Experience for Management of Surgical Treatment in Patients with Carcinomas of the Pancreatic Head or Periampullary Region

LUO Tao¹, LI Xing², GONG Jianping² and LI Qujin^2,

¹Department of General Surgery Hospital of traditional Chinese medicine of Yubei, Chongqing, 401120, China

²Department of Hepatobiliary Surgery, the Second Affiliated Hospital of Chongqing Medical University, Chongqing 400010, China

Cite this paper:
LUO Tao, LI Xing, GONG Jianping and LI Qujin. Experience for Management of Surgical Treatment in Patients with Carcinomas of the Pancreatic Head or Periampullary Region. American Journal of Cancer Prevention. 2017; 5(1):1-9. doi: 10.12691/ajcp-5-1-1

Abstract

Objective: Pancreaticoduodenectomy was considered as the standard choice of surgery treatment to carcinomas in the pancreatic head or periampullary region. This study will focus on the experience summary to manage the patients with carcinomas in the pancreatic head or periampullary region who underwent surgery treatment in west area of China to investigate the different surgical methods, prognosis and long term survival. Method: We consecutively reviewed 73 patients underwent surgery treatment in our hospital between January 2007 and December 2011. Surgery treatment described as radical operation of PD treatment and palliative operation of choledochojejunostomy plus drainage. We assessed different variables to summarize the management of patients and to evaluate the long term survival. Result: 32 patients received PD treatment and 41 patients received palliative surgery treatment. Histologic diagnosis indicated that all patients had malignant disease. PD procedures spent more time to complete the operation. 3 patients in PD group developed pancreatic fistula and 1 of them died on the seventh days postoperative. 2 patients developed wound infection and 1 patient developed malnutrition which finally reversed by medical intervention. The postoperative mortality in PD group was observed in 2 of 32 patients. The postoperative mortality in PD group was 6.25% (n=2). Long term survival of PD and palliative surgery group was described as 15.4 months and 5.6 months respectively. Conclusion：The treatment of patients with carcinomas in the pancreatic head or periampullary region continues to be associated with high incidence of postoperative complicatons. Early diagnosis and pancreaticoduodenectomy represents the only possibility of cure.

Keywords:
carcinomas in the pancreatic head or periampullary region pancreaticoduodenectomy choledochojejunostomy plus drainage palliative operation

This work is licensed under a Creative Commons Attribution 4.0 International License. To view a copy of this license, visit http://creativecommons.org/licenses/by/4.0/

References:

[1]	Schmidt C Max, Powell Emilie S, Yiannoutsos Constantin T, et al. Pancreaticoduodenectomy a 20-year experience in 516 patients. Arch Surg, 2004; 139: 718-725.
[2]	Lai EC. H, Lau SH. Y, Lau WY. Measures to prevent pancreatic fistula after Pancreatoduodenectomy. Arch Surg. 2009, 144: 1074-1080.
[3]	Kong Justin, Gananadha Sivakumar, Hugh TJ, et al. pancreaticoduodenectomy: role of drain fluid analysis in the management of pancreatic fistula. Anz J. Surg, 2008; 78: 240-244.
[4]	Fuks David, Piessen Guillaume, Huet Emmanuel, et al. Life-threatening postoperativepancreatic fistula (grade C) after pancreaticoduodenectomy: incidence, prognosis, and risk factors. Am J Surg, 2009; 197: 702-709.
[5]	PatrikPessaux, Alain Sauvanet, Christophe Mariette, et al. External pancreatic duct stent decreases pancreatic fistula rate after pancreaticoduodenectomy: prospective multicenter randomized trial. Ann Surg, 2011; 253: 879-855.
[6]	Weitz J, Rahbari N, Koch M, et al. The “artery first” approach for resection of pancreatic head cancer. J Am Coll Surg. 2010; 210:e1-4.
[7]	Gaedcke J, Gunawan B, Grade M, et al. The meso-pancreas is the primary site for R1 resection in pancreatic head cancer: relevance for clinical trials. Langenbecks Arch Surg. 2010, 395: 451-8.
[8]	Petrou A1, Soonawalla Z, Silva MA, at al. Prognostic indicators following curative pancreatoduodenectomy for pancreatic carcinoma: A retrospective multivariate analysis of a single centre experience. J BUON. 2016 Jul-Aug; 21(4):874-882.
[9]	Xu HX, Liu L, Xiang JF, et al. Postoperative serum CEA and CA125 levels are supplementary to perioperative CA19-9 levels in predicting operative outcomes of pancreatic ductal adenocarcinoma. Surgery. 2016 Nov 9. [Epub ahead of print].
[10]	Van der Gaag, Rauws Erik A.J, Van Eijck Casper H, et al. Preoperative biliary drainage for cancer of the head of the pancreas. N Engl J Med 2010; 362: 129-137.
[11]	Eshuis Wietse J, Van Der Gaag N A, Rauws Erik A, et al. Therapeutic delay and survival after surgery for cancer of the pancreatic head with or without preoperative biliary drainage. Annals of Surg 2010; 252: 840-849.
[12]	Pannala Rahul, Leirness Jeffery, Bamlet William R, et al. Prevalence and clinical profile of pancreatic cancer-associated diabetes mellitus. Gastroenterology 2008; 134: 981-987.
[13]	Olivié Damien, Lepanto Luigi, Billiard Jean Sébastien, et al. Predicting resectability of pancreatic head cancer with multi-detector CT. Surgical and pathologic correlation. JOP 2007; 8: 753-758.
[14]	Hidalgo Manuel. Pancreatic cancer. N Eng J Med 2010; 362: 1605-1617.
[15]	De Jong Mechteld C, Farnell Michael B, Sclabas Guido, et al. Liver-directed therapy for hepatic metastases in patients undergoing pancreaticoduodenectomy. Ann Surg 2010; 252: 142-148.
[16]	Haga Yoshio, Wada Yasuo, Takeuchi Hitoshi, et al. Prediction of anastomotic leak and its prognosis in digestive surgery. World J Surg 2011; 35: 716-722.
[17]	Kawai Manabu, Yamaue Hiroki. Analysis of clinical trials evaluating complications after pancreaticoduodenectomy: a new era of pancreatic surgery. Surg Today, 2010; 40: 1011-1017.
[18]	Wu W, Wang X, Wu X, et al. Total mesopancreas excision for pancreatic head cancer: analysis of 120 cases. Chin J Cancer Res. 2016 Aug; 28(4):423-8.
[19]	Chu Carrie K, Farnell Michael B, Nguyen Justin H, et al. Prosthetic graft reconstruction after portal vein resection in pancreaticoduodenectomy: a multicenter analysis. J Am CollSurg 2010; 211: 316-324.
[20]	Chua Terence C, Saxena Akshat. Extended pancreaticoduodenectomy with vascular resection for pancreatic cancer: a systematic review. J Gastrointest Surg, 2010; 14: 1442-1452.
[21]	Xu Yufei, Liu Zuojin, Gong Jianping. Pancreaticoduodenectomy with early superior mesenteric artery dissection. Hepatobiliary Pancreat Dis Int. 2010, 9: 579-583.
[22]	Lin Q, Tan L, Zhou Y, et al. Radical nerve dissection for the carcinoma of head of pancreas: report of 30 cases. Chin J Cancer Res. 2016 Aug; 28(4):429-34.
[23]	Fujioka S, Misawa T, Yanaga K. Isolating tape method is useful for an early judgment of curability during pancreaticoduodenectomy forpancreatic cancer. J Hepatobiliary Pancreat Sci. 2016 Oct; 23(10): 20-24.
[24]	Yan L, Siddiqui AA, Laique S, et al. A large multicenter study of recurrence after surgical resection of branch-duct intraductal papillary mucinous neoplasm of the pancreas. Minerva Gastroenterol Dietol. 2016 Nov 8. [Epub ahead of print]
[25]	Werner Hartwig, Thilo Hackert, Ulf Hinz, et al. Pancreatic cancer surgery in the new millennium better prediction of outcome. Ann Surg 2011; 254: 311-319.
[26]	Katz Matthew H G, Merchant Nipun B, Brower Steven, et al. Standardization of surgical and pathologic variables is needed in multicenter trials of adjuvant therapy for pancreatic cancer: results from the ACOSOG Z5031 trial. Ann Surg Oncol, 2011; 18: 337-344.