Abstract
Background: pancreatic cancer remains a major health problem, with conventional cancer treatments having little impact on disease course. Almost all patients who have pancreatic cancer develop metastases and die, the disease is difficult to diagnose in its early stages, and most patients have incurable disease by the time they present with symptoms. The overall 5-year survival rate for this disease is less than5%.
Aim: This study was designed to evaluate the different surgical methods and long-term oncologic and functional outcomes of potentially resectable pancreatic cancer.
Patients and methods: This study was a retrospective analysis of prospectively collected data. It used records from the Tampere University Hospital Registry-Finland, and linked them to treatment information from the General Surgery Department-Sohag University Hospital. Between October 2008 and October 2012, it included 50 patients with potentially operable pancreatic cancer. This paper was approved by the ethical committee of both Tampere University Hospital and Sohag University Hospital.
Results: Out of 50 patients who underwent surgery for pancreatic cancer there were 32 (64%) male and 18 (36%) female patients. The age ranged between 29 to 88 years with a mean age of 43.82 (+/- 15.43) and a median of 43.5 years. Operative time for the standard Whipple ranged between 190 and 300 minutes. The mean was 207 minutes (+/- 35) and the median was 199 minutes, and it is 180 minutes, range (185-220) in case of distal pancreatectomy. Intraoperative blood transfusion was ranged from no need to 6units with a mean of 1.5 units. Postoperative ICU stay ranged from 4-17 days and the mean was 9.057 days. Postoperative hospital stay ranged from 12-54 days and the mean was 22.92 days in case of Whipple and 10-49 with a mean was 18 in case of distal pancreatectomy. Of the 50 cases of our study that were diagnosed to be potentially operable preoperatively, 30(60%) cases only were discovered to be resectable at the time of laparotomy, of them 19/30 cases have cancer head of pancreas treated by pancreaticoduodenectomy, while 11/30 cases have either carcinoma of the body or tail, treated by distal pancreatectomy with or without splenectomy; one of them has multicentric tumor treated with total pancreatectomy. Instead of the large number of available investigatory tools preoperatively, 20/50 (40%) cases discovered intraoperatively to be irresectable and were treated either by double bypass, celiac plexus block and FNAC in 12/20of the cases, and in the other 8/20 cases treated by celiac plexus block and FNAC without bypass procedure as the patients had carcinoma of the body or tail.
Conclusions: The diagnosis and treatment of pancreatic cancer continue to improve although most patients will succumb to their disease. Novel methods of earlier detection and more effective systemic therapies are needed to significantly improve outcome.