Skip to main content

Advertisement

Log in

Surgical Treatment of Resectable and Borderline Resectable Pancreas Cancer: Expert Consensus Statement

  • CONSENSUS REPORT: RESECTABLE AND BORDERLINE RESECTABLE PANCREAS CANCER
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

References

  1. Fortner JG. Regional resection of cancer of the pancreas: a new surgical approach. Surgery. 1973;73:307–20.

    PubMed  CAS  Google Scholar 

  2. Takahashi S, Ogata Y, Miyazaki H, Maeda D, Murai S, Yamataka K, et al. Aggressive surgery for pancreatic duct cell cancer: feasibility, validity, limitations. World J Surg. 1995;19:653–9; discussion 60.

    Article  PubMed  CAS  Google Scholar 

  3. Cubilla AL, Fortner J, Fitzgerald PJ. Lymph node involvement in carcinoma of the head of the pancreas area. Cancer. 1978;41:880–7.

    Article  PubMed  CAS  Google Scholar 

  4. Reber HA, Ashley SW, McFadden D. Curative treatment for pancreatic neoplasms. Radical resection. Surg Clin North Am. 1995;75 905–12.

    PubMed  CAS  Google Scholar 

  5. Satake K, Nishiwaki H, Yokomatsu H, Kawazoe Y, Kim K, Haku A, et al. Surgical curability and prognosis for standard versus extended resection for T1 carcinoma of the pancreas. Surg Gynecol Obstet. 1992;175:259–65.

    PubMed  CAS  Google Scholar 

  6. Kayahara M, Nagakawa T, Ueno K, Ohta T, Tsukioka Y, Miyazaki I. Surgical strategy for carcinoma of the pancreas head area based on clinicopathologic analysis of nodal involvement and plexus invasion. Surgery. 1995;117:616–23.

    Article  PubMed  CAS  Google Scholar 

  7. Liu CD, Slice LW, Balasubramaniam A, Walsh JH, Newton TR, Saxton RE, et al. Y2 receptors decrease human pancreatic cancer growth and intracellular cyclic adenosine monophosphate levels. Surgery. 1995;118: 229–35; discussion 35–6.

    Article  PubMed  CAS  Google Scholar 

  8. Ishikawa O, Ohhigashi H, Sasaki Y, Kabuto T, Fukuda I, Furukawa H, et al. Practical usefulness of lymphatic and connective tissue clearance for the carcinoma of the pancreas head. Ann Surg. 1988;208:215–20.

    Article  PubMed  CAS  Google Scholar 

  9. Manabe T, Ohshio G, Baba N, Miyashita T, Asano N, Tamura K, et al. Radical pancreatectomy for ductal cell carcinoma of the head of the pancreas. Cancer. 1989;64:1132–7.

    Article  PubMed  CAS  Google Scholar 

  10. Tsuchiya R, Oribe T, Noda T. Size of the tumor and other factors influencing prognosis of carcinoma of the head of the pancreas. Am J Gastroenterol. 1985;80:459–62.

    PubMed  CAS  Google Scholar 

  11. Tsuchiya R, Eto T, Tsunoda T. Radical resection of pancreatic and periampullary neoplasms. Pancreatoduodenectomy. In: Braasch J, Tompkins R, eds. Surgical disease of the biliary tract and pancreas. Multidisciplinary management. St. Louis: Mosby, 1994:570–87.

    Google Scholar 

  12. Hirata K, Sato T, Mukaiya M, Yamashiro K, Kimura M, Sasaki K, et al. Results of 1001 pancreatic resections for invasive ductal adenocarcinoma of the pancreas. Arch Surg. 1997;132:771–6; discussion 7.

    PubMed  CAS  Google Scholar 

  13. Ishikawa O, Ohigashi H, Sasaki Y, Kabuto T, Furukawa H, Nakamori S, et al. Practical grouping of positive lymph nodes in pancreatic head cancer treated by an extended pancreatectomy. Surgery. 1997;121:244–9.

    Article  PubMed  CAS  Google Scholar 

  14. Pedrazzoli S, DiCarlo V, Dionigi R, Mosca F, Pederzoli P, Pasquali C, et al. Standard versus extended lymphadenectomy associated with pancreatoduodenectomy in the surgical treatment of adenocarcinoma of the head of the pancreas: a multicenter, prospective, randomized study. Lymphadenectomy Study Group. Ann Surg. 1998;228:508–17.

    Article  PubMed  CAS  Google Scholar 

  15. Nimura Y, Nagino M, Kato H, Miyagawa S, Yamaguchi A, Kinoshita T, et al. Regional vs extended lymph node dissection in radical pancreaticoduodenectomy for pancreatic cancer. A multicenter randomized controlled trial. HPB. 2004;6:2 (abstract).

    Google Scholar 

  16. Yeo CJ, Cameron JL, Sohn TA, Coleman J, Sauter PK, Hruban RH, et al. Pancreaticoduodenectomy with or without extended retroperitoneal lymphadenectomy for periampullary adenocarcinoma: comparison of morbidity and mortality and short-term outcome. Ann Surg. 1999;229:613–22; discussion 22–4.

    Article  PubMed  CAS  Google Scholar 

  17. Yeo CJ, Cameron JL, Lillemoe KD, Sohn TA, Campbell KA, Sauter PK, et al. Pancreaticoduodenectomy with or without distal gastrectomy and extended retroperitoneal lymphadenectomy for periampullary adenocarcinoma, part 2: randomized controlled trial evaluating survival, morbidity, and mortality. Ann Surg. 2002;236:355–66; discussion 66–8.

    Article  PubMed  Google Scholar 

  18. Nguyen TC, Sohn TA, Cameron JL, Lillemoe KD, Campbell KA, Coleman J, et al. Standard vs. radical pancreaticoduodenectomy for periampullary adenocarcinoma: a prospective, randomized trial evaluating quality of life in pancreaticoduodenectomy survivors. J Gastrointest Surg. 2003;7:1–9; discussion 11.

    Article  PubMed  Google Scholar 

  19. Riall TS, Cameron JL, Lillemoe KD, Campbell KA, Sauter PK, Coleman J, et al. Pancreaticoduodenectomy with or without distal gastrectomy and extended retroperitoneal lymphadenectomy for periampullary adenocarcinoma—part 3: update on 5-year survival. J Gastrointest Surg. 2005;9:1191–204; discussion 204–6.

    Article  PubMed  Google Scholar 

  20. Farnell MB, Pearson RK, Sarr MG, DiMagno EP, Burgart LJ, Dahl TR, et al. A prospective randomized trial comparing standard pancreatoduodenectomy with pancreatoduodenectomy with extended lymphadenectomy in resectable pancreatic head adenocarcinoma. Surgery. 2005;138:618–28; discussion 28–30.

    Article  PubMed  Google Scholar 

  21. Pawlik TM, Abdalla EK, Barnett CC, Ahmad SA, Cleary KR, Vauthey JN, et al. Feasibility of a randomized trial of extended lymphadenectomy for pancreatic cancer. Arch Surg. 2005;140:584–9; discussion 9–91.

    Article  PubMed  Google Scholar 

  22. Tomlinson JS, Jain S, Bentrem DJ, Sekeris EG, Maggard MA, Hines OJ, et al. Accuracy of staging node-negative pancreas cancer: a potential quality measure. Arch Surg. 2007;142:767–23; discussion 73–4.

    Google Scholar 

  23. Asada S, Itaya H, Nakamura K, Isohashi T, Masuoka S. Radical pancreatoduodenectomy and portal vein resection. Report of two successful cases with transplantation of portal vein. Arch Surg. 1963;87:609–13.

    PubMed  CAS  Google Scholar 

  24. Wolff R, Crane C, Li D, Abbruzzese J, Evans D. Neoplasms of the exocrine pancreas. In: Kufe D, Bast R, Hait W, Hong WK, Pollock RE, Weichselbaum RR, et al., eds. Holland-Frei Cancer Medicine. Ontario: B.C. Decker, Inc., 2006:1331–58.

  25. Tseng JF, Raut CP, Lee JE, Pisters PW, Vauthey JN, Abdalla EK, et al. Pancreaticoduodenectomy with vascular resection: margin status and survival duration. J Gastrointest Surg. 2004;8:935–49; discussion 49–50.

    Google Scholar 

  26. Raut CP, Tseng JF, Sun CC, Wang H, Wolff RA, Crane CH, et al. Impact of resection status on pattern of failure and survival after pancreaticoduodenectomy for pancreatic adenocarcinoma. Ann Surg. 2007;246:52–60.

    Article  PubMed  Google Scholar 

  27. Al-Haddad M, Martin JK, Nguyen J, Pungpapong S, Raimondo M, Woodward T, et al. Vascular resection and reconstruction for pancreatic malignancy: a single center survival study. J Gastrointest Surg. 2007;11:1168–74.

    Article  PubMed  Google Scholar 

  28. Riediger H, Makowiec F, Fischer E, Adam U, Hopt UT. Postoperative morbidity and long-term survival after pancreaticoduodenectomy with superior mesenterico-portal vein resection. J Gastrointest Surg. 2006;10:1106–15.

    Article  PubMed  Google Scholar 

  29. Carrere N, Sauvanet A, Goere D, Kianmanesh R, Vullierme MP, Couvelard A, et al. Pancreaticoduodenectomy with mesentericoportal vein resection for adenocarcinoma of the pancreatic head. World J Surg. 2006;30:1526–35.

    Article  PubMed  Google Scholar 

  30. Poon RT, Fan ST, Lo CM, Liu CL, Lam CM, Yuen WK, et al. Pancreaticoduodenectomy with en bloc portal vein resection for pancreatic carcinoma with suspected portal vein involvement. World J Surg. 2004;28:602–8.

    Article  PubMed  Google Scholar 

  31. Capussotti L, Massucco P, Ribero D, Vigano L, Muratore A, Calgaro M. Extended lymphadenectomy and vein resection for pancreatic head cancer: outcomes and implications for therapy. Arch Surg. 2003;138:1316–22.

    Article  PubMed  Google Scholar 

  32. Howard TJ, Villanustre N, Moore SA, DeWitt J, LeBlanc J, Maglinte D, et al. Efficacy of venous reconstruction in patients with adenocarcinoma of the pancreatic head. J Gastrointest Surg. 2003;7:1089–95.

    Article  PubMed  Google Scholar 

  33. Shibata C, Kobari M, Tsuchiya T, Arai K, Anzai R, Takahashi M, et al. Pancreatectomy combined with superior mesenteric-portal vein resection for adenocarcinoma in pancreas. World J Surg. 2001;25:1002–5.

    Article  PubMed  CAS  Google Scholar 

  34. van Geenen RC, ten Kate FJ, de Wit LT, van Gulik TM, Obertop H, Gouma DJ. Segmental resection and wedge excision of the portal or superior mesenteric vein during pancreatoduodenectomy. Surgery. 2001;129:158–63.

    Article  PubMed  Google Scholar 

  35. Bachellier P, Nakano H, Oussoultzoglou PD, Weber JC, Boudjema K, Wolf PD, et al. Is pancreaticoduodenectomy with mesentericoportal venous resection safe and worthwhile? Am J Surg. 2001;182:120–9.

    Article  PubMed  CAS  Google Scholar 

  36. Launois B, Stasik C, Bardaxoglou E, Meunier B, Campion JP, Greco L, et al. Who benefits from portal vein resection during pancreaticoduodenectomy for pancreatic cancer? World J Surg. 1999;23:926–9.

    Article  PubMed  CAS  Google Scholar 

  37. Roder JD, Stein HJ, Siewert JR. Carcinoma of the periampullary region: who benefits from portal vein resection? Am J Surg. 1996;171:170–4; discussion 4–5.

    Article  PubMed  CAS  Google Scholar 

  38. Harrison LE, Klimstra DS, Brennan MF. Isolated portal vein involvement in pancreatic adenocarcinoma. A contraindication for resection? Ann Surg. 1996;224:342–7; discussion 7–9.

    Article  PubMed  CAS  Google Scholar 

  39. Yeo CJ, Cameron JL, Lillemoe KD, Sitzmann JV, Hruban RH, Goodman SN, et al. Pancreaticoduodenectomy for cancer of the head of the pancreas. 201 patients. Ann Surg. 1995;221:721–31; discussion 31–3.

    Article  PubMed  CAS  Google Scholar 

  40. Trede M, Schwall G, Saeger HD. Survival after pancreatoduodenectomy. 118 consecutive resections without an operative mortality. Ann Surg. 1990;211:447–58.

    Article  PubMed  CAS  Google Scholar 

  41. Sindelar WF. Clinical experience with regional pancreatectomy for adenocarcinoma of the pancreas. Arch Surg. 1989;124:127–32.

    PubMed  CAS  Google Scholar 

  42. Exocrine Pancreas. In: Greene F, Page D, Fleming I, Fritz AG, Balch CM, Haller DG, et al., eds. AJCC Cancer Staging Manual. New York: Springer-Verlag, 2002:157–64.

  43. Tempero M, Arnoletti JP, Ben-Josef E, Bhargava P, Casper ES, Kim P, et al. Pancreatic adenocarcinoma. Clinical Practice Guidelines in Oncology. J Natl Compr Cancer Netw. 2007;5:998–1033.

    Google Scholar 

  44. Howard TJ, Krug JE, Yu J, Zyromski NJ, Schmidt CM, Jacobson LE, et al. A margin-negative R0 resection accomplished with minimal postoperative complications is the surgeon’s contribution to long-term survival in pancreatic cancer. J Gastrointest Surg. 2006;10:1338–45; discussion 45–6.

    Article  PubMed  Google Scholar 

  45. Wagner M, Redaelli C, Lietz M, Seiler CA, Friess H, Buchler MW. Curative resection is the single most important factor determining outcome in patients with pancreatic adenocarcinoma. Br J Surg. 2004;91:586–94.

    Article  PubMed  CAS  Google Scholar 

  46. Forrest JF, Longmire WP, Jr. Carcinoma of the pancreas and periampullary region. Ann Surg. 1979;189:129–38.

    Article  PubMed  CAS  Google Scholar 

  47. Pingpank JF, Hoffman JP, Ross EA, Cooper HS, Meropol NJ, Freedman G, et al. Effect of preoperative chemoradiotherapy on surgical margin status of resected adenocarcinoma of the head of the pancreas. J Gastrointest Surg. 2001;5:121–30.

    Article  PubMed  CAS  Google Scholar 

  48. Sohn TA, Yeo CJ, Cameron JL, Koniaris L, Kaushal S, Abrams RA, et al. Resected adenocarcinoma of the pancreas-616 patients: results, outcomes, and prognostic indicators. J Gastrointest Surg. 2000;4:567–79.

    Article  PubMed  CAS  Google Scholar 

  49. Strasberg SM, Drebin JA, Linehan D. Radical antegrade modular pancreatosplenectomy. Surgery. 2003;133:521–7.

    Article  PubMed  Google Scholar 

  50. Christein JD, Kendrick ML, Iqbal CW, Nagorney DM, Farnell MB. Distal pancreatectomy for resectable adenocarcinoma of the body and tail of the pancreas. J Gastrointest Surg. 2005;9:922–7.

    Article  PubMed  Google Scholar 

  51. Cioc AM, Ellison EC, Proca DM, Lucas JG, Frankel WL. Frozen section diagnosis of pancreatic lesions. Arch Pathol Lab Med. 2002;126:1169–73.

    PubMed  Google Scholar 

  52. Raut CP, Cleary KR, Staerkel GA, Abbruzzese JL, Wolff RA, Lee JH, et al. Intraductal papillary mucinous neoplasms of the pancreas: effect of invasion and pancreatic margin status on recurrence and survival. Ann Surg Oncol. 2006;13:582–94.

    Article  PubMed  Google Scholar 

  53. Tran KT, Smeenk HG, van Eijck CH, Kazemier G, Hop WC, Greve JW, et al. Pylorus preserving pancreaticoduodenectomy versus standard Whipple procedure: a prospective, randomized, multicenter analysis of 170 patients with pancreatic and periampullary tumors. Ann Surg. 2004;240:738–45.

    Article  PubMed  Google Scholar 

  54. Tseng JF, Pisters PW, Lee JE, Wang H, Gomez HF, Sun CC, et al. The learning curve in pancreatic surgery. Surgery. 2007;141:456–63. Corrected and republished in: Surgery 2007;141:694–701.

  55. Butturini G, Stocken DD, Wente MN, Jeekel H, Klinkenbijl JH, Bakkevold KE, et al. Influence of resection margins and treatment on survival in patients with pancreatic cancer: meta-analysis of randomized controlled trials. Arch Surg. 2008;143:75–83; discussion.

    Article  PubMed  Google Scholar 

  56. Winter JM, Cameron JL, Campbell KA, Arnold MA, Chang DC, Coleman J, et al. 1423 pancreaticoduodenectomies for pancreatic cancer: a single-institution experience. J Gastrointest Surg. 2006;10:1199–210; discussion 210–1.

    Article  PubMed  Google Scholar 

  57. Lillemoe KD, Cameron JL, Yeo CJ, Sohn TA, Nakeeb A, Sauter PK, et al. Pancreaticoduodenectomy. Does it have a role in the palliation of pancreatic cancer? Ann Surg. 1996;223:718–25; discussion 25–8.

    Article  PubMed  CAS  Google Scholar 

  58. Reinders ME, Allema JH, van Gulik TM, Karsten TM, de Wit LT, Verbeek PC, et al. Outcome of microscopically nonradical, subtotal pancreaticoduodenectomy (Whipple’s resection) for treatment of pancreatic head tumors. World J Surg. 1995;19:410–5; discussion 4–5.

    Article  PubMed  CAS  Google Scholar 

  59. Kuhlmann K, de Castro S, van Heek T, Busch O, van Gulik T, Obertop H, et al. Microscopically incomplete resection offers acceptable palliation in pancreatic cancer. Surgery. 2006;139:188–96.

    Article  PubMed  Google Scholar 

  60. Schniewind B, Bestmann B, Kurdow R, Tepel J, Henne-Bruns D, Faendrich F, et al. Bypass surgery versus palliative pancreaticoduodenectomy in patients with advanced ductal adenocarcinoma of the pancreatic head, with an emphasis on quality of life analyses. Ann Surg Oncol. 2006;13:1403–11.

    Article  PubMed  CAS  Google Scholar 

  61. Imamura M, Doi R, Imaizumi T, Funakoshi A, Wakasugi H, Sunamura M, et al. A randomized multicenter trial comparing resection and radiochemotherapy for resectable locally invasive pancreatic cancer. Surgery. 2004;136:1003–11.

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Richard D. Schulick MD.

Additional information

Proceedings of the Consensus Conference sponsored by the American Hepato-Pancreato-Biliary Association and Cosponsored by The Society for Surgery of the Alimentary Tract, The Society of Surgical Oncology, The Gastrointestinal Symposium Steering Committee, and The University of Texas M.D. Anderson Cancer Center held in Orlando, FL, January 24, 2008.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Evans, D.B., Farnell, M.B., Lillemoe, K.D. et al. Surgical Treatment of Resectable and Borderline Resectable Pancreas Cancer: Expert Consensus Statement. Ann Surg Oncol 16, 1736–1744 (2009). https://doi.org/10.1245/s10434-009-0416-6

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1245/s10434-009-0416-6

Keywords

Navigation