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==Overview==
==Overview==
Herophilus of Chalcedon (circa 300 B.C.), the father of scientific [[anatomy]], was the first to describe the [[pancreas]] but he had no conception of its [[Function (biology)|function]]. Rufus of Ephesus (circa 100 A.D)  coined the term [[pancreas]] (from the Greek words pan meaning all and ''kreas meaning'' [[flesh]]). It literally means all [[flesh]] due to its homogeneous composition. In 1679, Morgagni was the first to recognize [[cancer]] of the [[pancreas]] and described the [[pancreas]] of one of his patients as a dry white [[pancreas]] of a ''scirrhous'' nature with “pretty hard” distinct lobules. By the late 1800s, the clinical [[Symptom|symptoms]], [[Medical sign|signs]] and [[histology]] of [[pancreatic cancer]] had been defined. Bard and Pit differentiated between [[Duct (anatomy)|duct]], [[Acinus|acinar]] cell and [[Islets of Langerhans|islet cell]] [[cancers]]. Trendelenburg was the first to successfully excise a solid [[tumor]] of the [[pancreas]] and  Kappeler described the first cholecystojejunostomy performed as [[Palliative care|palliative therapy]] in a [[pancreatic cancer]] patient. In February 1955, [[Whipple]] performed a two stage operation for [[carcinoma]] of the [[Ampulla of Vater|ampulla]], where a cholecystojejunostomy and total duodenectomy were performed. This was the first total duodenectomy to be recorded in a human subject. [[Whipple]] and Nelson subsequently performed the first ever recorded one-stage [[pancreaticoduodenectomy]] followed by occlusion of  the [[pancreas]]. Post 1940, the one-stage has been modified repeatedly by [[surgeons]] world wide. Even today, the treatment of [[pancreatic cancer]] continues to be a dilemma. However, the mortality rate for [[Pancreaticoduodenectomy|pancreatoduodenal resection]] has declined considerably after 1970. 


Pancreatic cancer was first discovered in 18th-century by Italian scientist Giovanni Battista Morgagni who is also known as historical father of modern-day anatomic pathology.
==Historical Perspective==


==History==
=== History of the pancreas ===
The earliest recognition of pancreatic cancer has been attributed to the 18th-century Italian scientist [[Giovanni Battista Morgagni]], the historical father of modern-day [[anatomic pathology]], who claimed to have traced several cases of cancer in the pancreas. Many 18th and 19th-century physicians were skeptical about the existence of the disease, given the similar appearance of pancreatitis. Some [[case report]]s were published in the 1820s and 1830s, and a genuine [[histopathologic]] diagnosis was eventually recorded by the American clinician [[Jacob Mendes Da Costa]], who also doubted the reliability of Morgagni's interpretations. By the start of the 20th century, cancer of the head of the pancreas had become a well-established diagnosis.<ref name=Busnardo-1983/>
The history of the [[pancreas]] is as follows:<ref name="pmid4560737">{{cite journal |vauthors=Lamadrid Montemayor F, Rico Nieva P |title=[Analgesic and antiphlogistic action of benzidamine in obstetrics] |language=Spanish; Castilian |journal=Ginecol Obstet Mex |volume=32 |issue=190 |pages=209–12 |year=1972 |pmid=4560737 |doi= |url=}}</ref>
* Due to its hidden [[Retroperitoneum|retroperitoneal]] location, the [[pancreas]] was initially termed as the hermit organ by 20<sup>th</sup> century surgeons and ignored both as an [[Organ (anatomy)|organ]] and as a seat of disease. 
* The [[pancreas]] was first recognized as a discrete [[Organ (anatomy)|organ]] by the Greeks.
* Herophilus of Chalcedon (circa 300 B.C.), the father of scientific [[anatomy]], was the first to describe the [[pancreas]] but he had no conception of its [[Function (biology)|function]].  
* Rufus of Ephesus (circa 100 A.D)  coined the term [[pancreas]] (from the Greek words pan: all and ''kreas''':''''' flesh).  
* The [[pancreas]], literally means all [[flesh]] due to its homogeneous composition.
'''16th century:'''
* Vesalius described the [[pancreas]] and the vessels running through it, but knew nothing of the ductal system or its [[Function (biology)|function]].
'''17th century:'''
*  Johann George Wirsung achieved medical [[immortality]] when he described the main [[Duct (anatomy)|duct]] of the human [[pancreas]] which currently bears his name.


Regarding the recognition of PanNETs, the possibility of cancer of the islet cells was initially suggested in 1888. The first case of [[hyperinsulinism]] due to a tumor of this type was reported in 1927. Recognition of a non-insulin-secreting type of PanNET is generally ascribed to the American surgeons,  R.&nbsp;M. Zollinger and E.&nbsp;H. Ellison, who gave their names to [[Zollinger–Ellison syndrome]], after postulating the existence of a gastrin-secreting pancreatic tumor in a report of two cases of unusually severe [[peptic ulcer]]s published in 1955.<ref name=Busnardo-1983>{{cite journal | author = Busnardo AC, DiDio LJ, Tidrick RT, Thomford NR | title = History of the pancreas | journal = American Journal of Surgery | volume = 146 | issue = 5 | pages = 539–50 | year = 1983 | pmid = 6356946 | doi = 10.1016/0002-9610(83)90286-6 | url = http://www.sciencedirect.com/science/article/pii/0002961083902866/pdfft?md5=34f4309b3b458333f9ba746946125abb&pid=1-s2.0-0002961083902866-main.pdf }}</ref> In 2010, the WHO recommended that PanNETs be referred to as "neuroendocrine" rather than "endocrine" tumors.<ref name="pmid20664470 [">{{cite journal| author=Klimstra DS, Modlin IR, Coppola D, Lloyd RV, Suster S| title=The pathologic classification of neuroendocrine tumors: a review of nomenclature, grading, and staging systems. | journal=Pancreas | year= 2010 | volume= 39 | issue= 6 | pages= 707-12 | pmid=20664470 [ | doi=10.1097/MPA.0b013e3181ec124e | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=20664470  }} </ref>
* Regnier de Graaf utilized [[Cannula|cannulation]] and studies on [[Pancreas|pancreatic]] secretions to demonstrate the true significance of the [[pancreatic duct]].
The first reported partial pancreaticoduodenectomy was performed by the Italian surgeon [[Alessandro Codivilla]] in 1898, but the patient only survived 18 days before succumbing to complications. Early operations were compromised partly because of mistaken beliefs that people would die if their duodenum was removed, and also, at first, if the flow of pancreatic juices stopped.  Later it was thought, also mistakenly, that the pancreatic duct could simply be tied up without serious adverse effects; in fact it will very often leak later on.  In 1907-08, after some more unsuccessful operations by other surgeons, experimental procedures were tried on corpses by French surgeons.<ref name="History">{{cite journal | author = Are C, Dhir M, Ravipati L | title = History of pancreaticoduodenectomy: early misconceptions, initial milestones and the pioneers | journal = HPB : the official journal of the International Hepato Pancreato Biliary Association | volume = 13 | issue = 6 | pages = 377–84 | date = June 2011 | pmid = 21609369 | doi = 10.1111/j.1477-2574.2011.00305.x }}</ref>
'''18th century:'''
* Albrecht Von Haller pointed out that the [[Pancreatic duct|pancreatic]] and [[Bile duct|bile ducts]] entered the [[intestine]] jointly and the function of [[Pancreas|pancreatic]] juice was to dilute [[bile]].


In 1912 the German surgeon [[Walther Kausch]] was the first to remove large parts of the duodenum and pancreas together (''en bloc''). This was in Breslau, now [[Wrocław]] in Poland. In 1918 it was demonstrated in operations on dogs that total removal of the duodenum is compatible with life, but this was not reported in human surgery until 1935, when the American surgeon [[Allen Oldfather Whipple]] published the results of a series of three operations at [[Columbia Presbyterian Hospital]] in New York. Only one of the patients had the duodenum totally removed, but he survived for two years before dying of metastasis to the liver.  The first operation was unplanned, as cancer was only discovered in the operating theatre. Whipple's success showed the way for the future, but the operation remained a difficult and dangerous one until recent decades.  He published several refinements to his procedure, including the first total removal of the duodenum in 1940, but he only performed a total of 37 operations.<ref name="History" />
* In 1742, Santorini illustrated the accessory [[Duct (anatomy)|duct]] which currently bears his name.
'''19th century:'''  
* Willy Kuhne discovered [[trypsin]].  


The discovery in the late 1930s that [[vitamin&nbsp;K]] prevented [[Vitamin K deficiency|bleeding with jaundice]], and the development of [[blood transfusion]] as an everyday process, both improved post-operative survival,<ref name="History" /> but about 25% of people never left hospital alive as late as the 1970s.<ref name="Thousand" >{{cite journal | author = Cameron JL, Riall TS, Coleman J, Belcher KA | title = One thousand consecutive pancreaticoduodenectomies | journal = Annals of surgery | volume = 244 | issue = 1 | pages = 10–5 | date = July 2006 | pmid = 16794383 | doi = 10.1097/01.sla.0000217673.04165.ea }}</ref> In the 1970s a group of American surgeons wrote urging that the procedure was too dangerous and should be abandoned.  Since then outcomes in larger centers have improved considerably, and mortality from the operation is often less than 4%.In 2006 a report was published of a series of 1,000 consecutive pancreaticoduodenectomies performed by a single surgeon from [[Johns Hopkins Hospital]] between 1969 and 2003. The rate of these operations had increased steadily over this period, with only three of them before 1980, and the median operating time reduced from 8.8&nbsp;hours in the 1970s to 5.5&nbsp;hours in the 2000s, and mortality within 30 days or in hospital was only 1%.<ref name="History" /><ref name="Thousand" /> Another series of 2,050 operations at the [[Massachusetts General Hospital]] between 1941 and 2011 showed a similar picture of improvement.<ref>{{cite journal | author = Fernández-del Castillo C, Morales-Oyarvide V, McGrath D, Wargo JA, Ferrone CR, Thayer SP, Lillemoe KD, Warshaw AL | title = Evolution of the Whipple procedure at the Massachusetts General Hospital | journal = Surgery | volume = 152 | issue = 3 Suppl 1 | pages = S56–63 | date = September 2012 | pmid = 22770961 | pmc = 3806095 | doi = 10.1016/j.surg.2012.05.022 }}</ref>
* In 1815, Alexander discovered [[pancreatic lipase]] and its role in [[digestion]].
 
=== '''History of pancreatic cancer:''' ===
The history of the [[pancreatic cancer]] is as follows:<ref name="Busnardo-1983">{{cite journal | author = Busnardo AC, DiDio LJ, Tidrick RT, Thomford NR | title = History of the pancreas | journal = American Journal of Surgery | volume = 146 | issue = 5 | pages = 539–50 | year = 1983 | pmid = 6356946 | doi = 10.1016/0002-9610(83)90286-6 | url = http://www.sciencedirect.com/science/article/pii/0002961083902866/pdfft?md5=34f4309b3b458333f9ba746946125abb&pid=1-s2.0-0002961083902866-main.pdf }}</ref><ref name="History">{{cite journal | author = Are C, Dhir M, Ravipati L | title = History of pancreaticoduodenectomy: early misconceptions, initial milestones and the pioneers | journal = HPB : the official journal of the International Hepato Pancreato Biliary Association | volume = 13 | issue = 6 | pages = 377–84 | date = June 2011 | pmid = 21609369 | doi = 10.1111/j.1477-2574.2011.00305.x }}</ref><ref name="Thousand">{{cite journal | author = Cameron JL, Riall TS, Coleman J, Belcher KA | title = One thousand consecutive pancreaticoduodenectomies | journal = Annals of surgery | volume = 244 | issue = 1 | pages = 10–5 | date = July 2006 | pmid = 16794383 | doi = 10.1097/01.sla.0000217673.04165.ea }}</ref><ref name="pmid20664470 [">{{cite journal| author=Klimstra DS, Modlin IR, Coppola D, Lloyd RV, Suster S| title=The pathologic classification of neuroendocrine tumors: a review of nomenclature, grading, and staging systems. | journal=Pancreas | year= 2010 | volume= 39 | issue= 6 | pages= 707-12 | pmid=20664470 | doi=10.1097/MPA.0b013e3181ec124e | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=20664470  }} </ref><ref>{{cite journal | author = Fernández-del Castillo C, Morales-Oyarvide V, McGrath D, Wargo JA, Ferrone CR, Thayer SP, Lillemoe KD, Warshaw AL | title = Evolution of the Whipple procedure at the Massachusetts General Hospital | journal = Surgery | volume = 152 | issue = 3 Suppl 1 | pages = S56–63 | date = September 2012 | pmid = 22770961 | pmc = 3806095 | doi = 10.1016/j.surg.2012.05.022 }}</ref>
* In 1679, Morgagni was the first to recognize [[Pancreatic cancer|cancer of the pancreas]] and described the [[pancreas]] of one of his patients as a dry white [[pancreas]] of a scirrhous nature with “pretty hard” distinct lobules.
* Morgagni also described a distended [[Gallbladder|gall bladder]] which is now known as the Corvosier’s sign in [[Patient|patients]] of [[pancreatic cancer]].
* By the late 1800s, the clinical [[symptoms]], signs and [[histology]] of [[pancreatic cancer]] had been defined. Bard and Pit differentiated between [[Duct (anatomy)|duct]], [[acinar cell]] and [[Islets of Langerhans|islet cell]] cancers.
* In 1882, Trendelenburg was the first to successfully excise a solid [[tumor]] of the [[pancreas]].
* In 1887, Kappeler described the first cholecystojejunostomy performed as [[Palliative care|palliative therapy]] in a [[pancreatic cancer]] patient.
* In 1893, Nimier published a detailed review on [[Surgery|surgical treatment]] of [[pancreatitis]] and [[pancreatic cancer]].
* In 1898, Codivilla performed a block excision of a major part of the [[duodenum]] and head of the [[pancreas]] for [[Pancreatic cancer|pancreatic carcinoma]].
*  in 1912, Kausch carried out the first successful two stage partial pancreaticoduodectomy , where he implanted the stump of the resected [[pancreas]] into the distal stump of the resected [[duodenum]].
* In February 1955, [[Whipple]] performed a two stage operation for [[carcinoma]] of the [[ampulla]], where a cholecystojejunostomy  and  total duodenectomy were performed. This was the first total duodenectomy to be recorded in a human subject.
 
* In 1940, Whipple and Nelson performed the first ever recorded one-stage [[pancreaticoduodenectomy]] followed by occlusion of  the [[pancreas]].
* Post 1940, the one-stage has been modified repeatedly by [[Surgery|surgeons]] world wide.
* Even today, only one tenth of the patients with [[Pancreatic cancer|pancreatic carcinoma]] undergo [[resection]].
* The mortality rate for  [[pancreaticoduodenectomy]] has declined from 21 percent before 1970 to 0 percent after 1970, but the [[five year survival rate]] is still in the range of 5 to 8 percent.


Small precancerous neoplasms for many pancreatic cancers are being detected at greatly increased rates by modern medical imaging. One type, the intraductal papillary mucinous neoplasm (IPMN) was first described by Japanese researchers in 1982; "For the next decade, little attention was paid to this report; however, over the subsequent 15 years, there has been a virtual explosion in the recognition of this tumor.
==References==
==References==
{{Reflist|2}}
{{Reflist|2}}
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[[Category:Disease]]
[[Category:Disease]]
[[Category:Types of cancer]]
[[Category:Types of cancer]]
[[Category:Mature chapter]]
[[Category:Up-To-Date]]
[[Category:Oncology]]
[[Category:Oncology]]
[[Category:Mature chapter]]
[[Category:Medicine]]
[[Category:Primary care]]
[[Category:Surgery]]
[[Category:Gastroenterology]]

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Sudarshana Datta, MD [2]

Overview

Herophilus of Chalcedon (circa 300 B.C.), the father of scientific anatomy, was the first to describe the pancreas but he had no conception of its function. Rufus of Ephesus (circa 100 A.D)  coined the term pancreas (from the Greek words pan meaning all and kreas meaning flesh). It literally means all flesh due to its homogeneous composition. In 1679, Morgagni was the first to recognize cancer of the pancreas and described the pancreas of one of his patients as a dry white pancreas of a scirrhous nature with “pretty hard” distinct lobules. By the late 1800s, the clinical symptoms, signs and histology of pancreatic cancer had been defined. Bard and Pit differentiated between duct, acinar cell and islet cell cancers. Trendelenburg was the first to successfully excise a solid tumor of the pancreas and Kappeler described the first cholecystojejunostomy performed as palliative therapy in a pancreatic cancer patient. In February 1955, Whipple performed a two stage operation for carcinoma of the ampulla, where a cholecystojejunostomy and total duodenectomy were performed. This was the first total duodenectomy to be recorded in a human subject. Whipple and Nelson subsequently performed the first ever recorded one-stage pancreaticoduodenectomy followed by occlusion of the pancreas. Post 1940, the one-stage has been modified repeatedly by surgeons world wide. Even today, the treatment of pancreatic cancer continues to be a dilemma. However, the mortality rate for pancreatoduodenal resection has declined considerably after 1970.

Historical Perspective

History of the pancreas

The history of the pancreas is as follows:[1]

  • Due to its hidden retroperitoneal location, the pancreas was initially termed as the hermit organ by 20th century surgeons and ignored both as an organ and as a seat of disease.
  • The pancreas was first recognized as a discrete organ by the Greeks.
  • Herophilus of Chalcedon (circa 300 B.C.), the father of scientific anatomy, was the first to describe the pancreas but he had no conception of its function.
  • Rufus of Ephesus (circa 100 A.D)  coined the term pancreas (from the Greek words pan: all and kreas: flesh).
  • The pancreas, literally means all flesh due to its homogeneous composition.

16th century:

  • Vesalius described the pancreas and the vessels running through it, but knew nothing of the ductal system or its function.

17th century:

  • Johann George Wirsung achieved medical immortality when he described the main duct of the human pancreas which currently bears his name.

18th century:

  • In 1742, Santorini illustrated the accessory duct which currently bears his name.

19th century:

History of pancreatic cancer:

The history of the pancreatic cancer is as follows:[2][3][4][5][6]

References

  1. Lamadrid Montemayor F, Rico Nieva P (1972). "[Analgesic and antiphlogistic action of benzidamine in obstetrics]". Ginecol Obstet Mex (in Spanish; Castilian). 32 (190): 209–12. PMID 4560737.
  2. Busnardo AC, DiDio LJ, Tidrick RT, Thomford NR (1983). "History of the pancreas" (PDF). American Journal of Surgery. 146 (5): 539–50. doi:10.1016/0002-9610(83)90286-6. PMID 6356946.
  3. Are C, Dhir M, Ravipati L (June 2011). "History of pancreaticoduodenectomy: early misconceptions, initial milestones and the pioneers". HPB : the official journal of the International Hepato Pancreato Biliary Association. 13 (6): 377–84. doi:10.1111/j.1477-2574.2011.00305.x. PMID 21609369.
  4. Cameron JL, Riall TS, Coleman J, Belcher KA (July 2006). "One thousand consecutive pancreaticoduodenectomies". Annals of surgery. 244 (1): 10–5. doi:10.1097/01.sla.0000217673.04165.ea. PMID 16794383.
  5. Klimstra DS, Modlin IR, Coppola D, Lloyd RV, Suster S (2010). "The pathologic classification of neuroendocrine tumors: a review of nomenclature, grading, and staging systems". Pancreas. 39 (6): 707–12. doi:10.1097/MPA.0b013e3181ec124e. PMID 20664470.
  6. Fernández-del Castillo C, Morales-Oyarvide V, McGrath D, Wargo JA, Ferrone CR, Thayer SP, Lillemoe KD, Warshaw AL (September 2012). "Evolution of the Whipple procedure at the Massachusetts General Hospital". Surgery. 152 (3 Suppl 1): S56–63. doi:10.1016/j.surg.2012.05.022. PMC 3806095. PMID 22770961.