From the Guidelines
Surgical Approach for Pancreatic Head Tumor
The surgical approach for a pancreatic head tumor is partial pancreatico-duodenectomy, also known as the Whipple procedure 1.
- This approach is mainly suitable for patients with early-stage disease, mainly stage I and some stage II.
- Pancreatoduodenectomy is the treatment of choice for patients with pancreatic head tumors, and it involves the dissection of the lymph nodes of the hepatoduodenal ligament, the common hepatic artery, the portal vein, and the right-sided celiac artery lymph node 1.
- The goal of surgery is to achieve an R0 resection, which means removing all cancerous tissue with a margin of healthy tissue around it 1.
- In cases where the tumor involves the portal or superior mesenteric vein, complete venous resection followed by reconstruction may be possible to obtain an R0 resection 1.
- Arterial resections during pancreatoduodenectomy are associated with increased morbidity and mortality and are not recommended 1.
- Frozen sections analysis of pancreatic neck transection and common bile duct transection margins is recommended to ensure clear margins 1.
- The International Study Group of Pancreatic Surgery recommends adhering to the guidelines from the British Royal College of Pathologists for specimen examination and the R1 definition (margin <1 mm) 1.
From the Research
Surgical Approaches for Pancreatic Head Tumors
The surgical approach for pancreatic head tumors can vary depending on the type and stage of the tumor. Some of the common surgical approaches include:
- Pancreaticoduodenectomy (Whipple procedure) 2, 3, 4
- Duodenum-preserving pancreatic head resection 2
- Extended radical Whipple operation 3
- Minimally invasive pancreaticoduodenectomy (PD) 5, 6
- Vascular resection and reconstruction for locally invasive tumors 6
Key Considerations
When deciding on a surgical approach, several factors are taken into consideration, including:
- Tumor resectability 3, 4
- Lymph node involvement 3, 5, 4
- Vascular involvement 3, 6
- Patient's overall health and medical history 2, 6
Surgical Techniques
Various surgical techniques are used to restore gastrointestinal continuity and preserve pancreatic function, including: