17. Tumors of the pancreas – radical and palliative surgery

Question 1

Diagnostic steps

Answer 1

1. Lab values
2. CT
3. Endoscopy
4. Angiography
5. FNAB

Question 2

1. Lab values

Answer 2

• Increased bilirubin, LFT, ALP, serum glucose and amylase

- Blood in stool, low Hb, genetic markers (k-ras, p52) tumor markers (CA19-9)

Question 3

3. Endoscopy

Answer 3

Shows impression on duodenum or stomach

ERCP

Question 4

4. Angiography

Answer 4

hypervascularized and infiltration of vessels

Question 5

Resection and survival

Answer 5

• Resection is the only curative/long term survival option
• Resectability: <20%, symptoms occur late
• Tumor size:
  < 2,5 cm: 33% survival
  > 2,5 cm: 12 %
  > 5 cm: 0%
• lymph node metastasis and proximal SMA spread has low prognosis

Question 6

Techniques of parcreaticoduodenectomy

Answer 6

1. Standard PD
2. Radical PD
3. Extended PD

Question 7

Total vs. regional pancreatectomy

Answer 7

• No difference in intraoperative mortality or survival
• Postoperative cure of total is problematic
• The resectability is improved with regional

Question 8

Standard vs radical

Answer 8

• Extended lymphadenectomy + SMV resection does not improve mortality, morbidity nor long term survival
• LN removal is done to prevent local reoccurrence