In situ surgical procedures for locally advanced pancreatic cancer: partial abdominal evisceration and intestinal autotransplantation View Full Text


Ontology type: schema:ScholarlyArticle     


Article Info

DATE

2009-11-10

AUTHORS

Hodaka Amano, Fumihiko Miura, Naoyuki Toyota, Keita Wada, Ken-ichirou Katoh, Kouichi Hayano, Susumu Kadowaki, Makoto Shibuya, Sawako Maeno, Tomoaki Eguchi, Tadahiro Takada, Takehide Asano

ABSTRACT

Background/purposePancreatic cancers in which invasion to the root of the mesentery are suspected have been regarded as unresectable in general. We report the surgical techniques in two cases of locally advanced pancreatic cancer for which in situ surgical procedures including partial abdominal evisceration and intestinal autotransplantation were performed.MethodsThe patients were a woman 57 years of age and a man 64 years of age. Both cases had a locally advanced cancer that had originated in the pancreatic uncus and was found to have invaded the root of the mesentery, as well as the superior mesenteric artery (SMA) and the superior mesenteric vein (SMV). The cancers in both patients were assessed as resectable because the jejunal artery and vein were secured intact at a site peripheral from the root of the mesentery, and the origin of the SMA along with the portal and splenic veins was intact at a proximal site, so pancreatectomy and resection of the transverse and ascending colons were performed. The SMA and the SMV were ablated just below each origin at a site proximal to the root of the mesentery. At a distal site, two jejunal arteries and one jejunal vein were kept intact and all the remaining arteries and veins were ablated. The remaining small intestine had become a free autograft. As for the portal and jejunal veins, end-to-end anastomosis was performed. Reconstruction of the SMA was achieved with an end-to-end anastomosis, using the right internal iliac artery as a graft. Reconstruction of the alimentary tract was achieved using small intestine as an autograft.ResultsBoth patients survived the major operative procedures. Warm ischemia time was 84 min for the SMA and 12 min for the SMV-portal system in Case 1 while it was 30 min for the SMA and 25 min for the SMV-portal system in Case 2. No ex-vivo resection technique was used. Leakage occurred in both cases at the anastomotic lesion between the small intestine and the left colon. Abdominal drainage and conservative treatment were applied in both cases. Cure was achieved within 3 months postoperatively in Case 1 and within 2.5 months in Case 2. Subsequently, the patients returned to their preoperative lives. Case 1 died 11 months and Case 2 died 12 months after the operation due to abdominal dissemination and liver metastases.ConclusionsWe were able to perform in situ procedures including partial abdominal evisceration and intestinal autotransplantation for two cases of pancreatic cancer with possible invasion to the root of the mesentery. There are few reports of such procedures. There has been one report of a case which applied an ex vivo technique. It is expected that the development of adequate adjuvant therapy will lead to further improvement in the prognosis of pancreatic cancers. More... »

PAGES

771

Identifiers

URI

http://scigraph.springernature.com/pub.10.1007/s00534-009-0188-1

DOI

http://dx.doi.org/10.1007/s00534-009-0188-1

DIMENSIONS

https://app.dimensions.ai/details/publication/pub.1051088743

PUBMED

https://www.ncbi.nlm.nih.gov/pubmed/19902139


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25 schema:description Background/purposePancreatic cancers in which invasion to the root of the mesentery are suspected have been regarded as unresectable in general. We report the surgical techniques in two cases of locally advanced pancreatic cancer for which in situ surgical procedures including partial abdominal evisceration and intestinal autotransplantation were performed.MethodsThe patients were a woman 57 years of age and a man 64 years of age. Both cases had a locally advanced cancer that had originated in the pancreatic uncus and was found to have invaded the root of the mesentery, as well as the superior mesenteric artery (SMA) and the superior mesenteric vein (SMV). The cancers in both patients were assessed as resectable because the jejunal artery and vein were secured intact at a site peripheral from the root of the mesentery, and the origin of the SMA along with the portal and splenic veins was intact at a proximal site, so pancreatectomy and resection of the transverse and ascending colons were performed. The SMA and the SMV were ablated just below each origin at a site proximal to the root of the mesentery. At a distal site, two jejunal arteries and one jejunal vein were kept intact and all the remaining arteries and veins were ablated. The remaining small intestine had become a free autograft. As for the portal and jejunal veins, end-to-end anastomosis was performed. Reconstruction of the SMA was achieved with an end-to-end anastomosis, using the right internal iliac artery as a graft. Reconstruction of the alimentary tract was achieved using small intestine as an autograft.ResultsBoth patients survived the major operative procedures. Warm ischemia time was 84 min for the SMA and 12 min for the SMV-portal system in Case 1 while it was 30 min for the SMA and 25 min for the SMV-portal system in Case 2. No ex-vivo resection technique was used. Leakage occurred in both cases at the anastomotic lesion between the small intestine and the left colon. Abdominal drainage and conservative treatment were applied in both cases. Cure was achieved within 3 months postoperatively in Case 1 and within 2.5 months in Case 2. Subsequently, the patients returned to their preoperative lives. Case 1 died 11 months and Case 2 died 12 months after the operation due to abdominal dissemination and liver metastases.ConclusionsWe were able to perform in situ procedures including partial abdominal evisceration and intestinal autotransplantation for two cases of pancreatic cancer with possible invasion to the root of the mesentery. There are few reports of such procedures. There has been one report of a case which applied an ex vivo technique. It is expected that the development of adequate adjuvant therapy will lead to further improvement in the prognosis of pancreatic cancers.
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32 schema:keywords Background/purposePancreatic cancers
33 Case 1
34 Case 2
35 ConclusionsWe
36 MethodsThe patients
37 ResultsBoth patients
38 SMV-portal system
39 abdominal dissemination
40 abdominal drainage
41 abdominal evisceration
42 adequate adjuvant therapy
43 adjuvant therapy
44 advanced cancer
45 advanced pancreatic cancer
46 age
47 alimentary tract
48 anastomosis
49 anastomotic lesions
50 artery
51 ascending colon
52 autograft
53 autotransplantation
54 cancer
55 cases
56 colon
57 conservative treatment
58 cure
59 development
60 dissemination
61 distal sites
62 drainage
63 end
64 end anastomosis
65 evisceration
66 ex-vivo resection technique
67 free autograft
68 further improvement
69 graft
70 iliac artery
71 improvement
72 internal iliac artery
73 intestinal autotransplantation
74 intestine
75 invasion
76 ischemia time
77 jejunal artery
78 jejunal vein
79 leakage
80 left colon
81 lesions
82 life
83 liver metastases
84 major operative procedures
85 man 64
86 mesenteric artery
87 mesenteric vein
88 mesentery
89 metastasis
90 min
91 months
92 operation
93 operative procedure
94 origin
95 pancreatectomy
96 pancreatic cancer
97 pancreatic uncus
98 partial abdominal evisceration
99 patients
100 possible invasion
101 preoperative lives
102 procedure
103 prognosis
104 proximal site
105 purposePancreatic cancers
106 reconstruction
107 report
108 resection
109 resection technique
110 right internal iliac artery
111 roots
112 sites
113 situ procedure
114 small intestine
115 splenic vein
116 such procedures
117 superior mesenteric artery
118 superior mesenteric vein
119 surgical procedures
120 surgical technique
121 system
122 technique
123 therapy
124 time
125 tract
126 transverse
127 treatment
128 uncus
129 vein
130 vivo techniques
131 warm ischemia time
132 women 57
133 years
134 years of age
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