Recent Innovations in Surgical Procedures of Pancreatic Neoplasms

Foreword
Preface
Contents
1: Introduction to Diagnosis and Treatment in Pancreatic Neoplasms
	1.1	 The Environment for Nihilism in Pancreatic Cancer
	1.2	 Key Points in the Diagnosis of Pancreatic Cancer
		1.2.1	 Molecular Diagnosis: Toward the Early Diagnosis in Pancreatic Cancer
		1.2.2	 Radiomics: Diagnostic Imaging as a Tool for Pathological Specification and Prognosis in Pancreatic Cancer
	1.3	 Key Points in the Treatment of Pancreatic Cancer
		1.3.1	 Medical Treatment: Personalized and Precision Therapy in Pancreatic Cancer
		1.3.2	 The Surgical Approach as a Guarantor of the Locoregional Eradication of Pancreatic Cancer
	References
2: Pancreatic Cystic Neoplasms: Serous Cystadenoma, Mucinous Cystadenoma
	2.1	 Serous Cystadenoma
	2.2	 Mucinous Cystic Neoplasia (MCN) (Tables 2.2 and 2.3)
	References
3: Intraductal Papillary Mucinous Tumors Principal and Lateral Branch of IPMT: Preoperative Management, Surgical Indications, and Surgical Techniques
	3.1	 Definition
	3.2	 Epidemiology
	3.3	 Classification
	3.4	 Pathogenesis
	3.5	 Clinical Presentation
	3.6	 Diagnostic Approach
	3.7	 Clinical and Surgical Management According to Published Guidelines
	References
4: Pancreatic Neuroendocrine Tumors: Diagnosis, Management, and Intraoperative Techniques
	4.1	 Background
	4.2	 Diagnosis of pNETs: Imagining and Histological Diagnosis
		4.2.1	 Imaging Studies
			4.2.1.1	 Ultrasound (US)
			4.2.1.2	 Computed Tomography
			4.2.1.3	 Magnetic Resonance Imaging
			4.2.1.4	 Endoscopic Ultrasonography
			4.2.1.5	 Somatostatin Receptor-Based Imaging and Positron Emission Tomography
		4.2.2	 Histological Diagnosis
	4.3	 Classification
	4.4	 Neuroendocrine Syndromes
		4.4.1	 Functioning Pancreatic Neuroendocrine Tumors
			4.4.1.1	 Insulinoma
			4.4.1.2	 Gastrinoma
			4.4.1.3	 VIPoma
			4.4.1.4	 Glucagonoma
		4.4.2	 Non-functioning Pancreatic Neuroendocrine Tumors
	4.5	 Localized pNETs Management
		4.5.1	 How Should Small Non-functioning (NF) pNETs Be Treated?
		4.5.2	 How Should Functional Lesions Be Treated?
		4.5.3	 What Is the Role of Parenchymal-Sparing Surgical Techniques (PSRs)?
		4.5.4	 What Is the Role of Splenic Preservation During DP as the Management of pNETs?
		4.5.5	 What Is the Role of Lymphadenectomy in pNETs?
		4.5.6	 What Is the Role of Minimally Invasive Surgery in the Treatment of pNETs?
		4.5.7	 How Should We Manage pNETs in MEN1 Syndrome and Other Familial Diseases?
	4.6	 Management of Metastatic pNETS
		4.6.1	 Primary Tumor Resection in Patients with Metastatic PNET
		4.6.2	 Hepatic Cytoreduction
		4.6.3	 Liver Transplantation
		4.6.4	 Combined Pancreatectomy and Liver Debulking
		4.6.5	 Removing Primary Tumor When Unresectable Metastatic Disease Is Present
		4.6.6	 Primary Tumor Resection or Hepatic Cytoreduction When There Is Extrahepatic Disease
	4.7	 Systemic Therapy
		4.7.1	 Symptoms-Directed Therapy in pNETs
		4.7.2	 Somatostatin Analogues
		4.7.3	 Molecularly Targeted Therapies
		4.7.4	 Cytotoxic Chemotherapy
		4.7.5	 Peptide Receptor Radionuclide Therapy (PRRT)
	References
5: Pancreatic Adenocarcinoma: Current Status in Diagnostic Methods, Surgical Techniques, Complications, and Short/Long-Term Survival
	5.1	 Epidemiology and Risk Factors
	5.2	 Clinical Symptoms and Early Diagnosis
	5.3	 Diagnostic Protocol
	5.4	 Resectability Assessment
	5.5	 Staging and Prognosis
	5.6	 Surgical Management
	5.7	 Complications and Postoperative Results
	5.8	 Medical Management
	5.9	 Recurrence in Ca Pancreas
	5.10	 Conclusions
	References
6: Role of Endoscopic Ultrasound and Endoscopic Retrograde Cholangiopancreatography in the Diagnosis and Treatment of Pancreatic Tumors
	6.1	 Introduction
	6.2	 Role of EUS for Diagnosis of Pancreatic Cancer
		6.2.1	 EUS-Guided Tissue Diagnosis
			6.2.1.1	 Indications of EUS-FNA
			6.2.1.2	 Safety and Complications
		6.2.2	 Pancreatic Cancer Screening
	6.3	 Role of EUS for the Staging of Pancreatic Cancer
	6.4	 Role of EUS in Treatment
		6.4.1	 Celiac Plexus Neurolysis/Block
		6.4.2	 EUS Fine Needle Injection and Radiofrequency Ablation
		6.4.3	 Biliary Drainage
		6.4.4	 Role of EUS in Gastric Outlet Obstruction
	6.5	 Role of ERCP in Pancreatic Cancer
		6.5.1	 Indications
	6.6	 Role of ERCP for Diagnosis of Pancreatic Cancer
		6.6.1	 ERCP-Tissue Sampling
			6.6.1.1	 Brush Cytology
			6.6.1.2	 Endobiliary Forceps Biopsy
			6.6.1.3	 Multimodal Tissue Sampling
			6.6.1.4	 Cholangiopancreatoscopic-Guided Biopsy
	6.7	 Role of ERCP in Treatment
		6.7.1	 ERCP in Preoperative Biliary Drainage in Resectable Pancreatic Cancer
		6.7.2	 ERCP Biliary Drainage in Unresectable Pancreatic Cancer
		6.7.3	 Role of ERCP in Gastric Outlet Obstruction
	6.8	 Conclusions
	References
7: Interventional Biliary Radiology in Pancreatic Neoplasm
	7.1	 Introduction
	7.2	 Etiology
	7.3	 Diagnostic Imaging
	7.4	 Management of Malignant Stenosis of the Bile Ducts
	7.5	 Biliary Drainage Technique
		7.5.1	 Patient Preparation
		7.5.2	 Percutaneous Transhepatic Cholangiography
		7.5.3	 Biliary Drainage
		7.5.4	 Percutaneous Cholecystostomy
	7.6	 Indications Percutaneous Biliary Drainage
	7.7	 Biliary Drainage Complications
	7.8	 Biliary Percutaneous Treatment in Malignant Neoplastic Obstructions
		7.8.1	 Indications
		7.8.2	 Complications of Metallic Stents in Malignant Obstruction of Bile Ducts
	7.9	 Conclusions
	References
8: Pancreatic Surgical Resections
	8.1	 Introduction
	8.2	 The Pancreaticodu
	8.3	 Methods for Restoration of Pancreatico-Enteric Continuity
		8.3.1	 Invagination Pancreaticojejunostomy
		8.3.2	 Binding Pancreaticojejunostomy
		8.3.3	 Duct-to-Mucosa Pancreaticojejunostomy
	8.4	 Pancreaticogastrostomy
	8.5	 Ways to Decrease Complications After Pancreatic Anastomosis
	References
9: Current Status of Vascular Resections in Pancreatic Cancer Surgery
	9.1	 Introduction
	9.2	 Resectability of Pancreatic Ductal Adenocarcinomas
	9.3	 Neoadjuvant Therapy and Patient Selection
	9.4	 Venous Resections and Reconstruction
	9.5	 Arterial Resections
	9.6	 Conclusions
	References
10: Minimally Invasive Surgery in Pancreatic Tumors
	10.1	 Introduction
	10.2	 Laparoscopic Distal Pancreatectomy
	10.3	 Laparoscopic Distal Pancreatectomy (LDP) with Splenectomy
	10.4	 Laparoscopic Pancreaticoduodenectomy (LPD)
		10.4.1	 Indications for LPD
		10.4.2	 Pancreaticoyeyunostomy (Duc-to-Mucosa Anastomosis)
		10.4.3	 Hepaticojejunostomy
		10.4.4	 Gastrojejunostomy
	10.5	 Robotic Pancreaticoduodenectomy
	References
11: Quality Standards in Pancreatic Surgery
	11.1	 Introduction
	11.2	 Mortality
	11.3	 Postoperative Bleeding
	11.4	 Pancreatic Fistula
	11.5	 Surgical Reintervention
	11.6	 Quality of Oncological Resection
	11.7	 Other Indicators
	References
12: Postoperative Complications Management in Pancreatic Surgery
	12.1	 Introduction
	12.2	 Pancreatic Fistula
	12.3	 Postoperative Bleeding
	12.4	 Delayed Gastric Emptying
	12.5	 Early Postoperative Pancreatitis
	12.6	 Diabetes Mellitus
	12.7	 Exocrine Pancreatic Insufficiency
	12.8	 Cholangitis
	12.9	 Late Acute Pancreatitis
	References
13: Oncologic Adjuvant and Neoadjuvant Treatments in Pancreatic Adenocarcinoma
	13.1	 Introduction
	13.2	 Adjuvant Chemotherapy in PAC
		13.2.1	 ACT Indication
		13.2.2	 ACT Regimens
			13.2.2.1	 Adjuvant Monotherapy
			13.2.2.2	 Combinations with Gemcitabine
			13.2.2.3	 FOLFIRINOX
		13.2.3	 Chemoradiotherapy (CT-RT)
		13.2.4	 ACT Starting Point and Duration
		13.2.5	 Biomarkers
			13.2.5.1	 Ca 19.9
			13.2.5.2	 Circulating Tumoral DNA (ctDNA)
			13.2.5.3	 BRCA Mutation
			13.2.5.4	 Predictive Gemcitabine Response Biomarkers
	13.3	 Neoadjuvant Chemotherapy in PAC
		13.3.1	 Overview
		13.3.2	 NACT in Locally Advanced PAC (LAPAC)
		13.3.3	 NACT in Borderline PAC (BLPAC)
		13.3.4	 NACT in PAC Potentially Resectable (PACPR)
	References