سرطان پانکراس
DESCRIPTION
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. - PowerPoint PPT PresentationTRANSCRIPT
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پانکراس سرطان
حکیمیان سیدمحمدرضا دکترعمومی جراحی متخصصسرطان جراحی فلوشیپ
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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
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Staging
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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.
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Diagnosis:
• History & Ph Ex• CT scan (the single most versatile and costeffective
tool for the diagnosis)• Sonography • MRI• Endosono• LFT• CA19-9• laparoscopy
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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 resectable diseas• 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.
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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 gastrojejunostomy located 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)
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Curative surgery
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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)
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• transpancreatic U-suture technique (Blumgart anastomosis)
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total 1392(10m) 1391(12m)
29 13 16 N.O.
6(20%) 2(15%) 4 (25%) leak
4(13%) 0(0%) 4(25%) mortality
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