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Treatment Policies

Treatment methods for Pancreatic cancer

Surgical Policy

  1. Head: in principle, implement a pylorus-preserving pancreatoduodenectomy (PpPD) Depending on the condition, in cases of gastric infiltration or #6 type, etc., a conventional pancreatoduodenectomy (PD) may be implemented
    Body and tail: pancreatic body and tail resection, D2 removal
  2. If possible, the portal vein should be detached, and if infiltrated, it should be removed
  3. From a QOL point of view, 1/2 (or up to 2/3) of the superior mesenteric artery (SMA) should be removed, and in order to eliminate residual cancer from the detached surface, the left-right neuroplexus is frozen and a segment presented and tested. If it is positive, it is completely removed.  The neuroplexus is be compared with HE after surgery, and PCR molecular diagnosis added (with the target molecule assumed to be cytokeratin) in order to implement comparison with various factors
  4. #16 removal is picked up, but if they test positive when frozen, everything from #16a2 to bl should be removed.

Methods for Pancreatic Cystic Conditions

Diagnosis: if MRCP, CT or EUS is required at the outpatient stage, ERCP and Angio are added

sereous cyst adenoma under observation
pseudocyst under observation
mucinous cyst adenoma surgery
SCT(solid and cystic tumor) surgery
IPMT(intrapancreatic duct mucinous tumor)  

Furthermore, determine indications – ERCP, Angio (CTA/CTAP)

Methods for IMPT Surgical Indications

Surgical Indication

  1. Main pancreatic duct type: 1 cm or more, branch type: 4 cm or more
  2. Pancreatic fluid cytodiagnosis ≥ Class 4
  3. Mural nodule 3 mm or more
  4. Significant quantity of mucosal fluid produced and leaking from Vater
  5. Abdominal condition
  6. Sudden increase
  7. High value of tumor markers

Surgical Method

  1. Benignity suspected: Segment 2 Pancreaticoduodenectomy, surgical reduction using segmented pancreatectomy, etc.
  2. Borderline (including minimum invasion): PpPD
  3. Malignancy suspected (invasive): PpPD, removal of D1 and above

Treatment of Primary Liver Cancer

 

Treatment of primary liver cancer

  1. Target age range: 80 years or less (for patients aged 80 or older refer to TAE, RF and PMCT)
  2. Surgical indicators: Not dependent on tumor size, but preferably single, up to Vp0 (Stage II) (Cases with metastasis to outside the liver not included in scope)
  3. Liver function evaluation: In reference to Morino method (Alb, HPT, GOT, ICG K value and O-GTT)1) and ICG standards2)
    1. 164.8 - 0.58 Alb (g/dl) - 1.07 HPT (%) + 0.062 GOT (U/L) - 68.5 ICG K - 3.57 OGTT* + 0.074 × resected volume (gram) > 50 dead < 25 alive (*BS60/BS120)
    2. Right lobe resection ICG K value 0.15 or more, ICGR15 10% or less. Left lobe resection ICG K value 0.13 or more, ICGR15 15% or less

      Note1) Even if resection is determined possible based on function evaluation, if 40% of the remaining liver (other than the tumor) is to be resectioned PTPE is implemented
      Note2) PTPE cases undergo surgery four weeks later
  4. Surgical method: In principle, systematic lobe resection or (sub) segmental resection. In cases with liver cirrhosis, a minimum surgical margin of 1 cm is maintained

Indicators for liver resection

Indicators for Liver Resection

  1. Primary focus surgery is curative
  2. Metastasized tumor can be completely resected by liver resection (five or more metastasized tumors)
  3. No metastasis note to other organs (including lymph nodes) (in cases of lung metastasis where curative resection is possible, patient is target for liver resection)

Surgical Method

  1. Basically, systematic lobe resection or (sub) segmental resection, but in cases of partial resection a minimum surgical margin of 1 cm is maintained
  2. In simultaneous cases, the primary lesion should in principle be removed at the same time as the liver resection
  3. If images suggest curability, liver resection should be proactively implemented

Post-Surgical Treatment

Hepatic artery injection reservoir inserted and 5-Fu type drugs used for chemotherapy

 

Treatment Method for bladder cancer

  1. m cancer – simple bladder extirpation; May be carried out using LC, but in cases where cancer is strongly suspected open surgery is selected
  2. mp cancer – resection of all layers of bladder, including liver floor resection (biliary duct resection) + D2 removal
  3. ss cancer; (H, P, M factors (-), #16 (-)) – S4a + 5 + (6) Liver resection (biliary duct resection) + D2 removal
    Subsequent to biliary duct removal, similar to cases of ss cancer, standard surgical method for ss cancer second phase
    In #13 (+) and #16 (-) cases, removal of possible areas can preserve the pancreas
    PD in cases with infiltration of the pancrease
    ; (H, P, M factors (+) #16 (+)) – Select treatment method prioritizing QOL
  4. se, si cancers; (H, P, M factors (-), #16 (-)) – select surgery based on criteria for ss cancer   ; (H, P, M factors (+) #16 (+)) – Select treatment method prioritizing QOL