RT Book, Section
A1 Evans, Douglas B.
A2 Zinner, Michael J.
A2 Ashley, Stanley W.
A2 Hines, O. Joe
SR Print(0)
ID 1160046035
T1 Perspective on Pancreatic Neoplasms
T2 Maingot's Abdominal Operations, 13e
YR 2019
FD 2019
PB McGraw-Hill Education
PP New York, NY
SN 9780071843072
LK accesssurgery.mhmedical.com/content.aspx?aid=1160046035
RD 2024/10/03
AB Drs.  Gajdos,  McCarter,  Edil,  Paniccia,  and  Schulick  provide  an  extremely  comprehensive  chapter  on  the  evaluation  and  treatment  of  patients  with  cancer  of  the  periampullary  region  and  especially  the  pancreatic  head  (Chapter  73).  ­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  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  operation,  especially  if  vascular  resection  and  reconstruction  may  be  indicated.  The  ability  to  preoperatively  classify  patients  as  having  resectable,  borderline  resectable,  or  locally  advanced  pancreatic  cancer  (LAPC)  allows  for  optimal  treatment  sequencing  (often  including  neoadjuvant  therapy),  the  evaluation  of  patients  for  investigator-­initiated  and  cooperative  group  clinical  trials,  and  the  referral  of  patients  to  higher  volume  centers.1  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.