TY  - CHAP
M1  - Book, Section
TI  - Chapter 61A. Perspective on Pancreatic Neoplasms
A1  - Evans, Douglas B.
A2  - Zinner, Michael J.
A2  - Ashley, Stanley W.
Y1  - 2013
N1  - 
T2  - Maingot's Abdominal Operations, 12e
AB  - Dr  Wolfgang,  Dr  Schulick,  and  Dr  Cameron  provide  an  extremely  comprehensive  chapter  on  the  evaluation  and  treatment  of  patients  with  cancer  of  the  periampullary  region  and  specifically  the  pancreatic  head.  The  multidisciplinary  working  group  from  Johns  Hopkins  Hospital  has  made  numerous  contributions  to  the  field  of  pancreatic  cancer  biology  as  well  as  the  clinical  management  of  patients  with  this  disease.  As  all  of  you  know,  over  the  past  two  to  three  decades,  Dr  Cameron  has  demonstrated  how  to  surgically  manage  patients  with  pancreatic  cancer  to  achieve  optimal  outcome.  Importantly,  there  has  been  a  tremendous  advance  in  both  the  understanding  of  the  molecular  biology  of  pancreatic  cancer  as  well  as  our  ability  to  accurately  image  the  pancreas  and  periampullary  region  prior  to  surgery.  Advances  in  both  computed  tomography  (CT)  and  magnetic  resonance  imaging  (MRI)  have  allowed  for  accurate  assessment  of  critically  important  tumor-vessel  relationships.  Such  accurate  assessment  of  the  relevant  anatomy  is  important  for  both  pretreatment  staging  and  for  planning  the  technical  steps  in  performing  pancreaticoduodenectomy,  especially  if  vascular  resection  and  reconstruction  may  be  indicated.  Although  very  experienced  surgeons  such  as  the  authors  can  accurately  assess  resectability  at  the  time  of  laparotomy,  the  ability  to  preoperatively  classify  patients  as  resectable,  borderline  resectable  or  locally  advanced  allows  for  the  appropriate  triage  of  patients  for  optimal  treatment  sequencing  (surgery  first  or  after  neoadjuvant  therapy),  the  evaluation  of  patients  for  investigator-initiated  and  cooperative  group  clinical  trials,  and  for  the  referral  of  patients  to  higher  volume  centers.  Indeed,  to  the  extent  that  outcome  is  improved  for  patients  with  localized  disease  at  high-volume  centers  (by  high-volume  surgeons),  patients  will  need  to  be  accurately  staged  (CT  imaging)  and,  when  necessary,  have  biliary  stents  placed  safely  in  order  to  facilitate  referral  to  a  specialty  center.  The  ability  to  perform  endoscopic  ultrasound  (EUS)–guided  fine-needle  aspiration  (FNA)  biopsy  will  prevent  diagnostic  uncertainty  and  allow  for  medical  oncology  consultation  and  multidisciplinary  care.  
SN  - 
PB  - The McGraw-Hill Companies
CY  - New York, NY
Y2  - 2024/04/24
UR  - accesssurgery.mhmedical.com/content.aspx?aid=57020703
ER  -