Clinical Research Of Surgical Management Of Adenocarcinoma Of Pancreas

Background:Pancreatic adenocarcinoma is recognized as one of the most lethal disease of all cancers with a five-year survival rate of 3 percent.The disease is usually diagnosed when it is too far advanced for surgical cure. At the time of diagosis, the tumor is confined to the pancreas in less than 10 percent of patients. Improvements in surgical technique, perioperative management, and adjuvant therapy have substantially reduced the postoperative morbidity and mortality rate of patients with this malignancy. The resection rate has increased from 15 to approximately 25 percent. The median survival for resection alone is between 18 and 20 months, with 15 to 25 percent of patients surviving for five years.Objectives:Further to realize the clinical features of pancreatic adenocarcinoma. To investigate the surgical therapeutic effects of pancreatic adenocarcinoma, and summarize the experiences in surgical management of pancreatic adenocarcinoma .By refering to concerning literatures, to investigate the methods to improve the surgical therapeutic effects of pancreatic adenocarcinoma .Methods:The data of 203 cases of pancreatic adenocarcinoma in our department from 1987 to 1999 were retrospectively analyzed. Follow-up was completed. The experience in surgical management of pancreatic adenocarcinoma was summarized and the therapeutic effects of the management were discussed by refering to concerning literatures.Results:1 Of the 203 cases of pancreatic adenocarcinoma, 69. 95%(l42cases) arose in the head, 20. 69%(42 cases) in the body and tail, and 9. 36%(19 cases) in the whole pancreas. Jaundice (58. 1%), upper abdominal pain (41. 3%), and upper abdominal discomfort (28. 1%) were the common clinical symptoms. By the time of diagnosis , the TNM classification of the 203 pancreatic adenocarcinoma was: stage I 6. 3%, stage II 15. 2%, stage HI 55. 1%, stage IV 23. 4%.2 Of the 142 cases of adenocarcinoma of pancreatic head, the resection rate was 16. 2%(23/142). The most common postoperative complication was pancreatic fistula(34.8%). Patients with surgical resection had a mean survival time of 13 months. Among these patients, the 1-,3- and 5-yr survival rates were 57. 1%, 23.8% and 0%. Patients without surgical resection had a mean survival time of 5. 7 months.3 Of the 42 patients with adenocarcinoma of pancreatic body and tail, 30 were subjected to an exploratory operation. Out of the 30 patients, 12 received resection of lesions (resection rate = 40%). Among these 12, 9 survived for 1 year, 2 for 3 years and If or 5 years after the resection. All those patients with non-resectable tumors had a mean survival time of 4. 4 months.Conclusions:1 Symptoms of pancreatic adenocarcinoma are often non-specific. It is difficult to diagnose the disease early, most disease are at stage II, III, even at stage IV.2 The only potential method to cure pancreatic adenocarcinoma is surgical resection. Until surgical technique and perioperative management are developed,clinicians can only achieve any improvement in the prognosis of this disease by doing the radical resection rationally.3 Classical Whipple's operation can not achieve the aim of radical cure of pancreatic adenocarcinoma.Only by doing the radical resection for pancreatic adenocarcinoma rationally, doing standardized radical lymphadenectomy and improving the skill for managing the portal vein and superior tnesenteric vein, can we increase the resection and long-term survival rate, reduce the postoperative morbidity and mortality rate of patients with pancreatic adenocarcinoma.