pancreatic%20cancer
PANCREATIC CANCER
Pancreatic cancer is malignancy arising from the pancreas.
It is the 13th most common cancer in the world, 10th most common in the United States, and 4th leading cause of cancer-related deaths in the United Stated and Europe.
Exocrine tumors account for 95% of malignant pancreatic disease.
It is more common in women.
The median age of occurrence is at 71 years old.

Surgical Intervention

  • Surgical resection is the definitive treatment of pancreatic cancer w/ a goal of achieving negative (R0) margins of resection
    • Upfront surgery is the standard of care for resectable tumors

Resectability status criteria:

Locally & clearly resectable tumors

  • Distant metastases absent
  • Evidence of superior mesenteric vein (SMV) or portal vein (PV) invasion absent on radiographic exam
  • Surrounding structures of the celiac axis, hepatic artery, & superior mesenteric artery (SMA) clear

Borderline resectable tumors

  • Distant metastases absent
  • SMV or PV venous involvement w/ distortion or narrowing, or venous occlusion w/ patent proximal & distal vessel allowing venous reconstruction
  • Gastroduodenal artery encasement up to the hepatic artery w/ either short segment encasement or direct abutment of the hepatic artery w/out extension to the celiac axis
  • Tumor abutment of the SMA not to exceed >180 degrees of the circumference of the vessel wall

Unresectable tumors

  • HEAD: Distant metastases absent; >180 degrees SMA encasement or any celiac abutment; unreconstructable SMV/PV occlusion; aortic invasion or encasement
  • BODY: Distant metastases absent; >180 degrees SMA or celiac encasement; unreconstructable SMV/PV occlusion; aortic invasion
  • TAIL: Distant metastases absent; >180 degrees SMA or celiac encasement
  • ALL: Metastases to lymph node beyond the field of resection

Surgical Procedures

Pancreatoduodenectomy (Whipple Technique)

  • Procedure of choice for pancreatic head tumors
  • Preserves the distal stomach & pylorus
    • Further studies are suggested to prove the benefit of pylorus-preserving pancreatoduodenectomy as an alternative to the classic pancreatoduodenectomy
    • Extended lymphadenectomy does not increase overall survival of patients undergoing whipple technique

Distal Pancreatectomy

  • Procedure of choice for pancreatic body & tail tumors
  • Reports have shown a tumor clearance of 72-91% after distal pancreatectomy, w/ good long-term survival rates comparable to that of total resection for localized tumors

Total Pancreatectomy

  • The only curative treatment option for pancreatic cancer patients w/ stage I/II disease
  • Indicated for multifocal tumors & tumors w/ borders that cannot be delineated w/ other techniques
  • Not recommended for patients ≥75 yr due to possible comorbidities
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