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pancreaticoduodenectomy for borderline resectable pancreatic head cancer with a modified artery-first approach technique

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Hepatobiliary & pancreatic Diseases International 2017年第2期16卷 215-221页

作者： Min Wang Hang Zhang Feng Zhu Feng Peng Xin Wang Ming Shen Ren-Yi Qin Department of pancreatic-Biliary Surgery Affiliated Tongji Hospital Tongji Medical College Huazhong University of Science and Technology Wuhan 430030 China

BACKGROUND： The treatment of borderline resectable pancreatic head cancer（BRPHC） is still controversial and challenging. The artery-first approaches are described to be the important options for the early determination. Whether these approaches can achieve an increase R0 rate, better bleeding control and increasing long-term survival for BRPHC are still controversial. We compared a previously reported technique, a modified artery-first approach（MAFA）, with conventional techniques for the surgical treatment of ***： A total of 117 patients with BRPHC undergone pancreaticoduodenectomy（PD） from January 2013 to June 2015 were included. They were divided into an MAFA group（n=78） and a conventional-technique group（n=39）. Background characteristics, operative data and complications were compared between the two ***： Mean operation time was significantly shorter in the MAFA group than that in the conventional-technique group（313 vs 384 min; P=0.014）; mean volume of intraoperative blood loss was significantly lower in the MAFA group than that in the conventional-technique group（534 vs 756 m L; P=0.043）; and mean rate of venous resection was significantly higher in the conventional-technique group than that in the MAFA group（61.5% vs 35.9%; P=0.014）. Pathologic data, early mortality and morbidity were not different significantly between the two ***： MAFA is safe, simple, less time-consuming, less intraoperative blood loss and less venous resection, and therefore, may become a standard surgical approach to PD for BRPHC with the superior mesenteric vein-portal vein involvement but without superior mesenteric artery invasion.

关键词： pancreatic head cancer pancreaticoduodenectomy borderline resectable

Treatment strategy for pancreatic head cancer with celiac axis stenosis in pancreaticoduodenectomy:A case report and review of literature

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World Journal of Gastroenterology 2022年第8期28卷 868-877页

作者： Eiji Yoshida Yasutoshi Kimura Takuro Kyuno Ryoko Kawagishi Kei Sato Tsuyoshi Kono Takehiro Chiba Toshimoto Kimura Hitoshi Yonezawa Osamu Funato Makoto Kobayashi Kenji Murakami Akinori Takagane Ichiro Takemasa Department of Surgery Hakodate Goryoukaku HospitalHakodate City 040-8611Japan Department of Surgery Surgical Oncology and ScienceSapporo Medical UniversitySapporo City 060-8543HokkaidoJapan Department of Diagnostic Radiology Hakodate Goryoukaku HospitalHakodate City 040-8611Japan

BACKGROUND During pancreaticoduodenectomy in patients with celiac axis(CA)stenosis due to compression by the median arcuate ligament(MAL),the MAL has to be divided to maintain hepatic blood flow in many ***,MAL division often fails,and success can only be determined *** overcome this problem,we performed endovascular CA stenting preoperatively,and thereafter safely performed *** present this case as a new preoperative treatment strategy that was *** SUMMARY A 77-year-old man with a diagnosis of pancreatic head cancer presented to our department for *** assessment revealed CA stenosis caused by *** performed endovascular stenting in the CA preoperatively because we knew that going into the operation without a strategy could lead to ischemic ***-antiplatelet therapy(DAPT)–which is needed when a stent is inserted–was then administered in parallel with neoadjuvant chemotherapy(NAC).This allowed us to administer DAPT for a sufficient period before the main pancreaticoduodenectomy procedure while obtaining therapeutic effects from *** stomach-preserving pancreaticoduodenectomy was *** operation did not require any unusual techniques and was performed ***,the patient progressed well,without any ischemic ***,curative resection was confirmed,and the patient had no recurrence or complications due to ischemia up to six months *** Preoperative endovascular stenting,with NAC and DAPT,is effective and safe prior to pancreaticoduodenectomy in potentially resectable pancreatic cancer.

关键词： pancreaticoduodenectomy Celiac axis stenosis Median arcuate ligament Endovascular stenting pancreatic head cancer Case report

Standard pancreatoduodenectomy versus extended pancreatoduodenectomy with modified retroperitoneal nerve resection in patients with pancreatic head cancer:a multicenter randomized controlled trial

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cancer Communications 2023年第2期43卷 257-275页

作者： Qing Lin Shangyou Zheng Xianjun Yu Meifu Chen Yu Zhou Quanbo Zhou Chonghui Hu Jing Gu Zhongdong Xu LinWang Yimin Liu Qingyu Liu MinWang Guolin Li He Cheng Dongkai Zhou Guodong Liu Zhiqiang Fu Yu Long Yixiong Li Weilin Wang Renyi Qin Zhihua Li Rufu Chen Department of Pancreas Center Department of General SurgeryGuangdong Provincial People’s HospitalGuangdong Academy of Medical SciencesGuangzhouGuangdongPeople’s Republic of China Department of Pancreatobiliary Surgery Sun Yat-sen Memorial HospitalSun Yat-sen UniversityGuangzhouGuangdongPeople’s Republic of China Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation Medical Research Center Sun Yat-Sen Memorial HospitalSun Yat-Sen UniversityGuangzhouGuangdongPeople’s Republic of China Department of pancreatic Surgery Fudan University Shanghai Cancer CenterShanghaiPeople’s Republic of China Hunan Research Center of Biliary Disease/Department of Hepatobiliary Surgery Hunan Provincial People’s Hospital/The First Affiliated Hospital of Hunan Normal UniversityChangshaHunanPeople’s Republic of China Department of Medical Statistics School of Public HealthSun Yat-sen UniversityGuangzhouGuangdongPeople’s Republic of China Department of Anesthesiology Sun Yat-sen Memorial HospitalSun Yat-sen UniversityGuangzhouGuangdongPeople’s Republic of China Department of Pathology Sun Yat-sen Memorial HospitalGuangzhouGuangdongPeople’s Republic of China Department of Oncology Sun Yat-sen Memorial HospitalSun Yat-sen University GuangzhouGuangdongPeople’s Republic of China Department of Radiology Sun Yat-sen Memorial HospitalSun Yat-sen UniversityGuangzhouGuangdongPeople’s Republic of China Department of Biliary-pancreatic Surgery Affiliated Tongji HospitalTongji Medical CollegeHuazhong University of Science and TechnologyWuhanHubeiPeople’s Republic of China Department of Hepatobiliary Pancreatic and Splenic surgerythe Sixth Affiliated Hospital of Sun Yat-sen UniversityGuangzhouGuangdongPeople’s Republic of China Hepatobiliary and pancreatic Interventional Treatment Center Division of Hepatobiliary and Pancreatic SurgeryThe First Affiliated HospitalCollege of MedicineZhejiang UniversityHangzhouZhejiangPeople’s Republic of China Department of General Surge

Background:The extent of pancreatoduodenectomy for pancreatic head cancer remains controversial,and more high-level clinical evidence is *** study aimed to evaluate the outcome of extended pancreatoduodenectomy(EPD)with retroperitoneal nerve resection in pancreatic head ***:This multicenter randomized trial was performed at 6 Chinese highvolume hospitals that enrolled patients between October 3,2012,and September 21,*** hundred patients with stage I or II pancreatic head cancer and without specific pancreatic cancer treatments(preoperative chemotherapy or chemoradiation)within three months were randomly assigned to undergo standard pancreatoduodenectomy(SPD)or EPD,with the latter followed by dissection of additional lymph nodes(LNs),nerves and soft tissues 270◦on the right side surrounding the superior mesenteric artery and celiac *** primary endpoint was overall survival(OS)by intention-to-treat(ITT).The secondary endpoints were disease-free survival(DFS),mortality,morbidity,and postoperative pain ***:TheR1 ratewas slightly lower with EPD(8.46%)thanwith SPD(12.56%).The morbidity and mortality rates were similar between the two *** median OS was similar in the EPD and SPD groups by ITT in the whole study cohort(23.0 vs.20.2 months,P=0.100),while the median DFS was superior in the EPD group(16.1 vs.13.2 months,P=0.031).Patients with preoperative CA19–9pancreatic head cancer did not significantly improve OS,but patients with EPD treatment had significantly improved *** the subgroup analysis,improvements in bothOS and DFS in the EPD armwere observed in pati

关键词： disease-free survival extended lymph nodes nerve resection overall survival pancreatic head cancer pancreatoduodenectomy standard

Laparoscopy and laparoscopic ultrasonography in judging the resectability of pancreatic head cancer

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Hepatobiliary & pancreatic Diseases International 2003年第4期2卷 609-611页

作者： Zuo-Wei Zhao Jin-Yun He Guang Tan Hong-Jiang Wang Ke-Jun Li the Department of General Surgery, First Affiliated Hospital of Dalian Medical University, Dalian 116011, China Department of General Surgery First Affiliated Hospital of Dalian Medical University Dalian 116011 China. zhaozuowei9999@***

OBJECTIVE: To explore the clinical value of laparoscopy and laparoscopic ultrasonography (LUS) in judging the resectability of pancreatic head cancer. METHODS: LUS was employed as a prospective diagnosis of tumor staging before exploratory laparotomy in 22 patients diagnosed with pancreatic head cancer to identify whether the liver and peritoneum had small metastases or local invasion to the portal vein, superior mesenteric vessel, aorta, inferior vena cava. RESULTS: In the 22 patients receiving laparoscopy and LUS, we found peritoneal or surface liver metastases (3 patients), hepatic parenchyma metastases (1), and pancreatitis proved by biopsy under ultrasound guidance (1). Laparotomy was avoided in these 5 patients. Of the remaining 17 patients, 8 patients, including 2 patients with portal vein emboli due to tumor metastases had hypertrophic lymph nodes or tumor invasion of local vessels in the peritoneal cavity, retroperitoneum, and omentum and the other 9 patients had resectable tumors shown by LUS. The 17 patients were subjected to exploratory laparotomy, and pancreaticoduodenectomy was successful in 8 patients. CONCLUSIONS: Laparoscopy and LUS can be used to precisely estimate the possibility of resection of pancreatic head cancer, and prevent unnecessary exploratory laparotomy and its complications. It can be used as a routine examination before exploratory laparotomy.

关键词： laparoscopy laparoscopic ultrasonography pancreatic head cancer resectabilty

Extended radical operation of pancreatic head cancer: Appraisal of its clinical significance

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World Journal of Gastroenterology 2005年第16期11卷 2467-2471页

作者： De-QingMu Shu-YouPeng Guo-FengWang DepartmentofSurgery SecondAffiliatedHospitalMedicalCollegeofZhejiangUniversityHangzhou310009ZhejiangProvinceChina DepartmentofPathology SecondAffiliatedHospitalMedicalCollegeofZhejiangUniversityHangzhou310009ZhejiangProvinceChina

AIM: To evaluate the significance of extended radical operation and its ***: Between January 1995 and December 1998, 56inpatients with pancreatic head cancer received *** them 35 patients (group 1) experienced the Whipple operation, and 21 patients (group 2) received the extended radical operation. The 1-, 2-, 3-year cumulative survival rates were used to evaluate the efficacy of the two operative procedures. Clinical stage (CS) was assessed retrospectively with the help of CT. The indications for extended radical operation were ***: There was no difference in hospital mortality and morbidity rates. Whereas the 1-, 2-, 3-year cumulative survival rates were 84.8%, 62.8%, 39.9% in the extended radical operation group, and were 70.8%, 47.6%, 17.2%in the Whipple operation group, there was a significant difference between the two groups (P＜0.001, P＜0.001,P＜0.001, respectively). Most of the deaths within 3 years after operation were due to recurrence in the two ***, the 1-, 2-, 3-year cumulative rates of death due to local recurrence were decreased from 37.4% in patients that received the Whipple procedure to 23.8% in those who received by extended radical operation. Patients who survived for more than 3 years were only noted in those with CS1 in the Whipple procedure group and were founded in cases with CS1, CS2 and part of CS3 in the extended radical operation ***: The extended radical operation appears to benefit patients with pancreatic head carcinoma which was indicated in CS1, CS2 and part of CS3 without severe invasion.

关键词： Radical operation pancreatic head cancer

Impact of resection margins on long-term survival after pancreaticoduodenectomy for pancreatic head carcinoma

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World Journal of Clinical Cases 2019年第24期7卷 4186-4195页

作者： Cheng-Gang Li Zhi-Peng Zhou Xiang-Long Tan Yuan-Xing Gao Zi-Zheng Wang Qu Liu Zhi-Ming Zhao Second Department of Hepatobiliary Surgery Chinese People’s Liberation Army General Hospital

BACKGROUND The impact of resection margin status on long-term survival after pancreaticoduodenectomy(PD) for patients with pancreatic head carcinoma remains controversial and depends on the method used in the histopathological study of the resected specimens. This study aimed to examine the impact of resection margin status on the long-term overall survival of patients with pancreatic head carcinoma after PD using the tumor node metastasis *** Consecutive patients with pancreatic head carcinoma who underwent PD at the Chinese People's Liberation Army General Hospital between May 2010 and May 2016 were included. The impact of resection margin status on long-term survival was retrospectively *** Among the 124 patients, R0 resection was achieved in 85 patients(68.5%), R1 resection in 38 patients(30.7%) and R2 resection in 1 patient(0.8%). The 1-and 3-year overall survival(OS) rates were significantly higher for the patients who underwent R0 resection than the rates for those who underwent R1 resection(1-year OS rates: 69.4% vs 53.0%;3-year OS rates: 26.9% vs 11.7%). Multivariate analysis showed that resection margin status and venous invasion were significant risk factors for *** Resection margin was an independent risk factor for OS for patients with pancreatic head carcinoma after PD. R0 resection was associated with significantly better OS after surgery.

关键词： pancreatic head cancer pancreaticoduodenectomy R0 resection margin Overall survival Disease-free survival R1 resection

Treatment of Candida albicans liver abscess complicated with COVID-19 after liver metastasis ablation:A case report

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World Journal of Gastrointestinal Oncology 2023年第7期15卷 1311-1316页

作者： Wen Hu Xi Lin Meng Qian Tao-Ming Du Xi Lan Department of Oncology Chengdu Seventh People’s HospitalChengdu 610000Sichuan ProvinceChina Department of Oncology Yanting County People’s HospitalMianyang 621600Sichuan ProvinceChina Department of Radiology Chengdu Seventh People’s HospitalChengdu 610000Sichuan ProvinceChina

BACKGROUND Liver interventional surgery is a relatively safe and minimally invasive ***,for patients who have undergone Whipple surgery,the probability of developing a liver abscess after liver interventional surgery is very *** liver abscess has a high mortality rate,especially when complicated with malignant tumors,diabetes,coronavirus disease 2019(COVID-19)and other *** liver abscess is rare,and there are no guidelines or expert consensus on the course of antifungal *** SUMMARY A 54-year-old woman with pancreatic head cancer received albumin-bound paclitaxel in combination with gemcitabine chemotherapy after laparoscopic *** metastasis was found 1 mo after completion of 8 cycles of chemotherapy,followed by ablation of the liver *** half a month of liver metastasis ablation,the patient experienced fever after chemotherapy and was diagnosed with liver abscess complicated with COVID-19 by contrast-enhanced abdominal computed tomography and real-time polymerase chain reaction *** results of pus culture showed Candida albicans,which was sensitive to *** patient underwent percutaneous catheter drainage,antifungal therapy with fluconazole,and antiviral therapy with *** antifungal therapy,the patient showed a significant increase in liver enzyme levels and was discharged after liver protection *** fluconazole was continued for 1 wk outside the hospital,and fluconazole was used for a total of 5 *** patient recovered well and received 4 cycles of fluorouracil,leucovorin,oxaliplatin,and irinotecan after 2 mo of antifungal *** Effective treatment of Candida albicans liver abscess requires early detection,percutaneous catheter drainage,and 5 wk of antifungal ***,complications such as COVID-19 should be actively managed and nutritional support should be provided.

关键词： Fungal Liver abscess COVID-19 Liver metastasis ablation pancreatic head cancer Case report