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سرطان پانکراس. دکتر سیدمحمدرضا حکیمیان متخصص جراحی عمومی فلوشیپ جراحی سرطان. 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.
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سرطان پانکراس دکتر سیدمحمدرضا حکیمیان متخصص جراحی عمومی فلوشیپ جراحی سرطان
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
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 resectablediseas • 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 gastrojejunostomylocated 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)
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)
