Zeitschriftenartikel: „Pancreatic resection“

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Johnson, C. D. „Palliative Resection of Pancreatic Adenocarcinoma“. HPB Surgery 8, Nr. 3 (01.01.1995): 181–83. http://dx.doi.org/10.1155/1995/54241.

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A survey was carried out by postal questionnaire of the attitudes of British surgeons to pancreatic resection as palliation for ductal adenocarcinoma of the pancreas. Replies from 24 surgeons related to experience in over 700 resections. The incidence of estimated residual local disease after resection was median 12.5 percent, range 0–35 percent. Half(12) of the surgeons felt that pancreatic resection with residual macroscopic disease was justified. Only 3 (12.5 percent) surgeons accepted that palliative resection in the presence of liver metastases was sometimes justifiable. Further evidence is required of improved quality of life after resection before the majority of surgeons will accept palliative resection in the management of pancreatic ductal adenocarcinoma.

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Bhandare, Manish S., Nikhil Mehta, Vikram Chaudhari, Naveena An Kumar, Esha Pai, Mahesh Goel und Shailesh V. Shrikhande. „Re-Operative Pancreaticoduodenectomy: Challenges and Outcomes“. Digestive Surgery 36, Nr. 4 (23.05.2018): 302–8. http://dx.doi.org/10.1159/000489275.

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Background: Tata Memorial Centre (TMC) is a high-volume centre for pancreatic tumour resections. We found a continually increasing referral of pancreatic tumours for re-evaluation for surgery, after an initial unsuccessful attempt at resection. Aim: To evaluate reasons of initial in-operability, the feasibility of re-operative pancreatico-duodenectomy (R-PD) and short- and long-term outcomes after R-PD. Methods: Data was collected from a prospective database of GI and hepato-pancreato-biliary service, TMC, Mumbai from January 2008 to December 2016. Results: Forty patients with periampullary/pancreatic head tumours were referred to us after exploration. Thirty were planned for re-exploration, of whom 25 patients underwent successful R-PD, either upfront (n = 12) or after neo-adjuvant therapy (n = 13). Twenty were adenocarcinomas, 5 had other histologies. Majority of the patients were deemed inoperable in view of suspected vascular involvement at the time of initial surgery (68%). R0 resection was achieved in 90% of adenocarcinoma cases (n = 18). Postoperative major morbidity was 20% and mortality was 4% (n = 1). The estimated 1-, 2- and 5-year survival for those with adenocarcinoma was 83, 71.2, and 29.9% respectively. Conclusion: R-PD is safe and should be performed in experienced centres and can achieve long-term outcomes, comparable to conventional PD. The most common reason for denying resection at initial surgery was suspected or perceived vascular involvement.

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Hegde, Sheetal, Jaswanth Kintada, Miren Peña, Sammira Rouhani, Ali Seifi, Pratap Kumar und Dimpy Shah. „Disparities in surgical resection for pancreatic cancer stratified by insurance coverage.“ Journal of Clinical Oncology 36, Nr. 4_suppl (01.02.2018): 451. http://dx.doi.org/10.1200/jco.2018.36.4_suppl.451.

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451 Background: Roughly 50,000 Americans are diagnosed with pancreatic cancer yearly (Howlader, N, Noone, A, Krapcho, M. Cancer Stat Facts: Pancreas Cancer. http://seer.cancer.gov/statfacts/html/pancreas ). High mortality rates following pancreatic cancer make surgical resection the primary curative method for treatment. Literature suggests significantly higher mortality rates (12.3%) in patients classified as government payers vs those with private insurance (7.3%) (Glasgow, RE, Mulvihill, SJ (1996)). Hospital volume influences outcome in patients undergoing pancreatic resection for cancer. Western journal of medicine, 165(5),294). This study investigated disparities in use of resection as pancreatic cancer treatment, based on insurance status. Methods: A retrospective study was performed to evaluate use of pancreatic resection (ICD9: 52.51-52.53, 52.59, 52.6, 52.7) vs non-surgical options to treat patients with a principal diagnosis of pancreatic cancer (ICD9: 230.9, 157.1-157.4, 157.8, 157.9) from 2005-2014, using the Healthcare Cost and Utilization Project database. Rates of surgical resection were stratified based on insurance coverage status: private insurance, government insurance, or no insurance. Results: After adjusting for total discharges, we observed that percent pancreatic resections were highest for uninsured populations and lowest for Medicare. By 2014, the rate of surgical resections in uninsured patients decreased as a steady increase was observed for patients with Medicaid. Conclusions: Our preliminary findings suggest that the trends in rates of surgical resection as a treatment for pancreatic cancer vary by insurance status. Further research examining factors such as race, socioeconomic status, and comorbidities that increase the likelihood of uninsured patients receiving pancreatic resections vs other treatments are warranted. [Table: see text]

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Connell, Louise Catherine, Erica Mulvihill, Margaret O'Keeffe, Seamus O'Reilly, Justin Geoghegan, Criostoir O'Suilleabhain und Derek Gerard Power. „Does age count in pancreatic resection? An Irish experience.“ Journal of Clinical Oncology 30, Nr. 4_suppl (01.02.2012): 348. http://dx.doi.org/10.1200/jco.2012.30.4_suppl.348.

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348 Background: Radical resection offers the only potential cure in pancreas cancer. The majority of patients (pts) are >65 years(yrs) at presentation. Age alone is often a key factor in deciding to resect. The elderly represent 11.5% of the population of Ireland, with an anticipated growth of 26% in the over-65 age group by the end of 2011. Appropriate treatment for elderly potential candidates for pancreatic resection has become increasingly important. We assessed our national experience of pancreatic resection for elderly pts. Methods: Prospectively maintained institutional databases were retrospectively reviewed for all pts undergoing pancreatic resection from 2006 to 2011, in the 2 specialised pancreas cancer centres in Ireland. Demographic, laboratory, treatment and outcome data were obtained and analysed. Results: In a single institution,of the 69 pts who had surgery for pancreas neoplasm, 19 (28%) pts were ≥ 70 yrs. Surgical procedures included pancreaticoduodenectomy (n=16, 84%) and double biliary bypass (n=3,16%). Pathologies included adenocarcinoma (AC) (n=16,84%) and NET (neuroendocrine tumour)/IPMN(intraductal papillary mucinous neoplasms) (n=3, 16%). Number of R0 resections was 15 (15/16,94%). Median baseline ECOG was 1 (range, 0-2).There was no perioperative mortality. Median length of hospital stay was 13 days (range,9-50). Thirteen pts who underwent pancreatico-duodenectomy for AC (81%) received adjuvant chemotherapy (with expected toxicities). Ten pts, after pancreatico-duodenectomy and adjuvant therapy had at least 2 yrs follow-up with median overall survival of 21.5 mths (range,12-44). A further 3 pts aged ≥ 80 yrs underwent pancreaticoduodenectomy followed by adjuvant chemotherapy in the past 12 mths, with no peri-operative complications or significant acute chemotherapy-related toxicities. The data set from the second specialised pancreas cancer centre, with similar survival outcomes, is currently being added to provide overall national results. Conclusions: Age alone should not be a contraindication to pancreatic resection in elderly pts with pancreas cancer. This group can undergo pancreatic resection, with acceptable post-operative morbidity, mortality and overall outcome as evidenced by our national experience.

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Murphy, Melissa M., Jessica P. Simons, Joshua S. Hill, Theodore P. McDade, Sing Chau Ng, Giles F. Whalen, Shimul A. Shah, Lynn H. Harrison und Jennifer F. Tseng. „Pancreatic resection“. Cancer 115, Nr. 17 (01.09.2009): 3979–90. http://dx.doi.org/10.1002/cncr.24433.

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Schmidt, Thomas, Oliver Strobel, Martin Schneider, Markus K. Diener, Christoph Berchtold, André L. Mihaljevic, Arianeb Mehrabi, Beat P. Müller-Stich, Thilo Hackert und Markus W. Büchler. „Cavernous transformation of the portal vein in pancreatic cancer surgery—venous bypass graft first“. Langenbeck's Archives of Surgery 405, Nr. 7 (11.09.2020): 1045–50. http://dx.doi.org/10.1007/s00423-020-01974-0.

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Abstract Background In recent years, several techniques have been introduced to allow safe oncologic resections of cancers of the pancreatic head. While resections of the mesenterico-portal axis became now a part of the routine treatment, patients with a cavernous transformation of the portal vein still pose a surgical challenge and are regularly deemed unresectable. Objective Here, we describe a technique of initial venous bypass graft placement between the superior mesenteric vein or its tributaries and the portal vein before the resection of the pancreatic head. This approach avoids uncontrollable bleeding as well as venous congestion of the intestine with a continuous hepatic perfusion and facilitates oncologic resection of pancreatic head cancers. This technique, in combination with previously published resection strategies, enables tumor resection in locally advanced pancreatic head cancers. Conclusions Venous bypass graft first operations facilitate and enable the resection of the pancreatic head cancers in patients with a cavernous transformation of the portal vein thus rendering these patients resectable.

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Brahmbhatt, Bhaumik, Abhishek Bhurwal, Frank J. Lukens, Mauricia A. Buchanan, John A. Stauffer und Horacio J. Asbun. „Pancreatic Surgery in the Older Population: A Single Institution’s Experience over Two Decades“. Current Gerontology and Geriatrics Research 2016 (2016): 1–6. http://dx.doi.org/10.1155/2016/8052175.

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Objectives. Surgery is the most effective treatment for pancreatic cancer. However, present literature varies on outcomes of curative pancreatic resection in the elderly. The objective of the study was to evaluate age as an independent risk factor for 90-day mortality and complications after pancreatic resection. Methods. Nine hundred twenty-nine consecutive patients underwent 934 pancreatic resections between March 1995 and July 2014 in a tertiary care center. Primary analyses focused on outcomes in terms of 90-day mortality and postoperative complications after pancreatic resection in these two age groups. Results. Even though patients aged 75 years or older had significantly more postoperative morbidities compared with the younger patient group, the age group was not associated with increased risk of 90-day mortality after pancreatic resection. Discussion. The study suggests that age alone should not preclude patients from undergoing curative pancreatic resection.

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Genyk, Yuri, Lea Matsuoka, Anthony B. El-Khoueiry, Syma Iqbal, James Buxbaum, Rick Selby, Jacquez Vandam und Heinz-Josef Lenz. „R0 resection of locally advanced pancreatic cancer encasing major visceral arteries using arterial reconstruction: Short- and long-term results.“ Journal of Clinical Oncology 30, Nr. 15_suppl (20.05.2012): e14679-e14679. http://dx.doi.org/10.1200/jco.2012.30.15_suppl.e14679.

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e14679 Background: Locally advanced disease is found in about 40% of patients with pancreatic cancer at initial presentation. Tumors involving major visceral arteries are commonly deemed unresectable. In this study we analyzed the feasibility of R0 resection of locally advanced pancreatic cancer encasing major visceral arteries using arterial reconstruction. Methods: The following data were collected: age, gender, operative details, post-operative complications, chemotherapy and/or radiation therapy and overall and disease free survival. Patient survival was calculated utilizing Kaplan-Meier survival probability estimates. Results: From Dec., 2002 to Jan., 2012, 13 patients underwent pancreatic resection with concomitant resection and reconstruction of major visceral arteries for pancreatic cancer (9 males and 4 females, median age 63 yrs (range: 50–82 yrs)). The arterial involvement included celiac artery (n=6), superior mesenteric artery (n=4) and hepatic artery (n=3). Resections included pancreatico-duodenectomy (n=9), distal pancreatectomy (n=3), and total pancreatectomy (n=1). Management of the arterial involvement included: resection of celiac axis without reconstruction (n=2), reconstruction of one artery (n=6), two arteries (n=4) and three arteries (n=1). Nine of the 13 patients underwent simultaneous venous reconstruction. R0 resection was accomplished in 11, R1 in 1, and R2 in 1 patient. Ten of the 13 patients received neoadjuvant and/or adjuvant chemo- or chemo-radiation therapy outside protocols. To date, 4 patients are alive and disease free at 1, 4, 15 and 111 months, and 1 patient is alive with recurrence at 100 months. Six-month patient survival was 65% and median overall survival was 17 months. The probability of 5-year survival was 22%. Conclusions: Our study indicates that in select patients with locally advanced pancreatic cancer with involvement of major visceral arteries R0 resection is feasible by performing pancreatic resection with arterial reconstruction. The survival data in this group of patients are encouraging and provide the opportunity to reconsider the contraindications to surgical management of such patients.

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Bachmann, Jeannine, Christoph W. Michalski, Marc E. Martignoni, Markus W. Büchler und Helmut Friess. „Pancreatic resection for pancreatic cancer“. HPB 8, Nr. 5 (Oktober 2006): 346–51. http://dx.doi.org/10.1080/13651820600803981.

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Jordan, George L. „Pancreatic Resection for Pancreatic Cancer“. Surgical Clinics of North America 69, Nr. 3 (Juni 1989): 569–97. http://dx.doi.org/10.1016/s0039-6109(16)44836-x.

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Gevorkyan, Yuriy A., Oksana V. Katelnitskaya, Oleg I. Kit, Andrey A. Maslov, Natalya V. Soldatkina, Dmitriy S. Petrov, Vladimir E. Kolesnikov et al. „Venous segmental resection in locally advanced pancreatic tumors.“ Journal of Clinical Oncology 40, Nr. 16_suppl (01.06.2022): e16243-e16243. http://dx.doi.org/10.1200/jco.2022.40.16_suppl.e16243.

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e16243 Background: Surgical treatment is considered the main treatment for pancreatic cancer improving the patient survival. The most common obstacle to surgery with R0 resection is the involvement of the great vessels. Recently, venous resections have been increasingly performed for this type of tumors. Our purpose was to evaluate radicality of surgical treatment and postoperative morbidity in patients with locally advanced pancreatic cancer. Methods: The study included patients with locally advanced pancreatic cancer (T3 N0-1 M0) with damage to the venous segment (portal vein system) confirmed by CT angiography. Results: Over a 5-year period, 73 (18.9%) of 386 operated-on patients with pancreatic cancer underwent surgeries for pancreatic ductal adenocarcinoma with venous resection. The frequency of wedge venous resection was 24.7% (18), segmental resection with end-to-end anastomosis - 46.6% (34), prosthetics - 26% (19), prosthetics with replantation of the splenic vein - 2.7% (2). The postoperative morbidity rate was 30.1%. Within 30 days after surgery, the mortality rate reached 5.5% (4 patients). The main causes were bleeding and thrombosis of the reconstruction area. Only patients with venous segment replacement developed thrombotic complications. Microscopically complete resection was performed in 87.7% of cases (64 patients). During the follow-up period, the 1-year survival rate reached 90%, and the recurrence-free rate was 93%. Conclusions: Surgical treatment for locally advanced pancreatic tumors with damage to the portal vein system shows an acceptable rate of postoperative complications due to the vascular stage, and a high rate of reaching a negative resection margin. Initial assessment of the need for venous resection is required in patients with pancreatic tumors, as well as expanding the extent of surgical intervention due to venous resection to achieve R0 resections.

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Guzman, Eduardo A., Rebecca A. Nelson, Joseph Kim, Alessio Pigazzi, Vijay Trisal, Benjamin Paz und Joshua Di Ellenhorn. „Increased Incidence of Pancreatic Fistulas after the Introduction of a Bioabsorbable Staple Line Reinforcement in Distal Pancreatic Resections“. American Surgeon 75, Nr. 10 (Oktober 2009): 954–57. http://dx.doi.org/10.1177/000313480907501020.

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Pancreatic fistula is a major cause of morbidity after distal pancreatic resection. When resections are performed with linear stapling devices, the use of bioabsorbable staple line reinforcement has been suggested to decrease the rate of pancreatic fistula. Our objective was to investigate the incidence of pancreatic fistula when using the Gore Seamguard® staple line reinforcement in stapled distal pancreatic resections. A retrospective review of 30 consecutive patients with stapled distal pancreatectomy was conducted. A broad definition of pancreatic fistula was used. Clinicopathologic factors and outcomes were compared between groups. Pancreatic fistula was diagnosed in 11 of 15 patients (73%) and three of 15 patients (20%) in the Seamguard® and non-Seamguard® groups, respectively ( P = 0.002). Pancreatic parenchymal transection at the neck of the gland was associated with pancreatic fistula, whereas laparoscopic procedures, splenic preservation, or additional organ resection were not. On multivariate analysis, the association between Seamguard® use and pancreatic fistula was significant ( P = 0.005). In conclusion, after introduction of the Gore Seamguard® bioabsorbable staple line reinforcement, we experienced a significant increase in the rate of pancreatic fistula. This experience raises concern about the efficacy of this device in limiting pancreatic fistula after stapled distal pancreatic resection.

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Garden, O. J. „Liver and Pancreatic Resection in the Elderly“. HPB Surgery 10, Nr. 4 (01.01.1997): 259–61. http://dx.doi.org/10.1155/1997/84160.

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Background: Liver resection, or pancreaticoduodenectomy, has traditionally been thought to have a high morbidity and. mortality rate among the elderly. Recent improvements in surgical and anesthetic techniques, an increasing number of elderly patients, and an increasing need to justify use of limited health care resources prompted an assessment of recent surgical outcomes.Methods: Five hundred seventy-seven liver resections (July 1985–July 1994) performed for metastatic colorectal cancer and 488 pancreatic resections (October 1983–July 1994) performed for pancreatic malignancies were identified in departmental data bases. Outcomes of patients younger than age 70 years were compared with those of patients age 70 years or older.Results: Liver resection for 128 patients age 70 years or older resulted in a 4% perioperative. mortality rate and a 42% complication rate. Median hospital stay was 13 days, and 8% of the patients required admission to the intensive care unit (ICU). Median survival was 40 months, and the 5-year survival rate was 35%. No difference were found between results for the elderly and those for younger patients who had undergone liver resection, except for a minimally shorter hospital stay fortheyoungerpatients (median, 12 days vs. 13 days p=0.003). Pancreatic resection for 138 elderly patients resulted in a mortality rate of 6% and a complication rate of 45%. Median stay was 20 days, and 19% of the patients required ICU admission, results identical to those for the younger cohort. Long-term survival was poorer for the elderly patients, with a 5-year survival rate of 21% compared with 29% for the younger cohort (p=0.03).Conclusions: Major liver or pancreatic resections can be performed for the elderly with acceptable morbidity and mortality rates and possible long-term survival. Chronologic age alone is not a contraindication to liver or pancreatic resection for malignancy.

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Williams, Graham, Simon R. Bramhall und John P. Neoptolemos. „Purse-String Pancreatico-Jejunostomy following Pancreatic Resection“. Digestive Surgery 14, Nr. 3 (1997): 183–86. http://dx.doi.org/10.1159/000172538.

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Orelkin, V. I., E. A. Toneev, A. V. Zhinov, S. V. Gorodnov, B. V. Abroskin und Y. D. Orelkina. „EXPERIENCE OF GASTROPANCREATODUODENAL RESECTION WITH CIRCULAR RESECTION OF MAJOR VENOUS VESSELS“. Surgical practice, Nr. 4 (22.02.2021): 40–47. http://dx.doi.org/10.38181/2223-2427-2020-4-40-47.

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Purpose of work. Improve patient outcomes in patients with pancreatic cancer.Material and methods of research. We present our own clinical observation of surgical treatment of malignant neoplasms of the head of the pancreas with invasion of the main venous vessels. In 2019, on the basis of 1 surgical Department of the GUZ Regional clinical oncological dispensary, 2 patients underwent gastropancreatoduodenal resections with circular portal vein resection and end-to-end angioplasty.The results of the study and their discussion. Tumor invasion into the main venous vessels is not a contraindication to performing radical surgery and is achievable when performing gastropancreatoduodenal resection, due to resections of the main venous vessels together with the tumor invading its wall.Conclusions. Resection of the portal vein together with the pancreatic head tumor invading its wall contributes to the achievement of radical surgery when performing gastropancreatoduodenal resection.

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Bacalbasa, Nicolae, Irina Balescu, Mihai Dimitriu, Cristian Balalau, Florentina Furtunescu, Florentina Gherghiceanu, Daniel Radavoi et al. „Extended Venous Resections for Borderline Resectable Pancreatic Head Adenocarcinoma—A Retrospective Studies of Nine Cases“. Healthcare 9, Nr. 8 (31.07.2021): 978. http://dx.doi.org/10.3390/healthcare9080978.

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Background: pancreatic cancer is one of the most lethal malignancies and a leading cause of cancer-related death worldwide. The only chance to improve the long-term outcomes of patients with pancreatic cancer is surgery with radical intent. Methods: in the present paper, we aim to describe a case series of 9 patients submitted to radical surgery for borderline resectable pancreatic cancer. Results: in all cases, negative resection margins were achieved. The types of venous resection consisted of tangential portal vein resection in four cases, circumferential portal vein resection with direct reanastomosis in one case and circumferential resection with graft placement in another four cases; postoperatively, one patient developed a vascular surgery-related complication consisting of graft thrombosis and thus necessitated prolonged anticoagulant therapy. Conclusions: extended venous resections can be a safe and efficient way to maximize the benefits of radical surgery in locally advanced, borderline resectable pancreatic cancer.

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Morrison, Maureen. „Post-Pancreatic Resection“. Dimensions of Critical Care Nursing 29, Nr. 4 (Juli 2010): 157–62. http://dx.doi.org/10.1097/dcc.0b013e3181de95dc.

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Nichkaode, Prabhat, Shusrut Bhukte und Aakash Bandhe. „Audit of 62 cases of pancreatic resections for pancreatic cancer“. International Surgery Journal 4, Nr. 10 (27.09.2017): 3382. http://dx.doi.org/10.18203/2349-2902.isj20174500.

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Background: Varieties of pancreatic pathologies, needs resection of pancreatic tissue. Adenocarcinoma of the pancreatic duct is the most common malignancy presenting with early metastasis and seen as resistant to alternative treatment regimens currently available. Management and handling of such tumors is a complex and challenging task for a surgeon. Surgical resection offers an improved prognosis, with a median survival after resection of 14-20 months and up to 25% 5-year survival rates. Present study is aimed at presenting data of 62 pancreatic resections for various malignant pancreatic lesions.Methods: This is an ongoing longitudinal study which started in 2009 at teaching institute in central India. Though we had 109 patients for pancreatic resection, only 62 patients were considered suitable for the study. All patients after admission were thoroughly investigated and then considered for surgery. 48 patients were male and 14 patients were female. Age group was ranging from 33 to 65 years with mean age between 45 to 55 years. Spectrum of various malignancies and different types of pancreatic resections were done and results are presented here.Results: Pancreatic adenocarcinoma is an aggressive malignancy responds to surgical treatment better than other alternative modalities. In the present series out of 62 patients 27 patients with pancreatic head cancer, 22 patients with periampullary cancer, 2 patients with duodenal cancer, 6 patients with distal cholangio carcinoma, 1 patient with mucinous cystadenocarcinoma. 4 patients with body and tail of pancreas cancer. Average age 38 to 65 years, 47 males and 15 females. Commonest procedure was Whipple’s operation, and distal pancreatectomy. Survival in present series was 18 -24 months and 5-year survival was 12 % that is seen mainly with Periampullary cancer.Conclusions: Surgery is the only chance of cure or long-term survival in pancreatic cancer. Chemo radiation as a primary therapy is ineffective. But some reports suggest the improved quality of life with palliative chemotherapy. Biology of the disease is the king and dictates the survival, the type of surgical procedure had no impact on survival, nor on morbidity and mortality.

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Kozlov, I. A., M. D. Baydarova, T. V. Shevchenko, R. Z. Ikramov und Yu O. Zharikov. „Duodenum-preserving total pancreatic head resection. Early postoperative outcomes“. Annaly khirurgicheskoy gepatologii = Annals of HPB Surgery 25, Nr. 4 (17.12.2020): 107–17. http://dx.doi.org/10.16931/1995-5464.20204107-117.

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Aim. To study the early postoperative outcomes of duodenum-preserving total pancreatic head resections in benign, premalignant tumors of the pancreatic head and chronic pancreatitis complicated by duodenal dystrophy in comparison with the results of pylorus-preserving pancreaticoduodenectomy. Materials and methods. From 2006 to 2019, 54 patients underwent duodenum-preserving total pancreatic head resection for chronic pancreatitis complicated by duodenal dystrophy, benign or premalignant tumors of the pancreatic head. At the same time, in 25 cases, the operation was performed in an isolated version, in 29 – with a resection of the duodenum. As a comparison group, we used data from 89 patients who underwent pyloruspreserving pancreaticoduodenectomy during the same period. Results. Compared to pancreaticoduodenectomy, duodenum-preserving total pancreatic head resection exhibits significantly longer times for surgery (420 and 310 minutes, respectively). There was no statistically significant difference in the volume of intraoperative blood loss. There are no differences between groups in hospital morbidity (the frequency of pancreatic fistulas, delayed gastric emptying, bile leakage and post-resection bleeding). The frequency of postoperative complications for Clavien-Dindo III and higher did not differ significantly in the groups. There is no hospital mortality after duodenum-preserving total pancreatic head resection; three patients died after pancreatoduodenectomy. Conclusion. Early postoperative outcomes following duodenum-preserving total pancreatic head resection and pylorus-preserving pancreaticoduodenectomy are comparable. However, to develop a full-fledged concept of surgical treatment of pancreatic head benign, premalignant neoplasms and chronic pancreatitis with duodenal dystrophy, it is necessary to analyze the long-term outcomes of treatment.

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Barannikov, Anton Yu, Vladimir D. Sakhno, Vladimir M. Durleshter, Laura G. Izmailova, Andrei V. Andreev und Evgenii V. Tokarenko. „Differentiated approach to pancreatic-enteroanastomosis in pancreaticoduodenal resection: a clinical experimental controlled trial“. Kuban Scientific Medical Bulletin 28, Nr. 5 (30.10.2021): 29–46. http://dx.doi.org/10.25207/1608-6228-2021-28-5-29-46.

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Background. Despite decreasing mortality in pancreaticoduodenal resection, the incidence of postoperative complications in such patients remains high. The choice and formation of “reliable” pancreatic-enteroanastomosis remain relevant.Objectives. The improvement of immediate surgery outcomes in pancreaticoduodenal resection via development of a differentiated algorithm for pancreatic-enteroanastomosis formation.Methods. A prospective non-randomised controlled trial enrolled 90 patients with a pancreaticoduodenal resection surgery. The patients were divided in three cohorts, A (n = 30), B (n = 30) and control C (n = 30). Pancreatic shear wave ultrasound elastography was conducted pre-surgery in main cohorts A and B. Average parenchymal stiffness and intraoperative data decided between the two pancreatico-enteric anastomosis techniques, end-to-side or the original pancreatic-enteroanastomosis. Control cohort C had pancreatico-enteric anastomosis without taking into account the pancreas stiffness and macrocondition.Results. Class A postoperative pancreatic fistula was registered in 2 (6.7%) of 30 patients in cohort B; it was transient, asymptomatic, not requiring additional treatment or a longer postoperative period. No class B and C pancreatic-enteroanastomosis failures or stump pancreonecroses were observed in main cohorts A and B. Clinically significant class B and C postoperative pancreatic fistulae were registered in 5 (16.7%) of 30 patients in control cohort C (inter-cohort comparison statistically significant).Conclusion. The proposed differentiated approach to pancreatic-enteroanastomosis formation associates with a reliably low postoperative complication frequency and lack of clinically significant class B and C postoperative pancreatic fistulae.

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Clout, Emma, James Wei Tatt Toh, Adeeb Majid, Ju-En Tan, Jim Iliopoulos und Neil Merrett. „Splenic vein turndown for vascular reconstruction following pancreatic cancer resection in patients with high risk profile“. International Journal of Hepatobiliary and Pancreatic Diseases 7, Nr. 2 (04.08.2017): 1–4. http://dx.doi.org/10.5348/ijhpd-2016-58-cr-14.

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Introduction: Vascular reconstruction is utilized following resections for pancreatic cancers with borderline resectability. This is defined by venous or partial superior mesenteric artery (SMA) involvement, where vessels are resected en bloc to achieve an R0 resection. There are many vascular reconstruction techniques post en bloc R0 resection, each with its own complication profile. The splenic turndown technique separates the vascular anastomosis from the pancreatic anastomosis, reducing the risk of vascular disruption should a pancreatic leak occur. Case Report: This is the first report in literature of the splenic vein turndown technique being utilized for vascular reconstruction post- pancreatic resection for borderline resectable pancreatic cancer. To date, splenic vein turndown repair has only been described in a trauma setting. In this case, splenic vein turndown was preferred as the patient was on long-term corticosteroids with a high risk of anastomotic leak. Conclusion: This case report showing that splenic vein turndown technique is a feasible option for vascular reconstruction post-pancreatic resection. The main disadvantage of this technique is high risk of segmental portal hypertension if the spleen is not removed concomitantly. For this reason, its utility should be restricted to patients at high risk of pancreatic leak.

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Sabol, M., R. Donat, D. Dyttert, V. Reken, D. Sintal, J. Palaj und S. Durdik. „Postoperative pancreatic fistula after pancreatic resection“. Bratislava Medical Journal 121, Nr. 08 (2020): 541–46. http://dx.doi.org/10.4149/bll_2020_090.

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Bassi, Claudio, Giovanni Butturini, Enrico Molinari, Giuseppe Mascetta, Roberto Salvia, Massimo Falconi, Andrew Gumbs und Paolo Pederzoli. „Pancreatic Fistula Rate after Pancreatic Resection“. Digestive Surgery 21, Nr. 1 (2004): 54–59. http://dx.doi.org/10.1159/000075943.

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Webb, Travis P., Joseph A. Blansfield und Mohsen M. Shabahang. „Tu1561 Pancreatic Insufficiency Following Pancreatic Resection“. Gastroenterology 144, Nr. 5 (Mai 2013): S—1126—S—1127. http://dx.doi.org/10.1016/s0016-5085(13)64199-2.

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Phillips, Mary E. „Pancreatic exocrine insufficiency following pancreatic resection“. Pancreatology 15, Nr. 5 (September 2015): 449–55. http://dx.doi.org/10.1016/j.pan.2015.06.003.

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Büchler, M. W., H. Friess, M. Wagner, C. Kulli, V. Wagener und K. Z'graggen. „Pancreatic fistula after pancreatic head resection“. British Journal of Surgery 87, Nr. 7 (Juli 2000): 883–89. http://dx.doi.org/10.1046/j.1365-2168.2000.01465.x.

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Ghaneh, Paula, und John P. Neoptolemos. „Pancreatic Exocrine Insufficiency following Pancreatic Resection“. Digestion 60, Suppl. 1 (1999): 104–10. http://dx.doi.org/10.1159/000051464.

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Beltrame, Valentina, Mario Gruppo, Sergio Pedrazzoli, Stefano Merigliano, Davide Pastorelli und Cosimo Sperti. „Mesenteric-Portal Vein Resection during Pancreatectomy for Pancreatic Cancer“. Gastroenterology Research and Practice 2015 (2015): 1–5. http://dx.doi.org/10.1155/2015/659730.

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The aim of the present study was to determine the outcome of patients undergoing pancreatic resection with (VR+) or without (VR−) mesenteric-portal vein resection for pancreatic carcinoma. Between January 1998 and December 2012, 241 patients with pancreatic cancer underwent pancreatic resection: in 64 patients, surgery included venous resection for macroscopic invasion of mesenteric-portal vein axis. Morbidity and mortality did not differ between the two groups (VR+: 29% and 3%; VR−: 30% and 4.0%, resp.). Radical resection was achieved in 55/64 (78%) in the VR+ group and in 126/177 (71%) in the VR− group. Vascular invasion was histologically proven in 44 (69%) of the VR+ group. Survival curves were not statistically different between the two groups. Mean and median survival time were 26 and 15 months, respectively, in VR− versus 20 and 14 months, respectively, in VR+ groupp=0.52. In the VR+ group, only histologically proven vascular invasion significantly impacted survivalp=0.02, while, in the VR− group, R0 resectionp=0.001and tumor’s gradingp=0.01significantly influenced long-term survival. Vascular resection during pancreatectomy can be performed safely, with acceptable morbidity and mortality. Long-term survival was the same, with or without venous resection. Survival was worse for patients with histologically confirmed vascular infiltration.

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Kutluturk, Koray, Abdul Hamid Alam, Cuneyt Kayaalp, Emrah Otan und Cemalettin Aydin. „En Masse Resection of Pancreas, Spleen, Celiac Axis, Stomach, Kidney, Adrenal, and Colon for Invasive Pancreatic Corpus and Tail Tumor“. Case Reports in Surgery 2013 (2013): 1–4. http://dx.doi.org/10.1155/2013/376035.

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Providing a more comfortable life and a longer survival for pancreatic corpus/tail tumors without metastasis depends on the complete resection. Recently, distal pancreatectomy with celiac axis resection was reported as a feasible and favorable method in selected pancreatic corpus/tail tumors which had invaded the celiac axis. Additional organ resections to the celiac axis were rarely required, and when necessary it was included only a single extra organ resection such as adrenal or intestine. Here, we described a distal pancreatic tumor invading most of the neighboring organs—stomach, celiac axis, left renal vein, left adrenal gland, and splenic flexure were treated by en bloc resection of all these organs. The patient was a 60-year-old man without any severe medical comorbidities. Postoperative course of the patient was uneventful, and he was discharged on postoperative day eight without any complication. Histopathology and stage of the tumor were adenocarcinoma and T4 N1 M0, respectively. Preoperative back pain of the patient was completely relieved in the postoperative period. As a result, celiac axis resection for pancreatic cancer is an extensive surgery, and a combined en masse resection of the invaded neighboring organs is a more extensive surgery than the celiac axis resection alone. This more extensive surgery is safe and feasible for selected patients with pancreatic cancer.

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Durlik, Marek, Marta Matejak-Górska, Anna Nasierowska-Guttmejer und Ireneusz Ziobrowski. „Laparoscopic pancreatic resection – The new “gold standard” for distal pancreatic resection“. Pancreatology 12, Nr. 6 (November 2012): 516. http://dx.doi.org/10.1016/j.pan.2012.11.050.

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Miyazaki, Masaru, Hideyuki Yoshitomi, Shigetsugu Takano, Hiroaki Shimizu, Atsushi Kato, Hiroyuki Yoshidome, Katunori Furukawa et al. „Combined hepatic arterial resection in pancreatic resections for locally advanced pancreatic cancer“. Langenbeck's Archives of Surgery 402, Nr. 3 (30.03.2017): 447–56. http://dx.doi.org/10.1007/s00423-017-1578-5.

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Propp, A. R., und E. N. Degovtsov. „Comparative Analysis of the Results of Various Methods for Pancreatic Head Resection in Chronic Pancreatitis“. Russian Sklifosovsky Journal "Emergency Medical Care" 9, Nr. 2 (22.10.2020): 238–50. http://dx.doi.org/10.23934/2223-9022-2020-9-2-238-250.

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Background In more than half of cases of chronic pancreatitis (CP), enlargement of the pancreatic head is diagnosed with the presence of complications that serve as an indication for organ resection. The development of an optimal method for the surgical treatment of CP with damage to the pancreatic head (PH) is one of the tasks of surgical pancreatology.Aim of study To perform comparative evaluation of immediate and late results of different types of PH resection in CP.Material and methods A prospective controlled study was conducted with a comparative analysis of the results of surgical treatment of 131 patients with CP with pancreatic head enlargement. In 29% (n=38) cases inflammatory complications were revealed, in 86.3% (n=113), they have been associated with compression of adjacent organs, jaundice also developed (n=60), as well as duodenal obstruction at the level of duodenum (n=43), regional portal hypertension (n=10). A total of 47 pancreatoduodenal, 58 subtotal, and 26 partial resections of the pancreas were performed.Results Duodenum preserving pancreatic head resections had significantly better short-term results compared to pancreatoduodenal resections. Subtotal PH resection in the Bern’s version was superior to all other resections in terms of average duration of surgery, postoperative inpatient treatment, and intraoperative blood loss. The frequency of relaparotomy for intraperitoneal complications of hemorrhagic etiology was 8.2% (n=4). The frequency of the adverse effect according to pain preservation 5 years after duodenum preserving resection tract was 0.125; after pancreatoduodenal resection - 0.357 with a statistically significant relative risk (RR) of 0.350 (CI95% = 0.13–0.98). According to other indicators of clinical long-term surgical treatment depending on the various methods of PH resection, there were no statistically significant differences (p>0.05). The quality of life of patients 5 years after the operation according to the EORTC QLQ-C30 questionnaire was statistically significant (p=0.0228) by only two indicators: dyspnea (DY:8.3) and insomnia (SL:16.67; 27.4) with higher values after operations of Beger and the Bern’s version of the subtotal PH resection, respectively.

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Kriger, A. G., D. S. Gorin, A. V. Pavlov, N. A. Pronin, D. V. Sidorov, A. R. Kaldarov, K. E. Ponezhev und V. I. Panteleev. „Distal resection for pancreatic tumors“. Annaly khirurgicheskoy gepatologii = Annals of HPB Surgery 27, Nr. 3 (20.09.2022): 55–62. http://dx.doi.org/10.16931/1995-5464.2022-3-55-62.

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Aim. To study the specific features of the splenic artery architectonics and evaluate the results of distal pancreatic resection for various tumors.Materials and Methods. In the anatomical part, we examined 88 organ complexes taken from people whose death was not associated with diseases of the abdominal organs. We studied the topography of the splenic artery and the dependence of the number of its branches to the pancreas on the vessel tortuosity. The clinical part of the study presents the results of 122 distal resections performed during 2016-2021. 79 operations were carried out using the traditional method, 32 operations were robot-assisted, and 11 were performed laparoscopically.Results. The research found a relationship between the degree of the splenic artery tortuosity and the number of branches to the pancreas, which varies from three to nine. Out of the 122 operated patients, in 24 (19.7%) cases a clinically relevant (type B) pancreatic fistula that required additional treatment was formed. Intra-abdominal bleeding developed in 15 (12.3%) patients: early – in 10, late arrosive hemorrhage associated with a pancreatic fistula – in 5 cases. One (0.8%) patient died.Conclusion. It is necessary to consider the architectonics of the splenic artery during distal pancreatic resection. The frequency of pancreatic fistula formation does not depend on the method of performing the operation. Of the prognostic factors, the body mass index is statistically significant. Late arrosive bleeding develops against the background of a clinically relevant pancreatic fistula.

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Toomey, Paul, Jonathan Hernandez, Connor Morton, Lorent Duce, Thomas Farrior, Desiree Villadolid, Sharona Ross und Alexander Rosemurgy. „Resection of Portovenous Structures to Obtain Microscopically Negative Margins during Pancreaticoduodenectomy for Pancreatic Adenocarcinoma is Worthwhile“. American Surgeon 75, Nr. 9 (September 2009): 804–10. http://dx.doi.org/10.1177/000313480907500911.

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Locally advanced pancreatic adenocarcinoma may require resections of the portal vein and/or its major tributaries to achieve tumor extirpation, albeit with the potential for increased morbidity and mortality. However, major venous resections can impart complete tumor extirpation and thereby a survival advantage compared with resections with residual microscopic disease. This study was undertaken to determine if resection of the portal vein and/or its splenic or superior mesenteric venous (SMV) tributaries is a worthwhile endeavor. Since 1995, patients undergoing pancreaticoduodenectomy (PD) for pancreatic adenocarcinoma have been prospectively followed. The impact of portovenous resections (portal vein, SMV, and/or splenic vein) on survival was evaluated using survival curve analysis (Mantel-Cox test). Margins were codified as R0 or R1 and data are presented as median, mean ± SD where appropriate. For 220 patients undergoing PD for pancreatic adenocarcinoma, survival was 17 months. Patients undergoing RO resections had improved survival relative to patients undergoing R1 resections (20 vs 13 months, P < 0.03). Concomitant portovenous resections were undertaken in 48 patients. There was no difference in survival after PD without portovenous resection (17 months) versus PD with portovenous resection (18 months). Resections with complete tumor extirpation (i.e., RO resections) provide superior long-term survival; all efforts to obtain RO resections should be undertaken. Portovenous resections during pancreaticoduodenectomy can be undertaken safely and are worthwhile when complete tumor extirpation is attainable.

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Smith, J. K., E. R. Witkowski, M. M. Murphy, S. Ng, S. A. Shah und J. F. Tseng. „Minimally invasive surgery for resectable pancreatic cancer in the United States: From staging tool to treatment strategy.“ Journal of Clinical Oncology 29, Nr. 4_suppl (01.02.2011): 243. http://dx.doi.org/10.1200/jco.2011.29.4_suppl.243.

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243 Background: Debate exists regarding the use of laparoscopy in pancreatic malignancy. The goal of this study was to examine recent laparoscopy use in pancreatic resections for cancer in the US. We hypothesized that there would be two noticeable trends in the use of laparoscopy – the first reflecting staging laparoscopy, the second associated with advancement of laparoscopic pancreatectomy. Methods: The Nationwide Inpatient Sample (NIS), 1998-2007, was used to identify patients ≥ 18 years old with pancreatic cancer who underwent pancreatic resection with or without associated laparoscopy. Patterns of laparoscopy use and correlated outcomes were examined. Results: Among 47599 patients (nationally weighted) who underwent resection for pancreatic cancer, 2640 (5.5%) had procedures that included laparoscopy. Yearly trend analyses demonstrated a peak in laparoscopy in 2003 followed by decreased use, then steady increase after 2005. Laparoscopy at time of resection was not significantly associated with decreased complications (p=0.09), but was associated with lower mortality compared to open resection alone (3.2% vs. 5.9%, p = 0.008). On multivariate analysis, independent predictors of increased complications included older age, male sex, higher comorbidity (Charlson) score, urban location, and non-teaching hospital. For increased risk of death, predictors were older age, male sex, Charlson >2, non-teaching hospital, and non-use of laparoscopy. Conclusions: Trends in the use of laparoscopy during pancreatic resections for cancer suggest initial increased use in the early 2000's following published staging recommendations, with a subsequent decrease contemporaneous with improving imaging techniques. A recent upward trend is likely associated with increased attempts at minimally-invasive resection. The use of laparoscopy is not associated with any difference in complication rate following surgery and is associated with improved perioperative survival. The effects of patient factors, selection, and volume status on minimally invasive pancreatectomy outcomes warrant further investigation. No significant financial relationships to disclose.

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Ramacciato, Giovanni, Paolo Mercantini, Alessandro Cucchetti und Massimo Del Gaudio. „About Pancreatic Resection With Portal Vein Resection“. Annals of Surgery 249, Nr. 2 (Februar 2009): 349. http://dx.doi.org/10.1097/sla.0b013e3181982f01.

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Yekebas, Emre F. „About Pancreatic Resection With Portal Vein Resection“. Annals of Surgery 249, Nr. 2 (Februar 2009): 349–50. http://dx.doi.org/10.1097/sla.0b013e3181982f2b.

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Genyk, Yuri, Afsaneh Barzi, Anthony B. El-Khoueiry, Lea Matsuoka, Vanessa Sutton, James Buxbaum, Syma Iqbal, Jacques van Dam, Rick Selby und Heinz-Josef Lenz. „The feasibility of R0 resection of locally advanced pancreatic cancer (LAPC) encasing major visceral arteries (T4 lesions) using arterial resection and reconstruction: Short- and long-term outcomes.“ Journal of Clinical Oncology 31, Nr. 4_suppl (01.02.2013): 243. http://dx.doi.org/10.1200/jco.2013.31.4_suppl.243.

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243 Background: LAPC is found in about 40% of patients with pancreatic cancer at initial presentation. Tumors involving major visceral arteries are commonly deemed unresectable. In this study we analyzed the feasibility of R0 resection of LAPC encasing major visceral arteries using arterial resection and reconstruction. Methods: The following data were collected prospectively following pancreatic resection with vascular reconstruction in patients with LAPC: age, gender, operative details, post-operative complications, chemotherapy and/or radiation therapy and overall and disease free survival. Patient survival was calculated utilizing Kaplan-Meier survival probability estimates. Results: From Dec., 2002 to Sep., 2012, 12 patients with LAPC (8 males and 4 females, median age 58.5 yrs (range: 51–78 yrs)) underwent pancreatic resection with concomitant resection and reconstruction of major visceral arteries in our institution. The arterial involvement included celiac artery (n=8), and superior mesenteric artery (n=4). Resections included pancreatico-duodenectomy (n=8), distal pancreatectomy (n=3), and total pancreatectomy (n=1). Management of the arterial involvement included: resection of celiac axis without reconstruction (n=2), resection and reconstruction of one artery (n=6), two arteries (n=3) and three arteries (n=1). R0 resection was accomplished in 9, R1 in 2, and R2 in 1 patient. One patient (8%) died peri-operatively from pulmonary thromboembolism. Chemo- or chemo-radiation therapy was not protocolized. To date, 5 patients are alive and disease free at 7, 9, 11, 23 and 117 months, and 1 patient is alive with recurrence at 107 months. Six-month patient survival was 75% and median overall survival (MOS) was 19 months. Conclusions: The MOS in this patient population with systemic therapy is around 9 months. Although the sample size in our study is limited, observed MOS of 19 months is encouraging and provides the opportunity to reconsider the contraindications to surgical management of such patients with T4 LAPC. Timing of perioperative chemotherapy will be evaluated in a prospective trial.

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Takahashi, Caitlin, Ravi Shridhar, Cynthia L. Harris, Justin Lee, Anjan Jayantilal Patel, Richard H. Brown, Jamie Huston, Stephen Kucera und Ken Lee Meredith. „Adjuvant therapy for margin positive pancreatic cancer.“ Journal of Clinical Oncology 36, Nr. 4_suppl (01.02.2018): 390. http://dx.doi.org/10.1200/jco.2018.36.4_suppl.390.

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390 Background: Pancreatic cancer continues to have a dismal prognosis despite improvements in surgical care. Approximately 26% of patients are deemed resectable, and at the time of operation, 28% will have R1 resections. Adjuvant chemotherapy (AC) or chemoradiation (CRT) is recommended, however the magnitude of benefit is unclear. We sought to examine the impact these therapies on R1 resected pancreatic cancer. Methods: Utilizing the National Cancer Database we identified patients who underwent pancreatic resection for adenocarcinoma. Patients were stratified by resection status and adjuvant therapy. Baseline comparisons of patient characteristics were made using Mann-Whitney U, Kruskal Wallis and Pearson’s Chi-square test as appropriate. Survival analyses were performed using the Kaplan-Meier method. Multivariable cox proportional models(MVA) were developed to identify predictors of survival. All statistical tests were two-sided and α <0.05 was considered significant. Results: We identified 28,440 patients: 22,005 (77.4%) underwent R0 resections and 6,435 (22.4%) underwent R1 resections with a median age of 67.5 years (18-90) and median tumor size of 3.1 cm (2.4-4.2). Patients with tumor size >2cm were more likely to undergo R1 resections, p<0.001. Within the R1 resection group, AC was administered in 1,802 (19.4%), CRT 2,153 (28.5%), and no adjuvant therapy (NA) 2,480 (21.4%). Adjuvant therapy improved survival in all patients with median and 5-year survival of: AC (21.7 months, 17.45%), CRT (23.3 months, 20.9%) vs NA (19.5 months, 19.1%), p<0.001. In the R1 resection cohort survival was also improved with adjuvant therapy with CRT demonstrating the most significant improvement: AC (15.9 months, 6.5%), CRT (18.7 months. 11.2%) vs NA (12.5 months, 8.7%), p<0.001. Additionally CRT but not AC improved survival in the R1 node negative, p<0.004, and node positive, p<0.001. AC benefited survival in R1 node positive patients, p<0.001. MVA revealed age, tumor grade, tumor size >2cm, T-stage, N-stage, AC, and CRT were predictive of survival. Conclusions: Patients with pancreatic cancer who undergo R1 resection have significant improvement in survival when treated with adjuvant CRT and AC. However, benefits were greater in those receiving adjuvant CRT.

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M??ller, Michael W., Helmut Friess, J??rg Kleeff, Ulf Hinz, Moritz N. Wente, Daniel Paramythiotis, Pascal O. Berberat, G??ralp O. Ceyhan und Markus W. B??chler. „Middle Segmental Pancreatic Resection“. Annals of Surgery 244, Nr. 6 (Dezember 2006): 909–20. http://dx.doi.org/10.1097/01.sla.0000247970.43080.23.

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Thompson, Traci K., Rob W. Hutchison, Deborrah J. Wegmann, G. Tom Shires und Ernest Beecherl. „Pancreatic Resection Pain Management“. Pancreas 37, Nr. 1 (Juli 2008): 103–4. http://dx.doi.org/10.1097/mpa.0b013e31816074b7.

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Root, Jeff, Ninh Nguyen, Blanding Jones, Scott Mccloud, John Lee, Phuong Nguyen, Ken Chang, Peter Lin und David Imagawa. „Laparoscopic Distal Pancreatic Resection“. American Surgeon 71, Nr. 9 (September 2005): 744–49. http://dx.doi.org/10.1177/000313480507100910.

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Laparoscopic resection is not an established treatment for pancreatic tumors. Previous reports, mainly in Europe and Japan, have demonstrated the potential utility of laparoscopic distal pancreatectomy (LDP). However, few reports have been published from the United States. We instituted a pilot program to assess LDP. A total of 11 patients were included from December 2003 to December 2004. All patients were staged with preoperative endoscopic ultrasound and received vaccinations for possible splenectomy. The indications for surgery were as follows: neuroendocrine tumor (n = 7), unspecified tumor (n = 1), and cystic neoplasm (n = 3). All procedures began with diagnostic laparoscopy and intraoperative ultrasound. Three patients underwent laparoscopic enucleation of a discrete pancreatic nodule. In eight patients, LDP was attempted. One patient required conversion to an open procedure. In the other seven patients, the procedure was completed laparoscopically, two with hand-assist. The average operative time was 5 hours and 3 minutes; average length of stay was 5 days; and the splenectomy rate was 57 per cent (n = 4). There was one complication of an infected hematoma. There were no pancreatic leaks, deaths, nor readmissions. LDP with or without splenectomy is feasible and can be performed with minimum morbidity and only slightly increased operative time.

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Puri, Vichin, Vijay G. Menon, Alagappan Annamalai und Nicholas N. Nissen. „Su1657 Central Pancreatic Resection“. Gastroenterology 144, Nr. 5 (Mai 2013): S—1083. http://dx.doi.org/10.1016/s0016-5085(13)64039-1.

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Hardacre, Jeffrey M., Kerri Simo, Michael F. McGee, Thomas A. Stellato und James A. Schulak. „Pancreatic Resection In Octogenarians“. Journal of Surgical Research 156, Nr. 1 (September 2009): 129–32. http://dx.doi.org/10.1016/j.jss.2009.03.047.

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Büchler, Markus W., Peter Kienle und Jörg Köninger. „Morbidity after pancreatic resection“. Langenbeck's Archives of Surgery 392, Nr. 1 (05.12.2006): 115–16. http://dx.doi.org/10.1007/s00423-006-0130-9.

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Izrailov, R. E., V. V. Tsvirkun, R. B. Alikhanov und A. V. Andrianov. „Laparoscopic pancreatic head resection“. Khirurgiya. Zhurnal im. N.I. Pirogova, Nr. 2 (2018): 45. http://dx.doi.org/10.17116/hirurgia2018245-51.

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Michalski, Christoph, Jörg Kleeff, Markus Büchler und Helmut Friess. „Pancreatic cancer — Curative resection“. Chinese-German Journal of Clinical Oncology 6, Nr. 2 (April 2007): 149–53. http://dx.doi.org/10.1007/s10330-007-0043-2.

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Zhao, Yupei, Songjie Shen und Junchao Guo. „Pancreatic cancer — Laparoscopic resection“. Chinese-German Journal of Clinical Oncology 6, Nr. 2 (April 2007): 154–58. http://dx.doi.org/10.1007/s10330-007-0044-1.

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Shrikhande, Shailesh V., Jörg Kleeff, Carolin Reiser, Jürgen Weitz, Ulf Hinz, Irene Esposito, Jan Schmidt, Helmut Friess und Markus W. Büchler. „Pancreatic Resection for M1 Pancreatic Ductal Adenocarcinoma“. Annals of Surgical Oncology 14, Nr. 1 (25.10.2006): 118–27. http://dx.doi.org/10.1245/s10434-006-9131-8.

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Handgraaf, Henricus J. M., Martin C. Boonstra, Arian R. Van Erkel, Bert A. Bonsing, Hein Putter, Cornelis J. H. Van De Velde, Alexander L. Vahrmeijer und J. Sven D. Mieog. „Current and Future Intraoperative Imaging Strategies to Increase Radical Resection Rates in Pancreatic Cancer Surgery“. BioMed Research International 2014 (2014): 1–8. http://dx.doi.org/10.1155/2014/890230.

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Prognosis of patients with pancreatic cancer is poor. Even the small minority that undergoes resection with curative intent has low 5-year survival rates. This may partly be explained by the high number of irradical resections, which results in local recurrence and impaired overall survival. Currently, ultrasonography is used during surgery for resectability assessment and frozen-section analysis is used for assessment of resection margins in order to decrease the number of irradical resections. The introduction of minimal invasive techniques in pancreatic surgery has deprived surgeons from direct tactile information. To improve intraoperative assessment of pancreatic tumor extension, enhanced or novel intraoperative imaging technologies accurately visualizing and delineating cancer cells are necessary. Emerging modalities are intraoperative near-infrared fluorescence imaging and freehand nuclear imaging using tumor-specific targeted contrast agents. In this review, we performed a meta-analysis of the literature on laparoscopic ultrasonography and we summarized and discussed current and future intraoperative imaging modalities and their potential for improved tumor demarcation during pancreatic surgery.

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