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Pancreatic carcinoma. Second-look operation?
1Department of Surgery, Bradford Royal Infirmary, UK.
Summary
Second-look operation (SLO) may benefit selected patients with pancreatic cancer. Consider SLO for fit patients with acute pancreatitis during initial surgery, as it can affect tumor resectability assessment.
Area of Science:
- Surgical Oncology
- Gastroenterology
Background:
- Pancreatic and preiampullary cancers present complex surgical challenges.
- Palliative bypass procedures are common for unresectable cases.
Purpose of the Study:
- To evaluate the utility of second-look operation (SLO) in patients with pancreatic head and preiampullary tumors.
- To determine if acute pancreatitis influences surgical resectability assessment.
Main Methods:
- Retrospective analysis of 146 patients with pancreatic head/preiampullary carcinoma.
- 31 patients underwent Whipple's pancreaticoduodenectomy (18 initial, 13 SLO).
- 36 patients selected for palliative bypass were reassessed for SLO.
Main Results:
- 13 patients underwent Whipple's procedure during SLO.
- 10 of these 13 patients had elevated serum amylase, indicating pancreatitis.
- Pancreatitis may falsely suggest local tumor invasion, impacting initial resectability decisions.
Conclusions:
- SLO is a viable option for selected patients with pancreatic head and preiampullary tumors.
- Concomitant acute pancreatitis at initial laparotomy warrants consideration for SLO.
- SLO can potentially identify resectable disease masked by pancreatitis during initial exploration.