
Publisher
Hindawi Publishing Corporation
Publication Date
2009-03-11
Country of Publication
Egypt
No. of Pages
8
Main Subjects
Abstract EN
Synchronous major vessel resection during pancreaticoduodenectomy (PD) for borderline resectable pancreatic adenocarcinoma remains controversial.
In the 1970s, regional pancreatectomy advocated by Fortner was associated with unacceptably high morbidity and mortality rates, with no impact on long-term survival.
With the establishment of a multidisciplinary approach, improvements in preoperative staging techniques, surgical expertise, and perioperative care reduced mortality rates and improved 5-year-survival rates are now achieved following resection in high-volume centres.
Perioperative morbidity and mortality following PD with portal vein resection are comparable to standard PD, with reported 5-year-survival rates of up to 17%.
Segmental resection and reconstruction of the common hepatic artery/proper hepatic artery (CHA/PHA) can be performed to achieve an R0 resection in selected patients with limited involvement of the CHA/PHA at the origin of the gastroduodenal artery (GDA).
PD with concomitant major vessel resection for borderline resectable tumours should be performed when a margin-negative resection is anticipated at high-volume centres with expertise in complex pancreatic surgery.
Where an incomplete (R1 or R2) resection is likely neoadjuvant treatment with systemic chemotherapy followed by chemoradiation as part of a clinical trial should be offered to all patients.
American Psychological Association (APA)
Tucker, Olga N.& Rela, Mohamed. 2009. Controversies in the Management of Borderline Resectable Proximal Pancreatic Adenocarcinoma with Vascular Involvement. HPB Surgery،Vol. 2008, no. 2008, pp.1-8.
https://search.emarefa.net/detail/BIM-502304
Modern Language Association (MLA)
Tucker, Olga N.& Rela, Mohamed. Controversies in the Management of Borderline Resectable Proximal Pancreatic Adenocarcinoma with Vascular Involvement. HPB Surgery No. 2008 (2008), pp.1-8.
https://search.emarefa.net/detail/BIM-502304
American Medical Association (AMA)
Tucker, Olga N.& Rela, Mohamed. Controversies in the Management of Borderline Resectable Proximal Pancreatic Adenocarcinoma with Vascular Involvement. HPB Surgery. 2009. Vol. 2008, no. 2008, pp.1-8.
https://search.emarefa.net/detail/BIM-502304
Data Type
Journal Articles
Language
English
Notes
Includes bibliographical references
Record ID
BIM-502304