Transcript سرطان پانکراس - poursinahakim.ir

‫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
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 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.
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)
Curative surgery
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)
• transpancreatic U-suture technique
(Blumgart anastomosis)
1391(12m)
1392(10m)
total
N.O.
16
13
29
leak
4 (25%)
2(15%)
6(20%)
mortality
4(25%)
0(0%)
4(13%)