Category Ranking
98%
Total Visits
921
Avg Visit Duration
2 minutes
Citations
20
Article Abstract
Purpose: To introduce sub-adventitial divestment technique (SDT), a procedure to remove the tumor while preserving the artery during curative pancreatectomy. Peri-operative safety profile was also evaluated.
Methods: In a single center consecutive series of pancreatectomy for pancreatic cancer, the outcome of patients who had pancreatectomy with SDT was compared to standard pancreatic surgery.
Results: From June 2014 to June 2016, 72 patients had pancreatectomy with SDT and 235 had standard surgery. Tumor stage was T4 in all 72 (100%) tumors removed using SDT compared to four (2%) with standard pancreatectomy (p < 0.001). All 72 (100%) tumors in the SDT group were stage III compared to 24 (10%) in the standard surgery group (p < 0.001). Both groups had a high proportion of poorly differentiated tumors (52 (72%) and 163 (69%) respectively) and perineural tumor invasion (62 (86%) and 186 (79%) respectively). R1 (< 1 mm) was found in 24 (86%) of 28 tumors in the SDT group, and in 72 (60%) out of 120 standard pancreatectomy tumors (p = 0.01). Complications occurred in 29 (40%) of the SDT group and in 88 (37%) of the standard group. The in-hospital mortality was four (6%) in the SDT group and one (0.4%) in the standard group (p = 0.01), with a 90-day mortality of 5 (8%)/60 and 6 (3%)/209 (p = 0.07) respectively.
Conclusions: The sub-adventitial divestment technique appeared to be an effective surgical technique to remove the tumor while preserving the artery. This approach warrants further validation in prospective studies.
Download full-text PDF |
Source |
|---|---|
| http://dx.doi.org/10.1007/s00423-021-02080-5 | DOI Listing |
Publication Analysis
Top Keywords
Similar Publications
Periarterial Divestment of the Superior Mesenteric Artery Utilizing Dual Artery First Approach for Locally Advanced Pancreatic Cancer.
Ann Surg Oncol
July 2025
Department of Surgery, Hanoi Medical University, Hanoi, Vietnam.
Background: For locally advanced pancreatic cancer (LAPC) involving the superior mesenteric artery (SMA), periarterial and sub-adventitial divestment offers oncologic efficacy while minimizing postoperative complications and mortality. However, safe and standardized techniques for circumferential SMA dissection remain limited. We adopted a dual SMA-first strategy-posterior and left-sided approaches-to improve arterial control, enhance surgical exposure, and ensure procedural safety.
View Article and Find Full Text PDFPeriarterial and Sub-adventitial Divestment Along with Triangle Operation and RAMPS for Pancreatic Body Cancer.
Ann Surg Oncol
July 2024
Department of Surgical Oncology, Manipal Comprehensive Cancer Care Centre, Kasturba Medical College, Manipal, Manipal Academy of Higher Education (MAHE), Manipal, Karnataka, India.
Background: Locally advanced cancers of the pancreatic body can abut or involve the celiac axis, hepatic artery, or superior mesenteric artery. Recent evidence suggests that these tumors are amenable to surgery after neoadjuvant chemotherapy (Hackert et al., Locally advanced pancreatic cancer: neoadjuvant therapy with FOLFIRINOX results in resectability in 60 % of the patients.
View Article and Find Full Text PDFTechnical options in surgery for artery-involving pancreatic cancer: Invasion depth matters.
Surg Open Sci
March 2023
Pancreas Center, First Affiliated Hospital, Nanjing Medical University, Nanjing, PR China.
Background: The artery involvement explains the majority of primary unresectability of non-metastatic pancreatic cancer patients and both arterial resection and artery-sparing dissection techniques are utilized in curative-intent pancreatectomies for artery-involving pancreatic cancer (ai-PC) patients.
Methods: This narrative review summarized the history of resectability evaluation for ai-PC and attempted to interpret its current pitfalls that led to the divergence of resectability prediction and surgical exploration, with a focus on the rationale and the surgical outcomes of the sub-adventitial divestment technique.
Results: The circumferential involvement of artery by tumor currently defined the resectability of ai-PC but insufficient to preclude laparotomy with curative intent.
[Current surgical concepts and future perspectives in the treatment of pancreatic cancer].
Zhonghua Wai Ke Za Zhi
January 2023
Department of Surgery, Peking University First Hospital, Beijing 100034,China.
Over the past 20 years, the concept of pancreatic surgery has been updated and surgical skills has improved dramatically. With the significant improvement of surgical safety and increase of resection rate for pancreatic cancer, some traditional surgical issues such as surgical indications, timing and extent of resection are being re-evaluated. The improvement of patients' prognosis is the gold standard for judging the surgical indications.
View Article and Find Full Text PDF[Comparison of distal pancreatectomy with celiac axis resection and sub-adventitial divestment technique for locally advanced or borderline resectable pancreatic body cancer].
Zhonghua Wai Ke Za Zhi
May 2022
Pancreas Center,First Affiliated Hospital of Nanjing Medical University,Pancreas Institute, Nanjing Medical University,Nanjing 210029,China.
To compare the outcomes of modified Appleby procedure and sub-adventitial divestment technique for locally advanced or borderline resectable pancreatic body cancer. A total of consecutive 58 patients(33 males and 25 females) who were diagnosed as locally advanced or borderline resectable pancreatic body cancer and underwent distal pancreatectomy at Pancreas Center, First Affiliated Hospital of Nanjing Medical University between September 2013 and May 2019 were retrospectively reviewed. The age((IQR)) was 62(9)years(range: 43 to 79 years).
View Article and Find Full Text PDF