Abstract
Pancreatic ductal adenocarcinoma is the fourth leading cause of cancer-related mortality in the Western world. The current treatment is multimodal, and in resectable patients radical surgery represents the key-step toward long-term survival. Pancreaticoduodenectomy (PD) is the most widely performed operation, because the majority of ductal carcinomas arise in the head of the pancreas. Once considered extremely hazardous, PD has evolved into a safe procedure, with mortality below 5% and morbidity rates in the range from 20% to 60% at high-volume centers. Verona is regarded as one of the most prominent institutions for pancreatic surgery in Europe. More than 5500 patients with pancreatic diseases have been managed, and the surgical case load has increased substantially, with more than 1350 PDs performed. This review discusses this center’s experience in surgical treatment of pancreatic head cancer. Furthermore, the preliminary results of radiofrequency thermal ablation of locally advanced ductal cancer are presented.
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Stathis A, Moore MJ. advanced pancreatic carcinoma: current treatment and future challenges. Nat Rev Clin Oncol 2010;7:163–172.
Vin Y, Sima CS, Getrajdman GI, Brown KT, Covey A, Brennan MF, et al. Management and outcomes of postpancreatectomy fistula, leak, and abscess: results of 908 patients resected at a single institution between 2000 and 2005. J Am Coll Surg 2008;207:490–498.
Diener M, Heukaeufer C, Schwarzer G, Seiler CM, Antes G, Knaebel HP, et al. Pancreaticoduodenectomy (classic Whipple) versus pylorus-preserving pancreaticoduodenectomy (pp Whipple) for surgical treatment of periampullary and pancreatic carcinoma. Cochrane Database Syst Rev 2008;2:CD006053.
Wente MN, Shrikhande SV, Müller MW, Diener MK, Seiler CM, Friess H, et al. Pancreaticojejunostomy versus pancreaticogastrostomy: systematic review and meta-analysis. Am J Surg 2007;193:171–183.
Tani M, Terasawa H, Kawai M, Ina S, Hirono S, Uchiyama K, et al. Improvement of delayed gastric emptying in pylorus-preserving pancreaticoduodenectomy: results of a prospective, randomized, controlled trial. Ann Surg 2006;243:316–320.
Busquets J, Fabregat J, Borobia FG, Jorba R, Valls C, Serrano T, et al. Organ-preserving surgery for benign lesions and low-grade malignancies of the pancreatic head: a matched case-control study. Surg Today 2010;40:125–131.
Reddy SK, Tyler DS, Pappas TN, Clary BM. Extended resection for pancreatic adenocarcinoma. Oncologist 2007;12:654–663.
Girelli R, Frigerio I, Salvia R, Barbi E, Tinazzi Martini P, Bassi C. Feasibility and safety of radiofrequency ablation for locally advanced pancreatic cancer. Br J Surg 2010;97:220–225.
Balzano G, Zerbi A, Capretti G, Rocchetti S, Capitanio V, Di Carlo V. Effect of hospital volume on outcome of pancreaticoduodenectomy in Italy. Br J Surg 2008;95:357–362.
Wong JC, Lu DS. Staging of pancreatic adenocarcinoma by imaging studies. Clin Gastroenterol Hepatol 2008;6:1301–1308.
Faccioli N, Crippa S, Bassi C, D’Onofrio M. Contrast-enhanced ultrasonography of the pancreas. Pancreatology 2009;9:560–566.
Barugola G, Partelli S, Marcucci S, Sartori N, Capelli P, Bassi C, et al. Resectable pancreatic cancer: who really benefits from resection? Ann Surg Oncol 2009;16:3316–3322.
Bassi C, Falconi M, Molinari E, Mantovani W, Butturini G, Gumbs AA, et al. Duct-to-mucosa versus end-to-side pancreaticojejunostomy reconstruction after pancreaticoduodenectomy: results of a prospective randomized trial. Surgery 2003;134:766–771.
Bassi C, Butturini G, Salvia R, Crippa S, Falconi M, Pederzoli P. Open pancreaticogastrostomy after pancreaticoduodenectomy: a pilot study. J Gastrointest Surg 2006;10:1072–1080.
Bassi C, Falconi M, Molinari E, Salvia R, Butturini G, Sartori N, et al. Reconstruction by pancreaticojejunostomy versus pancreaticogastrostomy following pancreatectomy: results of a comparative study. Ann Surg 2005;242:767–771.
Hartel M, Wente MN, Hinz U, Kleeff J, Wagner M, Müller MW, et al. Effect of antecolic reconstruction on delayed gastric emptying after the pylorus-preserving Whipple procedure. Arch Surg 2005;140:1094–1099.
Ishikawa O, Ohhigashi H, Sasaki Y, Kabuto T, Fukuda I, Furukawa H, et al. Practical usefulness of lymphatic and connective tissue clearance for the carcinoma of the pancreas head. Ann Surg 1988;208:215–220.
Nakao A, Takeda S, Inoue S, Nomoto S, Kanazumi N, Sugimoto H, et al. Indications and techniques of extended resection for pancreatic cancer. World J Surg 2006;30:976–982.
Farnell MB, Pearson RK, Sarr MG, DiMagno EP, Blumgart LJ, Dahl TR, et al. A prospective randomized trial comparing standard pancreatoduodenectomy with pancreatoduodenectomy with extended lymphadenectomy in resectable pancreatic head adenocarcinoma. Surgery 2005;138:618–628.
Yeo CJ, Cameron JL, Lillemoe KD, Sohn TA, Campbell KA, Sauter PK, et al. Pancreaticoduodenectomy with or without distal gastrectomy and extended retroperitoneal lymphadenectomy for periampullary adenocarcinoma, part 2: randomized controlled trial evaluating survival, morbidity, and mortality. Ann Surg 2002;236:355–366.
Pedrazzoli S, Di Carlo V, Dionigi R, Mosca F, Pederzoli P, Pasquali C, et al. Standard versus extended lymphadenectomy associated with pancreatoduodenectomy in the surgical treatment of adenocarcinoma of the head of the pancreas: a multicenter, prospective, randomized study. Lymphadenectomy Study Group. Ann Surg 1998;228:508–517.
Michalski CW, Kleeff J, Wente MN, Diener MK, Büchler MW, Friess H. Systematic review and meta-analysis of standard and extended lymphadenectomy in pancreaticoduodenectomy for pancreatic cancer. Br J Surg 2007;94:265–273.
Schwarz RE, Smith DD. Extent of lymph node retrieval and pancreatic cancer survival: information from a large US population database. Ann Surg Oncol 2006;13:1189–1200.
Riediger H, Keck T, Wellner U, zur Hausen A, Adam U, Hopt UT, et al. The lymph node ratio is the strongest prognostic factor after resection of pancreatic cancer. J Gastrointest Surg 2009;13:1337–1344.
Siriwardana HPP, Siriwardena AK. Systematic review of outcome of synchronous portal-superior mesenteric vein resection during pancreatectomy for cancer. Br J Surg 2006;93:662–673.
Ramacciato G, Mercantini P, Petrucciani N, Giaccaglia V, Nigri G, Ravaioli M, et al. Does portal-superior mesenteric vein invasion still indicate irresectability for pancreatic carcinoma? Ann Surg Oncol 2009;16:817–825.
Amano H, Miura F, Toyota N, Wada K, Katoh K, Hayano K, et al. Is pancreatectomy with arterial reconstruction a safe and useful procedure for locally advanced pancreatic cancer? J Hepatobiliary Pancreat Surg 2009;16:850–857.
Kennedy EP, Rosato EL, Sauter PK, Rosenberg LM, Doria C, Marino IR, et al. Initiation of a critical pathway for pancreaticoduodenectomy at an academic institution. The first step in multidisciplinary team building. J Am Coll Surg 2007;204:917–923.
Berberat PO, Ingold H, Gulbinas A, Kleeff J, Müller MW, Gutt C, et al. Fast track — different implications in pancreatic surgery. J Gastrointest Surg 2007;11:880–887.
Balzano G, Zerbi A, Braga M, Rocchetti S, Beneduce A, Di Carlo V. Fast-track recovery programme after pancreaticoduodenectomy reduces delayed gastric emptying. Br J Surg 2008;95:1387–1393.
Bassi C, Dervenis C, Butturini G, Fingerhut A, Yeo C, Izbicki J, et al. Postoperative pancreatic fistula: an international study group (ISGPF) definition. Surgery 2005;138:8–13.
Molinari E, Bassi C, Salvia R, Butturini G, Crippa S, Talamini G, et al. Amylase value in drains after pancreatic resection as predictive factor of postoperative pancreatic fistula: results of a prospective study in 137 patients. Ann Surg 2007;246:281–287.
Bassi C, Molinari E, Malleo G, Crippa S, Butturini G, Salvia R, et al. Early versus late drain removal after standard pancreatic resections. Results of a prospective randomized trial. Ann Surg 2010;252:207–214.
Raut CP, Tseng JF, Sun CC, Wang H, Wolff RA, Crane CH, et al. Impact of resection status on pattern of failure and survival after pancreaticoduodenectomy for pancreatic adenocarcinoma. Ann Surg 2007;246:52–60.
Neoptolemos JP, Stocken DD, Friess H, Bassi C, Dunn JA, Hickey H, et al. A randomized trial of chemoradiotherapy and chemotherapy after resection of pancreatic cancer. N Engl J Med 2004;350:1200–1210.
Regine WF, Winter KA, Abrams RA, Safran H, Hoffman JP, Konski A, et al. Fluorouracil vs gemcitabine chemotherapy before and after fluorouracil-based chemoradiation following resection of pancreatic adenocarcinoma: a randomized controlled trial. JAMA 2008;299:1019–1026.
Herman JM, Swartz MJ, Hsu CC, Winter J, Pawlik TM, Sugar E, et al. Analysis of fluorouracil-based adjuvant chemotherapy and radiation after pancreaticoduodenectomy for ductal adenocarcinoma of the pancreas: results of a large, prospectively collected database at the Johns Hopkins Hospital. J Clin Oncol 2008;26:3503–3510.
Hidalgo M. Pancreatic cancer. N Engl J Med 2010;362:1605–1617.
Evans DB, Varadhachary GR, Crane CH, Sun CC, Lee JE, Pisters PW, et al. Preoperative gemcitabine-based chemoradiation for patients with resectable adenocarcinoma of the pancreatic head. J Clin Oncol 2008;26:3496–3502.
Katz MH, Pisters PW, Evans DB, Sun CC, Lee JE, Fleming JB, et al. Borderline resectable pancreatic cancer: the importance of this emerging stage of disease. J Am Coll Surg 2008;206:833–846.
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Malleo, G., Marchegiani, G., Salvia, R. et al. Pancreaticoduodenectomy for pancreatic cancer: The Verona experience. Surg Today 41, 463–470 (2011). https://doi.org/10.1007/s00595-010-4419-5
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DOI: https://doi.org/10.1007/s00595-010-4419-5