Characterization of Tumors of the Pancreas and the Pancreatoduodenal Area in own Material, in 2-Year Prospective Observation

• Authors: Andrzej Cichocki , Mariusz Jóźwiak , Radosław Samsel , Paweł Piotrowski , Grzegorz Nawrocki , Katarzyna Roszkowska
• Languages of publication: EN

Abstracts

EN

Tumors of the pancreas and the pancreatoduodenal area constitute a group characterized by highly variable histological structure and differing prognosis. Adenocarcinoma of the pancreas is the most common tumor of this area and prognosis of patients with this tumor still remains poor.The aim of the study was to present characteristics of tumors of the pancreatoduodenal are and the pancreas in our own material.Material and methods. Since May 2005, a systematic prospective assessment was started of patients with tumors of the pancreas that underwent surgery in Department of Surgery, Clinic of Oncology, Center of Oncology in Warsaw. Within 22 months, between 1.03.2005 and 31.12.2006, 85 patients (42 women, 43 men) with lesions of the pancreas or ampulla of Vater, potentially amenable to resection, were qualified for surgical treatment. An average age of patients that underwent surgery was 61.2 years.Results. Surgical resection was performed in 43 patients (50.6%), including: 17 pancreatoduodenectomies (39.5%), 7 total pancreatectomies (16.3%), 16 peripheral splenopancreatectomies (37.2%) and 3 local resections/lesion extirpation (7%).The most common reasons for refraining from resection included: involvement of mesenteric vessels (12/42 - 28.6%), infiltration of portal vein system (19%), liver metastases (19%).Adenocarcinoma of the pancreas was the predominant histological diagnosis (32/85 - 37.64%), followed by chronic pancreatitis (14.1%). Tumors of uncertain or unknown malignant potential (neuroendocrine tumors, mucinous cystic neoplasm, solid cystic papillary tumor) were diagnosed in 13 patients (15.3%).Conclusions. Despite more and more precise preoperative diagnosis, significant percentage of patients qualified for radical resection of tumors of the pancreas and pancreatoduodenal area, have lesions not amenable to surgical resection. Significant percentage of tumors of uncertain or unknown malignant potential in the presented material must be emphasized. This group of patients requires different management approach than patients with adenocarcinoma.

Keywords

EN

cancer of the pancreas; cancer of the ampulla of Vater; neuroendocrine tumors of the pancreas; surgical treatment of tumors of the pancreas

• Publisher: Index Copernicus International
• Journal: Polish Journal of Surgery
• Year: 2008
• Volume: 80
• Issue: 5
• Pages: 233-240

Dates

published

1 - 5 - 2008

online

9 - 6 - 2008

Contributors

author

Andrzej Cichocki

• Department of Surgery, Clinic of Oncology Center of Oncology, M. Skłodowska-Curie Institute, Warsaw, Kierownik: dr n. med.

author

Mariusz Jóźwiak

• Department of Surgery, Clinic of Oncology Center of Oncology, M. Skłodowska-Curie Institute, Warsaw, Kierownik: dr n. med.

author

Radosław Samsel

• Department of General Surgery, Bielański Hospital, Warsaw, Ordynator: dr hab.

author

Paweł Piotrowski

• Department of Surgery, Clinic of Oncology Center of Oncology, M. Skłodowska-Curie Institute, Warsaw, Kierownik: dr n. med.

author

Grzegorz Nawrocki

• Department of Surgery, Clinic of Oncology Center of Oncology, M. Skłodowska-Curie Institute, Warsaw, Kierownik: dr n. med.

author

Katarzyna Roszkowska

• Department of Pathomorphology Center of Oncology, M. Skłodowska-Curie Institute, Warsaw, Kierownik: prof. dr hab.

References

• Lowenfels AB, Maisonneuve P: Epidemiology and risk factors for Pancreatic cancer. Best Pract Res Clin Gastroenterol 2006; 20:197-209.
• Bramhall SR, Allum WH, Jones AG et al.: Treatment and survival in 13560 patients with pancreatic cancer, and incidence of the disease, in the West Midlands: an epidemiological study. Br J Surg 1995; 82: 111-15.
• Sener SF, Fremgen A, Menck HR et al.: Pancreatic cancer: a report of treatment and survival trends for 103,313 patients diagnosed from 1985-1995, using the National Cancer Database. J Am Coll Surg 1999; 189: 1-7.
• Ghaneh P, Sultana A, Shore S et al.: The case for adiuvant chemotherapy in pancreatic cancer. Best Pract Res Clin Gastroenterol 2006; 20: 383-401.
• Popiela T, Kulig J, Sierżega M i wsp.: Analiza trendów czasowych u chorych na raka trzustki i raka brodawki Vatera leczonych w latach 1972-2003. Gastroenterol Pol 2007; 14(4): 241-49.
• Whipple AO, Parsons WB, Mullins CR: Treatment of carcinoma of the ampula of Vater. Ann Surg 1935; 102: 763-76.
• Sohn TA, Yeo CJ, Cameron JL et al.: Resected adenocarcinoma of the pancreas -616 patients:results, outcomes, and prognostic indicators. J Gastrointest Surg 2000; 4: 567-79.
• Cameron JL, Crist DW, Sitzmann JV et al.: Factors influencing survival after pancreaticoduodenectomy for pancreatic cancer. Am J Surg 1991; 161: 120-24.
• Harrison LE, Klimstra DS, Brennan MF: Isolated portal vein involvement in pancreatic adenocarcinoma. A contradication for resection? Ann Surg 1996; 224(3): 342-47.
• Tseng JF, Raut CP, Lee JE et al.: Pancreatoduodenectomy with wascular resection: margin status and survival duration. J Gastrointest Surg 2004; 8: 935-49.[Crossref][PubMed]
• Nakagori T, Kinoshita T, Konishi M et al.: Survival benefits of portal vein resection for pancreatic cancer. Am J Surg 2003; 186: 149-53.
• Ishikawa O, Ohhhigaeshi H, Sasaki Y et al.: Practical usefulness of lymphatic and connective tissue clearance for carcinoma of the head of the pancreas. Ann Surg 1988; 208: 215-20.
• Yeo CJ, Cameron JL: Arguments against radical (extended) resection for adenocarcinoma of the pancreas. Adv Surg 1994; 27: 273-84.
• Yeo CJ, Cameron JL, Lillemoe KD et al.: Pancreatoduodenectomy with or without distal gastrectomy and extended retroperitoneal lymphadenectomy for periampullary adenocarcinoma, part 2:randomized controlled trial evaluating survival, morbidity, and mortality. Ann Surg 2002; 236: 355-66.
• Shapiro TM: Adenocarcinoma of the pancreas: A statistical analysis of by-pass vs. Whipple resection in good risk patients. Ann Surg 1975; 182: 715-21.
• Lieberman MD, Kilburn H, Lindsey M et al.: Relation of perioperative deaths to hospital volume among patients undergoing pancreatic resection for malignancy. Ann Surg 1995; 222: 538-645.
• Birkmeyer JD, Siewers AE, Finlayson EV et al.: Hospital volume and surgical mortality in the United States. N Engl J Med 2002; 346(15): 1128-37.
• Birkmeyer JD, Stkel TA, Siewers AE et al.: Surgeon volume and operative mortality in the United States. N Engl J Med 2003; 349(22): 2117-27.
• Callery MP, Strasberg SM, Doherty GM et al.: Staging laparoscopy with laparoscopic ultrasonography: Optimizing resectability in hepatobiliary and pancreatic malignancy. J Am Coll Surg 1997; 185(1): 33-39.
• Vollmer C, Drebin JA, Middleton WD et al.: Utility of staging laparoscopy in subsets of peripancreatic and biliary malignancies. Ann Surg 2002; 235: 1-7.
• Szymański D, Nowicki M, Iljin A i wsp.: Operacje paliatywne w nieresekcyjnym raku głowy trzustki. Pol Med Paliatywna 2006; 5: 9-13.
• Wilenitz RE, Hruban RH: Pathology of pancreatic cancer. W: Cameron JL, ed. Pancreatic Cancer, London: B.C. Decker; 2001: 37-66.
• Strasberg SM, Drebin JA, Soper NJ: Evolution and current status of the Whipple procedure: An update for gastroentrologists. Gastroenterology 1997; 113: 983-94.
• Cullen JJ, Sarr MG, Ilstrup DM: Pancreatic anastomotic leak after pancreaticoduodenectomy: incidence, significance and management. Am J Surg 1994; 168: 295-98.
• Stodjadinovic A, Hoss A, Brennan MF et al.: Randomized clinical trials In pancreatic cancer. Surg Onc Clin N Am 2002; 11(1): 207-29.[Crossref]

Identifiers

DOI

10.2478/v10035-008-0030-5