After making 16 pancreatic resections combined with arterial resection since 2007, the Department of General and digestive surgery HM Sanchinarro last 2 projects for the development of this technique
Pancreatic cancer is one of digestive specific therapeutic complexity tumors.
Surgery, chemotherapy and radiotherapy play an important role in their treatment. Approximately 35% of diagnosed cases are considered unresectable at the time of diagnosis and the most frequent cause of unresectability is the arterial or venous invasion.
Currently, venous invasion is not considered an absolute contraindication to perform a surgical treatment because tumor resection associated with posterior resection venous vascular reconstruction is performed. Not so with blood involvement. For most physicians who treat these patients groups, this involvement is considered as a given tumor aggressiveness and therefore palliative therapeutic procedures used.
Only a very small surgical groups in the world number believe that some of these patients should be treated similarly, ie with resection of the tumor and subsequent arterial reconstruction. One is the Department of General Surgery and Digestive Diseases Hospital HM University Sanchinarro, led by Drs. Vicente Emilio and Yolanda Quijano.
Both explained that the process described, pancreatic resection combined with arterial resection (celiac artery or hepatic artery), "was made first by HM hospitals in 2007. At that time it was one of the first Western surgical groups conducted successfully this intervention. "
Since then, HM Sanchinarro surgical team has acquired a total experience of 16 cases with the technique described, most of them made in that hospital. This series is one of the largest described in the Western world.
"The results have been very satisfactory in terms of complete disappearance of symptoms, improvement in quality of life obtained and obtaining prolonged survival", explain Drs. Vincent and Quijano. To obtain these results is essential to carry out radical surgery in order to make a complete tumor resection obtaining clear margins, ie, removing the entire tumor while macro or microscopic tumor remains. When this is achieved, certainly surprising results. "In the coming months we will publish an article describes surprisingly prolonged survival in patients suffering from locally advanced pancreatic carcinomas, some of them even with vascular involvement," added the expert.
Requirements to perform this surgery
The complexity of this surgery is given by dissection and resection of the tumor process, for the identification and release of different vascular axes and sometimes by resection thereof with subsequent reconstruction. In order to carry it out they are needed three basic aspects:
1) Possess extensive experience in pancreatic surgery. The service of general surgery and digestive HM Sanchinarro evaluates each year about 200 MS patients, of which 70-80 are considered surgical.
2) Have a surgical team that has a great experience in vascular surgery abdominal visceral trunks. This experience must include microsurgery, since sometimes arterial reconstruction is due to perform in vessels of very small gauge (2 mm diameter).
3) Incorporate the patient to a multidisciplinary medical group. It can not be considered this surgery outside a neo-adjuvant and adjuvant treatment including chemotherapy and radiotherapy personalized art technology.
"The service of general surgery and digestive HM Sanchinarro has all the requirements needed to treat these patients," say Drs. Vincent and Quijano.
-A High experience in treating patients with pancreatic cancer, given the large number of national and international patients they treat.
-a Surgical team with extensive experience in vascular surgery and microsurgery gained in the field of digestive organ transplants.
-A Cancer center that, despite it only takes eight years of activity, has achieved great prestige doctor. It has the highest means to try to form multidisciplinary these patients: laboratory of therapeutic targets, phase I unit, extracranial radiosurgery and xenograft program to provide customized treatments to the molecular characteristics of the tumor.
"Different scientific publications, published and communicated in international journals and, respectively, congresses have been performed in our hospital, where important innovations have been described in the surgical and oncological terrain" point specialists.
New projects for the development of this technique in the service of general surgery and digestive HM Sanchinarro have two very interesting projects for the development of this technique:
1) The incorporation of robotic surgery to perform this complex surgical technique. Experts explain that "since we started robotic surgery program in 2010, our group has performed 48 pancreatic resections with robotic support, many of them particularly complex. This series is one of the largest in the world surgical field. We believe that robotic surgery may represent an important advance in selected cases of pancreatic where due to a vascular resection associated cancer. "
2) The application of robotic microsurgical vascular support reconstruction. "We recently started this experience, unprecedented in the world, that we can have a significant impact in the future," say Drs. Vincent and Quijano.
The technique initially described by the Department of General Surgery and Digestive HM Sanchinarro and the various amendments that have been made in recent years, have been published in various medical journals: 2 international publications, 1 national, 21 international conferences and 4 national congresses.
Also, this experience has been presented in scientific forums of the highest level: 21 international and 4 national (American College of Surgeons, associations European, Asian and American Surgery Hepato-biliary-pancreatic, World Congress of Surgery Hepato-biliary-pancreatic, Congress World IASGO, Spanish Association of Surgeons, Spanish Association of Digestive Diseases, etc.
This procedure is also on the audio-visual library of the American College of Surgeons since 2008, forced the global benchmark for knowledge and dissemination of those considered innovative surgical techniques point.