Reconsideration of the Appropriate Dissection Range Based on Japanese Anatomical Classification for Resectable Pancreatic Head Cancer in the Era of Multimodal Treatment

Patients with resectable pancreatic cancer are considered to already have micro-distant metastasis, because most of the recurrence patterns postoperatively are distant metastases. Multimodal treatment dramatically improves prognosis; thus, micro-distant metastasis is considered to be controlled by c...

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Main Authors:	Yuichi Nagakawa, Naoya Nakagawa, Chie Takishita, Ichiro Uyama, Shingo Kozono, Hiroaki Osakabe, Kenta Suzuki, Nobuhiko Nakagawa, Yuichi Hosokawa, Tomoki Shirota, Masayuki Honda, Tesshi Yamada, Kenji Katsumata, Akihiko Tsuchida
Format:	Article
Language:	English
Published:	MDPI AG 2021-07-01
Series:	Cancers
Subjects:	pancreatic cancer pancreaticoduodenectomy mesopancreas superior mesenteric artery nerve and fibrous tissues adjuvant chemotherapy
Online Access:	https://www.mdpi.com/2072-6694/13/14/3605

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spelling	doaj-afde1ba1267841beb354d4eb96f08fcd2021-07-23T13:33:55ZengMDPI AGCancers2072-66942021-07-01133605360510.3390/cancers13143605Reconsideration of the Appropriate Dissection Range Based on Japanese Anatomical Classification for Resectable Pancreatic Head Cancer in the Era of Multimodal TreatmentYuichi Nagakawa0Naoya Nakagawa1Chie Takishita2Ichiro Uyama3Shingo Kozono4Hiroaki Osakabe5Kenta Suzuki6Nobuhiko Nakagawa7Yuichi Hosokawa8Tomoki Shirota9Masayuki Honda10Tesshi Yamada11Kenji Katsumata12Akihiko Tsuchida13Department of Gastrointestinal and Pediatric Surgery, Tokyo Medical University, Tokyo 160-8402, JapanDepartment of Gastrointestinal and Pediatric Surgery, Tokyo Medical University, Tokyo 160-8402, JapanDepartment of Gastrointestinal and Pediatric Surgery, Tokyo Medical University, Tokyo 160-8402, JapanDepartment of Advanced Robotic and Endoscopic Surgery, Fujita Health University, Toyoake 470-1192, Aichi, JapanDepartment of Gastrointestinal and Pediatric Surgery, Tokyo Medical University, Tokyo 160-8402, JapanDepartment of Gastrointestinal and Pediatric Surgery, Tokyo Medical University, Tokyo 160-8402, JapanDepartment of Gastrointestinal and Pediatric Surgery, Tokyo Medical University, Tokyo 160-8402, JapanDepartment of Gastrointestinal and Pediatric Surgery, Tokyo Medical University, Tokyo 160-8402, JapanDepartment of Gastrointestinal and Pediatric Surgery, Tokyo Medical University, Tokyo 160-8402, JapanDepartment of Gastrointestinal and Pediatric Surgery, Tokyo Medical University, Tokyo 160-8402, JapanDepartment of Gastrointestinal and Pediatric Surgery, Tokyo Medical University, Tokyo 160-8402, JapanDepartment of Gastrointestinal and Pediatric Surgery, Tokyo Medical University, Tokyo 160-8402, JapanDepartment of Gastrointestinal and Pediatric Surgery, Tokyo Medical University, Tokyo 160-8402, JapanDepartment of Gastrointestinal and Pediatric Surgery, Tokyo Medical University, Tokyo 160-8402, JapanPatients with resectable pancreatic cancer are considered to already have micro-distant metastasis, because most of the recurrence patterns postoperatively are distant metastases. Multimodal treatment dramatically improves prognosis; thus, micro-distant metastasis is considered to be controlled by chemotherapy. The survival benefit of “regional lymph node dissection” for pancreatic head cancer remains unclear. We reviewed the literature that could be helpful in determining the appropriate resection range. Regional lymph nodes with no suspected metastases on preoperative imaging may become areas treated with preoperative and postoperative adjuvant chemotherapy. Many studies have reported that the R0 resection rate is associated with prognosis. Thus, “dissection to achieve R0 resection” is required. The recent development of high-quality computed tomography has made it possible to evaluate the extent of cancer infiltration. Therefore, it is possible to simulate the dissection range to achieve R0 resection preoperatively. However, it is often difficult to distinguish between areas of inflammatory changes and cancer infiltration during resection. Even if the “dissection to achieve R0 resection” range is simulated based on the computed tomography evaluation, it is difficult to identify the range intraoperatively. It is necessary to be aware of anatomical landmarks to determine the appropriate dissection range during surgery.https://www.mdpi.com/2072-6694/13/14/3605pancreatic cancerpancreaticoduodenectomymesopancreassuperior mesenteric arterynerve and fibrous tissuesadjuvant chemotherapy
collection	DOAJ
language	English
format	Article
sources	DOAJ
author	Yuichi Nagakawa Naoya Nakagawa Chie Takishita Ichiro Uyama Shingo Kozono Hiroaki Osakabe Kenta Suzuki Nobuhiko Nakagawa Yuichi Hosokawa Tomoki Shirota Masayuki Honda Tesshi Yamada Kenji Katsumata Akihiko Tsuchida
spellingShingle	Yuichi Nagakawa Naoya Nakagawa Chie Takishita Ichiro Uyama Shingo Kozono Hiroaki Osakabe Kenta Suzuki Nobuhiko Nakagawa Yuichi Hosokawa Tomoki Shirota Masayuki Honda Tesshi Yamada Kenji Katsumata Akihiko Tsuchida Reconsideration of the Appropriate Dissection Range Based on Japanese Anatomical Classification for Resectable Pancreatic Head Cancer in the Era of Multimodal Treatment Cancers pancreatic cancer pancreaticoduodenectomy mesopancreas superior mesenteric artery nerve and fibrous tissues adjuvant chemotherapy
author_facet	Yuichi Nagakawa Naoya Nakagawa Chie Takishita Ichiro Uyama Shingo Kozono Hiroaki Osakabe Kenta Suzuki Nobuhiko Nakagawa Yuichi Hosokawa Tomoki Shirota Masayuki Honda Tesshi Yamada Kenji Katsumata Akihiko Tsuchida
author_sort	Yuichi Nagakawa
title	Reconsideration of the Appropriate Dissection Range Based on Japanese Anatomical Classification for Resectable Pancreatic Head Cancer in the Era of Multimodal Treatment
title_short	Reconsideration of the Appropriate Dissection Range Based on Japanese Anatomical Classification for Resectable Pancreatic Head Cancer in the Era of Multimodal Treatment
title_full	Reconsideration of the Appropriate Dissection Range Based on Japanese Anatomical Classification for Resectable Pancreatic Head Cancer in the Era of Multimodal Treatment
title_fullStr	Reconsideration of the Appropriate Dissection Range Based on Japanese Anatomical Classification for Resectable Pancreatic Head Cancer in the Era of Multimodal Treatment
title_full_unstemmed	Reconsideration of the Appropriate Dissection Range Based on Japanese Anatomical Classification for Resectable Pancreatic Head Cancer in the Era of Multimodal Treatment
title_sort	reconsideration of the appropriate dissection range based on japanese anatomical classification for resectable pancreatic head cancer in the era of multimodal treatment
publisher	MDPI AG
series	Cancers
issn	2072-6694
publishDate	2021-07-01
description	Patients with resectable pancreatic cancer are considered to already have micro-distant metastasis, because most of the recurrence patterns postoperatively are distant metastases. Multimodal treatment dramatically improves prognosis; thus, micro-distant metastasis is considered to be controlled by chemotherapy. The survival benefit of “regional lymph node dissection” for pancreatic head cancer remains unclear. We reviewed the literature that could be helpful in determining the appropriate resection range. Regional lymph nodes with no suspected metastases on preoperative imaging may become areas treated with preoperative and postoperative adjuvant chemotherapy. Many studies have reported that the R0 resection rate is associated with prognosis. Thus, “dissection to achieve R0 resection” is required. The recent development of high-quality computed tomography has made it possible to evaluate the extent of cancer infiltration. Therefore, it is possible to simulate the dissection range to achieve R0 resection preoperatively. However, it is often difficult to distinguish between areas of inflammatory changes and cancer infiltration during resection. Even if the “dissection to achieve R0 resection” range is simulated based on the computed tomography evaluation, it is difficult to identify the range intraoperatively. It is necessary to be aware of anatomical landmarks to determine the appropriate dissection range during surgery.
topic	pancreatic cancer pancreaticoduodenectomy mesopancreas superior mesenteric artery nerve and fibrous tissues adjuvant chemotherapy
url	https://www.mdpi.com/2072-6694/13/14/3605
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Reconsideration of the Appropriate Dissection Range Based on Japanese Anatomical Classification for Resectable Pancreatic Head Cancer in the Era of Multimodal Treatment

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