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Titolo:
Advances in the surgical management of pancreatic cancer
Autore:
Spanknebel, K; Conlon, KCP;
Indirizzi:
Mem Sloan Kettering Canc Ctr, Dept Surg, New York, NY 10021 USA Mem Sloan Kettering Canc Ctr New York NY USA 10021 New York, NY 10021 USA
Titolo Testata:
CANCER JOURNAL
fascicolo: 4, volume: 7, anno: 2001,
pagine: 312 - 323
SICI:
1528-9117(200107/08)7:4<312:AITSMO>2.0.ZU;2-Y
Fonte:
ISI
Lingua:
ENG
Soggetto:
MALIGNANT OBSTRUCTIVE-JAUNDICE; PREOPERATIVE BILIARY DRAINAGE; PROSPECTIVE RANDOMIZED TRIAL; PLACEBO-CONTROLLED TRIAL; PORTAL-VEIN CONFLUENCE; LONG-TERM SURVIVAL; LAPAROSCOPIC ULTRASONOGRAPHY; PERIAMPULLARY ADENOCARCINOMA; CLINICAL-TRIAL; DIAGNOSTIC LAPAROSCOPY;
Keywords:
adenocarcinoma; laparoscopy; palliative surgery; pancreaticoduodenectomy; resection;
Tipo documento:
Article
Natura:
Periodico
Settore Disciplinare:
Clinical Medicine
Life Sciences
Citazioni:
89
Recensione:
Indirizzi per estratti:
Indirizzo: Conlon, KCP Mem Sloan Kettering Canc Ctr, Dept Surg, 1275 York Ave, New York, NY 10021USA Mem Sloan Kettering Canc Ctr 1275 York Ave New York NY USA 10021
Citazione:
K. Spanknebel e K.C.P. Conlon, "Advances in the surgical management of pancreatic cancer", CANCER J, 7(4), 2001, pp. 312-323

Abstract

Pancreatic cancer continues to pose a major public health concern and clinical challenge. The incidence of the disease is nearly equivalent to the death rate associated with the diagnosis of pancreatic cancer. Thus, there exists a need for continued improvement in the diagnostic, therapeutic and palliative care of these patients. Surgeons play an integral role in the management of pancreatic cancer patients, with surgery providing the only potentially curative intervention forthe disease. Specialized centers have reported improved hospital morbidity, mortality and survival after pancreaticoduodenectomy; however, disease-specific survival after surgical resection remains dismal. An emphasis therefore has been placed upon the accurate preoperative staging of patients in order to identify those patients who would benefit from a complete surgical resection. Surgical staging that incorporates the use of laparoscopic techniques now complements non-surgical methods of staging, including helical CTscans. While there is no defined preoperative staging approach, it is imperative that centers identify areas of expertise and experience with available modalities in any combination to effect accurate staging. Once patients have been accurately staged and deemed resectable, there exist various methods for resection of pancreas lesions, which include the standard "Whipple procedure," pylorus-preserving pancreaticoduodenectomy, regional pancreatectomy, total pancreatectomy, and en bloc vascular resection, where appropriate. Reconstructive techniques have been explored and includemethods of pancreaticojejunostomy and pancreaticogastrostomy with or without pancreatic ductal stents and intraoperatively placed closed suction drains. Perioperative mortality following pancreaticoduodenectomy for cancer has ageneral reported incidence of 1% to 4% at high volume centers experienced with the operation. Morbidity however still remains high with that of delayed gastric emptying, pancreatic anastomotic leak or fistula, intraabdominalabscess, and hemorrhage as the leading reported complications. Researchershave investigated several agents and strategies to decrease or prevent thepotential morbidity of these complications including the use of octreotide, drainage of the pancreatic bed and institution of early enteral feeding. Unfortunately, the majority of patients with pancreatic cancer present with either locally advanced or metastatic disease that precludes operative cure. The expected survival for these patients is usually less than six months from diagnosis. Therefore, a goal of therapy should be adequate palliation of symptoms of pain, biliary or duodenal obstruction and improvement of remaining quality of life with the least degree of morbidity possible.

ASDD Area Sistemi Dipartimentali e Documentali, Università di Bologna, Catalogo delle riviste ed altri periodici
Documento generato il 26/01/20 alle ore 01:23:30