پانکراس سرطان

حکیمیان سیدمحمدرضا دکترعمومی جراحی متخصصسرطان جراحی فلوشیپ

Types:

• Neoplasms of the Endocrine Pancreas(25%)

• Neoplasms of the Exocrine Pancreas(75%)• 75% arise within the head or uncinate process of

the pancreas;• l5 % are in the body,• 10% are in the tail

Staging

Diagnosis & stage:

• 7% percent of pancreas cancer cases are diagnosed while the cancer is still confined to the primary site (localized stage);

• 26% are diagnosed after the cancer has spread to regional lymph nodes or directly beyond the primary site

• 52% are diagnosed after the cancer has already metastasized (distant stage); and

• for the remaining l5% the staging information was unknown.

Diagnosis:

• History & Ph Ex• CT scan (the single most versatile and costeffective

tool for the diagnosis)• Sonography • MRI• Endosono• LFT• CA19-9• laparoscopy

Multislice, dynamic, contrast-enhanced CT with IV & oral contrast (pancreas protocol)• accuracy of CT scanning for predicting unresectable disease is about

90 to 95%• invasion of the hepatic or superior mesenteric artery, • enlarged lymph nodes outside the boundaries of resection, • ascites, and • distant metastases (e.g., liver).• Invasion of the superior mesenteric vein or portal vein is not in itself

a contraindication to resection as long as the veins are patent.• C T scanning is less accurate in predicting resectable diseas• When all of the current staging modalities are used, their accuracy in

predicting resectability is reported to be about 80%. 98% when laparoscopy with US is used.

Paliative surgery: • Jaundice & pruritus ; stent with ERCP, PTC drinage

(choledochojejunostomy is the preferred approach)• Duodenal obstruction (no bypass in the absence of

signs or symptomes. Roux-en-Y limb with the gastrojejunostomy located 50 cm downstream or a loop of jejunum with a jejunojejunostomy to divert the enteric stream away from the biliary-enteric anastomosis )

• Pain (celiac plexus nerve block)

Curative surgery

Technique:• Complication rate: 31%• pancreatic leakage rate: about 10%• mortality rate for pancreaticoduodenectomy is <5%

in "high volume" centers (where individual surgeons perform more than 15 cases per year)

• transpancreatic U-suture technique (Blumgart anastomosis)

total 1392(10m) 1391(12m)

29 13 16 N.O.

6(20%) 2(15%) 4 (25%) leak

4(13%) 0(0%) 4(25%) mortality