Surgical treatment of pancreatic cancer
Tóm tắt
From 1964 to 1982, there were 782 patients treated for carcinoma of the pancreas. In 174 patients pancreaticoduodenal resection was possible (22%). Until 1977 we performed Whipple procedures, while from 1978 to 1982 total pancreatectomy was preferred. Comparing the results of both methods, we did not find any advantages of total pancreatectomy. Operative mortality did not decrease, survival time did not extend, and the higher resection rates (up to 26%) for more advanced tumor stages were accompanied by greater morbidity. With respect to the patients with inoperable cancer of the pancreas, we found over the last 5 years that the rate of those not undergoing surgery has climbed from 8% to 25%, while the rate of exploratory laparotomies was reduced from 28% to 5%. With the advent of preoperative percutaneous transhepatic cholangio-drainage (PTCD), the mortality rate of our palliative procedures dropped to 12%. Biliodigestive anastomosis of choice is the hepaticojejunostomy.
Tài liệu tham khảo
Shapiro, T.M.: Adenocarcinoma of the pancreas: A statistical analysis of biliary bypass vs Whipple resection in good risk patients. Ann. Surg.182:715, 1975
Crile, G.: The advantages of bypass operations over radical pancreaticoduodenectomy in the treatment of pancreatic carcinoma. Surg. Gynecol. Obstet.130:1048, 1970
Kümmerle, F., Kirschner, P., Mangold, G.: Clinics and surgical treatment of cancer of the pancreas. Dtsch. Med. Wochenschr.101:729, 1976
Collins, J.J., Craighead, J.E., Brooks, J.R.: Rationale for total pancreatectomy for carcinoma of the pancreatic head. N. Engl. J. Med.274:599, 1966
Pliam, M.B., Remine, W.H.: Further evaluation of total pancreatectomy. Arch. Surg.110:506, 1975
Trede, M.: Die totale Pankreatektomie Langenbecks. Arch. Chir.340:227, 1976
Rückert, K., Kümmerle, F.: Totale Duodenopankreatektomie als Regeloperation beim Pankreascarcinoma. Chirurg.40:162, 1978
Klöppel, G., Held, G., Morohoshi, T., Seifert, G.: Klassifikation exokriner Pankreastumoren. Histologische Untersuchungen an 167 autoptischen und 97 bioptischen Fällen. Pathologe3:319, 1982
Klöppel, G., Sosnowski, J., Eichfuß, H-P., Rückert, K., Klapdor, R.: Actual aspects of cancer of the pancreas. Dtsch. Med. Wochenschr.104:1801, 1979
Günther, R., Thelen, M.: A fine-needle puncture set for percutaneous bile duct drainage. Fortschr. Röntgenstr.133:180, 1980
van Heerden, J.A., Heath, P.M., Alden, C.R.: Biliary bypass for ductal adenocarcinoma of the pancreas: Mayo Clinic experience, 1970–1975. Mayo Clin. Proc.55:537, 1981
von Bülow, M., Klöppel, G., Kern, H., Baisch, H., Schärfe, T.: Serial heterotransplantation of human pancreatic carcinoma on NMRI nu/nu mice: Morphology, growth kinetics and antigenic surface structure. J. Cancer Res. Clin. Oncol.105:39, 1983
Edis, A.J., Kiernan, P.D., Taylor, W.F.: Attempted curative resection of ductal carcinoma of the pancreas. Review of Mayo Clinic experience, 1951–1975. Mayo Clin. Proc.55:531, 1980
Fortner, J.G.: Regional resection of cancer of the pancreas: A new surgical approach. Surgery73:307, 1973
Cubilla, A.L., Fitzgerald, P.J.: Surgical pathology of tumors of the exocrine pancreas. In Tumors of the pancreas, A.R. Moosa, ed. Baltimore, Williams & Wilkins, 1980, p. 159
Klöppel, G., Schneider, H.-M., Volkholz, H., Stolte, M.: Zur multitopen Entstehung von Pankreaskarzinomen. Verh. Dtsch. Ges. Pathol.64:602, 1980
Klöppel, G., Kern, H., von Bülow, M.: Human pancreatic adenocarcinoma grown in nude mice: An analysis of their structural and biological features. Digestion25:44, 1982