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Review
. 2021 Apr 20;13(8):1971.
doi: 10.3390/cancers13081971.

Surgical Treatment of Pancreatic Ductal Adenocarcinoma

Kongyuan Wei  1 , Thilo Hackert  1
Affiliations
Review

Surgical Treatment of Pancreatic Ductal Adenocarcinoma

Kongyuan Wei et al. Cancers (Basel). .

Abstract

Pancreatic ductal adenocarcinoma (PDAC) represents an aggressive tumor of the digestive system with still low five-year survival of less than 10%. Although there are improvements for multimodal therapy of PDAC, surgery still remains the effective way to treat the disease. Combined with adjuvant and/or neoadjuvant treatment, pancreatic surgery is able to enhance the five-year survival up to around 20%. However, pancreatic resection is always associated with a high risk of complications and regarded as one of the most complex fields in abdominal surgery. This review gives a summary on the surgical treatment for PDAC based on the current literature with a special focus on resection techniques.

Keywords: pancreatic ductal adenocarcinoma; surgical treatment; technical advances.

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Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
Anatomical borderline resectability, contrast enhanced CT scan, and coronary reformatting. Pancreatic head cancer with contact to superior mesenteric vein/portal vein confluence (white circle), vascular reconstruction technically possible.
Figure 2
Figure 2
Intraoperative view after radical resection in pancreatic cancer (TRIANGLE operation). Porto-mesenteric vein resection and reconstruction with ringed allograft, dissection of all soft tissue (grey triangle) between celiac axis and superior mesenteric artery (red tapes) as well as the replaced mesenterico-portal vein. Blue tape: left kidney vein.
Figure 3
Figure 3
Example of splenic artery transposition on an aberrant right hepatic artery after resection of the aberrant hepatic artery due to tumor infiltration. Proper left hepatic artery with red tape and stump of the gastroduodenal artery (broken white arrow); portal vein (white asterisk); transposed splenic artery with end-to-end anastomosis on the aberrant right hepatic artery.
Figure 4
Figure 4
Intraoperative view after combined arterial and venous resection during partial pancreato-duodenectomy. Resection of the common hepatic artery (white circle) and reconstruction by splenic artery transposition with end-to-end anastomosis (white arrow) on the proper hepatic artery (upper left red tape). Distal splenic artery stump (black circle) below the pancreatic cut margin; black asterisk: celiac axis; end-to-end reconstruction of the superior mesenteric/portal vein (dotted white arrow) and splenic vein on inferior mesenteric vein (black circle); upper right red tape: left gastric artery; lower middle red tape: superior mesenteric artery.
See this image and copyright information in PMC

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