Surgical Management of Adenocarcinoma of the Pancreatic Uncinate Process in a Cancer Hospital in Egypt

Overview

Journal Clin Med Insights Gastroenterol

Publisher Sage Publications

Specialty Gastroenterology

Date 2015 Jan 31

PMID 25635169

Authors

Sameh Roshdy

Osama Hussein

Ahmed Abdallah

Khaled Abdel-Wahab

Ahmed Senbel

Affiliations

Soon will be listed here.

Abstract

Introduction: Pancreatic carcinoma affecting the uncinate process is a challenging surgical condition. Several considerations affect the management plan, including the need for vascular resection and the ability to achieve a clear margin.

Methods: The data of 19 patients who had curative resection for pancreatic adenocarcinoma of the uncinate process were reviewed. Operative mortality and morbidity, and disease-free survival (DFS) were calculated.

Results: The study population included 13 male and 6 female patients with a mean age of 55 years. Nine patients (47.4%) had stage I disease, seven patients (36.8%) had stage II disease, and three patients (15.8%) had stage III disease. A total of 12 patients had Whipple procedure and 7 patients had total pancreatectomy. In total, there were 9 R0 and 10 R1 resections. Operative mortality rate was 10.5% (2/19), postoperative leakage rate was 21.1% (4/19), and wound sepsis rate was 21.1%. Median DFS was 19.2 months. Survival was superior in the Whipple procedure group than in the total pancreatectomy group (median survival 19 months vs 4 months, respectively). Vascular resection and retroperitoneal safety margin status did not affect disease relapse.

Conclusion: Non-metastatic pancreatic adenocarcinoma of the uncinate process should be offered R0 or R1 resection whenever technically feasible.

References

Witkowski E, Smith J, Tseng J . Outcomes following resection of pancreatic cancer. J Surg Oncol. 2012; 107(1):97-103. DOI: 10.1002/jso.23267. View

OSullivan A, Heaton N, Rela M . Cancer of the uncinate process of the pancreas: surgical anatomy and clinicopathological features. Hepatobiliary Pancreat Dis Int. 2009; 8(6):569-74. View

Birk D, Schoenberg M, Gansauge F, Formentini A, Fortnagel G, Beger H . Carcinoma of the head of the pancreas arising from the uncinate process. Br J Surg. 1998; 85(4):498-501. DOI: 10.1046/j.1365-2168.1998.00629.x. View

Yamaguchi K . Carcinoma of the uncinate process of the pancreas with a peculiar clinical manifestation. Am J Gastroenterol. 1992; 87(8):1046-50. View

Yeo C, Cameron J, Lillemoe K, Sitzmann J, Hruban R, Goodman S . Pancreaticoduodenectomy for cancer of the head of the pancreas. 201 patients. Ann Surg. 1995; 221(6):721-31; discussion 731-3. PMC: 1234702. DOI: 10.1097/00000658-199506000-00011. View

Li S, Pei Y, Du F, Zhuang G, Li C, Song Q . Surgical treatment for uncinate process carcinoma of the pancreas. Hepatobiliary Pancreat Dis Int. 2003; 1(4):592-4. View

Sohn T, Yeo C, Cameron J, Koniaris L, Kaushal S, Abrams R . Resected adenocarcinoma of the pancreas-616 patients: results, outcomes, and prognostic indicators. J Gastrointest Surg. 2001; 4(6):567-79. DOI: 10.1016/s1091-255x(00)80105-5. View

Ye C, Xi P, Hu X . Clinical analysis of uncinate process carcinoma of the pancreas. Hepatobiliary Pancreat Dis Int. 2003; 2(4):605-8. View

Verbeke C . Resection margins in pancreatic cancer. Surg Clin North Am. 2013; 93(3):647-62. DOI: 10.1016/j.suc.2013.02.008. View

10.

Jong Moon H, An J, Heo J, Choi S, Joh J, Kim Y . Predicting survival after surgical resection for pancreatic ductal adenocarcinoma. Pancreas. 2005; 32(1):37-43. DOI: 10.1097/01.mpa.0000194609.24606.4b. View

11.

Riediger H, Keck T, Wellner U, Zur Hausen A, Adam U, Hopt U . The lymph node ratio is the strongest prognostic factor after resection of pancreatic cancer. J Gastrointest Surg. 2009; 13(7):1337-44. DOI: 10.1007/s11605-009-0919-2. View

12.

Kanji Z, Gallinger S . Diagnosis and management of pancreatic cancer. CMAJ. 2013; 185(14):1219-26. PMC: 3787168. DOI: 10.1503/cmaj.121368. View

13.

El Nakeeb A, Sultan A, Salah T, El Hemaly M, Hamdy E, Salem A . Impact of cirrhosis on surgical outcome after pancreaticoduodenectomy. World J Gastroenterol. 2013; 19(41):7129-37. PMC: 3819549. DOI: 10.3748/wjg.v19.i41.7129. View

14.

Benassai G, Mastrorilli M, Quarto G, Cappiello A, Giani U, Forestieri P . Factors influencing survival after resection for ductal adenocarcinoma of the head of the pancreas. J Surg Oncol. 2000; 73(4):212-8. DOI: 10.1002/(sici)1096-9098(200004)73:4<212::aid-jso5>3.0.co;2-d. View

15.

Jamieson N, Foulis A, Oien K, Going J, Glen P, Dickson E . Positive mobilization margins alone do not influence survival following pancreatico-duodenectomy for pancreatic ductal adenocarcinoma. Ann Surg. 2010; 251(6):1003-10. DOI: 10.1097/SLA.0b013e3181d77369. View

16.

Kang C, Choi J, Seong J, Song S, Lee W, Kim M . Pancreatoduodenectomy following neoadjuvant chemoradiation therapy in uncinate process pancreatic cancer. Pancreas. 2011; 41(3):467-73. DOI: 10.1097/MPA.0b013e31822a68bc. View

17.

Xu Q, Zhang T, Zhao Y . Advances in early diagnosis and therapy of pancreatic cancer. Hepatobiliary Pancreat Dis Int. 2011; 10(2):128-35. DOI: 10.1016/s1499-3872(11)60021-0. View

18.

Hernandez J, Mullinax J, Clark W, Toomey P, Villadolid D, Morton C . Survival after pancreaticoduodenectomy is not improved by extending resections to achieve negative margins. Ann Surg. 2009; 250(1):76-80. DOI: 10.1097/SLA.0b013e3181ad655e. View

19.

Dillhoff M, Yates R, Wall K, Muscarella P, Melvin W, Ellison E . Intraoperative assessment of pancreatic neck margin at the time of pancreaticoduodenectomy increases likelihood of margin-negative resection in patients with pancreatic cancer. J Gastrointest Surg. 2009; 13(5):825-30. PMC: 3154842. DOI: 10.1007/s11605-009-0845-3. View

20.

Takai S, Satoi S, Toyokawa H, Yanagimoto H, Sugimoto N, Tsuji K . Clinicopathologic evaluation after resection for ductal adenocarcinoma of the pancreas: a retrospective, single-institution experience. Pancreas. 2003; 26(3):243-9. DOI: 10.1097/00006676-200304000-00007. View