Showing papers by "M.W. Büchler published in 2021"
TL;DR: A review of the literature addressing current technical advances in surgery for PDAC was performed, and current state-of-the-art surgical techniques summarized in this article, providing an overview of technical advances to facilitate curative-intent resection in locally advanced pancreatic ductal adenocarcinoma.
Abstract: Background Multimodal treatment concepts enhance options for surgery in locally advanced pancreatic ductal adenocarcinoma (PDAC). This review provides an overview of technical advances to facilitate curative-intent resection in PDAC. Methods A review of the literature addressing current technical advances in surgery for PDAC was performed, and current state-of-the-art surgical techniques summarized. Results Artery-first and uncinate-first approaches, dissection of the anatomical triangle between the coeliac and superior mesenteric arteries and the portomesenteric vein, and radical antegrade modular pancreatosplenectomy were introduced to enhance the completeness of resection and reduce the risk of local recurrence. Elaborated techniques for resection and reconstruction of the mesenteric-portal vein axis and a venous bypass graft-first approach frequently allow resection of PDAC with venous involvement, even in patients with portal venous congestion and cavernous transformation. Arterial involvement does not preclude surgical resection per se, but may become surgically manageable with recent techniques of arterial divestment or arterial resection following neoadjuvant treatment. Conclusion Advanced techniques of surgical resection and vessel reconstruction provide a toolkit for curative-intent surgery in borderline resectable and locally advanced PDAC. Effects of these surgical approaches on overall survival remain to be proven with high-level clinical evidence.
21 citations
TL;DR: In an international case vignette study as mentioned in this paper, the authors evaluated current expert opinion regarding the diagnosis and treatment of pancreatic duct disruption and disconnection and found that there is no consensus among experts in clinical practice.
Abstract: Background: Pancreatic duct disruption or disconnection is a potentially severe complication of necrotizing pancreatitis With no existing treatment guidelines, it is unclear whether there is any consensus among experts in clinical practice We evaluated current expert opinion regarding the diagnosis and treatment of pancreatic duct disruption and disconnection in an international case vignette study Methods: An online case vignette survey was sent to 110 international expert pancreatologists Expert selection was based on publications in the last 5 years and/or participation in development of IAP/APA and ESGE guidelines on acute pancreatitis Consensus was defined as agreement by at least 75% of the experts Results: The response rate was 51% (n = 56) Forty-four experts (79%) obtained a MRI/MRCP and 52 experts (93%) measured amylase levels in percutaneous drain fluid to evaluate pancreatic duct integrity The majority of experts favored endoscopic transluminal drainage for infected (peri)pancreatic necrosis and pancreatic duct disruption (84%, n = 45) or disconnection (88%, n = 43) Consensus was lacking regarding the treatment of patients with persistent percutaneous drain production, and with persistent sterile necrosis Conclusion: This international survey of experts demonstrates that there are many areas for which no consensus existed, providing clear focus for future investigation
9 citations