ISSN:8756-0437    

DOI:10.1002/ssu.2980110202

出版商:John Wiley&Sons, Inc.    

年代:1995

数据来源: WILEY

摘要:

AbstractThe diagnosis of infiltrating adenocarcinoma of the pancreas is associated with an overall 5‐year survival of less than 5%. Although surgical resection has improved the prognosis for patients with localized disease, in the absence of ancillary techniques, clinical and pathologic assessment of pancreas cancer fails to predict outcome in many patients. Recent work has focused on the genetic alterations in pancreas cancer, offering the promise of improving our ability not only to predict survival but also to select the most appropriate therapy. The study of genetic alterations in colon cancer, wherein mutations in the oncogene, K‐ras, and the loss of functional activity of several tumor suppressor genes is required for progression from small adenoma to invasive carcinoma, has served as a paradigm for the molecular analysis of pancreas cancer. A similar pattern is emerging for pancreas cancer, in that there is apparently progression from intraductal lesions to invasive cancer, and that K‐ras, and several tumor suppressor genes, includingp53, deleted in colon cancer (DCC), and multiple tumor suppressor‐1 (MTS1), are frequent targets of mutation and/or deletion. Cytogenetic studies and molecular studies assessing allelic loss suggest that several additional oncogenes and tumor suppressor genes involved in the pathogenesis of pancreas cancer remain to be discovered. These recent findings enhance our understanding of the etiology of carcinoma of the pancreas, and serve as the basis for the early detection and, potentially, improved treatment of this typically fatal malignancy. © 1995 Wiley

ISSN:8756-0437    

DOI:10.1002/ssu.2980110203

出版商:John Wiley&Sons, Inc.    

年代:1995

数据来源: WILEY

摘要:

AbstractThe greatest impact on survival in pancreatic carcinoma will most likely be from earlier diagnosis. Newer technologies have surfaced and dramatic improvements in existing diagnostic techniques have occurred in detecting smaller tumors. Fast spiral CT scans utilizing dynamic intravenous contrast have resulted in very high resolution of small masses while improving accuracy of vascular staging. Improved cytology brushes and biopsy forceps during ERCP should improve the preoperative diagnosis of malignancy. Endoscopic ultrasound similarly is proving very useful for detecting small lesions, depth of invasion, and vascular involvement. Specialized use, lengthy training, and cost may limit its dissemination though. Also remarkable has been vastly improved MR images with 3‐D reconstruction (Magnetic Resonance Cholangiopancreatography). Randomized controlled trials comparing these improved and new techniques are awaited. © 1995 Wiley‐Liss,

ISSN:8756-0437    

DOI:10.1002/ssu.2980110204

出版商:John Wiley&Sons, Inc.    

年代:1995

数据来源: WILEY

摘要:

AbstractThere is no ideal tumor marker for pancreatic carcinoma. Most of the tumor‐associated antigens in this disease are cell surface mutins, such as CA19‐9, TAG‐72, CA242, CA50, CA195, and CA494. CA19‐9 is the most promising marker. It is used for clinical and pathological diagnosis, prognosis, and response to chemotherapy. The other mucin antigens are currently being investigated for clinical practice. CA242 shows promise as a marker of tumor load and CA494 may play a role in immunotherapy. Oncofetal antigens such as CEA are not specific for pancreatic carcinoma and have a limited use in this disease. Malignancies associated with the endocrine pancreas secrete hormonal products which can be used as tumor markers. Fluid aspirated from pancreatic cysts can also be evaluated. Tumor antigens in aspirated fluid from pancreatic cysts should be interpreted with caution since multi‐locu‐lated cysts do not have a uniform expression of these markers. © 1995 Wil

ISSN:8756-0437    

DOI:10.1002/ssu.2980110205

出版商:John Wiley&Sons, Inc.    

年代:1995

数据来源: WILEY

摘要:

AbstractAlthough attempts to treat pancreatic cancer were made at the end of the nineteenth century, there was no active interest in this field of surgery until 1935 when Whipple and his associates developed and popularized the technique for a two‐stage pancreaticoduodectomy. Several modifications of the original Whipple operation were made in the 1940s. Total pancreatectomy and regional pancreatectomy were introduced in the surgical armamentarium against pancreatic cancer, but they did not gain wide acceptance. Pylorus‐preserving pancreaticoduodectomy was introduced in 1978, but its role in the management of pancreatic cancer needs to be more clearly defined. The operative mortality of pancreatic resections has dramatically declined in large specialized centers during the last decade. A significant improvement in long‐term survival was also reported in recent series. Despite the decline in operative mortality and the improved long‐term survival after resection for pancreatic cancer, the overall prognosis of this disease remains dismal because of the lack of methods for early diagnosis. Future investigations should focus in the areas of early detection and more effective management approaches for locally advanced disease. © 1995 Wiley

ISSN:8756-0437    

DOI:10.1002/ssu.2980110206

出版商:John Wiley&Sons, Inc.    

年代:1995

数据来源: WILEY

摘要:

AbstractSome 60 years after Whipple popularized pancreaticoduodenectomy for carcinoma of the head of the pancreas, we have finally learned how to do the operation safely. When it is done before lymph node spread, the operative procedure can substantially prolong survival. The task for the immediate future is to identify a solid tumor marker that will facilitate earlier diagnosis of this disease at a stage prior to lymph node spread. In addition, adjuvant therapy which has clearly been shown to be effective, needs to be improved. © 1995 Wiley‐Liss, I

ISSN:8756-0437    

DOI:10.1002/ssu.2980110207

出版商:John Wiley&Sons, Inc.    

年代:1995

数据来源: WILEY

摘要:

AbstractPatients with carcinoma of the pancreas continue to be associated with a poor outcome, with surgical resection representing the only possibility of cure. The classic operation described by Whipple in 1935 has undergone many modifications with Traverso and Long‐mire reintroducing preservation of the pylorus in an attempt to decrease the sequelae from the gastrectomy and improve nutritional outcome. Since 1979, the Lahey Clinic has performed pylorus‐preserving pancreatoduodenectomy for the management of pancreatic and periampullary tumors as long as the duodenal margin is free of tumor and the antropyloric area appears viable. This article reviews the pattern of pancreatic tumor spread and the margins frequently involved with tumor. The management of distal biliary obstruction, our technique of pylorus‐preserving pancreatoduodenectomy and our results of 106 pylorus‐preserving pancreatoduode‐nectomies for pancreatic and periampullary carcinoma are discussed. We feel that pylorus‐preserving pancreatoduodenectomy can achieve results as a cancer operation similar to the standard Whipple operation while eliminating the side effects related to gastric resection and improve the nutritional status of the patient. © 1995 Wil

ISSN:8756-0437    

DOI:10.1002/ssu.2980110208

出版商:John Wiley&Sons, Inc.    

年代:1995

数据来源: WILEY

摘要:

AbstractThe controversy regarding total versus partial pancreatectomy for ductal adenocarcinoma of the pancreatic head remains unsettled. Proponents of total pancreatectomy claim wider margins of resection, avoidance of a troublesome pancreaticoenterostomy, and removal of a potentially multicentric disease. Advocates of partial pancreatectomy highlight the retention of exocrine and endocrine pancreatic function, the maintenance of splenic function, and a lower risk of marginal ulceration without sacrificing curative potential. Analysis of the current surgical literature with focus on the facets of each procedure that may differ (operative mortality, long‐term survival, and the six factors mentioned above), may help to resolve the controversy. The data reviewed would suggest that 1) wider resection margins have not transferred into longer postoperative survival, 2) the risk of multicen‐tricity is probably low and of questionable significance, and 3) the morbidity and mortality of pancreaticoenterostomy is currently less problematic. The additional benefits of retaining pancreatic endocrine and exocrine function, maintaining splenic immune competence, and a lower risk of marginal ulceration convinces us to advocate partial pancreatectomy over total pancreatectomy for the majority of patients with a resectable ductal adenocarcinoma of the pancreatic head. © 1995 Wiley‐Lis

ISSN:8756-0437    

DOI:10.1002/ssu.2980110209

出版商:John Wiley&Sons, Inc.    

年代:1995

数据来源: WILEY

摘要:

AbstractPancreatic cancer remains the fourth leading cause of cancer‐related deaths in adults in this country. Its etiology is unknown, and there is currently no effective method of early diagnosis. Although this article wil focus on the proper management of patients with potentially resectable disease, such patients represent the minority of those diagnosed with pancreatic cancer. Therefore, at most medical centers, clinical and basic science research is proceeding in parallel: while attempting to optimize the length and quality of life of patients with localized pancreatic tunors, research is also focusing on developing improved strategies for early and effective systemic therapy. For patients with localized pancreatic cancer, data from our institution support the use of detailed preoperative imaging studied to allow accurate assessment of tumor resectability. Patients found to have locally advanced or metastatic disease do not undergo laparotomy; biliary decompression, when necessary, is performed utilizing endoscopic or laparoscopic techniques. Pancreaticoduodenectomy is performed on carefully selected patients as part of a protocol‐based clinical research program emphasizing the importance of multimodality management for patients with potentially resectable adenocarcinoma of the pancreatic head. ©1995 Wiley‐Lis

ISSN:8756-0437    

DOI:10.1002/ssu.2980110210

出版商:John Wiley&Sons, Inc.    

年代:1995

数据来源: WILEY

摘要:

AbstractSixty‐three patients were treated with a program of preoperative radiotherapy (RT) and two 96‐hour infusions of 5‐fluorouracil (1,000 mg/m2/day, days 2–5 and 29–32) and a single bolus of mitomycin C (10 mg/m2) on day 2. Those who had no evidence of distant disease nor local unresectability underwent pancreatic resection (16 Whipple resections, 7 total pancreatectomies, 2 distal pancreatectomies). Thirty‐eight percent of the patients had grade 3 or 4 toxicity from the chemoradioth‐erapy (CTRT). One patient died during CTRT of biliary sepsis. Operative mortality for the 25 patients with potentially curative (PC) resections was 4%. One of the four patients with palliative resection died postoperatively. Two other patients with PC resection had major postoperative morbidity. Median survival for those with PC resections was 22 months, while 5‐year survival was 20%. Recurrence was noted in 20 patients, primarily in the liver (50% of patients). Follow‐up is 25 months for 7 patients remaining alive (range 16–77 months). We conclude that this technique is relatively safe, and can produce local cancer control in most patients and prolonged survival in a few with truly localized disease. It is still unclear whether this method of treatment sequencing is any better than postoperative CTRT. ©

ISSN:8756-0437    

DOI:10.1002/ssu.2980110211

出版商:John Wiley&Sons, Inc.    

年代:1995

数据来源: WILEY