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Langenbeck's Archives of Surgery

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06.11.2018 | REVIEW ARTICLE

Pancreatic surgery: we need clear definitions

verfasst von: André Mihaljevic, Mohammed Al-Saeedi, Thilo Hackert

Erschienen in: Langenbeck's Archives of Surgery | Ausgabe 2/2019

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Abstract

Background

Pancreatic surgery has undergone substantial changes during the last decades. Improved surgical techniques and perioperative care have contributed to improved outcomes and allow safe surgery with mortality rates below 5% in specialized centers today. In parallel, surgical indications and procedures have been continuously extended especially with regard to pancreatic cancer surgery including vascular resections and multivisceral approaches for advanced findings.

Purpose

With the growing awareness of the need to report outcomes scientifically, it has become obvious that only standardized definitions allow a reasonable description and comparability with regard to indications, procedures, and especially complications. Consequently, a number of efforts have been undertaken to achieve this aim, including basic nomenclatures, preoperative definition of resectability, and specific outcome parameters.

Conclusion

This review gives an overview on the development of international standardizations in pancreatic surgery and the current status and discusses their scientific importance and the most important current controversies in the context of the present literature as well as the ongoing future approaches in this field.

Scally CP, Yin H, Birkmeyer JD, Wong SL (2015) Comparing perioperative processes of care in high and low mortality centers performing pancreatic surgery. J Surg Oncol 112(8):866–871CrossRefPubMed

Hughes ES, Brown G (1960) Carcinoma of the pancreas. Med J Aust 47(2):7–10PubMed

Hackert T, Büchler MW (2013) Pancreatic cancer: advances in treatment, results and limitations. Dig Dis 31(1):51–56CrossRefPubMed

Kleeff J, Korc M, Apte M, La Vecchia C, Johnson CD, Biankin AV, Neale RE, Tempero M, Tuveson DA, Hruban RH, Neoptolemos JP (2016) Pancreatic cancer. Nat Rev Dis Primers 2:16022CrossRefPubMed

https://www.uicc.org/sites/main/files/private/History_Evolution_Milestones_0.pdf. Accessed 1 Oct 2018

Brierley JD, Gospodarowicz MK, Wittekind C (eds) (2017) UICC: TNM classification of malignant tumours, 8th edn. Wiley-Blackwell, Oxford

Helm J, Centeno BA, Coppola D, Melis M, Lloyd M, Park JY, Chen DT, Malafa MP (2009) Histologic characteristics enhance predictive value of American Joint Committee on Cancer staging in resectable pancreas cancer. Cancer 115(18):4080–4089CrossRefPubMed

Valsangkar NP, Bush DM, Michaelson JS, Ferrone CR, Wargo JA, Lillemoe KD, Fernández-del Castillo C, Warshaw AL, Thayer SP (2013) N0/N1, PNL, or LNR? The effect of lymph node number on accurate survival prediction in pancreatic ductal adenocarcinoma. J Gastrointest Surg 17(2):257–266CrossRefPubMed

Tarantino I, Warschkow R, Hackert T, Schmied BM, Büchler MW, Strobel O, Ulrich A (2017) Staging of pancreatic cancer based on the number of positive lymph nodes. Br J Surg 104(5):608–618CrossRefPubMed

10.

Strobel O, Hinz U, Gluth A, Hank T, Hackert T, Bergmann F, Werner J, Büchler MW (2015) Pancreatic adenocarcinoma: number of positive nodes allows to distinguish several N categories. Ann Surg 261(5):961–969CrossRefPubMed

11.

Allen PJ, Kuk D, Castillo CF, Basturk O, Wolfgang CL, Cameron JL, Lillemoe KD, Ferrone CR, Morales-Oyarvide V, He J, Weiss MJ, Hruban RH, Gönen M, Klimstra DS, Mino-Kenudson M (2017) Multi-institutional validation study of the American Joint Commission on Cancer (8th edition) changes for T and N staging in patients with pancreatic adenocarcinoma. Ann Surg 265(1):185–191CrossRefPubMedPubMedCentral

12.

Kamarajah SK, Burns WR, Frankel TL, Cho CS, Nathan H (2017) Validation of the American Joint Commission on Cancer (AJCC) 8th edition staging system for patients with pancreatic adenocarcinoma: a surveillance, epidemiology and end results (SEER) analysis. Ann Surg Oncol 24(7):2023–2030CrossRefPubMed

13.

Shi S, Hua J, Liang C, Meng Q, Liang D, Xu J, Ni Q, Yu X (2018) Proposed modification of the 8th edition of the AJCC staging system for pancreatic ductal adenocarcinoma. Ann Surg:1. https://doi.org/10.1097/SLA.0000000000002668

14.

Yu HF, Zhao BQ, Li YC, Fu J, Jiang W, Xu RW, Yang HC, Zhang XJ (2018) Stage III should be subclassified into stage IIIA and IIIB in the American Joint Committee on Cancer (8th edition) staging system for pancreatic cancer. World J Gastroenterol 24(22):2400–2405CrossRefPubMedPubMedCentral

15.

Merkel S, Mansmann U, Meyer T, Papadopoulos T, Hohenberger W, Hermanek P (2004) Confusion by frequent changes in staging of exocrine pancreatic carcinoma. Pancreas 29(3):171–178CrossRefPubMed

16.

Tanaka M, Fernández-Del Castillo C, Kamisawa T, Jang JY, Levy P, Ohtsuka T, Salvia R, Shimizu Y, Tada M, Wolfgang CL (2017) Revisions of international consensus Fukuoka guidelines for the management of IPMN of the pancreas. Pancreatology 17(5):738–753CrossRefPubMed

17.

European Study Group on Cystic Tumours of the Pancreas (2018) European evidence-based guidelines on pancreatic cystic neoplasms. Gut 67(5):789–804CrossRef

18.

Vege SS, Ziring B, Jain R, Moayyedi P (2015) Clinical guidelines committee; American Gastroenterology Association. American gastroenterological association institute guideline on the diagnosis and management of asymptomatic neoplastic pancreatic cysts. Gastroenterology 148(4):819–822CrossRefPubMed

19.

Hackert T, Fritz S, Klauss M, Bergmann F, Hinz U, Strobel O, Schneider L, Büchler MW (2015) Main-duct intraductal papillary mucinous neoplasm: high cancer risk in duct diameter of 5 to 9 mm. Ann Surg 262(5):875–880CrossRefPubMed

20.

Abdeljawad K, Vemulapalli KC, Schmidt CM, Dewitt J, Sherman S, Imperiale TF, Al-Hadda M (2014) Prevalence of malignancy in patients with pure main duct intraductal papillary mucinous neoplasms. Gastrointest Endosc 79(4):623–629CrossRefPubMed

21.

Del Chiaro M, Ateeb Z, Hansson MR, Rangelova E, Segersvard R, Kartalis N, Ansorge C, Löhr MJ, Arnelo U, Verbeke C (2017) Survival analysis and risk for progression of Intraductal papillary mucinous neoplasia of the pancreas (IPMN) under surveillance: a single-institution experience. Ann Surg Oncol 24(4):1120–1126CrossRefPubMed

22.

Verbeke CS, Leitch D, Menon KV, McMahon MJ, Guillou PJ, Anthoney A (2006) Redefining the R1 resection in pancreatic cancer. Br J Surg 93(10):1232–1237CrossRefPubMed

23.

Strobel O, Hank T, Hinz U, Bergmann F, Schneider L, Springfeld C, Jäger D, Schirmacher P, Hackert T, Büchler MW (2017) Pancreatic cancer surgery: the new R-status counts. Ann Surg 265(3):565–573CrossRefPubMed

24.

Ghaneh P, Kleeff J, Halloran CM, Raraty M, Jackson R, Melling J, Jones O, Palmer DH, Cox TF, Smith CJ, O'Reilly DA, Izbicki JR, Scarfe AG, Valle JW, McDonald AC, Carter R, Tebbutt NC, Goldstein D, Padbury R, Shannon J, Dervenis C, Glimelius B, Deakin M, Anthoney A, Lerch MM, Mayerle J, Oláh A, Rawcliffe CL, Campbell F, Strobel O, Büchler MW, Neoptolemos JP (2017) European study group for pancreatic cancer. The impact of positive resection margins on survival and recurrence following resection and adjuvant chemotherapy for pancreatic ductal adenocarcinoma. Ann Surg:1. https://doi.org/10.1097/SLA.0000000000002557

25.

Gaedcke J, Gunawan B, Grade M, Szöke R, Liersch T, Becker H, Ghadimi BM (2010) The mesopancreas is the primary site for R1 resection in pancreatic head cancer: relevance for clinical trials. Langenbeck's Arch Surg 395(4):451–458CrossRef

26.

Bassi C, Butturini G, Molinari E, Mascetta G, Salvia R, Falconi M, Gumbs A, Pederzoli P (2004) Pancreatic fistula rate after pancreatic resection. The importance of definitions. Dig Surg 21(1):54–59CrossRefPubMed

27.

Bassi C, Dervenis C, Butturini G, Fingerhut A, Yeo C, Izbicki J, Neoptolemos J, Sarr M, Traverso W, Buchler M (2005 Jul) International study group on pancreatic fistula definition. Postoperative pancreatic fistula: an international study group (ISGPF) definition. Surgery 138(1):8–13CrossRef

28.

https://apps.webofknowledge.com. Accessed 1 Oct 2018

29.

Wente MN, Bassi C, Dervenis C, Fingerhut A, Gouma DJ, Izbicki JR, Neoptolemos JP, Padbury RT, Sarr MG, Traverso LW, Yeo CJ, Büchler MW (2007) Delayed gastric emptying (DGE) after pancreatic surgery: a suggested definition by the International Study Group of Pancreatic Surgery (ISGPS). Surgery 142(5):761–768CrossRef

30.

Wente MN, Veit JA, Bassi C, Dervenis C, Fingerhut A, Gouma DJ, Izbicki JR, Neoptolemos JP, Padbury RT, Sarr MG, Yeo CJ, Büchler MW (2007) Postpancreatectomy hemorrhage (PPH): an International Study Group of Pancreatic Surgery (ISGPS) definition. Surgery 142(1):20–25 Review CrossRefPubMed

31.

Tol JA, Gouma DJ, Bassi C, Dervenis C, Montorsi M, Adham M, Andrén-Sandberg A, Asbun HJ, Bockhorn M, Büchler MW, Conlon KC, Fernández-Cruz L, Fingerhut A, Friess H, Hartwig W, Izbicki JR, Lillemoe KD, Milicevic MN, Neoptolemos JP, Shrikhande SV, Vollmer CM, Yeo CJ, Charnley RM, International Study Group on Pancreatic Surgery (2014) Definition of a standard lymphadenectomy in surgery for pancreatic ductal adenocarcinoma: a consensus statement by the International Study Group on Pancreatic Surgery (ISGPS). Surgery 156(3):591–600CrossRefPubMed

32.

Hartwig W, Vollmer CM, Fingerhut A, Yeo CJ, Neoptolemos JP, Adham M, Andrén-Sandberg A, Asbun HJ, Bassi C, Bockhorn M, Charnley R, Conlon KC, Dervenis C, Fernandez-Cruz L, Friess H, Gouma DJ, Imrie CW, Lillemoe KD, Milićević MN, Montorsi M, Shrikhande SV, Vashist YK, Izbicki JR, Büchler MW, International Study Group on Pancreatic Surgery (2014) Extended pancreatectomy in pancreatic ductal adenocarcinoma: definition and consensus of the International Study Group for Pancreatic Surgery (ISGPS). Surgery 156(1):1–14CrossRefPubMed

33.

Bockhorn M, Uzunoglu FG, Adham M, Imrie C, Milicevic M, Sandberg AA, Asbun HJ, Bassi C, Büchler M, Charnley RM, Conlon K, Cruz LF, Dervenis C, Fingerhutt A, Friess H, Gouma DJ, Hartwig W, Lillemoe KD, Montorsi M, Neoptolemos JP, Shrikhande SV, Takaori K, Traverso W, Vashist YK, Vollmer C, Yeo CJ, Izbicki JR, International Study Group of Pancreatic Surgery (2014) Borderline resectable pancreatic cancer: a consensus statement by the International Study Group of Pancreatic Surgery (ISGPS). Surgery 155(6):977–988CrossRef

34.

Shrikhande SV, Sivasanker M, Vollmer CM, Friess H, Besselink MG, Fingerhut A, Yeo CJ, Fernandez-del Castillo C, Dervenis C, Halloran C, Gouma DJ, Radenkovic D, Asbun HJ, Neoptolemos JP, Izbicki JR, Lillemoe KD, Conlon KC, Fernandez-Cruz L, Montorsi M, Bockhorn M, Adham M, Charnley R, Carter R, Hackert T, Hartwig W, Miao Y, Sarr M, Bassi C, Büchler MW, International Study Group of Pancreatic Surgery (ISGPS) (2017) Pancreatic anastomosis after pancreatoduodenectomy: a position statement by the International Study Group of Pancreatic Surgery (ISGPS). Surgery 161(5):1221–1234CrossRefPubMed

35.

Besselink MG, van Rijssen LB, Bassi C, Dervenis C, Montorsi M, Adham M, Asbun HJ, Bockhorn M, Strobel O, Büchler MW, Busch OR, Charnley RM, Conlon KC, Fernández-Cruz L, Fingerhut A, Friess H, Izbicki JR, Lillemoe KD, Neoptolemos JP, Sarr MG, Shrikhande SV, Sitarz R, Vollmer CM, Yeo CJ, Hartwig W, Wolfgang CL, Gouma DJ, International Study Group on Pancreatic Surgery (2017) Definition and classification of chyle leak after pancreatic operation: a consensus statement by the International Study Group on Pancreatic Surgery. Surgery 161(2):365–372CrossRefPubMed

36.

Gianotti L, Besselink MG, Sandini M, Hackert T, Conlon K, Gerritsen A, Griffin O, Fingerhut A, Probst P, Hilal MA, Marchegiani G, Nappo G, Zerbi A, Amodio A, Perinel J, Adham M, Raimondo M, Asbun HJ, Sato A, Takaori K, Shrikhande SV, Del Chiaro M, Bockhorn M, Izbicki JR, Dervenis C, Charnley RM, Martignoni ME, Friess H, de Pretis N, Radenkovic D, Montorsi M, Sarr MG, Vollmer CM, Frulloni L, Büchler MW, Bassi C (2018) Nutritional support and therapy in pancreatic surgery: a position paper of the International Study Group on Pancreatic Surgery (ISGPS). Surgery

37.

Asbun HJ, Conlon K, Fernandez-Cruz L, Friess H, Shrikhande SV, Adham M, Bassi C, Bockhorn M, Büchler M, Charnley RM, Dervenis C, Fingerhutt A, Gouma DJ, Hartwig W, Imrie C, Izbicki JR, Lillemoe KD, Milicevic M, Montorsi M, Neoptolemos JP, Sandberg AA, Sarr M, Vollmer C, Yeo CJ, Traverso LW, International Study Group of Pancreatic Surgery (2014) When to perform a pancreatoduodenectomy in the absence of positive histology? A consensus statement by the International Study Group of Pancreatic Surgery. Surgery 155(5):887–892CrossRefPubMed

38.

Bassi C, Marchegiani G, Dervenis C, Sarr M, Abu Hilal M, Adham M, Allen P, Andersson R, Asbun HJ, Besselink MG, Conlon K, Del Chiaro M, Falconi M, Fernandez-Cruz L, Fernandez-Del Castillo C, Fingerhut A, Friess H, Gouma DJ, Hackert T, Izbicki J, Lillemoe KD, Neoptolemos JP, Olah A, Schulick R, Shrikhande SV, Takada T, Takaori K, Traverso W, Vollmer CR, Wolfgang CL, Yeo CJ, Salvia R, Buchler M, International Study Group on Pancreatic Surgery (ISGPS) (2017) The 2016 update of the international study group (ISGPS) definition and grading of postoperative pancreatic fistula: 11 years after. Surgery 161(3):584–591CrossRef

39.

Hackert T, Hinz U, Pausch T, Fesenbeck I, Strobel O, Schneider L, Fritz S, Büchler MW (2016) Postoperative pancreatic fistula: we need to redefine grades B and C. Surgery 159(3):872–877CrossRef

40.

Shrikhande SV, Barreto SG, Goel M, Arya S (2012) Multimodality imaging of pancreatic ductal adenocarcinoma: a review of the literature. HPB (Oxford) 14(10):658–668CrossRef

41.

Tempero MA, Malafa MP, Behrman SW, Benson AB 3rd, Casper ES, Chiorean EG, Chung V, Cohen SJ, Czito B, Engebretson A, Feng M, Hawkins WG, Herman J, Hoffman JP, Ko A, Komanduri S, Koong A, Lowy AM, Ma WW, Merchant NB, Mulvihill SJ, Muscarella P 2nd, Nakakura EK, Obando J, Pitman MB, Reddy S, Sasson AR, Thayer SP, Weekes CD, Wolff RA, Wolpin BM, Burns JL, Freedman-Cass DA (2014) Pancreatic adenocarcinoma, version 2.2014: featured updates to the NCCN guidelines. J Natl Compr Cancer Netw 12(8):1083–1093CrossRef

42.

Callery MP, Chang KJ, Fishman EK, Talamonti MS, William Traverso L, Linehan DC (2009) Pretreatment assessment of resectable and borderline resectable pancreatic cancer: expert consensus statement. Ann Surg Oncol 16(7):1727–1733CrossRefPubMed

43.

Varadhachary GR, Tamm EP, Abbruzzese JL, Xiong HQ, Crane CH, Wang H, Lee JE, Pisters PW, Evans DB, Wolff RA (2006) Borderline resectable pancreatic cancer: definitions, management, and role of preoperative therapy. Ann Surg Oncol 13(8):1035–1046CrossRefPubMed

44.

Isaji S, Mizuno S, Windsor JA, Bassi C, Fernández-Del Castillo C, Hackert T, Hayasaki A, Katz MHG, Kim SW, Kishiwada M, Kitagawa H, Michalski CW, Wolfgang CL (2018) International consensus on definition and criteria of borderline resectable pancreatic ductal adenocarcinoma 2017. Pancreatology 18(1):2–11CrossRefPubMed

Titel: Pancreatic surgery: we need clear definitions
verfasst von: André Mihaljevic
Mohammed Al-Saeedi
Thilo Hackert
Publikationsdatum: 06.11.2018
Verlag: Springer Berlin Heidelberg
Erschienen in: Langenbeck's Archives of Surgery / Ausgabe 2/2019
Print ISSN: 1435-2443
Elektronische ISSN: 1435-2451
DOI: https://doi.org/10.1007/s00423-018-1725-7

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