3.3.1 Surgical Approaches to Pancreatic Cancer

Question 1

What is the most common # of pancreatodeudenectomy’s done in hospitals? What is the mortality rate?

Answer 1

1-5; 12-18%

Question 2

What are some of the revascularization options? (3)

Answer 2

Question 3

Describe the survival curve following pancreatoduodenectomy.

Answer 3

Question 4

What is being shown in this image?

Answer 4

Pancreatogastrostomy

Question 5

What are some of the familial pancreatic cancer risk factors?

Answer 5

Question 6

What is the median age of diagnosis?

Answer 6

72 y/o

Question 7

What procedure is this?

Answer 7

The whipple

Question 8

What are some of the genetic mutations associated with pancreatic cancer?

Answer 8

Question 9

What might determine surgical options and extent of resection?

Answer 9

Blood supply; the arterial supply is highly variable and dependent upon embryology, and venous follows arterial

Question 10

What is shown in these images?

Answer 10

Reconstruction

Question 11

What type of pancreatic surgery also requires splenectomy? It is technically simple, but is rarely ever an option for cancer.

Answer 11

Distal pancreatectomy

Question 12

What supplies blood to the following organs: stomach, liver, spleen, and pancreas?

Answer 12

GDA (gastroduodenal artery)

Question 13

What are some of the alternate names for pancreatoduodenectomy?

Answer 13

Whipple (US) and Kocher (Europe)

Question 14

What are the surgical steps to a PD? (6)

Answer 14

Question 15

What is important to note about this chart?

Answer 15

Hospitals that regularly perform PDs (>16/year) have significantly reduced mortality rates. As low as 4% as compared to 18%.

Question 16

What can be seen in the CT of the pancreas?

Answer 16

The double duct sign

Question 17

What is the incidence of pancreatic cancer?

Answer 17

10/100,000 in the US

Question 18

How often must the R hepatic artery be replaced?

Answer 18

15-20%

Question 19

How does the number of first degree relatives with familial pancreatic cancer increase the risk of developing pancreatic cancer?

Answer 19

Question 20

Describe the progression of the precursor lesions that lead to pancreatic cancer.

Answer 20

Question 21

What are some of the symptoms associated with pancreatic cancer?

Answer 21

Pain and Weight Loss

Question 22

Pancreatoduodenal arcades supply what type of circulation?

Answer 22

Collateral

Question 23

What is being done in these pictures?

Answer 23

Uncinate-SMA Dissection

Question 24

What % of pancreatic cancers are exocrine? What are some of the subtypes? The most common subtype?

Answer 24

98%; Adenocarcinoma

Question 25

What are some other risk factors for pancreatic cancer?

Answer 25

Chronic alcoholic pancreatitis (26x risk) Obesity (20% higher risk) African-American/Jewish/Hawaiian

Question 26

What imaging study is used as the gold standard for staging? (Also is the only needed test pre-op)

Answer 26

CT

Question 27

What percentage of pancreatic cancer is found as localized?

Answer 27

9%

Question 28

What % of pancreatic cancers are in stage IV/V?

Answer 28

80-90%

Question 29

What % of pancreatic cancers are endocrine? What are some of the subtypes?

Answer 29

2%

Question 30

Aside from distal pancreatectomy, what is surgical option for some pancreatic cancers?

Answer 30

Pancreatoduodenectomy

Question 31

What is the major risk factor for pancreatic cancer?

Answer 31

Cigarette smoking (2-3x higher risk)

Question 32

What imaging study is more sensitive than CT? (Better staging and gold standard for tissue dx)

Answer 32

Endoscopic US

Question 33

Describe the pancreatic cancer survival curve using adjuvant chemo/rad tx

Answer 33

Question 34

What are the overall survival rates of pancreatic cancers?

Answer 34

1-yr survival: 8% 5-yr survival: 2%

Question 35

What are the 3 advantages of pancreatogastrostomy?

Answer 35

Enterokinase not available (proteolytic enzymes not activated) Acidic gastric pH (reduces proteolytic activity) Alkaline pancreatic secretions (protects against ulceration)

Question 36

What is the 5-year survival % of all stages of pancreatic cancer?

Answer 36

~ 7%