Radiofrequency assisted pancreaticoduodenectomy for palliative surgical resection of locally advanced pancreatic adenocarcinoma
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Jayant Kumar1, Isabella Reccia1, Mikael H. Sodergren1, Tomokazu Kusano1, Artur Zanellato1, Madhava Pai1, Duncan Spalding1, Dimitris Zacharoulis2 and Nagy Habib1
1Department of Surgery and Cancer, Hammersmith Campus, Imperial College London, London, UK
2Department of General Surgery, University Hospital of Larissa, Larissa, Greece
Nagy Habib, email: [email protected]
Keywords: pancreatic ductal adenocarcinoma; radiofrequency ablation; pancreaticoduodenectomy; palliation
Received: October 02, 2017 Accepted: February 21, 2018 Epub: February 28, 2018 Published: March 20, 2018
Background: Despite careful patient selection and preoperative investigations curative resection rate (R0) in pancreaticoduodenectomy ranges from 15% to 87%. Here we describe a new palliative approach for pancreaticoduodenectomy using a radiofrequency energy device to ablate tumor in situ in patients undergoing R1/R2 resections for locally advanced pancreatic ductal adenocarcinoma where vascular reconstruction was not feasible.
Results: There was neither postoperative mortality nor significant morbidity. Each time the ablation lasted less than 15 minutes. Following radiofrequency ablation it was observed that the tumor remnant attached to the vessel had shrunk significantly. In four patients this allowed easier separation and dissection of the ablated tumor from the adherent vessel leading to R1 resection. In the other two patients, the ablated tumor did not separate from vessel due to true tumor invasion and patients had an R2 resection. The ablated remnant part of the tumor was left in situ.
Conclusion: Whenever pancreaticoduodenectomy with R0 resection cannot be achieved, this new palliative procedure could be considered in order to facilitate resection and enable maximum destruction in remnant tumors.
Method: Six patients with suspected tumor infiltration and where vascular reconstruction was not warranted underwent radiofrequency-assisted pancreaticoduodenectomy for locally advanced pancreatic ductal adenocarcinoma. Radiofrequency was applied across the tumor vertically 5–10 mm from the edge of the mesenteric and portal veins. Following ablation, the duodenum and the head of pancreas were removed after knife excision along the ablated line. The remaining ablated tissue was left in situ attached to the vessel.
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