Our understanding of pancreatic tumors is changing thanks to recent advances in the field. New diagnostic techniques and imaging tests have improved the early diagnosis of these lesions, and as a result, the growing number of R0 surgical resections has meant a better prognosis for patients. Further, minimally invasive laparoscopic approaches have increased postoperative comfort.
Presenting the latest research in the field, this book will appeal to clinicians in a wide range of medical specialities, including gastroenterologists, general physicians, and abdominal and biliopancreatic surgeons.
Author(s): Juan Bellido Luque, Angel Nogales Muñoz
Publisher: Springer
Year: 2023
Language: English
Pages: 158
City: Cham
Foreword
Preface
Contents
1: Introduction to Diagnosis and Treatment in Pancreatic Neoplasms
1.1 The Environment for Nihilism in Pancreatic Cancer
1.2 Key Points in the Diagnosis of Pancreatic Cancer
1.2.1 Molecular Diagnosis: Toward the Early Diagnosis in Pancreatic Cancer
1.2.2 Radiomics: Diagnostic Imaging as a Tool for Pathological Specification and Prognosis in Pancreatic Cancer
1.3 Key Points in the Treatment of Pancreatic Cancer
1.3.1 Medical Treatment: Personalized and Precision Therapy in Pancreatic Cancer
1.3.2 The Surgical Approach as a Guarantor of the Locoregional Eradication of Pancreatic Cancer
References
2: Pancreatic Cystic Neoplasms: Serous Cystadenoma, Mucinous Cystadenoma
2.1 Serous Cystadenoma
2.2 Mucinous Cystic Neoplasia (MCN) (Tables 2.2 and 2.3)
References
3: Intraductal Papillary Mucinous Tumors Principal and Lateral Branch of IPMT: Preoperative Management, Surgical Indications, and Surgical Techniques
3.1 Definition
3.2 Epidemiology
3.3 Classification
3.4 Pathogenesis
3.5 Clinical Presentation
3.6 Diagnostic Approach
3.7 Clinical and Surgical Management According to Published Guidelines
References
4: Pancreatic Neuroendocrine Tumors: Diagnosis, Management, and Intraoperative Techniques
4.1 Background
4.2 Diagnosis of pNETs: Imagining and Histological Diagnosis
4.2.1 Imaging Studies
4.2.1.1 Ultrasound (US)
4.2.1.2 Computed Tomography
4.2.1.3 Magnetic Resonance Imaging
4.2.1.4 Endoscopic Ultrasonography
4.2.1.5 Somatostatin Receptor-Based Imaging and Positron Emission Tomography
4.2.2 Histological Diagnosis
4.3 Classification
4.4 Neuroendocrine Syndromes
4.4.1 Functioning Pancreatic Neuroendocrine Tumors
4.4.1.1 Insulinoma
4.4.1.2 Gastrinoma
4.4.1.3 VIPoma
4.4.1.4 Glucagonoma
4.4.2 Non-functioning Pancreatic Neuroendocrine Tumors
4.5 Localized pNETs Management
4.5.1 How Should Small Non-functioning (NF) pNETs Be Treated?
4.5.2 How Should Functional Lesions Be Treated?
4.5.3 What Is the Role of Parenchymal-Sparing Surgical Techniques (PSRs)?
4.5.4 What Is the Role of Splenic Preservation During DP as the Management of pNETs?
4.5.5 What Is the Role of Lymphadenectomy in pNETs?
4.5.6 What Is the Role of Minimally Invasive Surgery in the Treatment of pNETs?
4.5.7 How Should We Manage pNETs in MEN1 Syndrome and Other Familial Diseases?
4.6 Management of Metastatic pNETS
4.6.1 Primary Tumor Resection in Patients with Metastatic PNET
4.6.2 Hepatic Cytoreduction
4.6.3 Liver Transplantation
4.6.4 Combined Pancreatectomy and Liver Debulking
4.6.5 Removing Primary Tumor When Unresectable Metastatic Disease Is Present
4.6.6 Primary Tumor Resection or Hepatic Cytoreduction When There Is Extrahepatic Disease
4.7 Systemic Therapy
4.7.1 Symptoms-Directed Therapy in pNETs
4.7.2 Somatostatin Analogues
4.7.3 Molecularly Targeted Therapies
4.7.4 Cytotoxic Chemotherapy
4.7.5 Peptide Receptor Radionuclide Therapy (PRRT)
References
5: Pancreatic Adenocarcinoma: Current Status in Diagnostic Methods, Surgical Techniques, Complications, and Short/Long-Term Survival
5.1 Epidemiology and Risk Factors
5.2 Clinical Symptoms and Early Diagnosis
5.3 Diagnostic Protocol
5.4 Resectability Assessment
5.5 Staging and Prognosis
5.6 Surgical Management
5.7 Complications and Postoperative Results
5.8 Medical Management
5.9 Recurrence in Ca Pancreas
5.10 Conclusions
References
6: Role of Endoscopic Ultrasound and Endoscopic Retrograde Cholangiopancreatography in the Diagnosis and Treatment of Pancreatic Tumors
6.1 Introduction
6.2 Role of EUS for Diagnosis of Pancreatic Cancer
6.2.1 EUS-Guided Tissue Diagnosis
6.2.1.1 Indications of EUS-FNA
6.2.1.2 Safety and Complications
6.2.2 Pancreatic Cancer Screening
6.3 Role of EUS for the Staging of Pancreatic Cancer
6.4 Role of EUS in Treatment
6.4.1 Celiac Plexus Neurolysis/Block
6.4.2 EUS Fine Needle Injection and Radiofrequency Ablation
6.4.3 Biliary Drainage
6.4.4 Role of EUS in Gastric Outlet Obstruction
6.5 Role of ERCP in Pancreatic Cancer
6.5.1 Indications
6.6 Role of ERCP for Diagnosis of Pancreatic Cancer
6.6.1 ERCP-Tissue Sampling
6.6.1.1 Brush Cytology
6.6.1.2 Endobiliary Forceps Biopsy
6.6.1.3 Multimodal Tissue Sampling
6.6.1.4 Cholangiopancreatoscopic-Guided Biopsy
6.7 Role of ERCP in Treatment
6.7.1 ERCP in Preoperative Biliary Drainage in Resectable Pancreatic Cancer
6.7.2 ERCP Biliary Drainage in Unresectable Pancreatic Cancer
6.7.3 Role of ERCP in Gastric Outlet Obstruction
6.8 Conclusions
References
7: Interventional Biliary Radiology in Pancreatic Neoplasm
7.1 Introduction
7.2 Etiology
7.3 Diagnostic Imaging
7.4 Management of Malignant Stenosis of the Bile Ducts
7.5 Biliary Drainage Technique
7.5.1 Patient Preparation
7.5.2 Percutaneous Transhepatic Cholangiography
7.5.3 Biliary Drainage
7.5.4 Percutaneous Cholecystostomy
7.6 Indications Percutaneous Biliary Drainage
7.7 Biliary Drainage Complications
7.8 Biliary Percutaneous Treatment in Malignant Neoplastic Obstructions
7.8.1 Indications
7.8.2 Complications of Metallic Stents in Malignant Obstruction of Bile Ducts
7.9 Conclusions
References
8: Pancreatic Surgical Resections
8.1 Introduction
8.2 The Pancreaticodu
8.3 Methods for Restoration of Pancreatico-Enteric Continuity
8.3.1 Invagination Pancreaticojejunostomy
8.3.2 Binding Pancreaticojejunostomy
8.3.3 Duct-to-Mucosa Pancreaticojejunostomy
8.4 Pancreaticogastrostomy
8.5 Ways to Decrease Complications After Pancreatic Anastomosis
References
9: Current Status of Vascular Resections in Pancreatic Cancer Surgery
9.1 Introduction
9.2 Resectability of Pancreatic Ductal Adenocarcinomas
9.3 Neoadjuvant Therapy and Patient Selection
9.4 Venous Resections and Reconstruction
9.5 Arterial Resections
9.6 Conclusions
References
10: Minimally Invasive Surgery in Pancreatic Tumors
10.1 Introduction
10.2 Laparoscopic Distal Pancreatectomy
10.3 Laparoscopic Distal Pancreatectomy (LDP) with Splenectomy
10.4 Laparoscopic Pancreaticoduodenectomy (LPD)
10.4.1 Indications for LPD
10.4.2 Pancreaticoyeyunostomy (Duc-to-Mucosa Anastomosis)
10.4.3 Hepaticojejunostomy
10.4.4 Gastrojejunostomy
10.5 Robotic Pancreaticoduodenectomy
References
11: Quality Standards in Pancreatic Surgery
11.1 Introduction
11.2 Mortality
11.3 Postoperative Bleeding
11.4 Pancreatic Fistula
11.5 Surgical Reintervention
11.6 Quality of Oncological Resection
11.7 Other Indicators
References
12: Postoperative Complications Management in Pancreatic Surgery
12.1 Introduction
12.2 Pancreatic Fistula
12.3 Postoperative Bleeding
12.4 Delayed Gastric Emptying
12.5 Early Postoperative Pancreatitis
12.6 Diabetes Mellitus
12.7 Exocrine Pancreatic Insufficiency
12.8 Cholangitis
12.9 Late Acute Pancreatitis
References
13: Oncologic Adjuvant and Neoadjuvant Treatments in Pancreatic Adenocarcinoma
13.1 Introduction
13.2 Adjuvant Chemotherapy in PAC
13.2.1 ACT Indication
13.2.2 ACT Regimens
13.2.2.1 Adjuvant Monotherapy
13.2.2.2 Combinations with Gemcitabine
13.2.2.3 FOLFIRINOX
13.2.3 Chemoradiotherapy (CT-RT)
13.2.4 ACT Starting Point and Duration
13.2.5 Biomarkers
13.2.5.1 Ca 19.9
13.2.5.2 Circulating Tumoral DNA (ctDNA)
13.2.5.3 BRCA Mutation
13.2.5.4 Predictive Gemcitabine Response Biomarkers
13.3 Neoadjuvant Chemotherapy in PAC
13.3.1 Overview
13.3.2 NACT in Locally Advanced PAC (LAPAC)
13.3.3 NACT in Borderline PAC (BLPAC)
13.3.4 NACT in PAC Potentially Resectable (PACPR)
References
