Healthcare Professionals
Approaches to improve long term survival
The surgical approaches to increase long term survival rates are:
- Extended Lymphadenectomy
- Vascular Resection
Extended Lymphadenectomy
- Lymph nodes are involved from the early stages of the cancer, and it was thought that removal of lymph nodes may lengthen survival rate and period.
- Lymph nodes may be affected by disease outside the regular dissection areas and dissection of such nodes during the resection has been attempted.
- While some studies support extended lymphadenectomy, level I evidence is lacking and extended lymphadenectomy is presently not recommended as a routine outside of clinical trials.
Vascular Resection
- Studies suggest that involvement of the portal vein and SMV is due to its proximal location and not because of aggressive growth and spread of the tumor.
- Outcome and survival after pancreaticoduodenectomy is unaffected by portal-vein resection but it is considered to help in achieving R0 resection, where all the margins are tumor free.9
- Arterial resection is a complex procedure and is performed only to achieve R0 resection. Benefits of arterial resection are not established but the procedure is associated with high morbidity and mortality rates.
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