Assessment of the level III of Inoue by preoperative endoscopic ultrasound and elastography : a novel approach to predict a periarterial divestment technique in borderline resectable (BR) or locally advanced (LA) pancreatic adenocarcinoma-How I do it
Alberti Delgado, Piero (Universitat Autònoma de Barcelona. Departament de Cirurgia)
Pando, Elizabeth (Universitat Autònoma de Barcelona. Departament de Cirurgia)
Abu-Suboh Abadia, Monder (Hospital Universitari Vall d'Hebron)
Masachs, Miquel (Hospital Universitari Vall d'Hebron)
Merino, Xavier (Hospital Universitari Vall d'Hebron)
Salcedo, Maite (Hospital Universitari Vall d'Hebron)
Macarulla Mercadé, Teresa (Vall d'Hebron Institut d'Oncologia)
Balsells, Joaquim (Hospital Universitari Vall d'Hebron)
Charco, Ramon (Hospital Universitari Vall d'Hebron)

Date:	2023
Abstract:	Background: Periarterial divestment is a surgical technique to approach borderline resectable (BR) or locally advanced (LA) pancreatic ductal adenocarcinoma (PDAC) with arterial involvement. There are no reports in the literature regarding the role of endoscopic ultrasound and elastography (EUS-EG) in exploring the integrity of Inoue's level III and its correlation with the periarterial divestment technique feasibility. Our research is aimed at exploring the role of EUS-EG in this scenario. Methods: We describe our approach to Inoue's level II by EUS-EG in patients with BR and LA pancreatic cancer patients after neoadjuvant chemotherapy. Results: Between June 2019 and December 2020, four patients out of 25 were eligible to perform a preoperative EUS-EG. In all cases, Inoue's level III integrity was corroborated by EUS-EG and confirmed posteriorly in the surgical scenario where a periarterial divestment technique was feasible. Vein resections were necessary in all cases, with no need for arterial resection. An R0 (> 1 mm) margin was achieved in all patients, and the histopathological assessment showed the presence of neurovascular tissue at the peripheral arterial margin. Conclusion: Preoperatively, EUS-EG is a novel approach to explore the integrity of Inoue's level III and could be helpful to preclude a periarterial divestment technique in borderline resectable or locally advanced pancreatic adenocarcinoma with arterial involvement.
Note:	Altres ajuts: acords transformatius de la UAB
Rights:	Aquest document està subjecte a una llicència d'ús Creative Commons. Es permet la reproducció total o parcial, la distribució, la comunicació pública de l'obra i la creació d'obres derivades, fins i tot amb finalitats comercials, sempre i quan es reconegui l'autoria de l'obra original.
Language:	Anglès
Document:	Article ; recerca ; Versió publicada
Subject:	Periarterial divestment ; Pancreatic cancer ; Locally advanced pancreatic cancer ; Triangle operation ; Borderline pancreatic cancer ; SDG 3 - Good Health and Well-being
Published in:	Langenbeck's archives of surgery, Vol. 408 (2023) , art. 367, ISSN 1435-2451

DOI: 10.1007/s00423-023-03105-x
PMID: 37731066

10 p, 1.6 MB

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