Surgery for pancreatic ductal adenocarcinoma

• R. Vera ^[1] ; L. Díez ^[2] ; E. Martín Pérez ^[5] ; J. C. Plaza ^[3] ; A. Sanjuanbenito ^[4] ; A. Carrato ^[4]
  1. [1] Gobierno de Navarra

     Gobierno de Navarra

     Pamplona, España

     
  2. [2] Hospital Clínico San Carlos de Madrid

     Hospital Clínico San Carlos de Madrid

     Madrid, España

     
  3. [3] Hospital Universitario HM Sanchinarro

     Hospital Universitario HM Sanchinarro

     Madrid, España

     
  4. [4] Hospital Ramón y Cajal

     Hospital Ramón y Cajal

     Madrid, España

     
  5. [5] Hospital Universitario La Princesa, España

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• Localización: Clinical & translational oncology, ISSN 1699-048X, Vol. 19, Nº. 11 (November 2017), 2017, págs. 1303-1311
• Idioma: inglés
• Texto completo no disponible (Saber más ...)
• Resumen

  • Surgical resection is the only potentially curative option in the treatment of pancreatic ductal adenocarcinoma. Preoperative radiological imaging allows to rule out the presence of metastases. Three resectability categories are established based on the radiological findings depending on the degree of contact between the tumor and the blood vessels. Histological confirmation of malignancy is only required in cases of borderline or non-resectable tumors, prior to neoadjuvant treatment initiation. Diagnostic laparoscopy is recommended in the presence of large tumors of the body or tail and in borderline tumors to explore the possibility of resection and to apply treatment with curative intent, as well as in those cases with high level of biomarkers to rule out peritoneal involvement. Prior to surgery preoperative nutritional measures as well as endoscopic biliary drainage can be applied to optimize patient’s conditions. Cephalic pancreaticoduodenectomy is the recommended surgical technique in tumors located in the head of the pancreas. The benefits from pyloric preservation, type or reconstruction (one vs. two loops), type of anastomosis (pancreaticojejunostomy vs. pancreaticogastrostomy), intraoperative biopsy of the pancreatic resection margin or the use of intraperitoneal drainages are inconclusive. Total pancreatectomy and/or portal resection should only be performed in particular cases; however, arterial resections have shown no benefits. Radical antegrade modular pancreaticosplenectomy, that can be performed laparoscopically, is the technique used for those tumors located in the pancreatic body-tail.