亚洲免费av电影一区二区三区,日韩爱爱视频,51精品视频一区二区三区,91视频爱爱,日韩欧美在线播放视频,中文字幕少妇AV,亚洲电影中文字幕,久久久久亚洲av成人网址,久久综合视频网站,国产在线不卡免费播放

        ?

        Surgical exploration with non-resection in the setting of resectable,borderline and locally advanced pancreatic cancer

        2022-11-21 04:21:00Kjetilreide

        Kjetil S?reide ,

        a Department of Gastrointestinal Surgery, HPB Unit, Stavanger University Hospital, P.O. Box 8100, Stavanger N-4068, Norway

        b Department of Clinical Medicine, University of Bergen, Bergen, Norway

        Pancreatic cancer has an overall dismal prognosis compared to most other malignancies. In general, only about 15%-20% of patients are deemed upfront resectable at time of diagnosis, with a similar proportion presenting with either borderline or locally advanced disease [1] . Novel and more effective treatment regimens including FOLFIRINOX have made yet more patients become resectable, with up to 60% reported in some centers [2] .Technical advances in surgery continue to literally explore new anatomical territory [3] . More aggressive attitude towards resection of involved vessels has provided opportunity for curative attempt resections, even for a subpopulation of biological responders staged with pre-treatment unresectable disease [ 4 , 5 ]. However, while surgery is the dominant modality for a potential curative approach to pancreatic cancer, there is a subgroup of patients scheduled for surgery who ends up with an aborted resection during explorative laparotomy, also referred to as an “openclose laparotomy”. The reasons for such non-resection events are manyfold and have likely changed over time. Indeed, in one Italian study the non-resection rate remained constant at about 25%over two decades [6] . While many institutional series report nonresection rates in the same range, these figures may be influenced by patient selection, referral patterns and institutional policies towards resection and surgical aggressiveness [ 2 , 4 , 6 ].

        Thus, the study from Sweden [7] in the current issue is a timely investigation into the contemporary patterns of non-resection after surgical exploration in a nationwide population. In the study, Andersson et al. [7] looked at non-resection trends during laparotomy in 1938 patients with pancreatic cancer from 2010 to 2018. The non-resection rate during surgery was 20.6%. Among the 399 openclose laparotomies, the most common cause was metastatic disease(58.6%) with the remaining events caused by locally advanced disease. The preoperative factors that were most notably related to the risk of non-resection due to metastatic disease were involuntary weight-loss before surgery and increased carbohydrate antigen 19-9 (CA19-9) levels. No cutoff level was provided in the Swedish study, but others have suggested that CA19-9 values ≥150 U/mL to be associated with computed tomography (CT)-occult metastatic disease found at time of surgical exploration [8] . A single-center,observational study from Japan found borderline resectable tumors,pre-treatment CA19-9 (with cut-off value at 260 ng/mL) and tumor size as risk factors associated with non-resectability status at surgical exploration [9] . Unfortunately, the subdivision of preoperative image-based categories of resectable, borderline or locally advanced tumors is not given in the Swedish study [7] , hence one cannot relate the preoperative risk factors to tumor imaging status in this study. Also, data on the use of neoadjuvant treatment are not included, which may potentially influence the selection to surgical exploration and thus the non-resection rate.

        A Dutch nationwide study [10] covering a similar, but shorter time-period (2009-2013) had a 38.4% non-resection rate that decreased to 28.7% at the later time of the study. Occult metastatic disease diagnosed on surgical exploration remained unchanged at 18.5% during the study period. A subsequent study found that resection rates had increased and were similar across hospital types in the Netherlands [11] . Another nationwide study from Italy found that the probability of undergoing palliative/explorative surgery was inversely related to hospital volume, being 24.4% in very highvolume hospitals and 62.5% in very low-volume centers [12] .

        In the past, contribution to non-resection operations may have been the result of preoperative suboptimal cross-sectional image quality or long delays (e.g.>4 weeks) between the imaging studies performed and scheduled surgery. However, with current state of the art three-phase contrast CT, the rate of “surprise” findings in upfront resectable patients has decreased [13] . Nonetheless, the debate continues over what additional imaging modalities may be necessary to increase sensitivity for detecting advanced disease prior to explorative laparotomy [14] . Some have advocated the use of liver-specific magnetic resonance imaging (MRI) or use of positron emission tomography (PET) scans for better sensitivity. A Canadian study found that with the use of routine preoperative MRI as part of staging, an incremental 7.6% of patients were excluded from surgery with a potential reduction of up to 13.6%in futile open-close laparotomies due to liver metastases detected on MRI only [15] . While not investigating non-resectabilityperse,others have looked at the metabolic response by pre- and postchemotherapy PET scans to predict relation to survival [16] . It remains to be demonstrated if any subsequent imaging modality,such as MRI or PET, will have an additional gain in staging as there are variations in both sensitivity and costs to each modality [14] ,with PET-CT at an almost 3 times higher price compared to MRI.

        Survival is affected by the non-resection rate, and is worst in patients who have metastatic disease (survival<7 months) [7] .An argument brought forward by some for surgical exploration,is the opportunity to provide the patient with a surgical bypass if resection cannot be done. However, a study found worse survival when a bypass procedure was added over laparotomy alone if chemotherapy could be ensued [17] . Indeed, this emphasizes the need to avoid unnecessary surgery for those unlikely to be resectable or have occult metastatic disease, and the attempt of palliative intervention by least invasive means possible, sparing a surgical double bypass for a select few patients at best [18] .

        Despite the progress being made in diagnosis and staging, the surgical exploration with a non-resection as the outcome still happens in about 1 in 5 laparotomies [ 6 , 7 , 10 ]. Some preoperative factors, such as weight loss and elevated CA19-9, may be indicative of non-resectability from occult diseases [7–9] . However, as more patients are subjected to neoadjuvant treatment, including FOLFIRNOX, new studies are needed to explore what preoperative factors are associated with non-resectability to the currently defined subgroups of resectable, borderline and locally advanced pancreatic cancers.

        Acknowledgments

        None.

        CRediT authorship contribution statement

        Kjetil S?reide : Conceptualization, Writing original draft, Writing review & editing.

        Funding

        None.

        Ethical approval

        Not needed.

        Competing interest

        No benefits in any form have been received or will be received from a commercial party related directly or indirectly to the subject of this article.

        91亚洲夫妻视频网站| 高潮毛片无遮挡高清免费| 精品无码AⅤ片| 午夜日本理论片最新片| 亚洲精品av一区二区| yw尤物av无码国产在线观看| 久久久久无码国产精品不卡 | 午夜国产精品视频在线观看| 午夜免费视频| 精品一区二区三区在线观看视频 | 老熟女毛茸茸浓毛| 日本第一区二区三区视频| 亚洲天堂一区二区偷拍| 一区二区三区av波多野结衣| 国产精品无需播放器| 一区二区三区午夜视频在线观看 | 亚洲欧美一区二区三区| 91美女片黄在线观看| 中文字幕亚洲高清精品一区在线| 精品亚洲国产成人蜜臀av| 久久人人爽天天玩人人妻精品| 蜜桃在线播放免费一区二区三区 | 精品日本一区二区三区| 野外亲子乱子伦视频丶| 欧美日韩综合网在线观看| 在线日本高清日本免费| 51国产偷自视频区视频| 久久精品女人天堂av| 福利网在线| 日本不卡一区二区三区久久精品 | 自拍偷自拍亚洲精品第按摩| 亚洲人午夜射精精品日韩| 国产激情久久99久久| 一区二区三区一片黄理论片| 亚洲av永久无码精品漫画| 国产精品 视频一区 二区三区 | 久久天堂精品一区专区av| 丝袜美腿亚洲一区二区| 无码人妻品一区二区三区精99 | 视频在线观看免费一区二区| 在线人成免费视频69国产|