Pancreatic cancer historical perspective

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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:

• Due to its hidden retroperitoneal location, the pancreas was initially termed as the hermit organ by 20^th 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.

• Regnier de Graaf utilized cannulation and studies on pancreatic secretions to demonstrate the true significance of the pancreatic duct.

18th century:

• Albrecht Von Haller pointed out that the pancreatic and bile ducts entered the intestine jointly and the function of pancreatic juice was to dilute bile.

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

19th century:

• Willy Kuhne discovered trypsin.

• In 1815, Alexander discovered pancreatic lipase and its role in digestion.

History of pancreatic cancer:

The history of the pancreatic cancer is as follows:

• 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.
• Morgagni also described a distended gall bladder which is now known as the Corvosier’s sign in 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, acinar cell and 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 therapy in a pancreatic cancer patient.
• In 1893, Nimier published a detailed review on 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 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 surgeons world wide.
• Even today, only one tenth of the patients with 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.