The Pancreas - An Integrated Textbook of Basic Science, Medicine, and Surgery

Title Page

Copyright Page

Contents

Contributors

Preface

Abbreviations

About the Companion Website

Section 1 Anatomy of the Pancreas

Chapter 1 Development of the Pancreas and Related Structures

Anatomy of the Pancreas

Organogenesis in the Region of the Pancreas

Early Pancreatic Development

Differentiation of Pancreas Cell Types

Transcriptional Mechanisms Underlying Pancreatic Cell Fate Decision

Development and Disease

Acknowledgment

References

Chapter 2 Anatomy, Histology, and Fine Structure of the Pancreas

Introduction

Gross Anatomy

Histology and Ultrastructure

Endocrine Pancreas

Acknowledgments

References

Chapter 3 Congenital and Inherited Anomalies of the Pancreas

Introduction

Primary Malformations

Isolated Congenital Disorders of Pancreatic Endocrine Function

Other Hereditary Disorders with Variable Pancreatic Involvement and Metabolic Diseases Affecting the Pancreas

Inherited Metabolic Disorders Affecting the Pancreas

References

Section 2 Physiology and Pathophysiology of Pancreatic Functions

Chapter 4 Physiology of Acinar Cell Secretion

Introduction

Composition of Pancreatic Acinar Juice

Acinar Fluid and Enzyme Secretion

Ca2+ Signaling

Organelles Important for Ca2+ Homeostasis

Mechanisms of Ca2+ Signal Generation

Ca2+ Entry and Exit

Ca2+-Mediated Control of Enzyme Secretion

Ca2+-Mediated Control of Fluid Secretion

Dangers of Ca2+ Signaling

References

Chapter 5 Physiology of Duct Cell Secretion

Introduction

Sequential Secretion by Acinar and Duct Cells

Regulation of Ductal Secretion

The Ca2+ and cAMP Pathways Synergize to Activate Ductal Secretion

Ductal Secretion-Associated Pancreatic Diseases

Acknowledgment

References

Chapter 6 Pathophysiology of Experimental Pancreatitis

Introduction

Models of Acute Pancreatitis

Phases of Acute Pancreatitis

Early Intra-Acinar Events in Acute Pancreatitis

Conclusion

References

Chapter 7 Physiology and Pathophysiology of Function of Sphincter of Oddi

Introduction

Anatomy and Morphology

Innervation

Physiology

Motility of the Sphincter of Oddi

Sphincter of Oddi Motility Studies in Animals

Sphincter of Oddi Motility in Humans

Pathophysiology of the Sphincter of Oddi Dysfunction (SOD)

Conclusion

References

Chapter 8 Neurohormonal and Hormonal Control of Pancreatic Secretion

Introduction

Stimulation of Pancreatic Secretion

Inhibition of Pancreatic Secretion

Feedback Regulation of Pancreatic Secretion

Conclusion

References

Chapter 9 Regulation of Pancreatic Protein Synthesis and Growth

Introduction

Regulation of Protein Synthesis

Regulation of Pancreatic Growth

References

Chapter 10 Fibrogenesis in the Pancreas: The Role of Stellate Cells

Introduction

Pancreatic Stellate Sells (PSC)

Acute Pancreatitis

Chronic Pancreatitis

Pancreatic Cancer

Conclusion

References

Chapter 11 Fibrogenesis of the Pancreas: The Role of Macrophages

Introduction

Macrophages

Origin and Characteristics of Pancreatic Macrophages

Role of Macrophages in Chronic Pancreatitis-Associated Fibrosis

Role of Macrophages in Pancreatic Cancer-Associated Fibrosis

Conclusion

References

Chapter 12 Insulo–Acinar Relationship

Introduction

Structural Relationships Between Pancreatic Islets and Exocrine Pancreas

Insulo-Acinar Portal System

Regulation of Pancreatic Exocrine Secretion by Islet Hormones

Pancreatic Exocrine Function and Diabetes Mellitus

References

Section 3 Acute Pancreatitis

Chapter 13 Epidemiology and Etiology of Alcohol?Induced Pancreatitis

Introduction

Epidemiology

Pathogenesis

Summary

Acknowledgment

References

Chapter 14 Epidemiology and Etiology of Acute Biliary Pancreatitis

Introduction

Etiology of Gallstone Pancreatitis

Epidemiology of Biliary Acute Pancreatitis

References

Chapter 15 Genetic Factors in Acute Pancreatitis

Introduction

Genetic Susceptibility Factors

Multiple Genetic Defects and Susceptibility

Progression to Chronic Pancreatitis

Future Directions

References

Chapter 16 The Role of the Intestine and Mesenteric Lymph in the Development of Systemic Inflammation and MODS in Severe Acute Pancreatitis

Introduction

Role of the Intestine and Mesenteric Lymph in Multiple Organ Dysfunction Syndrome

Role of the Intestine in Severe Acute Pancreatitis

Altered Gut–Lymph Composition in Acute Pancreatitis

Gut–Lymph Toxicity in Acute Pancreatitis

Translating the Gut–Lymph Concept to Clinical Treatments for Acute Pancreatitis

Conclusion

References

Chapter 17 The Role of Neurogenic Inflammation in Pancreatitis

References

Chapter 18 Molecular, Biochemical, and Metabolic Abnormalities in Acute Pancreatitis

Introduction

Molecular and Biochemical Abnormalities

Metabolic and Systemic Abnormalities

Electrocardiographic Abnormalities in Acute Pancreatitis

References

Chapter 19 Histopathology of Acute Pancreatitis

Introduction

Definition

Histopathologic Patterns of Tissue Necrosis

Acute Pancreatitis with Type 1 Necrosis Pattern

Acute Pancreatitis with Type 2 Necrosis Pattern

Acute Pancreatitis with Type 3 Necrosis Pattern

Histopathology Related to Etiologic Factors and Pathophysiologic Mechanisms

Unsolved Questions

References

Chapter 20 Clinical Classification Systems of Acute Pancreatitis

Introduction

Reasons for Classifying the Severity of Acute Pancreatitis

New Classification Systems

Validation and Comparison of Classification Systems

Future of Classification Systems

Conclusions

References

Chapter 21 Clinical Assessment and Biochemical Markers to Objectify Severity and Prognosis

Introduction

Historical Perspectives: Approaches to Severity Assessment

Dynamics of Organ Failure

Multiparameter Scoring Systems

Laboratory Variables

Overview

References

Chapter 22 Acute Pancreatitis Associated With Congenital Anomalies

Introduction

Pancreas Divisum

Anomalous Pancreaticobiliary Ductal Union

Choledochal Cyst/Choledochocele

Annular Pancreas

Ectopic Pancreatic Tissue

Enteric Duplication Cysts

Conclusions

References

Chapter 23 Acute Pancreatitis in Children

Introduction

Incidence

Etiology

Pathophysiology

Investigations

Diagnosis

Imaging

Management

Outcomes

Acute Recurrent Pancreatitis

References

Chapter 24 Acute Pancreatitis Associated With Metabolic Disorders, Infectious Diseases, or Drugs

Introduction

Metabolic Diseases

Infectious Diseases

Drug-Related Diseases

References

Chapter 25 Radiologic Diagnosis and Staging of Severe Acute Pancreatitis

Introduction

Classification of Acute Pancreatitis

Radiographic Diagnosis of Severe Acute Pancreatitis

Diagnosis of Local Complications of Acute Pancreatitis

Radiologic Staging of Severe Acute Pancreatitis

Limitations and Pitfalls of Radiological Diagnosis of Acute Pancreatitis

References

Clinical Course and Medical Treatment of Acute Pancreatitis

Chapter 26 Conservative Therapy of Acute Pancreatitis: Volume Substitution and Enteral and Parenteral Nutrition

Introduction

Fluid Resuscitation

Enteral and Parenteral Nutrition

Conclusions

References

Chapter 27 ICU Treatment of Severe Acute Pancreatitis

Introduction

Pre?ICU Management

Special Considerations

Indications for ICU Admission

ICU Treatment of Severe Acute Pancreatitis

Early ICU Management (0–48 Hours from Onset of Pain)

Management of Metabolic Derangements

Late ICU Management (>48?Hours After the Onset of Pain)

Management of Infectious Risks

Transition Planning

References

Chapter 28 Use of Antibiotics in Severe Acute Pancreatitis: Indications and Limitations

Introduction

Infectious Complications

Spectrum of Bacteria

Rationales for Antibiotics in Acute Pancreatitis

Clinical Studies with Antibiotics

Indications for Antibiotic Treatment

Limitations of Antibiotic Treatment

References

Interventional and Surgical Management of Acute Pancreatitis

Chapter 29 Indications for Interventional and Surgical Treatment of Necrotizing Pancreatitis

Introduction

Interventions for Pancreatic Necrosis: Historical Perspective

Indications and Timing of Intervention

Pancreatic Necrosis with Infection

Symptomatic Pancreatic Necrosis/Walled-Off Necrosis

Surgical and Interventional Procedures

Surgical Debridement

Percutaneous Catheter Drainage

Direct Endoscopic Necrosectomy

References

Chapter 30 Management of Infected Pancreatic Necroses: An Endoscopic Approach

Pancreatic Necrosis

Mechanical Intervention

Transmural Drainage

Results of Endoscopic Therapy of Pancreatic Necrosis

Adverse Events of Endoscopic Therapy of Pancreatic Necrosis

References

Chapter 31 Minimally Invasive Debridement and Lavage of Necrotizing Pancreatitis

Introduction

Technique

Techniques for Complex Collections

Early Complications

Postoperative Course

Outcome

References

Chapter 32 Open Surgical Debridement in Necrotizing Pancreatitis

Introduction

General Technique of Open Surgical Debridement

Continuous Closed Lavage

Debridement and Open Packing/Staged Laparotomy

Debridement and Closed Packing

Open Cystogastrostomy for Walled?Off Pancreatic Necrosis

Conclusion

References

Chapter 33 Endoscopic Treatment of Biliary Acute Pancreatitis

Pathogenesis of Acute Biliary Pancreatitis

Diagnosis

Indication of Endoscopic Treatment

Techniques

Outcomes and Timing of Endoscopic Interventions

Cholecystectomy After Endoscopic Treatment

References

Chapter 34 Strategies for the Treatment of Pancreatic Pseudocysts and Walled-Off Necrosis After Acute Pancreatitis: Interventional Endoscopic Approaches

Introduction

Indications for Endoscopic Treatment

Endoscopic Drainage vs. Necrosectomy: Choosing the Right Patient

Preventing Recurrence by Treating Disconnected Duct Syndrome

References

Chapter 35 Strategies for the Treatment of Pancreatic Pseudocysts and Walled-Off Necrosis After Acute Pancreatitis: Surgical Treatment

Introduction

Definition of Pancreatic Pseudocyst and Walled?Off Necrosis

Indications for Surgical Intervention

Timing of Interventions and Optimal Interventional Strategy for Walled?Off Necrosis

Surgical Intervention for PPC

References

Chapter 36 Management of Fluid Collection in Acute Pancreatitis

Introduction

Definitions

Imaging of Acute Fluid Collections

Conservative Treatment of Pancreatitis and Pancreatic Fluid Collections

Conclusion

References

Chapter 37 Management of Pancreatic Fistula in Acute Pancreatitis

Introduction

Pathogenesis and Classification

Diagnosis

Management of External Fistulas

Management of Internal Fistulas

Conclusions

References

Long-Term Outcome After Treatment of Acute Pancreatitis

Chapter 38 Long-Term Outcome After Acute Pancreatitis

Introduction

Risk Factors

Endocrine Pancreatic Dysfunction

Exocrine Dysfunction

Recurrent Pancreatitis and Chronic Pancreatitis

Quality of Life and Pain

Incisional Hernia

Pancreatic Cancer and  Pancreas?Related Death

Imaging Findings

Postpancreatitis Care and Follow?Up Visits

Conclusions

References

Section 4 Chronic Pancreatitis

Chapter 39 Molecular Understanding of Chronic Pancreatitis

Introduction

Risk Factors in Chronic Pancreatitis

Sentinel Acute Pancreatic Event Model

Epigenetics as a Modifying Factor in Chronic Pancreatitis

Environmental Exposures as Modifying Factors in Chronic Pancreatitis

Genetic Influences in Chronic Pancreatitis

Inflammatory Response in Chronic Pancreatitis

Fibrogenesis in Chronic Pancreatitis

Conclusions

References

Chapter 40 Epidemiology and Pathophysiology of Alcoholic Chronic Pancreatitis

Introduction

Epidemiology of Alcoholic Chronic Pancreatitis

Pathophysiology

Co-Predisposing Factors for the Development of Alcoholic Chronic Pancreatitis

References

Chapter 41 Pain Mechanisms in Chronic Pancreatitis

Introduction

Extrapancreatic Pain

Pancreatic Pain

Neural Remodeling

Conclusions

References

Chapter 42 Natural History of Recurrent Acute and Chronic Pancreatitis

Introduction

Natural History After First Attack of Acute Pancreatitis

Natural History of Chronic Pancreatitis

Conclusion

Chapter 43 Chronic Pancreatitis with Inflammatory Mass of the Pancreatic Head

Introduction

Incidence

Symptoms, Pathophysiology, and Clinical Problems

Clinical Workup and Differential Diagnosis

Treatment

Conclusions

References

Chapter 44 Early Chronic Pancreatitis

Introduction

Diagnosis of Early Chronic Pancreatitis

References

Chapter 45 Hereditary Chronic Pancreatitis: Molecular Pattern, Clinical Consequences, and Management Principles

Clinical and Genetic Definitions

Epidemiology

Clinical Presentation

Management

Molecular Genetics

Genetic Testing and Counseling

References

Chapter 46 Epidemiology and Pathophysiology of Tropical Chronic Pancreatitis

Introduction

Pathophysiology

Natural History of the Disease

Conclusion

References

Chapter 47 Cystic Fibrosis (CFTR)-Associated Pancreatic Disease

Introduction

Pathophysiology—Genotype and Phenotype Correlations

Clinical Manifestations

Diagnosis

Therapy

References

Chapter 48 Clinical and Laboratory Diagnosis of Chronic Pancreatitis

Introduction

Clinical Presentation

Etiology

Pain

Malabsorption and Weight Loss

Endocrine Insufficiency

Jaundice

Laboratory Diagnosis

Conclusion

References

Chapter 49 Evidence of Contrast-Enhanced CT and MRI/MRCP

Introduction

Diagnosis of Chronic Pancreatitis

Differential Diagnosis of Mass-Forming Chronic Pancreatitis and Pancreatic Cancer

CT and MRI for Autoimmune Pancreatitis

CT and MRI for Groove Pancreatitis

Complications of Chronic Pancreatitis

References

Chapter 50 Chronic Pancreatitis: Risk Factors in Cancer

Introduction

Descriptive Findings

Measuring the Strength of the Pancreatitis–Pancreatic Cancer Association

Discussion

References

Conservative Treatment of Chronic Pancreatitis

Chapter 51 Pain Management in Chronic Pancreatitis

Introduction

Neuropathologic Theory

The Plumbing Theory

Pain Measurement

Treatment Options for Patients with Chronic Pancreatitis

Timing

Conclusions

References

Chapter 52 Medical Treatment of Chronic Pancreatitis: Pancreatic Digestive Enzymes: Lipases, Proteases:

Introduction

Management of Exocrine Pancreatic Insufficiency

Emerging Therapies

References

Chapter 53 Nutritional Support of Chronic Pancreatitis

Introduction

Undernutrition

Nutrient Deficiency

Micronutrient Supplementation

Osteoporosis and Bone Health

Dietary Intervention

Enteral and Parenteral Nutrition

Combined Pancreatic Exocrine and Endocrine Deficiency

Structured Nutritional Assessment

References

Chapter 54 Medical Therapy for Chronic Pancreatitis: Antioxidants

Introduction

Pain and Oxidative Stress

Clinical Studies of Antioxidants for Pain

Conclusions

References

Strategies for Endoscopic and Surgical Treatment of Chronic Pancreatitis

Chapter 55 Evidence of Endoscopic and Interventional Treatment of Chronic Pancreatitis and Pseudocysts

Indications for Interventional Endoscopic or Surgical Therapy

Treatment of Pancreatic Cysts

Therapy of Pancreatic Duct Stenoses and Ductal Stones

Endoscopic Treatment of Bile Duct Obstruction

References

Chapter 56 Indications and Goals of Surgical Treatment

Introduction

Surgical Drainage of the Pancreatic Duct

Surgical Resection of the Pancreas

Surgical Management of Biliary Obstruction

References

Chapter 57 Pancreatic Duct Drainage Procedure

Introduction

Indication for Surgery

Drainage Procedures

Conclusion

References

Chapter 58 Duodenum-Preserving Pancreatic Head Resection

Introduction

Are Duct Stenting and Endoscopic Interventions an Alternative to Surgery?

Who Benefits from Surgical Treatment?

Kausch–Whipple Resection or Hemipancreatectomy—Still Standard Treatment for Chronic Pancreatitis?

Indications and Rationale for Duodenum?Preserving Pancreatic Head Resection

Surgical Technique of DPPHR for Chronic Pancreatitis

Early Postoperative Course

Long-Term Outcome After DPPHR

The Frey Procedure—an Alternative Surgical Approach for all Patients with Chronic Pancreatitis?

Summary

References

Chapter 59 Major Pancreatic Resection

Overview

Major Pancreatic Resection

Pancreatoduodenectomy

Distal Pancreatectomy

Total Pancreatectomy

References

Chapter 60 Laparoscopic Surgery

Introduction

Resection Procedures

Drainage Procedures

Combination Procedures (Resection and Drainage)

Patient Selection

Conclusion

References

Management of Diabetes and Long-Term Outcome of Chronic Pancreatitis

Chapter 61 Chronic Pancreatitis: Long-Term Outcome After Medical and Surgical Treatment

Introduction

Outcomes of Interventional and Surgical Therapy for Pancreatic Pseudocysts

Outcome of Pain Management in Chronic Pancreatitis

Outcome of Therapeutic Options for Biliary and Pancreatic Ductal Stenoses

Conclusion

References

Chapter 62 Management of Pancreatic Diabetes Secondary to Chronic Pancreatitis

Introduction

Definition and Prevalence of Pancreatic Diabetes

Incidence of Diabetes in Chronic Pancreatitis

Risk Factors for Pancreatic Diabetes in Chronic Pancreatitis

Pathogenesis of Pancreatic Diabetes

Diagnosis of Type 3c Diabetes

Clinical Characteristics of Pancreatic Diabetes

Complications of Pancreatic Diabetes

Therapy of Pancreatic Diabetes

Prognosis of Pancreatic Diabetes

References

Section 5 Autoimmune Pancreatitis

Chapter 63 Epidemiology of Autoimmune Pancreatitis

Introduction

Nationwide Survey of Autoimmune Pancreatitis in Japan

First International Survey of Autoimmune Pancreatitis

Second International Survey of Autoimmune Pancreatitis

Third International Survey of Autoimmune Pancreatitis

Conclusions

References

Chapter 64 Pathogenesis of Autoimmune Pancreatitis

Introduction

Type 1 Autoimmune Pancreatitis

Type 2 Autoimmune Pancreatitis

References

Chapter 65 Histology of Autoimmune Pancreatitis

Introduction

Type 1 Autoimmune Pancreatitis

Pancreatic Cancer and Autoimmune Pancreatitis

Type 2 Autoimmune Pancreatitis

Unclassified Autoimmune Pancreatitis

Conclusions

References

Chapter 66 Clinical Manifestation of Type 1 Autoimmune Pancreatitis

Type 1 and Type 2 Autoimmune Pancreatitis

International Consensus Diagnostic Criteria (ICDC) for Autoimmune Pancreatitis

Clinical Features of Type 1 Autoimmune Pancreatitis

IgG4-Related Disease (IgG4-RD)

References

Chapter 67 Clinical Manifestations of Type 2 Autoimmune Pancreatitis

Introduction

Search Criteria

Historical Perspective

Terminology

Epidemiology

Demographics

Disease Associations

Clinical Symptoms and Signs

Diagnosis

Differential Diagnosis

Treatment

Disease Relapse

Clinical Course and Outcome

Summary

References

Chapter 68 Laboratory Diagnosis of Autoimmune Pancreatitis

Introduction

Serum Markers

Markers of Autoimmunity

Other Markers

Conclusion

References

Chapter 69 What is the Evidence Measuring Immune Markers

Introduction

Evidence of the Utility of Markers in Autoimmune Pancreatitis Diagnosis

Evidence of the Utility of Markers in Differentiating Autoimmune Pancreatitis from Mimicking Conditions

Evidence of the Utility of Markers in Predicting Relapse

Acknowledgments

References

Chapter 70 Imaging Diagnosis of Autoimmune Pancreatitis

Introduction

Pancreatic Parenchyma Imaging

Pancreatic Duct Imaging

Acknowledgment

References

Chapter 71 Medical Management of Autoimmune Pancreatitis

Introduction

Management of Autoimmune Pancreatitis: An Overview

Definitions

Management of Initial Presentation

Management of Relapse

Follow-Up and Management of Disease-Related Sequelae

Risk of Pancreatic Malignancy

Management of Medication Side-Effects

Management of Idiopathic Duct-Centric Pancreatitis

Conclusion

References

Long-Term Outcome of Management of Autoimmune Pancreatitis

Chapter 72 Long-Term Outcome After Treatment of Autoimmune Pancreatitis

Introduction

Disease Relapse after Steroids and Treatment

Loss of Pancreatic Function and Evolution Toward Chronic Pancreatitis

Risk for Pancreatic and Extrapancreatic Cancer

References

Section 6 Neoplastic Tumors of the Exocrine Tissue: Benign Cystic Neoplasms of the Pancreas

Chapter 73 Epidemiology of Cystic Neoplasms of the Pancreas

Introduction

Pancreatic Cyst Lesions

Pancreatic Cystic Neoplasms

References

Chapter 74 Histologic Classification and Staging of Cystic Neoplasms

Introduction

Serous Cystic Neoplasms

Mucinous Cystic Neoplasm

Intraductal Papillary Mucinous Neoplasm

Solid Pseudopapillary Neoplasm

Acinar Cell Cystadenoma

Mature Cystic Teratoma

References

Chapter 75 Molecular Mechanisms of Cystic Neoplasia

Introduction

Serous Cystic Neoplasm

Intraductal Papillary Mucinous Neoplasm

Mucinous Cystic Neoplasm

Solid-Pseudopapillary Neoplasm

Other Cystic Neoplasms of the Pancreas

Clinical Applications

Implications for Families

Conclusions

References

Chapter 76 Clinical Presentation of Cystic Neoplasms

Introduction

Classification

General Clinical Presentation of Pancreatic Cysts

Clinical Presentation and Characteristics of Serous Cystic Neoplasms

Clinical Presentation and Characteristics of Mucinous Cystic Neoplasms

Clinical Presentation and Characteristics of Intraductal Papillary Mucous Neoplasms

Clinical Presentation and Characteristics of Solid-Pseudopapillary Neoplasms

Clinical Presentation and Characteristics of Cystic Pancreatic Neuroendocrine Neoplasms

References

Chapter 77 Evaluation of Cystic Lesions Using EUS, MRI, and CT

Introduction

Low-Risk Pancreatic Cysts

Pancreatic Cysts with Malignant Potential

Future Technology

Acknowledgment

References

Chapter 78 Cytologic Evaluation of Cystic Neoplasms

Introduction

Cytology of Neoplastic Cysts

Summary

References

Chapter 79 Natural History of Cystic Neoplasms: IPMN, MCN, SCN, and SPN

Introduction

Intraductal Papillary Mucinous Neoplasms

Mucinous Cystic Neoplasms

Serous Cystic Neoplasms

Solid-Pseudopapillary Neoplasm

References

Chapter 80 Surveillance or Surgical Treatment in Asymptomatic Cystic Neoplasms

Introduction

Rationale for Surveillance or Surgery in Asymptomatic Cystic Neoplasms

Treatment Guidelines for Asymptomatic Cystic Neoplasms

Quality of Life, Surgery Versus Surveillance

Cost-Effectiveness of Each Approach

References

Local and Standard Surgical Treatment of Cystic Neoplasms

Chapter 81 Duodenum-Preserving Partial or Total Pancreatic Head Resection

Background

Classical Pancreatoduodenectomy or Local Extirpation for Cystic Neoplasms of the Pancreatic Head?

Rationale for Local Pancreatic Head Resection

Duodenum-Preserving Total Pancreatic Head Resection With or Without Segmental Resection of the Peripapillary Duodenum and the Intrapancreatic Common Bile Duct

Conclusion

Acknowledgment

References

Chapter 82 Pancreatic Middle Segment Resection

Introduction

Indications

Contraindications

Technique

Results

Conclusions

References

Chapter 83 The Indications For and Limitations of Tumor Enucleation

Introduction

Indications

Contraindications

Surgical Technique

Postoperative Management

Complications

Outcomes

Contraindications

Cyst Ablation

Conclusions

References

Chapter 84 Standard Surgical Management of IPMN, MCN, SPN, and SCN Lesions: Open Approach

Introduction

Pancreatic Cystic Neoplasm Subtypes, Surgical Indications, and Operative Intervention

Pancreatectomy

Conclusion

References

Chapter 85 Surgical Treatment of Cystic Neoplasms: Laparoscopic Approach

Introduction

Specific Surgical Considerations and Procedures

Future Perspectives

References

Chapter 86 Management of Recurrence of Cystic Neoplasms

Introduction

Fate of the Pancreatic Remnant

Predictors of Recurrence

Low-Risk Lesions Left Behind in Remnant

Postoperative Surveillance Strategy

Conclusions

References

Long-Term Outcome of Management of Cystic Neoplasms

Chapter 87 Long-Term Outcome After Observation and Surgical Treatment: What is the Evidence?

Introduction

Serous Cystic Neoplasms

Mucinous Cystic Neoplasms

Intraductal Papillary Mucinous Neoplasms

Solid Pseudopapillary Neoplasms

Final Remarks

References

Section 7 Neoplastic Tumors of Exocrine Tissue: Pancreatic Cancer

Chapter 88 Epidemiology of Pancreatic Cancer

Incidence, Mortality Trends, Survival Prognosis

Cigarette Smoking

Diabetes

Body Mass Index

Alcohol

Pancreatitis

Dietary Factors

Gastrointestinal Microbiome

Allergy

Family History

Conclusions

References

Chapter 89 Smoking, a Risk for Pancreatic Cancer: Experimental and Clinical Data

Introduction

Experimental Data Regarding Smoking: A Risk Factor for Pancreatic Cancer

Clinical Data Supporting the Experimental Findings

Summary

References

Chapter 90 Molecular Understanding of Development of Ductal Pancreatic Cancer

Introduction

Genetic Alterations: The Four Mountains

Genetic Alterations: The Hills

Chromosome Instability

Microsatellite Instability

Mitochondrial Gene Mutations

Expression Changes

Precursor Lesions

Neoplasms with Acinar Differentiation

Clinical Applications

Summary and Conclusions

References

Chapter 91 Familial Pancreatic Cancer

Introduction

Familial Pancreatic Cancer

Pathology of Familial Pancreatic Cancer

Common Genetic Variants

Summary

References

Chapter 92 Pathology of Exocrine Pancreatic Tumors

Introduction

Ductal Adenocarcinoma

Cystic Neoplasms

Acinar Cell Lesions

Conclusions

References

Chapter 93 Pancreatic Cancer: Precancerous Lesions

Introduction

Pancreatic Intraepithelial Neoplasia

Intraductal Papillary Mucinous Neoplasm

Intraductal Tubulopapillary Neoplasm

Mucinous Cystic Neoplasms

Acknowledgments

References

Chapter 94 Clinical History and Risk Factors of Pancreatic Cancer

Introduction

Clinical History of Pancreatic Cancer

Risk Factors for Pancreatic Cancer

Conclusion

References

Chapter 95 Pancreatic Cancer Within the Uncinate Process: Radiologic and Clinical Characteristics

Embryology of the Pancreas

Radiologic Characteristics

Clinical Characteristics of the Uncinate Process Pancreatic Cancer (UPDAC)

References

Chapter 96 The Role of EUS in the Diagnosis and Differential Diagnosis of Neoplastic Lesions

Introduction

Characteristics of Endoscopic Ultrasound

New Screening Modality Comprising Contrast EUS and Elastography

EUS-FNA for Solid Pancreatic Lesions (Figs 96.2 and 96.3)

Diagnostic Yield and Safety of EUS-FNA for Solid Pancreatic Lesions

Factors Affecting EUS-FNA Procedures

References

Chapter 97 Radiologic Diagnosis of Pancreatic Cancer: CT, MRI

Introduction

Multidetector Computed Tomography

Magnetic Resonance Imaging

Conclusion

References

Chapter 98 Screening of Patients with Hereditary Pancreatic Cancer

Pancreatic Cancer Risk and Pancreatic Screening

At What Age Should Pancreatic Screening Begin and End?

Pancreatic Screening Tests

Lesions Identified by Pancreatic Screening

Pancreatic Pathology not Detected by Current Screening Tests

Surveillance

Surgery for Lesions Identified by Pancreatic Screening

Developing Better Pancreatic Screening Tests

Evaluating the Long-Term Outcomes of Patients who Undergo Pancreatic Screening

Summary

Acknowledgments

References

Chapter 99 The Role of ?PET?in Diagnosis of Pancreatic Cancer and Cancer Recurrence

Introduction

The Role of ?PET?and ?PET-CT?in Primary Tumor Diagnostic of Pancreatic Carcinoma

The Role of PET?and PET-CT?in Oncologic Staging of Pancreatic Carcinoma

Therapy Control and Diagnostics of Malignant Pancreatic Tumor Recurrence by PET?and PET?CT

Potential Value of PET-MRI?in Patients with Pancreatic Cancer

Conclusion

References

Chapter 100 Tumor Markers in Pancreatic Malignancies

Conventional Tumor Markers for Pancreatic Cancer

Other Markers for Pancreatic Malignancies

Novel Markers for Pancreatic Cancer

References

Chapter 101 The Role of Laparoscopy and Peritoneal Cytology in the Management of Pancreatic Cancer

Introduction

Laparoscopy

Peritoneal Cytology

References

Chapter 102 Clinical Assessment and Staging of Advanced Pancreatic Cancer

Introduction

Clinical Presentation

Evaluation for Pancreatic Cancer

Staging for Advanced Pancreatic Cancer

Conclusion

References

Surgical Treatment of Pancreatic Cancer

Chapter 103 Pancreatic Cancer: Indications for Resection

Introduction

Clinical Criteria for Resection

Surgical Criteria for Resection

Surgery for Pancreatic Cancer

Local Invasion

Extrapancreatic Nerve Plexus Invasion

Vascular Invasion

Lymph Node Metastases

Peritoneal Metastases

Liver Metastases

Other Distant Metastases

Effect of Clinical Volume

References

Chapter 104 Pancreaticoduodenectomy for Pancreatic Cancer, Short- and Long-Term Outcomes After Kausch–Whipple and Pylorus-Preserving Resection

Introduction

Short-Term Outcome

Long-Term Outcome

Future Trends

References

Chapter 105 Left Pancreatectomy for Body and Tail Cancer

Introduction

Tumor Staging and Resection Eligibility

Surgical Technique

Minimally Invasive Left Pancreatectomy

Postoperative Considerations

Conclusions

References

Chapter 106 Total Pancreatectomy: Indications and Limitations

Total Pancreatectomy

Elective Total Pancreatectomy and Salvage Completion Pancreatectomy

Perioperative Outcomes After Total Pancreatectomy

Long-Term Outcomes After Total Pancreatectomy

Indications for Total Pancreatectomy

Limitations of Total Pancreatectomy

References

Chapter 107 Laparoscopic and Robotic Resection for Pancreatic Cancer

Introduction

Patient Selection and Indications for the?MIS?Approach to Pancreaticoduodenectomy

Laparoscopic Pancreaticoduodenectomy

Robotic Pancreaticoduodenectomy

Indications for the MIS?Approach to the Distal Pancreatectomy

Laparoscopic Distal Pancreatectomy

Robot-Assisted Distal Pancreatectomy

Adopting the?MIS?Pancreatectomy: The Learning Curve

Conclusion

References

Chapter 108 Extended Radical Surgery for Pancreatic Cancer

Introduction

Surgical Procedures and Outcomes

Postoperative Outcome of Extended Surgical Approaches

References

Chapter 109 Palliative Pancreatoduodenectomy: Benefits and Limitations

Introduction

Definition of Palliative Resection

Review of the Literature

Management of Preoperatively Under?Staged Patients

Conclusions

References

Chapter 110 Bypass Surgery for Advanced Pancreatic Cancer

Introduction

Background

Symptoms

Endoscopic or Interventional Biliary Decompression

Surgical Bypass: Techniques

Endoscopic Versus Surgical Bypass

Gastric Decompression

Surgical Technique

Comparison of Surgical Gastric Decompression with Nonsurgical Management

Our Approach

References

Nonsurgical Palliation of Pancreatic Cancer

Chapter 111 Endoscopic and Interventional Palliation of Pancreatic Cancer

Introduction

Biliary Obstruction

Malignant Gastric Outlet Obstruction

Pain Management Derived from Cancer

Anticancer Therapy

Miscellaneous

Acknowledgment

References

Medical Treatment of Pancreatic Cancer

Chapter 112 Neoadjuvant Treatment of Pancreatic Cancer: Downstaging Results

Introduction

Neoadjuvant Therapy for Resectable Pancreatic Cancer

Emerging Recognition of Borderline Resectable Pancreatic Cancer

Downstaging Borderline Resectable Disease with Neoadjuvant Therapy

Challenges of Neoadjuvant Therapy in Borderline Resectable and Locally Advanced Pancreatic Cancer

Future Directions

Summary

References

Chapter 113 Adjuvant Chemotherapy in Pancreatic Cancer

Introduction

Rationale for Adjuvant Therapy

Adjuvant Chemoradiotherapy

Future Directions in Adjuvant Therapy

Timing and Duration of Adjuvant Therapy

Conclusions

References

Chapter 114 Immunotherapy for Pancreatic Cancer

Introduction

Immunology of Pancreatic Cancer

Therapeutic Vaccines

Non-Vaccine Immunomodulators Used in Pancreatic Cancer

Targeting Tumor-Associated Macrophages

Combination Immunotherapy

Conclusion

References

Chapter 115 Targeted Therapies for Pancreatic Cancer

Introduction

Genomic Landscape of PDAC

Molecular Subtypes Reveal Therapeutic Vulnerabilities

Targeting RAS

MEK/ERK Inhibition

Epidermal Growth Factor Receptor Inhibition

Insulin Growth Factor-1 Receptor

Pancreatic Stroma

Enabling Targeted Therapies in Pancreatic Cancer

Summary

References

Chapter 116 Palliative Chemotherapy for Advanced Pancreatic Cancer: Survival Benefit and Side Effects of Treatment

The Clinical Burden of Advanced Pancreatic Cancer

The Management of Advanced Pancreatic Carcinoma

References

Chapter 117 Management of Pain in Pancreatic Cancer

Anatomy and Physiology of Pancreas Cancer Pain

Pharmacologic Pain Management

Chemical Ablation of the Splanchnic Nerves or Celiac Plexus

Surgical Options for Treatment of Pancreatic Cancer

References

Chapter 118 Role of Radio and Proton Beam Therapy for Pancreatic Cancer

Introduction

Radiation in the Adjuvant Setting

Radiation in Borderline Resectable and Locally Advanced Disease

Proton Beam Therapy

Future Directions

References

Chapter 119 Management of Cancer Recurrence

Introduction

Incidence, Timing, and Pattern of Recurrence

Surveillance After Resection for Pancreatic Cancer

Treatment of Systemic Recurrence of Pancreatic Cancer

Treatment of Isolated Local Recurrence of Pancreatic Cancer

Rationale for “Local” Therapy Options

Chemoradiation for Isolated Local Recurrence

Re-resection for Isolated Local Recurrence

Selection of Patients for Local Therapy

Conclusions

References

Long-Term Outcome After Treatment of Pancreatic Cancer

Chapter 120 Survival and Late Morbidity After Resection of Pancreatic Cancer

Introduction

Survival after Resection for Pancreatic Cancer

Prognostic Risk Factors

Long-Term Morbidity

Conclusions

References

Section 8 Neoplastic Tumors of the Endocrine Pancreas: Neuroendocrine Tumors of the Pancreas

Chapter 121 Epidemiology and Classification of Neuroendocrine Tumors of the Pancreas

Introduction

Epidemiology of Pancreatic Neuroendocrine Tumors (Table 121.1)

Classification

Conclusions

Chapter 122 Pathology of Neuroendocrine Neoplasms

WHO Classification and TNM Classification

Macroscopy

Microscopy

Cytology

Immunohistochemistry and Differential Diagnosis

References

Chapter 123 Molecular Genetics of Neuroendocrine Tumors

Introduction

Genetics of Sporadic PanNET

Pathways Altered in PanNETs

High-Grade Neuroendocrine Carcinomas

Comparison of the PanNET Genetic Landscape with Other Pancreatic Neoplasias

Familial Syndromes

Epigenetics

Clinical Implications

Conclusions

References

Chapter 124 Clinical Manifestation of Endocrine Tumors of the Pancreas

Introduction

Epidemiology of PanNET

Clinical Symptoms of PanNET

Diagnosis of PanNET

References

Chapter 125 Evidence of Hormonal, Laboratory, Biochemical, and Instrumental Diagnostics of Neuroendocrine Tumors of the Pancreas

Introduction

Serum-Based Laboratory Investigations

Instrumental and Invasive Investigations

Imaging

Conclusions

References

Chapter 126 Pancreatic Neuroendocrine Tumors in Multiple Neoplasia Syndromes

Introduction

Epidemiology

Genetics

Diagnosis

Clinical Presentation

Surgical Treatment

Medical Treatment

Prognosis

References

Chapter 127 Nonfunctioning Pancreatic Neuroendocrine Tumors: Diagnosis and Management Principles

Definition

Pathology

Mechanism of Tumorigenicity

Clinical Findings

Symptoms

Diagnosis

Surgical Treatment for Localized Lesions

Multidisciplinary Treatment for Metastatic Lesions

References

Chapter 128 Medical and Nucleotide Treatment of Neuroendocrine Tumors of the Pancreas

Introduction

Nonsurgical Treatment of the Secretory Syndromes

Nonsurgical Treatment Directed Against Tumor Growth

Conclusions

References

Chapter 129 Interventional Radiology in the Treatment of Pancreatic Neuroendocrine Tumors

Type of Interventional Radiology Treatment

TAE/TACE

RFA

References

Surgical Management of Endocrine Tumors of the Pancreas

Chapter 130 Surgical Treatment of Endocrine Tumors: Enucleation

Introduction

Observation Versus Surgery for Small Sporadic, Benign?Appearing, Nonfunctioning Pancreatic Neuroendocrine Tumors

Preoperative Imaging and Assessment of Proliferative Tumor Activity

Surgical Technique of Enucleation

Short- and Long-Term Outcomes After Enucleation

Outcome After Laparoscopic Enucleation

References

Chapter 131 Local Treatment of Endocrine Tumors: Duodenum-Preserving Partial or Total Pancreatic Head Resection and Pancreatic Middle-Segment Resection

Background

Surveillance or Treatment of Neuroendocrine Tumors of the Pancreas?

Indication for Surgical Treatment of PanNETs

Parenchyma-Sparing Local Resection of Neuroendocrine Tumors of the Pancreatic Head

Duodenum-Preserving Total or Partial Pancreatic Head Resection

Pancreatic Middle?Segment Resection

Conclusion

Acknowledgment

References

Chapter 132 Surgical Treatment of Endocrine Tumors: Major Oncologic Resection

Introduction

Clinical Workup of Advanced PanNET for Major Oncologic Resection

Surgical Approach to Locally Advanced Nonfunctioning PanNET Without Clinical Evidence of Distant Metastases

Locally Advanced Nonfunctioning PanNET with Clinical Evidence of Distant Metastases

References

Chapter 133 Management of Insulinoma

Introduction

Clinical Features of Insulinomas

Diagnosis of Insulinomas

Localization of Insulinomas

Treatment of Insulinomas

References

Chapter 134 Evidence of Medical and Surgical Treatment of Gastrinoma

Treatment Strategy

Tumor Localization

Surgery

Treatment of Hepatic Metastases

Systemic Chemotherapy

References

Chapter 135 Rare Neuroendocrine Tumors of the Pancreas: Management and Evidence of Surgical Treatment

Introduction

Clinical Features

Prognosis and Survival

Diagnosis

Tumor Localization

Surgical Treatment

Medical Treatment

References

Chapter 136 Treatment of Neuroendocrine Tumors of the Pancreas and Biliary Tract

Introduction

Neuroendocrine Tumors of the Pancreas

Neuroendocrine Tumors of the Duodenum

Neuroendocrine Tumors of the Liver

Neuroendocrine Tumors of the Extrahepatic Biliary Tract

Neuroendocrine Tumors of the Gallbladder

References

Long-Term Outcome After Treatment of Neuroendocrine Tumors of the Pancreas

Chapter 137 Long-Term Outcome After Treatment of Endocrine Tumors

Introduction

Risk Stratification of Pancreatic Endocrine Tumors

Surgical Considerations for Pancreatic Endocrine Tumors

Conclusion

References

Section 9 Periampullary Cancers and Tumors Other Than Pancreatic Cancer

Chapter 138 Periampullary Cancer: Clinical Presentation and Diagnostic Strategies

Introduction

Clinical Presentation

Diagnostic Evaluation

Determination of Extent of Resection

Summary

References

Chapter 139 Histology and Genetics of Cancer of the Papilla, Distal Common Bile Duct, and Duodenum

Carcinoma of Papilla (Ampulla of Vater)

Distal Common Bile Duct Carcinoma

Nonampullary Duodenal Carcinoma

Pathologic Staging of Cancers of this Region

Neuroendocrine Neoplasms and Related Tumors

Pseudotumors that Commonly Mimic Cancer

Secondary Tumors

References

Chapter 140 Adenoma and Adenocarcinoma of the Ampulla of Vater: Diagnosis and Management

Introduction

Epidemiology and Biologic Behavior

Pathology and Pathogenesis

Clinical Features

Diagnosis and Staging of Ampullary Malignancy

Management and Treatment

Posttreatment Surveillance

Long-Term Results of Surgical Resection

References

Chapter 141 Endoscopic Treatment of Adenomas of the Ampulla of Vater: Techniques, Results, Benefits, and Limitations

Introduction

Endoscopic Papillectomy

Preprocedural Evaluation

Techniques

Clinical Results

Complications

Postprocedural Surveillance

Conclusions

References

Chapter 142 Surgical Treatment of Adenoma and Cancer of Papilla of Vater

Introduction

Molecular Pathology of Ampullary Cancer

Endoscopic and Surgical Treatment of Large Adenomas and Carcinoma of the Ampulla of Vater

Ampullectomy for Large Adenomas and Low-Risk Ampullary Cancer

Pancreatoduodenectomy for Advanced Ampullary Cancer

Survival After Ampullectomy and Pancreatoduodenectomy

Conclusion

Acknowledgment

References

Chapter 143 Surgical Treatment of Duodenal Cancer

References

Chapter 144 Surgical Treatment of Distal Cholangiocarcinoma

Introduction

Pyloric Ring Preservation

Lymph Node Dissection

Skeletonization of the Hepatoduodenal Ligament and Dissection of Pancreatic Head Neural Plexus

Bile Duct Cut Margin

Surgery-Related Complications

Summary

References

Chapter 145 Adjuvant and Palliative Chemotherapy of Periampullary Cancers

Introduction

Distal Cholangiocarcinoma

Duodenal Adenocarcinoma

Ampullary Carcinoma

Conclusion

References

Long-Term Survival After Tumor Resection

Chapter 146 Long-Term Survival After Resection of Periampullary Cancer

Introduction

Distal Bile Duct Cancer

Ampullary Region Cancer

Duodenal Cancer

References

Section 10 Transplantation of the Pancreas

Chapter 147 Transplantation of Pancreatic Islets

Introduction

Manufacturing, Release Testing, and Infusion of Allogeneic Human Islets

Selection of Islet Allotransplant Recipients

Outcomes of Islet Allotransplantation in T1D

Adverse Effects of Islet Transplantation and Immunosuppression

Outcomes of Islet Autotransplantation in Chronic Pancreatitis

Research Priorities in Islet Transplantation

Conclusions

Acknowledgments

References

Chapter 148 Transplantation of the Pancreas

Introduction

Epidemiology and Sequelae of Insulin-Dependent Diabetes Mellitus

Historical Aspects

Indications for Pancreas Transplantation

Preoperative Workup and Cardiac Risk Assessment

Donor Selection and Donor Pancreatectomy

Donor Operation

Deceased Cardiac Death Donors (DCD)

Preservation

Technical Aspects of the Recipient Operation

Current Status and Results of Pancreas Transplantation in the United States

Conclusion

References

Index

EULA