Pancreatic malignancy in the backdrop of chronic pancreatitis: How much to push the boundaries to achieve R0 resection
Tumors of the body and tail of the pancreas are often more aggressive than tumors of the head and would have often undergone metastatic spread to other organs at the time of diagnosis. Most patients with carcinoma of the body and tail of the pancreas present at a late stage. Surgery is only indicate...
| Main Authors: | , , , , , |
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| Format: | Article |
| Language: | English |
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Sciendo
2021-08-01
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| Series: | Forum of Clinical Oncology |
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| Online Access: | https://doi.org/10.2478/fco-2019-0011 |
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| author | Joshi Kunal Sadanand Bodepudi Sisir Ganapathi Santhosh Kumar Murugesan Chandrasekar Balu Jagan Subramanian Sankar |
| author_facet | Joshi Kunal Sadanand Bodepudi Sisir Ganapathi Santhosh Kumar Murugesan Chandrasekar Balu Jagan Subramanian Sankar |
| author_sort | Joshi Kunal Sadanand |
| collection | DOAJ |
| description | Tumors of the body and tail of the pancreas are often more aggressive than tumors of the head and would have often undergone metastatic spread to other organs at the time of diagnosis. Most patients with carcinoma of the body and tail of the pancreas present at a late stage. Surgery is only indicated in those patients in whom there is no evidence of metastatic spread. Surgery is often not possible in cancers of the body and tail of the pancreas if the tumor invades celiac artery. Controversy exists regarding the margin status impact of microscopic resection margin involvement (R1) after pancreaticoduodenectomy (PD) for PDAC. There are reports indicating the rate of R1 resections increases significantly after PD if pathological examination is standardized. In this report, we present the case of a 56-year-old female who had undergone lateral pancreaticojejunostomy for chronic pancreatitis 8 years ago, but has now developed malignancy of the body and tail of the pancreas involving multiple organs. This patient underwent en bloc resection involving: 1. distal pancreatectomy with jejunal loop (lateral pancreaticojejunostomy) resection; 2. splenectomy; 3. left nephrectomy; 4. total gastrectomy; and 5. segmental colectomy with reconstruction by esophagojejunostomy, jejunojejunostomy, and colocolic anastomosis. The infrequent occurrence of tumor in the distal gland and advanced tumor stage at the time of diagnosis have both combined to produce therapeutic nihilism/dilemma in the minds of many surgeons. This report highlights the decision on how much to the push limits for multi-organ resection (en bloc resection with distal pancreatectomy, gastrectomy, splenectomy, colectomy, nephrectomy) with the intent of achieving R0 status in spite of the complexity of surgery in selected patients. |
| first_indexed | 2024-04-13T04:11:05Z |
| format | Article |
| id | doaj.art-9384379e1014435199a0c0b3978fdbba |
| institution | Directory Open Access Journal |
| issn | 1792-362X |
| language | English |
| last_indexed | 2024-04-13T04:11:05Z |
| publishDate | 2021-08-01 |
| publisher | Sciendo |
| record_format | Article |
| series | Forum of Clinical Oncology |
| spelling | doaj.art-9384379e1014435199a0c0b3978fdbba2022-12-22T03:03:06ZengSciendoForum of Clinical Oncology1792-362X2021-08-01121475110.2478/fco-2019-0011Pancreatic malignancy in the backdrop of chronic pancreatitis: How much to push the boundaries to achieve R0 resectionJoshi Kunal Sadanand0Bodepudi Sisir1Ganapathi Santhosh Kumar2Murugesan Chandrasekar3Balu Jagan4Subramanian Sankar5Department of Surgical Gastroenterology, Sri Ramachandra Institute of Higher Education and Research SRIHER (DU), Porur, Chennai, IndiaDepartment of Surgical Gastroenterology, Sri Ramachandra Institute of Higher Education and Research SRIHER (DU), Porur, Chennai, IndiaDepartment of Surgical Gastroenterology, Sri Ramachandra Institute of Higher Education and Research SRIHER (DU), Porur, Chennai, IndiaDepartment of Surgical Gastroenterology, Sri Ramachandra Institute of Higher Education and Research SRIHER (DU), Porur, Chennai, IndiaDepartment of Surgical Gastroenterology, Sri Ramachandra Institute of Higher Education and Research SRIHER (DU), Porur, Chennai, IndiaDepartment of Surgical Gastroenterology, Sri Ramachandra Institute of Higher Education and Research SRIHER (DU), Porur, Chennai, IndiaTumors of the body and tail of the pancreas are often more aggressive than tumors of the head and would have often undergone metastatic spread to other organs at the time of diagnosis. Most patients with carcinoma of the body and tail of the pancreas present at a late stage. Surgery is only indicated in those patients in whom there is no evidence of metastatic spread. Surgery is often not possible in cancers of the body and tail of the pancreas if the tumor invades celiac artery. Controversy exists regarding the margin status impact of microscopic resection margin involvement (R1) after pancreaticoduodenectomy (PD) for PDAC. There are reports indicating the rate of R1 resections increases significantly after PD if pathological examination is standardized. In this report, we present the case of a 56-year-old female who had undergone lateral pancreaticojejunostomy for chronic pancreatitis 8 years ago, but has now developed malignancy of the body and tail of the pancreas involving multiple organs. This patient underwent en bloc resection involving: 1. distal pancreatectomy with jejunal loop (lateral pancreaticojejunostomy) resection; 2. splenectomy; 3. left nephrectomy; 4. total gastrectomy; and 5. segmental colectomy with reconstruction by esophagojejunostomy, jejunojejunostomy, and colocolic anastomosis. The infrequent occurrence of tumor in the distal gland and advanced tumor stage at the time of diagnosis have both combined to produce therapeutic nihilism/dilemma in the minds of many surgeons. This report highlights the decision on how much to the push limits for multi-organ resection (en bloc resection with distal pancreatectomy, gastrectomy, splenectomy, colectomy, nephrectomy) with the intent of achieving R0 status in spite of the complexity of surgery in selected patients.https://doi.org/10.2478/fco-2019-0011r1 resectionpancreatic malignancychronic pancreatitis |
| spellingShingle | Joshi Kunal Sadanand Bodepudi Sisir Ganapathi Santhosh Kumar Murugesan Chandrasekar Balu Jagan Subramanian Sankar Pancreatic malignancy in the backdrop of chronic pancreatitis: How much to push the boundaries to achieve R0 resection Forum of Clinical Oncology r1 resection pancreatic malignancy chronic pancreatitis |
| title | Pancreatic malignancy in the backdrop of chronic pancreatitis: How much to push the boundaries to achieve R0 resection |
| title_full | Pancreatic malignancy in the backdrop of chronic pancreatitis: How much to push the boundaries to achieve R0 resection |
| title_fullStr | Pancreatic malignancy in the backdrop of chronic pancreatitis: How much to push the boundaries to achieve R0 resection |
| title_full_unstemmed | Pancreatic malignancy in the backdrop of chronic pancreatitis: How much to push the boundaries to achieve R0 resection |
| title_short | Pancreatic malignancy in the backdrop of chronic pancreatitis: How much to push the boundaries to achieve R0 resection |
| title_sort | pancreatic malignancy in the backdrop of chronic pancreatitis how much to push the boundaries to achieve r0 resection |
| topic | r1 resection pancreatic malignancy chronic pancreatitis |
| url | https://doi.org/10.2478/fco-2019-0011 |
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