Surgical Treatment of Pancreatic Cancer (original) (raw)

Experience of Pancreatic Resection for Pancreatic Cancer an Audit of 75 Cases

Scholarly Journal of Surgery, 2018

Introduction: Different pancreatic pathologies, needs resection of pancreatic tissue. Adenocarcinoma of the pancreatic duct is the most frequently seen malignancy, presenting with early metastasis and seen as resistant to alternative treatment regimens currently available [1,2]. Management and handling of such tumors is a complex and challenging task for a surgeon [1-3]. surgical resection offers improved prognosis, with a median survival after resection of 14-20 months and up to 25% 5-year survival rates [4,5]. This study is aimed at presenting data of 75 pancreatic resections for various malignant pancreatic lesions. Methods: This is an ongoing longitudinal study which started in 2009 at teaching institute in central India. Though we had 122 patients for pancreatic resection, only 75 patients were considered suitable for the present study. All patients after admission were thoroughly investigated and then considered for surgery. 53 patients were male and 22 patients were female. Age group was ranging from 34 to 67 years with mean age between 46 to 56 yrs. Spectrum of various malignancies and different types of pancreatic resections were done and results are presented in this study. Results: Pancreatic adenocarcinoma is one of the most aggressive malignancy, responds to surgical treatment better than other alternative modalities. In our series out of 75 patients 32 patients with pancreatic head cancer, 28 patients with Periampullary cancer, 2 patients with duodenal cancer, 8 patients with distal cholangio carcinoma, 1 patient with mucinous cystadenocarcinoma. 4 patients with body and tail of pancreas cancer. Average age 34 to 67 years, 53 males and 22 females. Commonest procedure was Whipple’s operation, and distal pancreatectomy. Survival in our series was 18 -24 months and 5-year survival was 12 % that is seen mainly with Periampullary cancer. Conclusion: Surgery is the only chance of cure or long term survival in pancreatic cancer. Chemo radiation as a primary therapy is ineffective. But some reports suggest the improved quality of life with palliative chemotherapy. Biology of the disease is the king and dictates the outcome, the type of surgical procedure had no impact on survival, nor on morbidity and mortality.

Clinical and pathologic prognostic factors for curative resection for pancreatic cancer

HPB, 2008

Background. Pancreatic cancer is the fifth leading cause of cancer-related deaths in the world. Operative resection is the only therapeutic option with curative potential for this disease. Objective. The aim of the present study was to correlate clinical and pathologic parameters with survival in patients submitted to pancreatic resection for pancreatic adenocarcinoma. Methods. Surgical resection with curative intent (R0 and R1 resections) was performed in 65 pancreatic cancer patients between 1990 and 2006. The overall results of surgical treatment were retrospectively analyzed and compared with the clinicopathologic features of these patients. Results. Pylorus-preserving pancreatoduodenectomy was performed in 37 patients (56.9%), classic resection in 35.4%, distal pancreatectomy in 4.6% and total pancreatectomy in 3.6%. The inhospital mortality was 5% (three patients). Postoperative complications occurred in 28 patients (43%). Mean survival and five-year survival rate after curative resection were 27 months and 9.0%, respectively. Sex, TNM stage, tumor differentiation, neural invasion, tumor size and involvement of resection margin were significant prognostic factors on univariate analysis. Multivariate analysis showed tumor differentiation and neural invasion as prognostic factors. Conclusion. Patients with pancreatic cancer, even those with poor prognostic factors should be given the opportunity of surgical resection with curative intent.

The role of surgery for pancreatic cancer: a 12-year review of patient outcome

The Ulster medical journal, 2010

Pancreatic cancer has a poor prognosis with <5% alive at 5 years, despite active surgical treatment. The study aim was to review patients undergoing pancreatic resection and assess the effect of clinical and pathological parameters on survival. All patients who had undergone radical pancreatic surgery, January 1996 to December 2008, were identified from the unit database. Additional information was retrieved from the patient records. The demographic, clinical, and pathological records were recorded using Microsoft Excel. Survival was assessed using Kaplan-Meier and predictors of survival determined by multinominal logistic regression and log rank test. 126 patients were identified from the database. The majority (106) had a Whipple's procedure, 14 had a distal pancreatectomy and 6 had local periampullary excision. The average age of the Whipple's group of patients was 61.7 years (± 11.7) with most procedures performed for malignancy (n=100). Survival was worse with adenoc...

Surgical and medical therapy for pancreatic carcinoma

Best Practice & Research Clinical Gastroenterology, 2002

Progress on the treatment of pancreatic ductal adenocarcinoma has involved advances in medical and surgical care with important contributions from disciplines such as radiology and intensive care. In the last decade large randomized controlled trials have been undertaken that demonstrate the improved patient outcomes. There is an increased risk of pancreatic cancer in chronic pancreatitis, hereditary pancreatitis and a variety of familial cancer syndromes. The optimum outcome from pancreatic cancer needs management by multidisciplinary teams in regional specialist units. Endoscopic stenting, good pain relief and pancreatic enzyme supplementation are the basis of care in advanced pancreatic cancer. Chemotherapy prolongs survival in advanced pancreatic cancer with little to be gained using drugs other than 5FU. Resection, if possible, prolongs life and provides the best quality of life. Adjuvant chemoradiotherapy is of no bene®t but chemotherapy may improve survival. Alongside the evolution in clinical management has been the elucidation of the molecular events that underlie pancreatic cancer and this knowledge has guided the introduction of targeted treatments for pancreatic cancer.

Current Surgical Aspects of Palliative Treatment for Unresectable Pancreatic Cancer

Cancers, 2011

Despite all improvements in both surgical and other conservative therapies, pancreatic cancer is steadily associated with a poor overall prognosis and remains a major cause of cancer mortality. Radical surgical resection has been established as the best chance these patients have for long-term survival. However, in most cases the disease has reached an incurable state at the time of diagnosis, mainly due to the silent clinical course at its early stages. The role of palliative surgery in locally advanced pancreatic cancer mainly involves patients who are found unresectable during open surgical exploration and consists of combined biliary and duodenal bypass procedures. Chemical splanchnicectomy is another modality that should also be applied intraoperatively with good results. There are no randomized controlled trials evaluating the outcomes of palliative pancreatic resection. Nevertheless, data from retrospective reports suggest that this practice, compared with bypass procedures, may lead to improved survival without increasing perioperative morbidity and mortality. All efforts at developing a more effective treatment for unresectable pancreatic cancer have been directed towards neoadjuvant and targeted therapies. The scenario of downstaging tumors in anticipation of a future oncological surgical resection has been advocated by trials combining gemcitabine with radiation therapy or with the tyrosine kinase inhibitor erlotinib, with promising early results.

Outcome of surgical treatment of carcinoma of the pancreas

Tumori

Pancreatic resections for neoplastic diseases have a high risk of severe intra- and postoperative complications and are associated with high mortality rates. They should be performed as a rule in centers specializing in this type of surgery. However, it is becoming increasingly likely that such tumors may have to be treated in surgery units which are not specifically dedicated to pancreatic surgery. The aim of this study was to assess the improvements in clinical results in a non-specialized general surgery setting in the light of the most recent progress in surgical techniques, drug treatments and nutritional support. We analyzed 48 patients with pancreatic cancer treated in our institution over the period from 1980 to 1998: 36 had cancer of the head of the pancreas, 5 of the ampulla, 1 in the second duodenal portion, and 6 of the body-tail. The operations performed consisted of 13 Whipple pancreaticoduodenectomies with cutting and stapling of the distal pancreatic stump at the lev...

Expanding Surgical Treatment of Pancreatic Cancer

Pancreas, 2012

Objectives-Pancreatic cancer is a lethal disease that offers little chance of long-term survival for patients with unresectable tumors. Surgery remains the most effective means of attaining prolonged survival, yet its role remains limited. Regional chemotherapy has been described for patients with pancreatic cancer, including reports of objective tumor regression allowing for tumor resection in previously unresectable cases, however comprehensive data have not been reviewed to date. Methods-A review of the literature from 1995 to 2010 was performed to analyze the results of regional chemotherapy administered to patients with advanced pancreatic cancer. Reports of individual cases, post-operative regional therapy and treatment of mixed tumor types were excluded. Results-Twenty-one reports of 895 total patients with pancreatic cancer were reviewed. Greater than 95% of patients had stage III or IV adenocarcinoma. Objective response rates ranged from nil to 58%, with associated median survivals of 4 to 22 months. Low grade gastrointestinal and hematologic toxicities were not uncommon. Conclusions-Regional chemotherapy can be administered safely to patients with pancreatic cancer, but with unclear benefit. Advanced pancreatic tumors converted to resectable status by the use of regional chemotherapy may improve patient survival.

Morbidity and mortality of pancreatic tumors undergoing surgical treatment

ABCD. Arquivos Brasileiros de Cirurgia Digestiva (São Paulo), 2014

BACKGROUND: Pancreatic cancer has a high mortality rate due to late diagnosis and aggressive behavior. The prognosis is poor, with 5-year survival occurring in less than 5% of cases. AIM: To analyze demographic characteristics, comorbidities, type of procedure and early postoperative complications of patients with pancreatic cancer submitted to surgical treatment. METHODS: Cross-sectional study with analysis of 28 medical records of patients with malignant tumors of the pancreas in a 62 month. Data collection was performed from the medical records of the hospital. RESULTS: Of the total, 53,6% were male and the mean age was 60.25 years. According to the procedure, 53,6% was submitted to duodenopancreactectomy the remainder to biliodigestive derivation or distal pancreatectomy. The ductal adenocarcinoma occurred in 82,1% and 92,9% of tumors were located in the pancreatic head. Early postoperative complications occurred in 64,3% of cases and the most prevalent was intra-abdominal absce...

Pancreatic cancer: surgical management and outcomes after 6 years of follow‐up

The Medical Journal of Australia, 2012

ancreatic cancer is the fourth leading cause of cancerrelated mortality in Australia. 1 Median survival from diagnosis is about 5 months. The 5-year survival rate is less than 5%, but higher rates (between 6.8% and 17%) have been reported in those selected for surgery. 2-4 Patients with unresectable disease have short survival times but benefit from palliative treatment. 5,6 Results of resection and treatment in trials or published case series may not be achieved in clinical practice, as many patients are older and have more extensive disease than those included in randomised trials or referred to tertiary centres. The Victorian Cooperative Oncology Group, in collaboration with the Victorian Cancer Registry (VCR), examined patterns of care for patients diagnosed with pancreatic cancer over a 2-year period. Here, we describe the surgical management of and outcomes for these patients. Chemotherapy and radiotherapy in this cohort have been described previously. 7 Conclusions: Most outcomes in Victoria compared favourably with other studies. Prognosis for patients with carcinoma of the pancreas is grim, with few long-term survivors. Six-year survival appears to be a better proxy for cure than 5-year survival.