|
|
| (378 intermediate revisions by 6 users not shown) |
| Line 1: |
Line 1: |
| | ==Physical examination== |
| | ==References== |
| | {{reflist|2}} |
| | |
| | {{WH}} |
| | {{WS}} |
| | |
| | ==References== |
| | {{Reflist|2}} |
| | |
| | |
| | ===Pathophysiology prev=== |
| | <div style="-webkit-user-select: none;"> |
| | {| class="infobox" style="position: fixed; top: 65%; right: 10px; margin: 0 0 0 0; border: 0; float: right;" |
| | |- |
| | | {{#ev:youtube|https://https://www.youtube.com/watch?v=5szNmKtyBW4|350}} |
| | |- |
| | |} |
| | __NOTOC__ |
| | {{Cirrhosis}} |
| | {{CMG}} {{AE}} |
| | |
| | |
| | ===Pathophysiology prev=== |
| | <div style="-webkit-user-select: none;"> |
| | {| class="infobox" style="position: fixed; top: 65%; right: 10px; margin: 0 0 0 0; border: 0; float: right;" |
| | |- |
| | | {{#ev:youtube|https://https://www.youtube.com/watch?v=5szNmKtyBW4|350}} |
| | |- |
| | |} |
| __NOTOC__ | | __NOTOC__ |
| {{Pancreatic cancer}} | | {{Cirrhosis}} |
| {{CMG}}; {{AE}} {{Cherry}} | | {{CMG}} {{AE}} |
| | |
| | == History and Symptoms == |
| | |
| | * History should include: |
| | ** Appearance of bowel movements |
| | ** Travel history |
| | ** Associated symptoms |
| | ** Immune status |
| | ** Woodland exposure |
| | ==References== |
| | {{reflist|2}} |
| | |
| | {{WH}} |
| | {{WS}} |
|
| |
|
| | ==Other Imaging Findings== |
| | * [[Endoscopy]] |
| | * [[Barium enema]] |
| | * [[Colonoscopy]] |
| | * [[Sigmoidoscopy]] |
|
| |
|
| | ==Other diagnostic studies== |
| | == Other Diagnostic Studies == |
|
| |
|
| NEW TREATMENTS
| | * Breath hydrogen test |
| Irinotecan in an encapsulated form inside a nanoliposome is being used in advanced pancreatic cancer patients who have been earlier been treated using gemcitabine-based chemotherapy. <ref name="pmid27140876">{{cite journal |vauthors=Chiang NJ, Chang JY, Shan YS, Chen LT |title=Development of nanoliposomal irinotecan (nal-IRI, MM-398, PEP02) in the management of metastatic pancreatic cancer |journal=Expert Opin Pharmacother |volume=17 |issue=10 |pages=1413–20 |year=2016 |pmid=27140876 |doi=10.1080/14656566.2016.1183646 |url=}}</ref>
| |
| Liposomal Irinotecan is used along with leucovorin and fluorouracil.<ref name="pmid26615328">{{cite journal |vauthors=Wang-Gillam A, Li CP, Bodoky G, Dean A, Shan YS, Jameson G, Macarulla T, Lee KH, Cunningham D, Blanc JF, Hubner RA, Chiu CF, Schwartsmann G, Siveke JT, Braiteh F, Moyo V, Belanger B, Dhindsa N, Bayever E, Von Hoff DD, Chen LT |title=Nanoliposomal irinotecan with fluorouracil and folinic acid in metastatic pancreatic cancer after previous gemcitabine-based therapy (NAPOLI-1): a global, randomised, open-label, phase 3 trial |journal=Lancet |volume=387 |issue=10018 |pages=545–57 |year=2016 |pmid=26615328 |doi=10.1016/S0140-6736(15)00986-1 |url=}}</ref>
| |
|
| |
|
| | * [[HIV test]]ing for those patients suspected of having HIV |
|
| |
|
| ADJUVANT THERAPY
| | == |
| The use of gemcitabine as adjuvant therapy is considered a standard form of therapy following surgical resection in pancreatic cancer patients.<ref name="pmid4015380">{{cite journal |vauthors=Kalser MH, Ellenberg SS |title=Pancreatic cancer. Adjuvant combined radiation and chemotherapy following curative resection |journal=Arch Surg |volume=120 |issue=8 |pages=899–903 |year=1985 |pmid=4015380 |doi= |url=}}</ref><ref name="pmid15028824">{{cite journal |vauthors=Neoptolemos JP, Stocken DD, Friess H, Bassi C, Dunn JA, Hickey H, Beger H, Fernandez-Cruz L, Dervenis C, Lacaine F, Falconi M, Pederzoli P, Pap A, Spooner D, Kerr DJ, Büchler MW |title=A randomized trial of chemoradiotherapy and chemotherapy after resection of pancreatic cancer |journal=N. Engl. J. Med. |volume=350 |issue=12 |pages=1200–10 |year=2004 |pmid=15028824 |doi=10.1056/NEJMoa032295 |url=}}</ref><ref name="pmid20083754">{{cite journal |vauthors=Yang R, Cheung MC, Byrne MM, Jin X, Montero AJ, Jones C, Koniaris LG |title=Survival effects of adjuvant chemoradiotherapy after resection for pancreatic carcinoma |journal=Arch Surg |volume=145 |issue=1 |pages=49–56 |year=2010 |pmid=20083754 |doi=10.1001/archsurg.2009.244 |url=}}</ref><ref name="pmid17227978">{{cite journal |vauthors=Oettle H, Post S, Neuhaus P, Gellert K, Langrehr J, Ridwelski K, Schramm H, Fahlke J, Zuelke C, Burkart C, Gutberlet K, Kettner E, Schmalenberg H, Weigang-Koehler K, Bechstein WO, Niedergethmann M, Schmidt-Wolf I, Roll L, Doerken B, Riess H |title=Adjuvant chemotherapy with gemcitabine vs observation in patients undergoing curative-intent resection of pancreatic cancer: a randomized controlled trial |journal=JAMA |volume=297 |issue=3 |pages=267–77 |year=2007 |pmid=17227978 |doi=10.1001/jama.297.3.267 |url=}}</ref><ref name="pmid24035532">{{cite journal |vauthors=Liao WC, Chien KL, Lin YL, Wu MS, Lin JT, Wang HP, Tu YK |title=Adjuvant treatments for resected pancreatic adenocarcinoma: a systematic review and network meta-analysis |journal=Lancet Oncol. |volume=14 |issue=11 |pages=1095–103 |year=2013 |pmid=24035532 |doi=10.1016/S1470-2045(13)70388-7 |url=}}</ref><ref name="pmid24419109">{{cite journal |vauthors=Valle JW, Palmer D, Jackson R, Cox T, Neoptolemos JP, Ghaneh P, Rawcliffe CL, Bassi C, Stocken DD, Cunningham D, O'Reilly D, Goldstein D, Robinson BA, Karapetis C, Scarfe A, Lacaine F, Sand J, Izbicki JR, Mayerle J, Dervenis C, Oláh A, Butturini G, Lind PA, Middleton MR, Anthoney A, Sumpter K, Carter R, Büchler MW |title=Optimal duration and timing of adjuvant chemotherapy after definitive surgery for ductal adenocarcinoma of the pancreas: ongoing lessons from the ESPAC-3 study |journal=J. Clin. Oncol. |volume=32 |issue=6 |pages=504–12 |year=2014 |pmid=24419109 |doi=10.1200/JCO.2013.50.7657 |url=}}</ref><ref name="pmid27328270">{{cite journal |vauthors=Mirkin KA, Greenleaf EK, Hollenbeak CS, Wong J |title=Time to the initiation of adjuvant chemotherapy does not impact survival in patients with resected pancreatic cancer |journal=Cancer |volume=122 |issue=19 |pages=2979–87 |year=2016 |pmid=27328270 |doi=10.1002/cncr.30163 |url=}}</ref><ref name="pmid28129987">{{cite journal |vauthors=Neoptolemos JP, Palmer DH, Ghaneh P, Psarelli EE, Valle JW, Halloran CM, Faluyi O, O'Reilly DA, Cunningham D, Wadsley J, Darby S, Meyer T, Gillmore R, Anthoney A, Lind P, Glimelius B, Falk S, Izbicki JR, Middleton GW, Cummins S, Ross PJ, Wasan H, McDonald A, Crosby T, Ma YT, Patel K, Sherriff D, Soomal R, Borg D, Sothi S, Hammel P, Hackert T, Jackson R, Büchler MW |title=Comparison of adjuvant gemcitabine and capecitabine with gemcitabine monotherapy in patients with resected pancreatic cancer (ESPAC-4): a multicentre, open-label, randomised, phase 3 trial |journal=Lancet |volume=389 |issue=10073 |pages=1011–1024 |year=2017 |pmid=28129987 |doi=10.1016/S0140-6736(16)32409-6 |url=}}</ref><ref name="pmid8471327">{{cite journal |vauthors=Bakkevold KE, Arnesjø B, Dahl O, Kambestad B |title=Adjuvant combination chemotherapy (AMF) following radical resection of carcinoma of the pancreas and papilla of Vater--results of a controlled, prospective, randomised multicentre study |journal=Eur. J. Cancer |volume=29A |issue=5 |pages=698–703 |year=1993 |pmid=8471327 |doi= |url=}}</ref>
| |
| NEOADJUVANT THERAPY
| |
| Neoadjuvant therapy may be used as a form of therapy due to the following reasons:<ref name="pmid9850029">{{cite journal |vauthors=Pisters PW, Abbruzzese JL, Janjan NA, Cleary KR, Charnsangavej C, Goswitz MS, Rich TA, Raijman I, Wolff RA, Lenzi R, Lee JE, Evans DB |title=Rapid-fractionation preoperative chemoradiation, pancreaticoduodenectomy, and intraoperative radiation therapy for resectable pancreatic adenocarcinoma |journal=J. Clin. Oncol. |volume=16 |issue=12 |pages=3843–50 |year=1998 |pmid=9850029 |doi=10.1200/JCO.1998.16.12.3843 |url=}}</ref><ref name="pmid12011133">{{cite journal |vauthors=Pisters PW, Wolff RA, Janjan NA, Cleary KR, Charnsangavej C, Crane CN, Lenzi R, Vauthey JN, Lee JE, Abbruzzese JL, Evans DB |title=Preoperative paclitaxel and concurrent rapid-fractionation radiation for resectable pancreatic adenocarcinoma: toxicities, histologic response rates, and event-free outcome |journal=J. Clin. Oncol. |volume=20 |issue=10 |pages=2537–44 |year=2002 |pmid=12011133 |doi=10.1200/JCO.2002.11.064 |url=}}</ref><ref name="pmid24306217">{{cite journal |vauthors=Kadera BE, Sunjaya DB, Isacoff WH, Li L, Hines OJ, Tomlinson JS, Dawson DW, Rochefort MM, Donald GW, Clerkin BM, Reber HA, Donahue TR |title=Locally advanced pancreatic cancer: association between prolonged preoperative treatment and lymph-node negativity and overall survival |journal=JAMA Surg |volume=149 |issue=2 |pages=145–53 |year=2014 |pmid=24306217 |doi=10.1001/jamasurg.2013.2690 |url=}}</ref><ref name="pmid21969502">{{cite journal |vauthors=Loehrer PJ, Feng Y, Cardenes H, Wagner L, Brell JM, Cella D, Flynn P, Ramanathan RK, Crane CH, Alberts SR, Benson AB |title=Gemcitabine alone versus gemcitabine plus radiotherapy in patients with locally advanced pancreatic cancer: an Eastern Cooperative Oncology Group trial |journal=J. Clin. Oncol. |volume=29 |issue=31 |pages=4105–12 |year=2011 |pmid=21969502 |pmc=3525836 |doi=10.1200/JCO.2011.34.8904 |url=}}</ref><ref name="pmid28105634">{{cite journal |vauthors=Xia BT, Fu B, Wang J, Kim Y, Ahmad SA, Dhar VK, Levinsky NC, Hanseman DJ, Habib DA, Wilson GC, Smith M, Olowokure OO, Kharofa J, Al Humaidi AH, Choe KA, Abbott DE, Ahmad SA |title=Does radiologic response correlate to pathologic response in patients undergoing neoadjuvant therapy for borderline resectable pancreatic malignancy? |journal=J Surg Oncol |volume=115 |issue=4 |pages=376–383 |year=2017 |pmid=28105634 |doi=10.1002/jso.24538 |url=}}</ref><ref name="pmid25599322">{{cite journal |vauthors=Ferrone CR, Marchegiani G, Hong TS, Ryan DP, Deshpande V, McDonnell EI, Sabbatino F, Santos DD, Allen JN, Blaszkowsky LS, Clark JW, Faris JE, Goyal L, Kwak EL, Murphy JE, Ting DT, Wo JY, Zhu AX, Warshaw AL, Lillemoe KD, Fernández-del Castillo C |title=Radiological and surgical implications of neoadjuvant treatment with FOLFIRINOX for locally advanced and borderline resectable pancreatic cancer |journal=Ann. Surg. |volume=261 |issue=1 |pages=12–7 |year=2015 |pmid=25599322 |pmc=4349683 |doi=10.1097/SLA.0000000000000867 |url=}}</ref><ref name="pmid23838925">{{cite journal |vauthors=Motoi F, Ishida K, Fujishima F, Ottomo S, Oikawa M, Okada T, Shimamura H, Takemura S, Ono F, Akada M, Nakagawa K, Katayose Y, Egawa S, Unno M |title=Neoadjuvant chemotherapy with gemcitabine and S-1 for resectable and borderline pancreatic ductal adenocarcinoma: results from a prospective multi-institutional phase 2 trial |journal=Ann. Surg. Oncol. |volume=20 |issue=12 |pages=3794–801 |year=2013 |pmid=23838925 |doi=10.1245/s10434-013-3129-9 |url=}}</ref><ref name="pmid20817204">{{cite journal |vauthors=Sahora K, Kuehrer I, Eisenhut A, Akan B, Koellblinger C, Goetzinger P, Teleky B, Jakesz R, Peck-Radosavljevic M, Ba'ssalamah A, Zielinski C, Gnant M |title=NeoGemOx: Gemcitabine and oxaliplatin as neoadjuvant treatment for locally advanced, nonmetastasized pancreatic cancer |journal=Surgery |volume=149 |issue=3 |pages=311–20 |year=2011 |pmid=20817204 |doi=10.1016/j.surg.2010.07.048 |url=}}</ref><ref name="pmid19307501">{{cite journal |vauthors=Huguet F, Girard N, Guerche CS, Hennequin C, Mornex F, Azria D |title=Chemoradiotherapy in the management of locally advanced pancreatic carcinoma: a qualitative systematic review |journal=J. Clin. Oncol. |volume=27 |issue=13 |pages=2269–77 |year=2009 |pmid=19307501 |doi=10.1200/JCO.2008.19.7921 |url=}}</ref><ref name="pmid20422030">{{cite journal |vauthors=Gillen S, Schuster T, Meyer Zum Büschenfelde C, Friess H, Kleeff J |title=Preoperative/neoadjuvant therapy in pancreatic cancer: a systematic review and meta-analysis of response and resection percentages |journal=PLoS Med. |volume=7 |issue=4 |pages=e1000267 |year=2010 |pmid=20422030 |pmc=2857873 |doi=10.1371/journal.pmed.1000267 |url=}}</ref><ref name="pmid22012027">{{cite journal |vauthors=Andriulli A, Festa V, Botteri E, Valvano MR, Koch M, Bassi C, Maisonneuve P, Sebastiano PD |title=Neoadjuvant/preoperative gemcitabine for patients with localized pancreatic cancer: a meta-analysis of prospective studies |journal=Ann. Surg. Oncol. |volume=19 |issue=5 |pages=1644–62 |year=2012 |pmid=22012027 |doi=10.1245/s10434-011-2110-8 |url=}}</ref><ref name="pmid18308215">{{cite journal |vauthors=Greer SE, Pipas JM, Sutton JE, Zaki BI, Tsapakos M, Colacchio TA, Gibson JJ, Wiener DC, Ripple GH, Barth RJ |title=Effect of neoadjuvant therapy on local recurrence after resection of pancreatic adenocarcinoma |journal=J. Am. Coll. Surg. |volume=206 |issue=3 |pages=451–7 |year=2008 |pmid=18308215 |doi=10.1016/j.jamcollsurg.2007.10.002 |url=}}</ref><ref name="pmid12399067">{{cite journal |vauthors=Kim HJ, Czischke K, Brennan MF, Conlon KC |title=Does neoadjuvant chemoradiation downstage locally advanced pancreatic cancer? |journal=J. Gastrointest. Surg. |volume=6 |issue=5 |pages=763–9 |year=2002 |pmid=12399067 |doi= |url=}}</ref><ref name="pmid10487547">{{cite journal |vauthors=Bajetta E, Di Bartolomeo M, Stani SC, Artale S, Ricci SB, Bozzetti F, Mazzaferro V, Toffolatti L, Buzzoni R |title=Chemoradiotherapy as preoperative treatment in locally advanced unresectable pancreatic cancer patients: results of a feasibility study |journal=Int. J. Radiat. Oncol. Biol. Phys. |volume=45 |issue=2 |pages=285–9 |year=1999 |pmid=10487547 |doi= |url=}}</ref><ref name="pmid25599322">{{cite journal |vauthors=Ferrone CR, Marchegiani G, Hong TS, Ryan DP, Deshpande V, McDonnell EI, Sabbatino F, Santos DD, Allen JN, Blaszkowsky LS, Clark JW, Faris JE, Goyal L, Kwak EL, Murphy JE, Ting DT, Wo JY, Zhu AX, Warshaw AL, Lillemoe KD, Fernández-del Castillo C |title=Radiological and surgical implications of neoadjuvant treatment with FOLFIRINOX for locally advanced and borderline resectable pancreatic cancer |journal=Ann. Surg. |volume=261 |issue=1 |pages=12–7 |year=2015 |pmid=25599322 |pmc=4349683 |doi=10.1097/SLA.0000000000000867 |url=}}</ref><ref name="pmid28105634">{{cite journal |vauthors=Xia BT, Fu B, Wang J, Kim Y, Ahmad SA, Dhar VK, Levinsky NC, Hanseman DJ, Habib DA, Wilson GC, Smith M, Olowokure OO, Kharofa J, Al Humaidi AH, Choe KA, Abbott DE, Ahmad SA |title=Does radiologic response correlate to pathologic response in patients undergoing neoadjuvant therapy for borderline resectable pancreatic malignancy? |journal=J Surg Oncol |volume=115 |issue=4 |pages=376–383 |year=2017 |pmid=28105634 |doi=10.1002/jso.24538 |url=}}</ref>
| |
| Toxic effects of chemotherapy can be tolerated more easily before surgery as compared to after resection
| |
| Shrinkage of tumor with neoadjuvant therapy makes resection easier and improves patient prognosis
| |
| Systemic treatment for cancer involving various systems improves prognosis
| |
| No therapy is considered as first line therapy under this category.Decisions for treatment are made on an individual basis.
| |
|
| |
|
| SURGERY
| | ==Overview== |
| There are different surgical techniques that may be used for resectable pancreatic cancer and their prognosis has been extensively studied: <ref name="pmid12972517">{{cite journal |vauthors=Krzyzanowska MK, Weeks JC, Earle CC |title=Treatment of locally advanced pancreatic cancer in the real world: population-based practices and effectiveness |journal=J. Clin. Oncol. |volume=21 |issue=18 |pages=3409–14 |year=2003 |pmid=12972517 |doi=10.1200/JCO.2003.03.007 |url=}}</ref><ref name="pmid16955382">{{cite journal |vauthors=Massucco P, Capussotti L, Magnino A, Sperti E, Gatti M, Muratore A, Sgotto E, Gabriele P, Aglietta M |title=Pancreatic resections after chemoradiotherapy for locally advanced ductal adenocarcinoma: analysis of perioperative outcome and survival |journal=Ann. Surg. Oncol. |volume=13 |issue=9 |pages=1201–8 |year=2006 |pmid=16955382 |doi=10.1245/s10434-006-9032-x |url=}}</ref><ref name="pmid12576921">{{cite journal |vauthors=Aristu J, Cañón R, Pardo F, Martínez-Monge R, Martin-Algarra S, Manuel Ordoñez J, Villafranca E, Moreno M, Cambeiro M, Azinovic I |title=Surgical resection after preoperative chemoradiotherapy benefits selected patients with unresectable pancreatic cancer |journal=Am. J. Clin. Oncol. |volume=26 |issue=1 |pages=30–6 |year=2003 |pmid=12576921 |doi= |url=}}</ref><ref name="pmid19576722">{{cite journal |vauthors=Turrini O, Viret F, Moureau-Zabotto L, Guiramand J, Moutardier V, Lelong B, Giovannini M, Delpero JR |title=Neoadjuvant chemoradiation and pancreaticoduodenectomy for initially locally advanced head pancreatic adenocarcinoma |journal=Eur J Surg Oncol |volume=35 |issue=12 |pages=1306–11 |year=2009 |pmid=19576722 |doi=10.1016/j.ejso.2009.06.005 |url=}}</ref><ref name="pmid27247221">{{cite journal |vauthors=Khorana AA, Mangu PB, Berlin J, Engebretson A, Hong TS, Maitra A, Mohile SG, Mumber M, Schulick R, Shapiro M, Urba S, Zeh HJ, Katz MH |title=Potentially Curable Pancreatic Cancer: American Society of Clinical Oncology Clinical Practice Guideline |journal=J. Clin. Oncol. |volume=34 |issue=21 |pages=2541–56 |year=2016 |pmid=27247221 |doi=10.1200/JCO.2016.67.5553 |url=}}</ref><ref name="pmid27247221">{{cite journal |vauthors=Khorana AA, Mangu PB, Berlin J, Engebretson A, Hong TS, Maitra A, Mohile SG, Mumber M, Schulick R, Shapiro M, Urba S, Zeh HJ, Katz MH |title=Potentially Curable Pancreatic Cancer: American Society of Clinical Oncology Clinical Practice Guideline |journal=J. Clin. Oncol. |volume=34 |issue=21 |pages=2541–56 |year=2016 |pmid=27247221 |doi=10.1200/JCO.2016.67.5553 |url=}}</ref><ref name="pmid25207767">{{cite journal |vauthors=Ryan DP, Hong TS, Bardeesy N |title=Pancreatic adenocarcinoma |journal=N. Engl. J. Med. |volume=371 |issue=11 |pages=1039–49 |year=2014 |pmid=25207767 |doi=10.1056/NEJMra1404198 |url=}}</ref><ref name="pmid28398845">{{cite journal |vauthors=Khorana AA, Mangu PB, Berlin J, Engebretson A, Hong TS, Maitra A, Mohile SG, Mumber M, Schulick R, Shapiro M, Urba S, Zeh HJ, Katz MHG |title=Potentially Curable Pancreatic Cancer: American Society of Clinical Oncology Clinical Practice Guideline Update |journal=J. Clin. Oncol. |volume=35 |issue=20 |pages=2324–2328 |year=2017 |pmid=28398845 |doi=10.1200/JCO.2017.72.4948 |url=}}</ref><ref name="pmid22569924">{{cite journal |vauthors=Sanjay P, Takaori K, Govil S, Shrikhande SV, Windsor JA |title='Artery-first' approaches to pancreatoduodenectomy |journal=Br J Surg |volume=99 |issue=8 |pages=1027–35 |year=2012 |pmid=22569924 |doi=10.1002/bjs.8763 |url=}}</ref><ref name="pmid24578248">{{cite journal |vauthors=Gurusamy KS, Kumar S, Davidson BR, Fusai G |title=Resection versus other treatments for locally advanced pancreatic cancer |journal=Cochrane Database Syst Rev |volume= |issue=2 |pages=CD010244 |year=2014 |pmid=24578248 |doi=10.1002/14651858.CD010244.pub2 |url=}}</ref><ref name="pmid18958561">{{cite journal |vauthors=Doi R, Imamura M, Hosotani R, Imaizumi T, Hatori T, Takasaki K, Funakoshi A, Wakasugi H, Asano T, Hishinuma S, Ogata Y, Sunamura M, Yamaguchi K, Tanaka M, Takao S, Aikou T, Hirata K, Maguchi H, Aiura K, Aoki T, Kakita A, Sasaki M, Ozaki M, Matsusue S, Higashide S, Noda H, Ikeda S, Maetani S, Yoshida S |title=Surgery versus radiochemotherapy for resectable locally invasive pancreatic cancer: final results of a randomized multi-institutional trial |journal=Surg. Today |volume=38 |issue=11 |pages=1021–8 |year=2008 |pmid=18958561 |doi=10.1007/s00595-007-3745-8 |url=}}</ref><ref name="pmid15086174">{{cite journal |vauthors=Lygidakis NJ, Singh G, Bardaxoglou E, Dedemadi G, Sgourakis G, Nestoridis J, Malliotakis A, Pedonomou M, Solomou EK, Safioleas M, Alamani M, Grigorakos L, Merikas EM |title=Mono-bloc total spleno-pancreaticoduodenectomy for pancreatic head carcinoma with portal-mesenteric venous invasion. A prospective randomized study |journal=Hepatogastroenterology |volume=51 |issue=56 |pages=427–33 |year=2004 |pmid=15086174 |doi= |url=}}</ref><ref name="pmid23532000">{{cite journal |vauthors=Yamada S, Fujii T, Sugimoto H, Nomoto S, Takeda S, Kodera Y, Nakao A |title=Aggressive surgery for borderline resectable pancreatic cancer: evaluation of National Comprehensive Cancer Network guidelines |journal=Pancreas |volume=42 |issue=6 |pages=1004–10 |year=2013 |pmid=23532000 |doi=10.1097/MPA.0b013e31827b2d7c |url=}}</ref><ref name="pmid8597508">{{cite journal |vauthors=Fortner JG, Klimstra DS, Senie RT, Maclean BJ |title=Tumor size is the primary prognosticator for pancreatic cancer after regional pancreatectomy |journal=Ann. Surg. |volume=223 |issue=2 |pages=147–53 |year=1996 |pmid=8597508 |pmc=1235090 |doi= |url=}}</ref><ref name="pmid2910241">{{cite journal |vauthors=Sindelar WF |title=Clinical experience with regional pancreatectomy for adenocarcinoma of the pancreas |journal=Arch Surg |volume=124 |issue=1 |pages=127–32 |year=1989 |pmid=2910241 |doi= |url=}}</ref><ref name="pmid6712317">{{cite journal |vauthors=Fortner JG |title=Regional pancreatectomy for cancer of the pancreas, ampulla, and other related sites. Tumor staging and results |journal=Ann. Surg. |volume=199 |issue=4 |pages=418–25 |year=1984 |pmid=6712317 |pmc=1353360 |doi= |url=}}</ref><ref name="pmid12192322">{{cite journal |vauthors=Yeo CJ, Cameron JL, Lillemoe KD, Sohn TA, Campbell KA, Sauter PK, Coleman J, Abrams RA, Hruban RH |title=Pancreaticoduodenectomy with or without distal gastrectomy and extended retroperitoneal lymphadenectomy for periampullary adenocarcinoma, part 2: randomized controlled trial evaluating survival, morbidity, and mortality |journal=Ann. Surg. |volume=236 |issue=3 |pages=355–66; discussion 366–8 |year=2002 |pmid=12192322 |pmc=1422589 |doi=10.1097/01.SLA.0000027272.08464.0B |url=}}</ref><ref name="pmid16269290">{{cite journal |vauthors=Farnell MB, Pearson RK, Sarr MG, DiMagno EP, Burgart LJ, Dahl TR, Foster N, Sargent DJ |title=A prospective randomized trial comparing standard pancreatoduodenectomy with pancreatoduodenectomy with extended lymphadenectomy in resectable pancreatic head adenocarcinoma |journal=Surgery |volume=138 |issue=4 |pages=618–28; discussion 628–30 |year=2005 |pmid=16269290 |doi=10.1016/j.surg.2005.06.044 |url=}}</ref><ref name="pmid24912627">{{cite journal |vauthors=Sun J, Yang Y, Wang X, Yu Z, Zhang T, Song J, Zhao H, Wen J, Du Y, Lau WY, Zhang Y |title=Meta-analysis of the efficacies of extended and standard pancreatoduodenectomy for ductal adenocarcinoma of the head of the pancreas |journal=World J Surg |volume=38 |issue=10 |pages=2708–15 |year=2014 |pmid=24912627 |doi=10.1007/s00268-014-2633-9 |url=}}</ref><ref name="pmid10399969">{{cite journal |vauthors=Millikan KW, Deziel DJ, Silverstein JC, Kanjo TM, Christein JD, Doolas A, Prinz RA |title=Prognostic factors associated with resectable adenocarcinoma of the head of the pancreas |journal=Am Surg |volume=65 |issue=7 |pages=618–23; discussion 623–4 |year=1999 |pmid=10399969 |doi= |url=}}</ref><ref name="pmid11296108">{{cite journal |vauthors=Balcom JH, Rattner DW, Warshaw AL, Chang Y, Fernandez-del Castillo C |title=Ten-year experience with 733 pancreatic resections: changing indications, older patients, and decreasing length of hospitalization |journal=Arch Surg |volume=136 |issue=4 |pages=391–8 |year=2001 |pmid=11296108 |doi= |url=}}</ref><ref name="pmid25348784">{{cite journal |vauthors=Serrano PE, Cleary SP, Dhani N, Kim PT, Greig PD, Leung K, Moulton CA, Gallinger S, Wei AC |title=Improved long-term outcomes after resection of pancreatic adenocarcinoma: a comparison between two time periods |journal=Ann. Surg. Oncol. |volume=22 |issue=4 |pages=1160–7 |year=2015 |pmid=25348784 |doi=10.1245/s10434-014-4196-2 |url=}}</ref><ref name="pmid21935914">{{cite journal |vauthors=Mayo SC, Nathan H, Cameron JL, Olino K, Edil BH, Herman JM, Hirose K, Schulick RD, Choti MA, Wolfgang CL, Pawlik TM |title=Conditional survival in patients with pancreatic ductal adenocarcinoma resected with curative intent |journal=Cancer |volume=118 |issue=10 |pages=2674–81 |year=2012 |pmid=21935914 |pmc=3578343 |doi=10.1002/cncr.26553 |url=}}</ref><ref name="pmid24038103">{{cite journal |vauthors=Sinn M, Striefler JK, Sinn BV, Sallmon D, Bischoff S, Stieler JM, Pelzer U, Bahra M, Neuhaus P, Dörken B, Denkert C, Riess H, Oettle H |title=Does long-term survival in patients with pancreatic cancer really exist? Results from the CONKO-001 study |journal=J Surg Oncol |volume=108 |issue=6 |pages=398–402 |year=2013 |pmid=24038103 |doi=10.1002/jso.23409 |url=}}</ref>
| |
| Pancreaticoduodenectomy (Whipple Procedure)<ref name="pmid26314780">{{cite journal |vauthors=Ducreux M, Cuhna AS, Caramella C, Hollebecque A, Burtin P, Goéré D, Seufferlein T, Haustermans K, Van Laethem JL, Conroy T, Arnold D |title=Cancer of the pancreas: ESMO Clinical Practice Guidelines for diagnosis, treatment, and follow-up |journal=Ann. Oncol. |volume=26 Suppl 5 |issue= |pages=v56–68 |year=2015 |pmid=26314780 |doi=10.1093/annonc/mdv295 |url=}}</ref><ref name="pmid27247221">{{cite journal |vauthors=Khorana AA, Mangu PB, Berlin J, Engebretson A, Hong TS, Maitra A, Mohile SG, Mumber M, Schulick R, Shapiro M, Urba S, Zeh HJ, Katz MH |title=Potentially Curable Pancreatic Cancer: American Society of Clinical Oncology Clinical Practice Guideline |journal=J. Clin. Oncol. |volume=34 |issue=21 |pages=2541–56 |year=2016 |pmid=27247221 |doi=10.1200/JCO.2016.67.5553 |url=}}</ref><ref name="pmid19387741">{{cite journal |vauthors=Evans DB, Farnell MB, Lillemoe KD, Vollmer C, Strasberg SM, Schulick RD |title=Surgical treatment of resectable and borderline resectable pancreas cancer: expert consensus statement |journal=Ann. Surg. Oncol. |volume=16 |issue=7 |pages=1736–44 |year=2009 |pmid=19387741 |doi=10.1245/s10434-009-0416-6 |url=}}</ref><ref name="pmid9339931">{{cite journal |vauthors=Yeo CJ, Cameron JL, Sohn TA, Lillemoe KD, Pitt HA, Talamini MA, Hruban RH, Ord SE, Sauter PK, Coleman J, Zahurak ML, Grochow LB, Abrams RA |title=Six hundred fifty consecutive pancreaticoduodenectomies in the 1990s: pathology, complications, and outcomes |journal=Ann. Surg. |volume=226 |issue=3 |pages=248–57; discussion 257–60 |year=1997 |pmid=9339931 |pmc=1191017 |doi= |url=}}</ref>
| |
| It is mainly performed for tumors located in:<ref name="pmid7794076">{{cite journal |vauthors=Yeo CJ, Cameron JL, Lillemoe KD, Sitzmann JV, Hruban RH, Goodman SN, Dooley WC, Coleman J, Pitt HA |title=Pancreaticoduodenectomy for cancer of the head of the pancreas. 201 patients |journal=Ann. Surg. |volume=221 |issue=6 |pages=721–31; discussion 731–3 |year=1995 |pmid=7794076 |pmc=1234702 |doi= |url=}}</ref><ref name="pmid9339931">{{cite journal |vauthors=Yeo CJ, Cameron JL, Sohn TA, Lillemoe KD, Pitt HA, Talamini MA, Hruban RH, Ord SE, Sauter PK, Coleman J, Zahurak ML, Grochow LB, Abrams RA |title=Six hundred fifty consecutive pancreaticoduodenectomies in the 1990s: pathology, complications, and outcomes |journal=Ann. Surg. |volume=226 |issue=3 |pages=248–57; discussion 257–60 |year=1997 |pmid=9339931 |pmc=1191017 |doi= |url=}}</ref><ref name="pmid8098202">{{cite journal |vauthors=Cameron JL, Pitt HA, Yeo CJ, Lillemoe KD, Kaufman HS, Coleman J |title=One hundred and forty-five consecutive pancreaticoduodenectomies without mortality |journal=Ann. Surg. |volume=217 |issue=5 |pages=430–5; discussion 435–8 |year=1993 |pmid=8098202 |pmc=1242815 |doi= |url=}}</ref>
| |
| Periampullary region
| |
| Duodenum
| |
| Bile duct (Cholangiocarcinoma)
| |
| Pancreatic duct
| |
| Head of pancreas
| |
| Whipple procedure involves removal of the following components due to common blood supply:
| |
| Stomach antrum
| |
| Gallbladder
| |
| Duodenum
| |
| Head of pancreas
| |
| After removal of the above structures, the biliary and distal pancreatic ducts are anastomosed to the jejunum to facilitate surgical drainage. Biliary drainage may also be performed preoperatively.<ref name="pmid20071702">{{cite journal |vauthors=van der Gaag NA, Rauws EA, van Eijck CH, Bruno MJ, van der Harst E, Kubben FJ, Gerritsen JJ, Greve JW, Gerhards MF, de Hingh IH, Klinkenbijl JH, Nio CY, de Castro SM, Busch OR, van Gulik TM, Bossuyt PM, Gouma DJ |title=Preoperative biliary drainage for cancer of the head of the pancreas |journal=N. Engl. J. Med. |volume=362 |issue=2 |pages=129–37 |year=2010 |pmid=20071702 |doi=10.1056/NEJMoa0903230 |url=}}</ref><ref name="pmid20071702">{{cite journal |vauthors=van der Gaag NA, Rauws EA, van Eijck CH, Bruno MJ, van der Harst E, Kubben FJ, Gerritsen JJ, Greve JW, Gerhards MF, de Hingh IH, Klinkenbijl JH, Nio CY, de Castro SM, Busch OR, van Gulik TM, Bossuyt PM, Gouma DJ |title=Preoperative biliary drainage for cancer of the head of the pancreas |journal=N. Engl. J. Med. |volume=362 |issue=2 |pages=129–37 |year=2010 |pmid=20071702 |doi=10.1056/NEJMoa0903230 |url=}}</ref>
| |
|
| |
|
| This procedure is associated with several morbidities:<ref name="pmid17667503">{{cite journal |vauthors=McPhee JT, Hill JS, Whalen GF, Zayaruzny M, Litwin DE, Sullivan ME, Anderson FA, Tseng JF |title=Perioperative mortality for pancreatectomy: a national perspective |journal=Ann. Surg. |volume=246 |issue=2 |pages=246–53 |year=2007 |pmid=17667503 |pmc=1933570 |doi=10.1097/01.sla.0000259993.17350.3a |url=}}</ref><ref name="pmid17462460">{{cite journal |vauthors=Pawlik TM, Gleisner AL, Cameron JL, Winter JM, Assumpcao L, Lillemoe KD, Wolfgang C, Hruban RH, Schulick RD, Yeo CJ, Choti MA |title=Prognostic relevance of lymph node ratio following pancreaticoduodenectomy for pancreatic cancer |journal=Surgery |volume=141 |issue=5 |pages=610–8 |year=2007 |pmid=17462460 |doi=10.1016/j.surg.2006.12.013 |url=}}</ref><ref name="pmid17786531">{{cite journal |vauthors=House MG, Gönen M, Jarnagin WR, D'Angelica M, DeMatteo RP, Fong Y, Brennan MF, Allen PJ |title=Prognostic significance of pathologic nodal status in patients with resected pancreatic cancer |journal=J. Gastrointest. Surg. |volume=11 |issue=11 |pages=1549–55 |year=2007 |pmid=17786531 |doi=10.1007/s11605-007-0243-7 |url=}}</ref><ref name="pmid17592291">{{cite journal |vauthors=Raut CP, Tseng JF, Sun CC, Wang H, Wolff RA, Crane CH, Hwang R, Vauthey JN, Abdalla EK, Lee JE, Pisters PW, Evans DB |title=Impact of resection status on pattern of failure and survival after pancreaticoduodenectomy for pancreatic adenocarcinoma |journal=Ann. Surg. |volume=246 |issue=1 |pages=52–60 |year=2007 |pmid=17592291 |pmc=1899216 |doi=10.1097/01.sla.0000259391.84304.2b |url=}}</ref><ref name="pmid8380315">{{cite journal |vauthors=Geer RJ, Brennan MF |title=Prognostic indicators for survival after resection of pancreatic adenocarcinoma |journal=Am. J. Surg. |volume=165 |issue=1 |pages=68–72; discussion 72–3 |year=1993 |pmid=8380315 |doi= |url=}}</ref><ref name="pmid10932371">{{cite journal |vauthors=Benassai G, Mastrorilli M, Quarto G, Cappiello A, Giani U, Mosella G |title=Survival after pancreaticoduodenectomy for ductal adenocarcinoma of the head of the pancreas |journal=Chir Ital |volume=52 |issue=3 |pages=263–70 |year=2000 |pmid=10932371 |doi= |url=}}</ref><ref name="pmid2322039">{{cite journal |vauthors=Trede M, Schwall G, Saeger HD |title=Survival after pancreatoduodenectomy. 118 consecutive resections without an operative mortality |journal=Ann. Surg. |volume=211 |issue=4 |pages=447–58 |year=1990 |pmid=2322039 |pmc=1358031 |doi= |url=}}</ref><ref name="pmid2742478">{{cite journal |vauthors=Pellegrini CA, Heck CF, Raper S, Way LW |title=An analysis of the reduced morbidity and mortality rates after pancreaticoduodenectomy |journal=Arch Surg |volume=124 |issue=7 |pages=778–81 |year=1989 |pmid=2742478 |doi= |url=}}</ref><ref name="pmid3632096">{{cite journal |vauthors=Crist DW, Sitzmann JV, Cameron JL |title=Improved hospital morbidity, mortality, and survival after the Whipple procedure |journal=Ann. Surg. |volume=206 |issue=3 |pages=358–65 |year=1987 |pmid=3632096 |pmc=1493175 |doi= |url=}}</ref><ref name="pmid22760965">{{cite journal |vauthors=Kneuertz PJ, Pitt HA, Bilimoria KY, Smiley JP, Cohen ME, Ko CY, Pawlik TM |title=Risk of morbidity and mortality following hepato-pancreato-biliary surgery |journal=J. Gastrointest. Surg. |volume=16 |issue=9 |pages=1727–35 |year=2012 |pmid=22760965 |doi=10.1007/s11605-012-1938-y |url=}}</ref><ref name="pmid11948273">{{cite journal |vauthors=Birkmeyer JD, Siewers AE, Finlayson EV, Stukel TA, Lucas FL, Batista I, Welch HG, Wennberg DE |title=Hospital volume and surgical mortality in the United States |journal=N. Engl. J. Med. |volume=346 |issue=15 |pages=1128–37 |year=2002 |pmid=11948273 |doi=10.1056/NEJMsa012337 |url=}}</ref><ref name="pmid10455881">{{cite journal |vauthors=Birkmeyer JD, Warshaw AL, Finlayson SR, Grove MR, Tosteson AN |title=Relationship between hospital volume and late survival after pancreaticoduodenectomy |journal=Surgery |volume=126 |issue=2 |pages=178–83 |year=1999 |pmid=10455881 |doi= |url=}}</ref><ref name="pmid18926452">{{cite journal |vauthors=Bilimoria KY, Talamonti MS, Sener SF, Bilimoria MM, Stewart AK, Winchester DP, Ko CY, Bentrem DJ |title=Effect of hospital volume on margin status after pancreaticoduodenectomy for cancer |journal=J. Am. Coll. Surg. |volume=207 |issue=4 |pages=510–9 |year=2008 |pmid=18926452 |doi=10.1016/j.jamcollsurg.2008.04.033 |url=}}</ref><ref name="pmid14645640">{{cite journal |vauthors=Birkmeyer JD, Stukel TA, Siewers AE, Goodney PP, Wennberg DE, Lucas FL |title=Surgeon volume and operative mortality in the United States |journal=N. Engl. J. Med. |volume=349 |issue=22 |pages=2117–27 |year=2003 |pmid=14645640 |doi=10.1056/NEJMsa035205 |url=}}</ref><ref name="pmid21500187">{{cite journal |vauthors=Gooiker GA, van Gijn W, Wouters MW, Post PN, van de Velde CJ, Tollenaar RA |title=Systematic review and meta-analysis of the volume-outcome relationship in pancreatic surgery |journal=Br J Surg |volume=98 |issue=4 |pages=485–94 |year=2011 |pmid=21500187 |doi=10.1002/bjs.7413 |url=}}</ref>
| | ==References== |
| Postoperative abcess
| | {{reflist|2}} |
| Wound infection<ref name="pmid17723881">{{cite journal |vauthors=Limongelli P, Pai M, Bansi D, Thiallinagram A, Tait P, Jackson J, Habib NA, Williamson RC, Jiao LR |title=Correlation between preoperative biliary drainage, bile duct contamination, and postoperative outcomes for pancreatic surgery |journal=Surgery |volume=142 |issue=3 |pages=313–8 |year=2007 |pmid=17723881 |doi=10.1016/j.surg.2007.04.022 |url=}}</ref>
| |
| Anastomotic leak
| |
| Delay in gastric emptying<ref name="pmid17981197">{{cite journal |vauthors=Wente MN, Bassi C, Dervenis C, Fingerhut A, Gouma DJ, Izbicki JR, Neoptolemos JP, Padbury RT, Sarr MG, Traverso LW, Yeo CJ, Büchler MW |title=Delayed gastric emptying (DGE) after pancreatic surgery: a suggested definition by the International Study Group of Pancreatic Surgery (ISGPS) |journal=Surgery |volume=142 |issue=5 |pages=761–8 |year=2007 |pmid=17981197 |doi=10.1016/j.surg.2007.05.005 |url=}}</ref>
| |
|
| |
| Pylorus sparing Whipple procedure:<ref name="pmid7908796">{{cite journal |vauthors=Tsao JI, Rossi RL, Lowell JA |title=Pylorus-preserving pancreatoduodenectomy. Is it an adequate cancer operation |journal=Arch Surg |volume=129 |issue=4 |pages=405–12 |year=1994 |pmid=7908796 |doi= |url=}}</ref>
| |
| The pylorus may be spared as a modification of Whipple procedure to decrease gastric emptying due to antrectomy. This significantly reduces the incidence of nutritional deficiencies arising from this surgery.
| |
|
| |
|
| | {{WH}} |
| | {{WS}} |
|
| |
|
| The European Society for Medical Oncology states that the only curative therapy is surgical resection.
| | ===Pathophysiology prev=== |
| Ten percent is the five year survival of patients with pancreatic cancer.
| | <div style="-webkit-user-select: none;"> |
| Patients with node-positive tumors have very poor long term survival.
| | {| class="infobox" style="position: fixed; top: 65%; right: 10px; margin: 0 0 0 0; border: 0; float: right;" |
| | |- |
| | | {{#ev:youtube|https://https://www.youtube.com/watch?v=5szNmKtyBW4|350}} |
| | |- |
| | |} |
| | __NOTOC__ |
| | {{Cirrhosis}} |
| | {{CMG}} {{AE}} |
|
| |
|
| Distal Pancreatectomy <ref name="pmid17667503">{{cite journal |vauthors=McPhee JT, Hill JS, Whalen GF, Zayaruzny M, Litwin DE, Sullivan ME, Anderson FA, Tseng JF |title=Perioperative mortality for pancreatectomy: a national perspective |journal=Ann. Surg. |volume=246 |issue=2 |pages=246–53 |year=2007 |pmid=17667503 |pmc=1933570 |doi=10.1097/01.sla.0000259993.17350.3a |url=}}</ref>
| | ==Video codes== |
| This procedure has a limited use in curative resection of pancreatic cancer.
| |
| It is mainly performed for tumors located in:<ref name="pmid8402126">{{cite journal |vauthors=Johnson CD, Schwall G, Flechtenmacher J, Trede M |title=Resection for adenocarcinoma of the body and tail of the pancreas |journal=Br J Surg |volume=80 |issue=9 |pages=1177–9 |year=1993 |pmid=8402126 |doi= |url=}}</ref>
| |
| Body of pancreas
| |
| Tail of pancreas
| |
| This form of surgery has fewer morbidities than the Whipple procedure.
| |
|
| |
|
|
| | ===Normal video=== |
| Distal Pancreatectomy involves the following components:
| | {{#ev:youtube|x6e9Pk6inYI}} |
| Separation of the distal pancreas bearing the tumor from the normal tissue
| | {{#ev:youtube|4uSSvD1BAHg}} |
| Resection of the affected portion
| | {{#ev:youtube|PQXb5D-5UZw}} |
| Oversewing of the distal pancreatic duct
| | {{#ev:youtube|UVJYQlUm2A8}} |
|
| |
|
| This procedure is associated with several morbidities:<ref name="pmid28406793">{{cite journal |vauthors=Elliott IA, Epelboym I, Winner M, Allendorf JD, Haigh PI |title=Population-Level Incidence and Predictors of Surgically Induced Diabetes and Exocrine Insufficiency after Partial Pancreatic Resection |journal=Perm J |volume=21 |issue= |pages= |year=2017 |pmid=28406793 |pmc=5391783 |doi=10.7812/TPP/16-095 |url=}}</ref><ref name="pmid28347869">{{cite journal |vauthors=Liu A, Carmichael KA, Schallom ME, Klinkenberg WD |title=Retrospective review of postoperative glycemic control in patients after distal pancreatectomy |journal=Int J Surg |volume=41 |issue= |pages=86–90 |year=2017 |pmid=28347869 |doi=10.1016/j.ijsu.2017.03.060 |url=}}</ref><ref name="pmid28272344">{{cite journal |vauthors=Gilliland TM, Villafane-Ferriol N, Shah KP, Shah RM, Tran Cao HS, Massarweh NN, Silberfein EJ, Choi EA, Hsu C, McElhany AL, Barakat O, Fisher W, Van Buren G |title=Nutritional and Metabolic Derangements in Pancreatic Cancer and Pancreatic Resection |journal=Nutrients |volume=9 |issue=3 |pages= |year=2017 |pmid=28272344 |pmc=5372906 |doi=10.3390/nu9030243 |url=}}</ref><ref name="pmid27763684">{{cite journal |vauthors=Strobel O, Brangs S, Hinz U, Pausch T, Hüttner FJ, Diener MK, Schneider L, Hackert T, Büchler MW |title=Incidence, risk factors and clinical implications of chyle leak after pancreatic surgery |journal=Br J Surg |volume=104 |issue=1 |pages=108–117 |year=2017 |pmid=27763684 |doi=10.1002/bjs.10316 |url=}}</ref>
| | ===Video in table=== |
| Pancreatic endocrine insufficiency
| | <div style="width:350px">{{#ev:youtube|5ucSlgqGAno}}</div> |
| Bleeding
| |
| Leakage of pancreatic stump
| |
|
| |
|
| Total Pancreatectomy<ref name="pmid17667503">{{cite journal |vauthors=McPhee JT, Hill JS, Whalen GF, Zayaruzny M, Litwin DE, Sullivan ME, Anderson FA, Tseng JF |title=Perioperative mortality for pancreatectomy: a national perspective |journal=Ann. Surg. |volume=246 |issue=2 |pages=246–53 |year=2007 |pmid=17667503 |pmc=1933570 |doi=10.1097/01.sla.0000259993.17350.3a |url=}}</ref><ref name="pmid18043098">{{cite journal |vauthors=Müller MW, Friess H, Kleeff J, Dahmen R, Wagner M, Hinz U, Breisch-Girbig D, Ceyhan GO, Büchler MW |title=Is there still a role for total pancreatectomy? |journal=Ann. Surg. |volume=246 |issue=6 |pages=966–74; discussion 974–5 |year=2007 |pmid=18043098 |doi=10.1097/SLA.0b013e31815c2ca3 |url=}}</ref><ref name="pmid2539061">{{cite journal |vauthors=Brooks JR, Brooks DC, Levine JD |title=Total pancreatectomy for ductal cell carcinoma of the pancreas. An update |journal=Ann. Surg. |volume=209 |issue=4 |pages=405–10 |year=1989 |pmid=2539061 |pmc=1493970 |doi= |url=}}</ref><ref name="pmid1867520">{{cite journal |vauthors=Dresler CM, Fortner JG, McDermott K, Bajorunas DR |title=Metabolic consequences of (regional) total pancreatectomy |journal=Ann. Surg. |volume=214 |issue=2 |pages=131–40 |year=1991 |pmid=1867520 |pmc=1358512 |doi= |url=}}</ref><ref name="pmid6639161">{{cite journal |vauthors=Andrén-Sandberg A, Ihse I |title=Factors influencing survival after total pancreatectomy in patients with pancreatic cancer |journal=Ann. Surg. |volume=198 |issue=5 |pages=605–10 |year=1983 |pmid=6639161 |pmc=1353132 |doi= |url=}}</ref><ref name="pmid11146775">{{cite journal |vauthors=Karpoff HM, Klimstra DS, Brennan MF, Conlon KC |title=Results of total pancreatectomy for adenocarcinoma of the pancreas |journal=Arch Surg |volume=136 |issue=1 |pages=44–7; discussion 48 |year=2001 |pmid=11146775 |doi= |url=}}</ref>
| | ===Floating video=== |
|
| |
|
| | {| class="infobox mw-collapsible" id="floatvideo" style="position: fixed; top: 65%; width:361px; right: 10px; margin: 0 0 0 0; border: 0; float: right;" |
| | | Title |
| | |- |
| | |- |
| | | {{#ev:youtube|https://https://www.youtube.com/watch?v=ypYI_lmLD7g|350}} |
| | |- |
| | |} |
|
| |
|
| It is the least preferred due to high mortality rate.
| | ===Redirect=== |
| It is mainly performed for tumors located in:
| | #REDIRECT[[Esophageal web]] |
| Neck of the pancreas.
| |
| Due to involvement of neck, patients develop insulin dependent DM.
| |
|
| |
|
| Lymphadnectomy<ref name="pmid25061003">{{cite journal |vauthors=Tol JA, Gouma DJ, Bassi C, Dervenis C, Montorsi M, Adham M, Andrén-Sandberg A, Asbun HJ, Bockhorn M, Büchler MW, Conlon KC, Fernández-Cruz L, Fingerhut A, Friess H, Hartwig W, Izbicki JR, Lillemoe KD, Milicevic MN, Neoptolemos JP, Shrikhande SV, Vollmer CM, Yeo CJ, Charnley RM |title=Definition of a standard lymphadenectomy in surgery for pancreatic ductal adenocarcinoma: a consensus statement by the International Study Group on Pancreatic Surgery (ISGPS) |journal=Surgery |volume=156 |issue=3 |pages=591–600 |year=2014 |pmid=25061003 |doi=10.1016/j.surg.2014.06.016 |url=}}</ref><ref name="pmid24368638">{{cite journal |vauthors=Jang JY, Kang MJ, Heo JS, Choi SH, Choi DW, Park SJ, Han SS, Yoon DS, Yu HC, Kang KJ, Kim SG, Kim SW |title=A prospective randomized controlled study comparing outcomes of standard resection and extended resection, including dissection of the nerve plexus and various lymph nodes, in patients with pancreatic head cancer |journal=Ann. Surg. |volume=259 |issue=4 |pages=656–64 |year=2014 |pmid=24368638 |doi=10.1097/SLA.0000000000000384 |url=}}</ref><ref name="pmid12192322">{{cite journal |vauthors=Yeo CJ, Cameron JL, Lillemoe KD, Sohn TA, Campbell KA, Sauter PK, Coleman J, Abrams RA, Hruban RH |title=Pancreaticoduodenectomy with or without distal gastrectomy and extended retroperitoneal lymphadenectomy for periampullary adenocarcinoma, part 2: randomized controlled trial evaluating survival, morbidity, and mortality |journal=Ann. Surg. |volume=236 |issue=3 |pages=355–66; discussion 366–8 |year=2002 |pmid=12192322 |pmc=1422589 |doi=10.1097/01.SLA.0000027272.08464.0B |url=}}</ref><ref name="pmid16269290">{{cite journal |vauthors=Farnell MB, Pearson RK, Sarr MG, DiMagno EP, Burgart LJ, Dahl TR, Foster N, Sargent DJ |title=A prospective randomized trial comparing standard pancreatoduodenectomy with pancreatoduodenectomy with extended lymphadenectomy in resectable pancreatic head adenocarcinoma |journal=Surgery |volume=138 |issue=4 |pages=618–28; discussion 628–30 |year=2005 |pmid=16269290 |doi=10.1016/j.surg.2005.06.044 |url=}}</ref><ref name="pmid9790340">{{cite journal |vauthors=Pedrazzoli S, DiCarlo V, Dionigi R, Mosca F, Pederzoli P, Pasquali C, Klöppel G, Dhaene K, Michelassi F |title=Standard versus extended lymphadenectomy associated with pancreatoduodenectomy in the surgical treatment of adenocarcinoma of the head of the pancreas: a multicenter, prospective, randomized study. Lymphadenectomy Study Group |journal=Ann. Surg. |volume=228 |issue=4 |pages=508–17 |year=1998 |pmid=9790340 |pmc=1191525 |doi= |url=}}</ref><ref name="pmid12192322">{{cite journal |vauthors=Yeo CJ, Cameron JL, Lillemoe KD, Sohn TA, Campbell KA, Sauter PK, Coleman J, Abrams RA, Hruban RH |title=Pancreaticoduodenectomy with or without distal gastrectomy and extended retroperitoneal lymphadenectomy for periampullary adenocarcinoma, part 2: randomized controlled trial evaluating survival, morbidity, and mortality |journal=Ann. Surg. |volume=236 |issue=3 |pages=355–66; discussion 366–8 |year=2002 |pmid=12192322 |pmc=1422589 |doi=10.1097/01.SLA.0000027272.08464.0B |url=}}</ref><ref name="pmid16269290">{{cite journal |vauthors=Farnell MB, Pearson RK, Sarr MG, DiMagno EP, Burgart LJ, Dahl TR, Foster N, Sargent DJ |title=A prospective randomized trial comparing standard pancreatoduodenectomy with pancreatoduodenectomy with extended lymphadenectomy in resectable pancreatic head adenocarcinoma |journal=Surgery |volume=138 |issue=4 |pages=618–28; discussion 628–30 |year=2005 |pmid=16269290 |doi=10.1016/j.surg.2005.06.044 |url=}}</ref><ref name="pmid22038501">{{cite journal |vauthors=Nimura Y, Nagino M, Takao S, Takada T, Miyazaki K, Kawarada Y, Miyagawa S, Yamaguchi A, Ishiyama S, Takeda Y, Sakoda K, Kinoshita T, Yasui K, Shimada H, Katoh H |title=Standard versus extended lymphadenectomy in radical pancreatoduodenectomy for ductal adenocarcinoma of the head of the pancreas: long-term results of a Japanese multicenter randomized controlled trial |journal=J Hepatobiliary Pancreat Sci |volume=19 |issue=3 |pages=230–41 |year=2012 |pmid=22038501 |doi=10.1007/s00534-011-0466-6 |url=}}</ref><ref name="pmid24419758">{{cite journal |vauthors=Kang MJ, Jang JY, Chang YR, Kwon W, Jung W, Kim SW |title=Revisiting the concept of lymph node metastases of pancreatic head cancer: number of metastatic lymph nodes and lymph node ratio according to N stage |journal=Ann. Surg. Oncol. |volume=21 |issue=5 |pages=1545–51 |year=2014 |pmid=24419758 |doi=10.1245/s10434-013-3473-9 |url=}}</ref>
| | ===synonym website=== |
| | https://mq.b2i.sg/snow-owl/#!terminology/snomed/10743008 |
|
| |
|
| Removal of positive nodes is preferrable, but some surgeons advocate extended lymphadnectomy.
| | ===Image=== |
| | [[Image: Normal versus Abnormal Barium study of esophagus.jpg|thumb|left|200px|Normal versus Abnormal Barium study of esophagus with varices]] |
|
| |
|
| CA 19-9 level
| |
|
| |
|
| Elevated levels of CA 19-9 can help in the following ways:<ref name="pmid27049786">{{cite journal |vauthors=Bergquist JR, Puig CA, Shubert CR, Groeschl RT, Habermann EB, Kendrick ML, Nagorney DM, Smoot RL, Farnell MB, Truty MJ |title=Carbohydrate Antigen 19-9 Elevation in Anatomically Resectable, Early Stage Pancreatic Cancer Is Independently Associated with Decreased Overall Survival and an Indication for Neoadjuvant Therapy: A National Cancer Database Study |journal=J. Am. Coll. Surg. |volume=223 |issue=1 |pages=52–65 |year=2016 |pmid=27049786 |doi=10.1016/j.jamcollsurg.2016.02.009 |url=}}</ref>
| | ===Image to the right=== |
| | {| style="float: right; width: 350px;" |
| | | [[Image:Coxiella burnetii.JPG|right|400px|C. burnetii, the Q fever causing agent]] |
| | |} |
|
| |
|
| Predicts the likelihood of complete resection
| | ===Image and text to the right=== |
|
| |
|
| Prognosis of patients with resectable disease
| | <figure-inline><figure-inline><figure-inline><figure-inline><figure-inline><figure-inline><figure-inline><figure-inline><figure-inline><figure-inline><figure-inline><figure-inline><figure-inline><figure-inline><figure-inline><figure-inline><figure-inline><figure-inline><figure-inline><figure-inline><figure-inline><figure-inline><figure-inline><figure-inline><figure-inline><figure-inline><figure-inline>[[File:Global distribution of leptospirosis.jpg|577x577px]]</figure-inline></figure-inline></figure-inline></figure-inline></figure-inline></figure-inline></figure-inline></figure-inline></figure-inline></figure-inline></figure-inline></figure-inline></figure-inline></figure-inline></figure-inline></figure-inline></figure-inline></figure-inline></figure-inline></figure-inline></figure-inline></figure-inline></figure-inline></figure-inline></figure-inline></figure-inline></figure-inline> Recent out break of leptospirosis is reported in Bronx, New York and found 3 cases in the months January and February, 2017. |
|
| |
|
| Predicts the presence of occult metastases
| | ===Gallery=== |
|
| |
|
| However, CA 19-9 levels are not used to dictate the initial strategy for treatment of pancreatic cancer.
| | <gallery widths="250px"> |
|
| |
|
| PALLIATIVE THERAPY
| | Pancreatic insulinoma histology 2.JPG|Histopathology of a pancreatic endocrine tumor (insulinoma). ''Source:https://librepathology.org/wiki/Neuroendocrine_tumour_of_the_pancreas''<ref name=aaa> Neuroendocrine tumor of the pancreas. Libre Pathology. http://librepathology.org/wiki/index.php/Neuroendocrine_tumour_of_the_pancreas</ref> |
|
| |
|
| Pain
| | Pancreatic insulinoma histopathology 3.JPG|Histopathology of a pancreatic endocrine tumor (insulinoma). Chromogranin A immunostain. ''Source:https://librepathology.org/wiki/Neuroendocrine_tumour_of_the_pancreas''<ref name=aaa> Neuroendocrine tumour of the pancreas. Libre Pathology. http://librepathology.org/wiki/index.php/Neuroendocrine_tumour_of_the_pancreas</ref> |
| There are various techniques for pain management as palliative therapy in patients:
| |
|
| |
|
| Narcotic analgesics
| | Pancreatic insulinoma histology 4.JPG|Histopathology of a pancreatic endocrine tumor (insulinoma). Insulin immunostain. ''Source:https://librepathology.org/wiki/Neuroendocrine_tumour_of_the_pancreas''<ref name=aaa> Neuroendocrine tumour of the pancreas. Libre Pathology. http://librepathology.org/wiki/index.php/Neuroendocrine_tumour_of_the_pancreas</ref> |
| Narcotic analgesics+ tricyclic antidepressants/ antiemetics
| |
| Endoscopic decompression with stent placement in patients with biliary or pancreatic duct obstruction
| |
| Radiation therapy
| |
| Neurolysis of the celiac ganglia by many approaches
| |
| Intraoperative
| |
| Transgastric
| |
| Transthoracic
| |
| Transabdominal
| |
|
| |
|
| Jaundice
| | </gallery> |
| Obstructive jaundice can present with features of cholangitis:
| | ==References== |
| Fever and chills
| | {{Reflist|2}} |
| Nausea, vomiting
| | {{WS}} |
| Clay-colored stools
| | {{WH}} |
| Dark urine
| |
| Yellowish discoloration of skin
| |
| Pruritus
| |
| Right upper quadrant pain
| |
| Anorexia
| |
| Preferred treatment in patients: Endoscopic decompression with stent placement in patients with biliary obstruction
| |
| Techniques of biliary decompression:
| |
| Cholecystojejunostomy
| |
| Choledochojejunostomy
| |
|
| |
|
| Types of stents:
| |
| Metal- costly, longer lifespan
| |
| Plastic- cheaper, need replacement every three months
| |
|
| |
| Duodenal obstruction
| |
| Preferred treatment:
| |
| Endoscopic stenting of duodenal obstruction
| |
| Gastrojejunostomy
| |
|
| |
|
| References
| | REFERENCES |
| <references /> | | <references /> |
| | |
| | [[Category:Gastroenterology]] |
| | [[Category:Needs overview]] |
| | [[Category:Hepatology]] |
| | [[Category:Disease]] |
</figure-inline></figure-inline></figure-inline></figure-inline></figure-inline></figure-inline></figure-inline></figure-inline></figure-inline></figure-inline></figure-inline></figure-inline></figure-inline></figure-inline></figure-inline></figure-inline></figure-inline></figure-inline></figure-inline></figure-inline></figure-inline></figure-inline></figure-inline></figure-inline></figure-inline></figure-inline></figure-inline> Recent out break of leptospirosis is reported in Bronx, New York and found 3 cases in the months January and February, 2017.
![Histopathology of a pancreatic endocrine tumor (insulinoma). Source:https://librepathology.org/wiki/Neuroendocrine_tumour_of_the_pancreas[1]](/images/2/2f/Pancreatic_insulinoma_histology_2.JPG)
Histopathology of a pancreatic endocrine tumor (insulinoma). Source:https://librepathology.org/wiki/Neuroendocrine_tumour_of_the_pancreas[1]![Histopathology of a pancreatic endocrine tumor (insulinoma). Chromogranin A immunostain. Source:https://librepathology.org/wiki/Neuroendocrine_tumour_of_the_pancreas[1]](/images/a/a3/Pancreatic_insulinoma_histopathology_3.JPG)
Histopathology of a pancreatic endocrine tumor (insulinoma). Chromogranin A immunostain. Source:https://librepathology.org/wiki/Neuroendocrine_tumour_of_the_pancreas[1]![Histopathology of a pancreatic endocrine tumor (insulinoma). Insulin immunostain. Source:https://librepathology.org/wiki/Neuroendocrine_tumour_of_the_pancreas[1]](/images/d/d5/Pancreatic_insulinoma_histology_4.JPG)
Histopathology of a pancreatic endocrine tumor (insulinoma). Insulin immunostain. Source:https://librepathology.org/wiki/Neuroendocrine_tumour_of_the_pancreas[1]![Histopathology of a pancreatic endocrine tumor (insulinoma). Source:https://librepathology.org/wiki/Neuroendocrine_tumour_of_the_pancreas[1]](/index.php/File:Pancreatic_insulinoma_histology_2.JPG)
![Histopathology of a pancreatic endocrine tumor (insulinoma). Chromogranin A immunostain. Source:https://librepathology.org/wiki/Neuroendocrine_tumour_of_the_pancreas[1]](/index.php/File:Pancreatic_insulinoma_histopathology_3.JPG)
![Histopathology of a pancreatic endocrine tumor (insulinoma). Insulin immunostain. Source:https://librepathology.org/wiki/Neuroendocrine_tumour_of_the_pancreas[1]](/index.php/File:Pancreatic_insulinoma_histology_4.JPG)