摘要:

Early diagnosis of pancreatic cancer is difficult because of the lack of early symptoms, accurate screening methods, and insensitivity of noninvasive imaging. Endoscopic retrograde cholangiopancreatography (ERCP) and endoscopic ultrasonography (EUS) are the most sensitive procedures to detect early pancreatic cancer. In patients with biliary obstruction, ERCP is performed as the first invasive procedure to assess morphology of the pancreatic and biliary duct and tissue diagnosis by brush cytology. In patients without biliary obstruction, guided aspiration cytology should be performed either by percutaneous sonography, CT scan or EUS. Staging should be performed if no metastases are present. EUS increases accuracy of T and N staging especially in periampullary tumors. Laparoscopy in combination with CT scan and angiography correctly identifies the majority of unresectable cases. Aggressive diagnostic and staging procedures are justified to identify the prognostically more favorable tumors.

ISSN:0253-4886    

DOI:10.1159/000172283

出版商:S. Karger AG    

年代:1994

数据来源: Karger

摘要:

Computed tomography (CT) is the modality of choice for evaluation of pancreatic disease. At present, dynamic and spiral CT are the optimal techniques for diagnosis and staging of patients with suspected pancreatic carcinoma. Images obtained with spiral CT showed superior vascular opacification compared with those obtained with dynamic CT. CT is more accurate in demonstrating tumor involvement of major peripancreatic vessels. CT staging criteria of unresectability are reliable. Indication for angiography is the preoperative assessment of patients who have resectable tumors with CT or the evaluation of equivocal CT/ERCP findings.

ISSN:0253-4886    

DOI:10.1159/000172284

出版商:S. Karger AG    

年代:1994

数据来源: Karger

摘要:

Among 29 verified neoplasms in 28 patients, CT detected 22 and MRI 27 (sensitivity 76% versus 93%). This apparent superiority of MRI is mainly caused by the higher inherent contrast difference between tumors and normal parenchyma, by fat signal suppression on scans with enhanced tumor, and by oblique axial demonstration of the entire gland on one section.

ISSN:0253-4886    

DOI:10.1159/000172285

出版商:S. Karger AG    

年代:1994

数据来源: Karger

摘要:

2-[18F]-fluoro-2-deoxy-D-glucose positron emission tomography (FDG-PET) for detection of pancreatic cancer was evaluated and compared to CT scan. Also the glucose transporter 1 (Glutl) encoding gene expression was determined by Northern blot analysis in 7 patients with pancreatic cancer (PC) and 5 patients with chronic pancreatitis (CP). 73 patients with suspected PC or CP underwent static PET imaging after injection of 250-350 MBq FDG. Focal FDG uptake was considered a sign of malignancy and was calculated using standardized uptake values (60 min p.L). Increased Glutl expression could be demonstrated in all patients with PC and not in patients with CP indicating an important contribution of Glutl to enhanced tumoral glucose consumption. In the visual FDG-PET analysis 41/43 (95%) patients with histologically controlled PC and 27/39 (90%) patients with CP were classified correctly by PET. With CT 33/41 (80%) patients with PC were diagnosed correctly, whereas 7/27 were false-positive (specificity 74%). Thus FDG-PET provided a reliable differentiation of pancreatic adenocarcinoma from chronic pancreatitis.

ISSN:0253-4886    

DOI:10.1159/000172286

出版商:S. Karger AG    

年代:1994

数据来源: Karger

摘要:

Endoscopic palliation of malignant biliary obstruction due to pancreatic cancer has become an accepted alternative to surgical bilioenteric bypass over the last decade. Clinical experience and randomized trials have shown equal efficacy with lower initial morbidity and mortality rates for endoscopic biliary stent therapy but the problem of stent occlusion remains as the dominant late problem. Metallic stents have an improved patency rate and are cost-effective. Newer applications of endoscopically-placed stents for pancreatic pain and gastric outlet obstruction are being explored. The place of laparoscopic approaches to the consequences of pancreatic cancer has yet to be defined.

ISSN:0253-4886    

DOI:10.1159/000172287

出版商:S. Karger AG    

年代:1994

数据来源: Karger

摘要:

Indications for surgery of the pancreas depend on two major factors: the tumor and the surgeon. Tumor stage and tumor spread are technical factors defining resectability. Hepatic and peritoneal metastases, complex vascular involvement, retroperitoneal infiltration and infiltration of adjacent organs are objective factors of irresectability. Technical skill, experience and aggressiveness of the surgeon are factors contributing to the resectability of the tumor. The individual surgeon alone has to take the decision to resect and to define the extent of possible resection in the light of his experience.

ISSN:0253-4886    

DOI:10.1159/000172288

出版商:S. Karger AG    

年代:1994

数据来源: Karger

摘要:

The nihilistic position adapted by many surgeons to the effect that the diagnosis of cancer of the pancreas presents a contraindication for a tumor resection is obsolete today. The early resection, especially of smaller tumors, is today considered to be the only therapeutic means of restituting the patient. 5-year survival rates of up to 30% following tumor resections and adjuvant treatment, mainly reported from Japan, underline this point of view. In order to be able to further improve the prognosis of patients with cancer of the pancreas, an aggressive diagnosis is required. In the event of epigastric complaints of unknown origin, the possibility of pancreatic carcinomas should always be excluded by means of an ERCP after any other epigastric causes were investigated. The 90% sensitivity of the ERCP makes it possible to diagnose small pancreatic tumors at an early stage and to subject the patient to an early curative resection. Pancreatic tumors have to be resected radically and safely, that is with a low perioperative morbidity and mortality. The figures obtained from the literature stress that a pancreatic resection in the case of a carcinoma can be carried out with a perioperative mortality of below 5%. Irrespective of the surgical treatment method, patients with cancer of the pancreas ought to be included in adjuvant therapy studies. Monocenter and/or multicenter studies ought to be able to work out new adjuvant therapeutic strategies which may help in future to improve the prognosis of cancer of the pancreas.

ISSN:0253-4886    

DOI:10.1159/000172289

出版商:S. Karger AG    

年代:1994

数据来源: Karger

摘要:

The classic Whipple operation, which has changed little in its fundamental principles in over 50 years, is performed today with operative mortality rates of 5% or less. It still represents the only chance for the cure of patients with malignant periampullary diseases. However, when applied to patients with pancreatic cancer, it cures very few. It probably provides excellent palliation in many, and may find wider application for palliation since it can be done safely. Certain modifications may yet decrease the morbidity associated with the Whipple, and improve the quality of life in patients who have undergone the procedure. Improved cure rates in patients with pancreatic cancer are more likely to come from newer diagnostic and nonsurgical treatments, than from more extensive and radical resections.

ISSN:0253-4886    

DOI:10.1159/000172290

出版商:S. Karger AG    

年代:1994

数据来源: Karger

摘要:

Although the history of duodenopancreatectomy is very old there is still an ongoing discussion on whether the pylorus-preserving type of duodenopancreatectomy should be done in patients with cancer of the pancreatic head. Recent data convincingly show a trend to consider the pylorus-preserving type of duodenopancreatectomy in pancreatic cancer as an excellent alternative. Though the experience with pancreatic cancer disease is not yet conclusive, the fascinating benefit of the pylorus-preserving duodenopancreatectomy has result in a reduction of surgical trauma, a decrease of operating time, a reduction of blood loss and very importantly, optimal postoperative digestion and nutrition due to the preservation of the antrum pylorus unit, resulting in an overall improvement in quality of life compared to the standard Whipple procedure. Recent data show an equal survival rate and incidence of locoregional recurrences or distant metastasis with both types of operation. This phenomenon still needs to be confirmed since so far no randomised prospective study comparing the standard Whipple operation with pylorus-preserving duodenopancreatectomy in pancreatic cancer has been done.

ISSN:0253-4886    

DOI:10.1159/000172291

出版商:S. Karger AG    

年代:1994

数据来源: Karger

摘要:

The preservation of the neurovascular supply to the antrum, pylorus and the first part of the duodenum (APD) via the right gastric (RG) and supraduodenal artery (SPD) is essential for the success of the pylorus-preserving pancreaticoduodenectomy (PPPD) and to prevent delayed gastric emptying (DGE). We analyzed 41 patients with malignant neoplasm and 25 patients with chronic pancreatitis. Preservation of the blood supply to the APD was not possible in 19 patients (46.3%) in the malignant group and DGE occurred in 84.2% of the patients. Furthermore 4 patients had intra-abdominal sepsis and DGE occurred in all patients. The RG and/or SPD arteries were preserved in all patients with benign disease and DGE occurred in 8% of cases. In conclusion DGE is the most frequent complication after PPPD for malignant tumors and is associated with the presence of intra-abdominal sepsis and with the ischemic injury to the APD segment for an oncologically adequate resection.

ISSN:0253-4886    

DOI:10.1159/000172292

出版商:S. Karger AG    

年代:1994

数据来源: Karger