| Added by | pmartino |
|---|---|
| Group name | EquipePM |
| Item Type | Journal Article |
| Title | Distal Pancreatectomy with Celiac Axis Resection (Modified Appleby Procedure) and Arterial Reconstruction for Locally Advanced Pancreatic Adenocarcinoma After FOLFIRINOX Chemotherapy and Chemoradiation Therapy |
| Creator | Colombo et al. |
| Author | Pierre-Emmanuel Colombo |
| Author | Pierre Alric |
| Author | Anne Mourregot |
| Author | Mathias Neron |
| Author | Fabienne Portales |
| Author | Philippe Rouanet |
| Author | Guillaume Carrier |
| Abstract | BACKGROUND: Resectability of pancreatic carcinoma (PC) is directly linked to vascular extension (Tempero MA et al. in J Natl Compr Canc Netw 15(8):1028-1061, 2017. https://doi.org/10.6004/jnccn.2017.0131; Isaji S et al. in Pancreatology 18(1):2-11, 2018. https://doi.org/10.1016/j.pan.2017.11.011). Involvement of the celiac axis (CA) is typically a contraindication to surgery. High postoperative morbidity and subsequent poor prognosis have been observed in this case, especially for contact?>?180° requiring arterial resection (Tempero MA et al. 2017). Recent medical advances in PC treatment, such as FOLFIRINOX-based chemotherapy eventually followed by chemoradiation therapy, offer the potential to select tumour for surgery and to obtain a negative-margin resection even in case of unresectable PC at diagnosis (Suker M et al. in Lancet Oncol 17(6):801-10, 2016. https://doi.org/10.1016/s1470-2045(16)00172-8; Pietrasz D et al. in Ann Surg Oncol 26(1):109-117, 2019. https://doi.org/10.1245/s10434-018-6931-6). A major pathologic response has been observed in more than 20% of patients after this treatment and is associated with an improved survival (Suker M et al. 2016; Pietrasz D et al. 2019). This evolution allows aggressive surgical strategies with the possibility of long-term disease control for patients showing a good response to induction treatment. PATIENT: This video presents the case of a 66-year-old man diagnosed with a locally advanced ductal adenocarcinoma of the pancreatic body with a 360° involvement of the CA and the hepatic artery. After eight courses of FOLFIRINOX chemotherapy and a capecitabin-based chemoradiation, a surgical exploration was planned for potential resection. TECHNIQUE: The key steps of the procedure are presented, i.e. surgical exposition, assessment of resectability with frozen sections of peri-arterial tissues, en bloc resection (Strasberg SM et al. in Surgery 133(5):521-527, 2003. https://doi.org/10.1067/msy.2003.146), and primary end-to-end arterial reconstruction. CONCLUSION: A modified Appleby operation for locally advanced PC is a technically challenging but feasible procedure in experienced teams. It offers the possibility of en bloc R0 resection of a locally advanced PC with the potential of long-term disease local control. This video may help surgeons to perform this complex intervention. |
| Publication | Annals of Surgical Oncology |
| Date | Jun 25, 2020 |
| Journal Abbr | Ann. Surg. Oncol. |
| Language | eng |
| DOI | 10.1245/s10434-020-08740-y |
| ISSN | 1534-4681 |
| Library Catalog | PubMed |
| Extra | 00001 PMID: 32588265 |
| Tags | Adenocarcinoma, Aged, Antineoplastic Combined Chemotherapy Protocols, clinic, Fluorouracil, Humans, Leucovorin, Male, Pancreatectomy, Pancreatic Neoplasms |
| Date Added | 2020/08/17 - 10:35:42 |
| Date Modified | 2021/05/07 - 14:11:31 |
| Notes and Attachments | PubMed entry (Attachment) PubMed entry (Attachment) PubMed entry (Attachment) PubMed entry (Attachment) |
Institut de Recherche en Cancérologie de
