Pancreatic cancer surgery: Difference between revisions
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The selection of a treatment intervention depends largely on the disease progression and the patient's stage of cancer. The most common surgical treatment for cancer involving the pancreas is the [[Pancreaticoduodenectomy|Whipple procedure]]. | The selection of a treatment intervention depends largely on the disease progression and the patient's stage of cancer. The most common surgical treatment for cancer involving the pancreas is the [[Pancreaticoduodenectomy|Whipple procedure]]. | ||
== | ==Surgery== | ||
Treatment of pancreatic cancer depends on the stage of the cancer.<ref>[http://pathology.jhu.edu/pancreas/TreatmentSurgery.php Pancreatic Cancer - Johns Hopkins Medicine: Surgical Treatment of Pancreatic Cancer<!-- Bot generated title -->]</ref> The [[Pancreaticoduodenectomy|Whipple procedure]] is the most common surgical treatment for cancers involving the head of the pancreas. It can only be performed if the patient is likely to survive major surgery and if the cancer is localised without invading local structures or metastasizing. It can therefore only be performed in the minority of cases. | Treatment of pancreatic cancer depends on the stage of the cancer.<ref>[http://pathology.jhu.edu/pancreas/TreatmentSurgery.php Pancreatic Cancer - Johns Hopkins Medicine: Surgical Treatment of Pancreatic Cancer<!-- Bot generated title -->]</ref> The [[Pancreaticoduodenectomy|Whipple procedure]] is the most common surgical treatment for cancers involving the head of the pancreas. It can only be performed if the patient is likely to survive major surgery and if the cancer is localised without invading local structures or metastasizing. It can therefore only be performed in the minority of cases. | ||
[[Spleen]]-preserving distal pancreatectomy can also be used as a method to remove a cancer running through | [[Spleen]]-preserving distal pancreatectomy can also be used as a method to remove a cancer running through center of the pancreas; this is invasive surgery, resulting in loss of body and tail. Cancers of the tail of the pancreas can be resected using a procedure known as a distal pancreatectomy.<ref>Retrieved from http://pathology.jhu.edu/pancreas/TreatmentSurgery.php.</ref> Recently, localized cancers of the pancreas have been resected using minimally invasive (laparoscopic) approaches. | ||
Surgery can be performed for palliation, if the malignancy is invading or compressing the [[duodenum]] or [[colon (anatomy)|colon]]. In that case, bypass surgery might overcome the obstruction and improve quality of life, but it is not intended as a cure. | |||
===Post-Operative Management=== | |||
After surgery, ''adjuvant'' chemotherapy with [[gemcitabine]] may be offered to eliminate whatever cancerous tissue may remain in the body. This has been shown to increase 5-year survival rates. Addition of [[radiation therapy]] is a hotly debated topic, with groups in the US often favoring the use of adjuvant radiation therapy, while groups in Europe do not.<ref name="pmid15028824">{{cite journal |author=Neoptolemos JP, Stocken DD, Friess H, ''et al'' |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}}</ref> | After surgery, ''adjuvant'' chemotherapy with [[gemcitabine]] may be offered to eliminate whatever cancerous tissue may remain in the body. This has been shown to increase 5-year survival rates. Addition of [[radiation therapy]] is a hotly debated topic, with groups in the US often favoring the use of adjuvant radiation therapy, while groups in Europe do not.<ref name="pmid15028824">{{cite journal |author=Neoptolemos JP, Stocken DD, Friess H, ''et al'' |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}}</ref> | ||
===Criteria for Unresectability=== | |||
* Tumor larger than 5 cm | * Tumor larger than 5 cm | ||
* Tumor invades adjacent tissue of organs (excluding duodenum) | * Tumor invades adjacent tissue of organs (excluding duodenum) |
Revision as of 18:38, 28 August 2012
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor-In-Chief: Cafer Zorkun, M.D., Ph.D. [2]
Overview
The selection of a treatment intervention depends largely on the disease progression and the patient's stage of cancer. The most common surgical treatment for cancer involving the pancreas is the Whipple procedure.
Surgery
Treatment of pancreatic cancer depends on the stage of the cancer.[1] The Whipple procedure is the most common surgical treatment for cancers involving the head of the pancreas. It can only be performed if the patient is likely to survive major surgery and if the cancer is localised without invading local structures or metastasizing. It can therefore only be performed in the minority of cases.
Spleen-preserving distal pancreatectomy can also be used as a method to remove a cancer running through center of the pancreas; this is invasive surgery, resulting in loss of body and tail. Cancers of the tail of the pancreas can be resected using a procedure known as a distal pancreatectomy.[2] Recently, localized cancers of the pancreas have been resected using minimally invasive (laparoscopic) approaches.
Surgery can be performed for palliation, if the malignancy is invading or compressing the duodenum or colon. In that case, bypass surgery might overcome the obstruction and improve quality of life, but it is not intended as a cure.
Post-Operative Management
After surgery, adjuvant chemotherapy with gemcitabine may be offered to eliminate whatever cancerous tissue may remain in the body. This has been shown to increase 5-year survival rates. Addition of radiation therapy is a hotly debated topic, with groups in the US often favoring the use of adjuvant radiation therapy, while groups in Europe do not.[3]
Criteria for Unresectability
- Tumor larger than 5 cm
- Tumor invades adjacent tissue of organs (excluding duodenum)
- Encasement, stenosis, or occlusion of the celiac artery, celiac artery branches, and/or SMA.
- PV and/or SMV encasement (some centers will operate with venous invasion)
- Hepatic metastases
- Distant metastases (i.e. non regional lymph nodes)
- Peritoneal carcinomatosis
References
- ↑ Pancreatic Cancer - Johns Hopkins Medicine: Surgical Treatment of Pancreatic Cancer
- ↑ Retrieved from http://pathology.jhu.edu/pancreas/TreatmentSurgery.php.
- ↑ Neoptolemos JP, Stocken DD, Friess H; et al. (2004). "A randomized trial of chemoradiotherapy and chemotherapy after resection of pancreatic cancer". N. Engl. J. Med. 350 (12): 1200–10. doi:10.1056/NEJMoa032295. PMID 15028824.