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Pancreatic Malignancies:
‘Think Different’
on Postoperative Complications
Jas Samra D Phil (Oxon), FRCS (Eng & Ed), FRACS
Clinical Professor of Surgery
Hepato-Biliary and Pancreatic Surgical Unit
Royal North Shore Hospital
No conflict of interest
Pancreatic Cancer
Mortality
Siegel RL et al CA Cancer J Clin 2016;66:7-30.
Pancreatic Cancer
Pancreatic Cancer and Mortality
2030
Rahib L et al Cancer Res 2014;74:2913-2921.
Individuals and institutions
Volume and Pancreatic Surgery
Birkmeyer JD et al New Eng J Med 2002; 346 (15):1128-1137.
Volume and Pancreatic Surgery
Birkmeyer JD et al New Eng J Med 2002; 346 (15):1128-1137.
Volume and Pancreatic Surgery
Birkmeyer JD et al New Eng J Med 2003; 349 (22):2117-2127.
Volume and Pancreatic Surgery
Birkmeyer JD et al New Eng J Med 2003; 349 (22):2117-2127.
Volume and Pancreatic Surgery
Birkmeyer JD et al New Eng J Med 2003; 349 (22):2117-2127.
Volume and Pancreatic Surgery
Volume and Pancreatic Surgery
Volume and Pancreatic Surgery
Volume and Pancreatic Surgery
Volume and Pancreatic Surgery
Volume and Pancreatic Surgery
Volume and Pancreatic Surgery
Volume and Pancreatic Surgery
Surgery + Chemotherapy
Systemic Disease
Adjuvant Chemotherapy and
Pancreatic cancer
Neoptolemos JP et al Lancet 2001; 358: 1576-1585.
Adjuvant Chemotherapy and
Pancreatic cancer
Neoptolemos JP et al Lancet 2001; 358: 1576-1585.
Adjuvant Chemotherapy and
Pancreatic cancer
Neoptolemos JP et al JAMA 2010; 304(10): 1073-1081.
Adjuvant Chemotherapy and
Pancreatic cancer
Neoptolemos JP et al JAMA 2010; 304(10): 1073-1081.
What is new in Chemotherapy
Pancreatic cancer?
What is new in Chemotherapy
Pancreatic cancer?
What is new in Chemotherapy
Pancreatic cancer?
What is new in Chemotherapy
Pancreatic cancer?
What is new in Chemotherapy
Pancreatic cancer?
Pancreatic Cancer and Progress
Uesaka K et al Lancet 2016; 388: 248-257.
Pancreatic Cancer and Progress
Uesaka K et al Lancet 2016; 388: 248-257.
Team Work
Defining the problem
Pancreatic Cancer and
Adjuvant vs Neoadjuvant
Mokdad AA et al J Clin Oncol 2016 ePub.
Pancreatic Cancer and
Guidelines
Khorana AA et al J Clin Oncol 2016 :34: 2541-2556.
Pancreatic Cancer and
Guidelines
Pancreatic Cancer and
Guidelines
Pancreatic Cancer &
Preoperative Imaging
Sai M et al Abdom Imaging 2010; 35: 154-162.
Sakaguchi T et al Am J Surg 2010; 200: 15-22.
Image Guided
Pancreatic Surgery
Sai M et al Abdom Imaging 2010; 35: 154-162.
Preoperative Imaging and
Lymphatic Involvement
Sai M et al Abdom Imaging 2010; 35: 154-162.
Preoperative Imaging and
Lymphatic Involvement
Yamada Y et al Abdom Imaging 2015; 40: 1617-1628.
Pancreatic Cancer & Lymph nodes
: Detailed Histopathology
Noto M et al Am J Surg Pathol 2005; 29: 1056-1061.
Pancreatic Cancer & Nerves
: Detailed Histopathology
Noto M et al Am J Surg Pathol 2005; 29: 1056-1061.
Pancreatic Cancer
& Neural Invasion
Kayahara M et al Pancreas 2007; 35: 218-223.
Technical Innovations in Pancreatic Surgery
Surgical Approach to Pancreatic
Head
Inoue Y et al Ann Surg 2015; 262: 1092-1101.
Surgical Approach to Pancreatic
Head
Inoue Y et al Ann Surg 2015; 262: 1092-1101.
Surgical Approach to Pancreatic
Head
Inoue Y et al Ann Surg 2015; 262: 1092-1101.
Surgical Approach to Pancreatic
Head
Inoue Y et al Ann Surg 2015; 262: 1092-1101.
Surgical Approach to Pancreatic
Head
Inoue Y et al Ann Surg 2015; 262: 1092-1101.
Surgical Approach to Pancreatic
Head
Inoue Y et al Ann Surg 2015; 262: 1092-1101.
Surgical Approach to Pancreatic
Head
Surgical Approach to Pancreatic
Head
PDACs – Celiac axis
Invasion or Abutment
Experience of Appleby’s operation for advanced carcinoma of the pancreatic
body and tail.
Nimura Y et al Shujutsu 1976;30:885-889
PDACs – Celiac axis invasion
Hirano S et al Ann Surg 2007;246:46-51
PDACs – Celiac axis invasion
Resection and no Reconstruction
PDACs – Celiac axis invasion
Resection & Reconstruction SVG
PDACs – Celiac axis invasion
Resection & Reconstruction PTFE
Pancreatic Cancer Treatment
What can be achieved
Takahashi H et al Ann Surg 2013;258(6):1040-1050.
Pancreatic Cancer Treatment
What can be achieved
Takahashi H et al Ann Surg 2013;258(6):1040-1050.
Pancreatic Cancer Treatment
What can be achieved
Takahashi H et al Ann Surg 2016;264(6):1091-1097.
Pancreatic Cancer Treatment
What can be achieved
Takahashi H et al Ann Surg 2016;264(6):1091-1097.
Surgical Approach to Pancreatic
Head
Inoue Y et al Ann Surg 2015; 262: 1092-1101.
Robotic Surgery
Robotic vs Lap DP
Chen S et al Surg Endosoc 2015; 29: 3507-3518.
Spleen Preserving DP
Robotic Pancreatoduodenectomy
Zureikat AH et al Ann Surg 2013; 258: 554-562.
Robotic Pancreatoduodenectomy
Kornaropoulos M et al Surg Endosoc 2017 ePub.
Robotic Pancreatoduodenectomy
Kornaropoulos M et al Surg Endosoc 2017 ePub.
Pancreaticojejunostomy
Genomics and Immunomodulation
Pancreatic Cancer and
Genomics
Pancreatic Cancer and
Genomics
Pancreatic Cancer and
Genomics
Pancreatic Cancer and
Genomics
Pancreatic Cancer and
Genomics
Jones S et al Science 2008;321:1801- 1806.
Pancreatic Cancer and
Genomics
Jones S et al Science 2008;321:1801- 1806.
Pancreatic Cancer and
Genomics
Biankin AV et al Nature 2012;491:399-405.
Pancreatic Cancer and
Genomics
Biankin AV et al Nature 2012;491:399-405.
Pancreatic Cancer and
Genomics
Biankin AV et al Nature 2012;491:399-405.
Pancreatic Cancer and
Genomics
Waddell N et al Nature 2015;518:495-501.
Pancreatic Cancer and
Genomics
Waddell N et al Nature 2015;518:495-501.
Pancreatic Cancer and
Genomics
Bailey P et al Nature 2016;531:47-52.
Pancreatic Cancer and
Genomics
Bailey P et al Nature 2016;531:47-52.
Pancreatic Cancer and
Genomics
Bailey P et al Nature 2016;531:47-52.
Pancreatic Cancer and
Genomics
Gentles AJ et al Nature Med 2015;21(8):938-945.
Pancreatic Cancer and
Genomics
Gentles AJ et al Nature Med 2015;21(8):938-945.
Pancreatic Cancer and
Genomics
Gentles AJ et al Nature Med 2015;21(8):938-945.
Pancreatic Cancer and
Immune Therapy
Salman B et al Oncoimmunology 2013;2(12):e26662.
Pancreatic Cancer
Immunotherapy Failure
Alexandrov LB et al Nature 2013;500:415-421.
Pancreatic Cancer
Immunotherapy Failure
Alexandrov LB et al Nature 2013;500:415-421.
Pancreatic Cancer and
Immune Therapy
Salman B et al Oncoimmunology 2013;2(12):e26662.
Pancreatic Cancer and Survival
l Hospital & Surgeon Volume
l Neoadjuvant Chemotherapy
l MDT & Guidelines
l Preoperative Imaging and Postop Pathology
l Surgical Techniques
l Minimal Access Surgery
l Genes and Immune System
Thank you

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