3.3.1 Surgical Approaches to Pancreatic Cancer Flashcards
What is the most common # of pancreatodeudenectomy’s done in hospitals? What is the mortality rate?
1-5; 12-18%
What are some of the revascularization options? (3)
Describe the survival curve following pancreatoduodenectomy.
What is being shown in this image?
Pancreatogastrostomy
What are some of the familial pancreatic cancer risk factors?
What is the median age of diagnosis?
72 y/o
What procedure is this?
The whipple
What are some of the genetic mutations associated with pancreatic cancer?
What might determine surgical options and extent of resection?
Blood supply; the arterial supply is highly variable and dependent upon embryology, and venous follows arterial
What is shown in these images?
Reconstruction
What type of pancreatic surgery also requires splenectomy? It is technically simple, but is rarely ever an option for cancer.
Distal pancreatectomy
What supplies blood to the following organs: stomach, liver, spleen, and pancreas?
GDA (gastroduodenal artery)
What are some of the alternate names for pancreatoduodenectomy?
Whipple (US) and Kocher (Europe)
What are the surgical steps to a PD? (6)
What is important to note about this chart?
Hospitals that regularly perform PDs (>16/year) have significantly reduced mortality rates. As low as 4% as compared to 18%.
What can be seen in the CT of the pancreas?
The double duct sign
What is the incidence of pancreatic cancer?
10/100,000 in the US
How often must the R hepatic artery be replaced?
15-20%
How does the number of first degree relatives with familial pancreatic cancer increase the risk of developing pancreatic cancer?
Describe the progression of the precursor lesions that lead to pancreatic cancer.
What are some of the symptoms associated with pancreatic cancer?
Pain and Weight Loss
Pancreatoduodenal arcades supply what type of circulation?
Collateral
What is being done in these pictures?
Uncinate-SMA Dissection
What % of pancreatic cancers are exocrine? What are some of the subtypes? The most common subtype?
98%; Adenocarcinoma
What are some other risk factors for pancreatic cancer?
Chronic alcoholic pancreatitis (26x risk)
Obesity (20% higher risk)
African-American/Jewish/Hawaiian
What imaging study is used as the gold standard for staging? (Also is the only needed test pre-op)
CT
What percentage of pancreatic cancer is found as localized?
9%
What % of pancreatic cancers are in stage IV/V?
80-90%
What % of pancreatic cancers are endocrine? What are some of the subtypes?
2%
Aside from distal pancreatectomy, what is surgical option for some pancreatic cancers?
Pancreatoduodenectomy
What is the major risk factor for pancreatic cancer?
Cigarette smoking (2-3x higher risk)
What imaging study is more sensitive than CT?
(Better staging and gold standard for tissue dx)
Endoscopic US
Describe the pancreatic cancer survival curve using adjuvant chemo/rad tx
What are the overall survival rates of pancreatic cancers?
1-yr survival: 8%
5-yr survival: 2%
What are the 3 advantages of pancreatogastrostomy?
Enterokinase not available (proteolytic enzymes not activated)
Acidic gastric pH (reduces proteolytic activity)
Alkaline pancreatic secretions (protects against ulceration)
What is the 5-year survival % of all stages of pancreatic cancer?
~ 7%
