Pancreatic cancer is the second most common gastrointestinal malignancy in the US. Risk factors include increasing age, male gender, African American race, smoking, obesity, and diabetes. The most common type is ductal adenocarcinoma, which accounts for 85-90% of cases. Overall survival is poor, with a 5-year rate of only 5%, due to most cases being diagnosed at an advanced stage when surgical resection is no longer an option.
This document discusses the evaluation and management of cystic tumors of the pancreas. It notes that the most common types are serous cystadenomas, mucinous cystic neoplasms, and intraductal papillary mucinous neoplasms. Initial imaging includes MRI with MRCP and EUS with FNA to characterize the cyst. Cyst fluid analysis is important to distinguish malignant potential. Small asymptomatic cysts may only need follow up imaging. Surveillance is recommended for certain non-surgical cases, monitoring for changes or malignant progression over multiple years.
This document provides information on the anatomy, histology, staging, and risk factors of gastric cancer. It discusses the divisions and layers of the stomach, innervation, blood supply, and lymphatic drainage. It describes the epidemiology of gastric cancer including higher rates in East Asia and associations with H. pylori infection and dietary factors. The document outlines the Borrmann, Lauren, and WHO histological classifications. It provides details on clinical presentation and diagnostic evaluation. Finally, it explains the AJCC and Japanese TNM staging systems including criteria for tumor (T), nodal (N), and metastatic (M) designations.
Clinically localized prostate cancer requires risk stratification and shared decision making between doctors and patients regarding treatment options. The document compares guidelines from ASCO and EAU on active surveillance, radical prostatectomy, radiotherapy, focal therapies, and whole gland cryosurgery. It notes side effects like erectile dysfunction and urinary incontinence vary depending on the treatment and should be discussed.
1. Management of colorectal liver metastases involves various treatment strategies depending on the extent of disease including primary-first, simultaneous resection, liver-first, and two-stage hepatectomy approaches.
2. The optimal strategy aims to achieve an R0 resection of all metastases while preserving sufficient future liver remnant volume.
3. Preoperative chemotherapy can help downstage initially unresectable disease in select patients, allowing for potentially curative surgery.
1. Neuroendocrine tumors (NETs) arise from neuroendocrine cells throughout the body and share features like secretory granules and hormone production. Pancreatic NETs (PNETs) comprise 1-2% of pancreatic tumors.
2. PNETs can be functional, producing symptoms from hormone hypersecretion, or nonfunctional. Major functional types are insulinomas, gastrinomas, VIPomas, and glucagonomas. Nonfunctional PNETs are usually larger and have worse prognosis than functional tumors.
3. Treatment involves surgical resection for localized disease. For advanced or metastatic disease, options include somatostatin analogs, hepatic artery embolization, targeted drugs, and
GB cancer is the 5th most common GIT malignancy(worldwide).200 years later it is still considered to be a highly malignant disease with a poor survival rate
.Here is a brief description regarding
This document summarizes the management of pancreatic carcinoma. It discusses the anatomy, epidemiology, risk factors, hereditary syndromes, pathophysiology including pre-cancerous lesions, types of pancreatic cancer, staging, prognostic factors, diagnostic techniques, treatment including surgery, chemotherapy, targeted therapy, radiotherapy and historical prospective studies. It provides a comprehensive overview of pancreatic carcinoma covering all relevant aspects of the disease.
Pancreatic cancer is the second most common gastrointestinal malignancy in the US. Risk factors include increasing age, male gender, African American race, smoking, obesity, and diabetes. The most common type is ductal adenocarcinoma, which accounts for 85-90% of cases. Overall survival is poor, with a 5-year rate of only 5%, due to most cases being diagnosed at an advanced stage when surgical resection is no longer an option.
This document discusses the evaluation and management of cystic tumors of the pancreas. It notes that the most common types are serous cystadenomas, mucinous cystic neoplasms, and intraductal papillary mucinous neoplasms. Initial imaging includes MRI with MRCP and EUS with FNA to characterize the cyst. Cyst fluid analysis is important to distinguish malignant potential. Small asymptomatic cysts may only need follow up imaging. Surveillance is recommended for certain non-surgical cases, monitoring for changes or malignant progression over multiple years.
This document provides information on the anatomy, histology, staging, and risk factors of gastric cancer. It discusses the divisions and layers of the stomach, innervation, blood supply, and lymphatic drainage. It describes the epidemiology of gastric cancer including higher rates in East Asia and associations with H. pylori infection and dietary factors. The document outlines the Borrmann, Lauren, and WHO histological classifications. It provides details on clinical presentation and diagnostic evaluation. Finally, it explains the AJCC and Japanese TNM staging systems including criteria for tumor (T), nodal (N), and metastatic (M) designations.
Clinically localized prostate cancer requires risk stratification and shared decision making between doctors and patients regarding treatment options. The document compares guidelines from ASCO and EAU on active surveillance, radical prostatectomy, radiotherapy, focal therapies, and whole gland cryosurgery. It notes side effects like erectile dysfunction and urinary incontinence vary depending on the treatment and should be discussed.
1. Management of colorectal liver metastases involves various treatment strategies depending on the extent of disease including primary-first, simultaneous resection, liver-first, and two-stage hepatectomy approaches.
2. The optimal strategy aims to achieve an R0 resection of all metastases while preserving sufficient future liver remnant volume.
3. Preoperative chemotherapy can help downstage initially unresectable disease in select patients, allowing for potentially curative surgery.
1. Neuroendocrine tumors (NETs) arise from neuroendocrine cells throughout the body and share features like secretory granules and hormone production. Pancreatic NETs (PNETs) comprise 1-2% of pancreatic tumors.
2. PNETs can be functional, producing symptoms from hormone hypersecretion, or nonfunctional. Major functional types are insulinomas, gastrinomas, VIPomas, and glucagonomas. Nonfunctional PNETs are usually larger and have worse prognosis than functional tumors.
3. Treatment involves surgical resection for localized disease. For advanced or metastatic disease, options include somatostatin analogs, hepatic artery embolization, targeted drugs, and
GB cancer is the 5th most common GIT malignancy(worldwide).200 years later it is still considered to be a highly malignant disease with a poor survival rate
.Here is a brief description regarding
This document summarizes the management of pancreatic carcinoma. It discusses the anatomy, epidemiology, risk factors, hereditary syndromes, pathophysiology including pre-cancerous lesions, types of pancreatic cancer, staging, prognostic factors, diagnostic techniques, treatment including surgery, chemotherapy, targeted therapy, radiotherapy and historical prospective studies. It provides a comprehensive overview of pancreatic carcinoma covering all relevant aspects of the disease.
Cystic neoplasms of the pancreas are relatively rare tumors that can be divided into four main types: serous cystic neoplasms (SCN), mucinous cystic neoplasms (MCN), intraductal papillary mucinous neoplasms (IPMN), and solid pseudopapillary neoplasms. SCNs are usually benign and surgical resection is only recommended for large or symptomatic cysts. MCNs and IPMNs have greater malignant potential and surgical resection is generally recommended due to the risk of cancer. IPMNs are further classified as main duct, branch duct, or mixed and location and histological subtype influence malignant risk and management. Surveillance with MRI is recommended post
This document discusses the surgical management of upper urinary tract urothelial cell carcinomas. It covers radical nephroureterectomy as the gold standard treatment and explores laparoscopic versus open approaches. For localized low-grade tumors, conservative kidney-sparing options are discussed, including endoscopic tumor ablation using ureteroscopy or percutaneous access. Follow-up includes potential adjuvant instillation of bacillus Calmette-Guérin or mitomycin C into the renal collecting system.
This document summarizes information about appendiceal adenocarcinoma. It discusses how the majority of patients present with acute appendicitis and describes the intestinal and mucinous tumor types. It also covers tumor classification, including mucinous tumors of uncertain malignant potential. Prognosis depends on factors like histologic type, T stage, and tumor grade. Treatment recommendations include simple appendectomy for early stage disease and hemicolectomy for more advanced tumors. Adjuvant chemotherapy and intraperitoneal hyperthermic chemotherapy are discussed as additional treatment options. Cytoreductive surgery can help palliate patients with peritoneal carcinomatosis.
This document provides an overview of gall bladder carcinoma. It discusses the epidemiology, etiology, pathology, histology, presentation, workup, treatment and follow up of gall bladder cancer. Gall bladder cancer is relatively uncommon but the 5th most common gastrointestinal malignancy worldwide. Chronic inflammation from gallstones is the main risk factor. Imaging studies like ultrasound, CT and MRI are used to diagnose and stage the cancer. Surgery is the main treatment but the outcome is often poor due to late diagnosis and aggressive nature of the disease.
This document provides an outline and overview of gallbladder carcinoma. It discusses the epidemiology, risk factors, presentation, workup, treatment and follow up of gallbladder cancer. Key points include: gallbladder cancer is the most common biliary tract malignancy and 20th most common cancer worldwide. The highest incidence is found in Chilean and Indian women. Risk factors include gallstones, salmonella infection, obesity and genetic predisposition. Presentation is often asymptomatic but can include jaundice, weight loss and palpable mass. Workup involves imaging like ultrasound, CT and MRI to determine extent of disease. Surgical resection along with lymph node dissection is the main treatment but prognosis remains poor with 5-year survival of only
Cystic Neoplasms of the Pancreas
https://drdhavalmangukiya.com/
http://www.youtube.com/c/DrDhavalMangukiyaGastrosurgeonSurat
https://gastrosurgerysurat.blogspot.com/
This document discusses tumors of the appendix. It outlines different types of appendix tumors including mucocele, primary adenocarcinoma, cystadenocarcinoma, and carcinoid tumors. Mucocele occurs when the appendix lumen becomes blocked, causing a fluid-filled cyst. Ruptured mucocele or adenocarcinoma can lead to pseudomyxoma peritonei, where mucus accumulates in the abdominal cavity. Carcinoid tumors are the most common appendix tumors but are generally not aggressive. Management depends on tumor type but often involves surgical removal of the appendix or part of the colon.
This document discusses chemotherapy trials and regimens for colon cancer. It summarizes several landmark trials that established the benefit of 5-FU-based adjuvant chemotherapy for stage III colon cancer. The MOSAIC, NSABP C-07 and NO16968 trials showed that adding oxaliplatin to 5-FU improves disease-free survival for stage III disease. For stage II, the benefit of oxaliplatin is unclear. The document also discusses staging, risk factors, treatment guidelines, neoadjuvant therapy and radiation therapy options for colon cancer.
This Presentation gives summarized overview of Gall Bladder Carcinoma especially the management as per latest National Comprehensive Cancer Network(NCCN) Guidelines version 2.2013
Rectal cancer is the third most common cancer and represents a significant health burden. It typically presents with bleeding and changes in bowel habits. Staging involves endoscopy, imaging and biopsy. Treatment options include surgery such as anterior resection or abdomino-perineal resection, with or without chemotherapy and radiation. Prognosis depends on stage, with 5-year survival rates ranging from over 90% for stage I to under 10% for stage IV disease. Close follow-up is needed to monitor for recurrence or new cancers.
This document discusses the management of gallbladder cancer. It covers diagnosis, staging, and surgical treatment approaches based on tumor stage. For early stage T1a tumors found incidentally after cholecystectomy, simple cholecystectomy may be adequate. For T1b and T2 tumors, radical resection including lymph node dissection is recommended due to higher risk of residual disease and lymph node involvement. For locally advanced T3/T4 or node positive cancers, radical surgery with hepatic resection or multi-organ resection is supported, though morbidity and mortality are high; N2 node involvement carries a poor prognosis. Staging laparoscopy is important to identify unresectable disease not apparent on imaging.
This document discusses metastatic colorectal liver cancer. It outlines risk factors, evaluation, and treatment options including surgery, chemotherapy, local tumor ablation, and radiotherapy. Surgery offers the best chance of survival if metastases are resectable, with 5-year survival rates of 24-58% for resection. Neoadjuvant chemotherapy can help make previously unresectable tumors operable. Local ablation techniques are alternatives for tumors that cannot be surgically removed.
This document provides information on pancreatic adenocarcinoma, including its anatomy, physiology, clinical presentation, investigations, staging, treatment and prognosis. It discusses the exocrine and endocrine functions of the pancreas. It also covers cystic lesions of the pancreas and pancreatic endocrine tumours. The staging and survival rates for pancreatic cancer are presented. Complications of pancreatic surgery and mortality rates at high volume centers are summarized.
1) Chemotherapy alone is the preferred adjuvant treatment after surgical resection of pancreatic cancer based on multiple trials showing a survival benefit. 2) Some trials showed improved survival with the addition of chemoradiotherapy to chemotherapy compared to chemotherapy alone, though the benefit is unclear. 3) Optimal chemotherapy regimens may include gemcitabine, gemcitabine plus capecitabine, FOLFIRINOX, or gemcitabine plus nab-paclitaxel based on various trial results.
Preoperative chemoradiotherapy is commonly used to treat rectal cancer. It can reduce the tumor size and increase the likelihood of sphincter-sparing surgery. Studies have shown that preoperative chemoradiotherapy results in lower local recurrence rates compared to postoperative chemoradiotherapy or radiotherapy alone, without increasing distant metastases or mortality. Short-course radiotherapy followed by surgery within a week is also effective at reducing local recurrence compared to surgery alone, especially when combined with total mesorectal excision.
Rectal carcinoma is the third leading cause of cancer death in the US. Risk factors include family history, inflammatory bowel disease, diet high in red meat and fat, and smoking. Staging follows the AJCC TNM system. Diagnosis involves history, physical exam, endoscopy, imaging like CT, MRI, PET. Treatment depends on stage but commonly includes surgery like low anterior resection or abdomino-perineal resection, with or without neoadjuvant chemoradiation, to completely remove the tumor while preserving sphincter function if possible. Ongoing surveillance after treatment monitors for recurrence or new cancers.
Lecture on colorectal carcinoma for medical students. Encompasses basic sciences, classifications, staging and principles of management. The author holds a special interest in this topic.
Colorectal carcinoma anatomy to managementDrAyush Garg
This document provides an overview of colorectal carcinoma, including its anatomy, epidemiology, risk factors, clinical features, screening, pathology, staging, and diagnostic workup. It begins with a description of the embryological development of the colon and rectum. It then discusses the risk factors for colorectal cancer, pre-invasive lesions, clinical presentation, screening guidelines, the adenoma-carcinoma sequence of tumor progression, staging system, and tests used to diagnose and stage colorectal cancer. The goal is to comprehensively cover colorectal carcinoma from anatomy to management.
1. Carcinoma of the gallbladder is often diagnosed at late stages due to nonspecific symptoms and difficulty distinguishing it from chronic cholecystitis.
2. Risk factors include gallstones, age, female sex, and conditions causing chronic inflammation like anomalous pancreaticobiliary duct junction.
3. Staging is based on tumor invasion depth and lymph node involvement, with surgery being potentially curative for early stages.
4. Advanced or metastatic disease requires palliative approaches to relieve symptoms from biliary or bowel obstruction.
The document discusses pancreatic neuroendocrine tumors. It covers types like insulinomas, gastrinomas, vipomas, glucagonomas, and somatostatinomas. For each type it discusses incidence, location, clinical features, diagnostic tests, management options like surgery or medication, and prognosis. It also covers non-functional pancreatic neuroendocrine tumors and tumors associated with MEN1 syndrome. Surgical resection is the primary treatment when possible but some types are often metastatic at diagnosis.
Pancreatic cancer has a poor prognosis, with only 15-20% of patients eligible for potentially curative surgery. Recent data shows survival may be improving, especially for those who receive adjuvant chemoradiation therapy after surgery. Diagnosis involves imaging like CT scans and endoscopic ultrasound to stage the cancer and determine if it can be surgically removed. Endoscopic ultrasound is particularly useful for assessing local tumor spread and blood vessel involvement. A tissue biopsy may also be taken during endoscopic ultrasound to identify the type of cancer.
Cystic neoplasms of the pancreas are relatively rare tumors that can be divided into four main types: serous cystic neoplasms (SCN), mucinous cystic neoplasms (MCN), intraductal papillary mucinous neoplasms (IPMN), and solid pseudopapillary neoplasms. SCNs are usually benign and surgical resection is only recommended for large or symptomatic cysts. MCNs and IPMNs have greater malignant potential and surgical resection is generally recommended due to the risk of cancer. IPMNs are further classified as main duct, branch duct, or mixed and location and histological subtype influence malignant risk and management. Surveillance with MRI is recommended post
This document discusses the surgical management of upper urinary tract urothelial cell carcinomas. It covers radical nephroureterectomy as the gold standard treatment and explores laparoscopic versus open approaches. For localized low-grade tumors, conservative kidney-sparing options are discussed, including endoscopic tumor ablation using ureteroscopy or percutaneous access. Follow-up includes potential adjuvant instillation of bacillus Calmette-Guérin or mitomycin C into the renal collecting system.
This document summarizes information about appendiceal adenocarcinoma. It discusses how the majority of patients present with acute appendicitis and describes the intestinal and mucinous tumor types. It also covers tumor classification, including mucinous tumors of uncertain malignant potential. Prognosis depends on factors like histologic type, T stage, and tumor grade. Treatment recommendations include simple appendectomy for early stage disease and hemicolectomy for more advanced tumors. Adjuvant chemotherapy and intraperitoneal hyperthermic chemotherapy are discussed as additional treatment options. Cytoreductive surgery can help palliate patients with peritoneal carcinomatosis.
This document provides an overview of gall bladder carcinoma. It discusses the epidemiology, etiology, pathology, histology, presentation, workup, treatment and follow up of gall bladder cancer. Gall bladder cancer is relatively uncommon but the 5th most common gastrointestinal malignancy worldwide. Chronic inflammation from gallstones is the main risk factor. Imaging studies like ultrasound, CT and MRI are used to diagnose and stage the cancer. Surgery is the main treatment but the outcome is often poor due to late diagnosis and aggressive nature of the disease.
This document provides an outline and overview of gallbladder carcinoma. It discusses the epidemiology, risk factors, presentation, workup, treatment and follow up of gallbladder cancer. Key points include: gallbladder cancer is the most common biliary tract malignancy and 20th most common cancer worldwide. The highest incidence is found in Chilean and Indian women. Risk factors include gallstones, salmonella infection, obesity and genetic predisposition. Presentation is often asymptomatic but can include jaundice, weight loss and palpable mass. Workup involves imaging like ultrasound, CT and MRI to determine extent of disease. Surgical resection along with lymph node dissection is the main treatment but prognosis remains poor with 5-year survival of only
Cystic Neoplasms of the Pancreas
https://drdhavalmangukiya.com/
http://www.youtube.com/c/DrDhavalMangukiyaGastrosurgeonSurat
https://gastrosurgerysurat.blogspot.com/
This document discusses tumors of the appendix. It outlines different types of appendix tumors including mucocele, primary adenocarcinoma, cystadenocarcinoma, and carcinoid tumors. Mucocele occurs when the appendix lumen becomes blocked, causing a fluid-filled cyst. Ruptured mucocele or adenocarcinoma can lead to pseudomyxoma peritonei, where mucus accumulates in the abdominal cavity. Carcinoid tumors are the most common appendix tumors but are generally not aggressive. Management depends on tumor type but often involves surgical removal of the appendix or part of the colon.
This document discusses chemotherapy trials and regimens for colon cancer. It summarizes several landmark trials that established the benefit of 5-FU-based adjuvant chemotherapy for stage III colon cancer. The MOSAIC, NSABP C-07 and NO16968 trials showed that adding oxaliplatin to 5-FU improves disease-free survival for stage III disease. For stage II, the benefit of oxaliplatin is unclear. The document also discusses staging, risk factors, treatment guidelines, neoadjuvant therapy and radiation therapy options for colon cancer.
This Presentation gives summarized overview of Gall Bladder Carcinoma especially the management as per latest National Comprehensive Cancer Network(NCCN) Guidelines version 2.2013
Rectal cancer is the third most common cancer and represents a significant health burden. It typically presents with bleeding and changes in bowel habits. Staging involves endoscopy, imaging and biopsy. Treatment options include surgery such as anterior resection or abdomino-perineal resection, with or without chemotherapy and radiation. Prognosis depends on stage, with 5-year survival rates ranging from over 90% for stage I to under 10% for stage IV disease. Close follow-up is needed to monitor for recurrence or new cancers.
This document discusses the management of gallbladder cancer. It covers diagnosis, staging, and surgical treatment approaches based on tumor stage. For early stage T1a tumors found incidentally after cholecystectomy, simple cholecystectomy may be adequate. For T1b and T2 tumors, radical resection including lymph node dissection is recommended due to higher risk of residual disease and lymph node involvement. For locally advanced T3/T4 or node positive cancers, radical surgery with hepatic resection or multi-organ resection is supported, though morbidity and mortality are high; N2 node involvement carries a poor prognosis. Staging laparoscopy is important to identify unresectable disease not apparent on imaging.
This document discusses metastatic colorectal liver cancer. It outlines risk factors, evaluation, and treatment options including surgery, chemotherapy, local tumor ablation, and radiotherapy. Surgery offers the best chance of survival if metastases are resectable, with 5-year survival rates of 24-58% for resection. Neoadjuvant chemotherapy can help make previously unresectable tumors operable. Local ablation techniques are alternatives for tumors that cannot be surgically removed.
This document provides information on pancreatic adenocarcinoma, including its anatomy, physiology, clinical presentation, investigations, staging, treatment and prognosis. It discusses the exocrine and endocrine functions of the pancreas. It also covers cystic lesions of the pancreas and pancreatic endocrine tumours. The staging and survival rates for pancreatic cancer are presented. Complications of pancreatic surgery and mortality rates at high volume centers are summarized.
1) Chemotherapy alone is the preferred adjuvant treatment after surgical resection of pancreatic cancer based on multiple trials showing a survival benefit. 2) Some trials showed improved survival with the addition of chemoradiotherapy to chemotherapy compared to chemotherapy alone, though the benefit is unclear. 3) Optimal chemotherapy regimens may include gemcitabine, gemcitabine plus capecitabine, FOLFIRINOX, or gemcitabine plus nab-paclitaxel based on various trial results.
Preoperative chemoradiotherapy is commonly used to treat rectal cancer. It can reduce the tumor size and increase the likelihood of sphincter-sparing surgery. Studies have shown that preoperative chemoradiotherapy results in lower local recurrence rates compared to postoperative chemoradiotherapy or radiotherapy alone, without increasing distant metastases or mortality. Short-course radiotherapy followed by surgery within a week is also effective at reducing local recurrence compared to surgery alone, especially when combined with total mesorectal excision.
Rectal carcinoma is the third leading cause of cancer death in the US. Risk factors include family history, inflammatory bowel disease, diet high in red meat and fat, and smoking. Staging follows the AJCC TNM system. Diagnosis involves history, physical exam, endoscopy, imaging like CT, MRI, PET. Treatment depends on stage but commonly includes surgery like low anterior resection or abdomino-perineal resection, with or without neoadjuvant chemoradiation, to completely remove the tumor while preserving sphincter function if possible. Ongoing surveillance after treatment monitors for recurrence or new cancers.
Lecture on colorectal carcinoma for medical students. Encompasses basic sciences, classifications, staging and principles of management. The author holds a special interest in this topic.
Colorectal carcinoma anatomy to managementDrAyush Garg
This document provides an overview of colorectal carcinoma, including its anatomy, epidemiology, risk factors, clinical features, screening, pathology, staging, and diagnostic workup. It begins with a description of the embryological development of the colon and rectum. It then discusses the risk factors for colorectal cancer, pre-invasive lesions, clinical presentation, screening guidelines, the adenoma-carcinoma sequence of tumor progression, staging system, and tests used to diagnose and stage colorectal cancer. The goal is to comprehensively cover colorectal carcinoma from anatomy to management.
1. Carcinoma of the gallbladder is often diagnosed at late stages due to nonspecific symptoms and difficulty distinguishing it from chronic cholecystitis.
2. Risk factors include gallstones, age, female sex, and conditions causing chronic inflammation like anomalous pancreaticobiliary duct junction.
3. Staging is based on tumor invasion depth and lymph node involvement, with surgery being potentially curative for early stages.
4. Advanced or metastatic disease requires palliative approaches to relieve symptoms from biliary or bowel obstruction.
The document discusses pancreatic neuroendocrine tumors. It covers types like insulinomas, gastrinomas, vipomas, glucagonomas, and somatostatinomas. For each type it discusses incidence, location, clinical features, diagnostic tests, management options like surgery or medication, and prognosis. It also covers non-functional pancreatic neuroendocrine tumors and tumors associated with MEN1 syndrome. Surgical resection is the primary treatment when possible but some types are often metastatic at diagnosis.
Pancreatic cancer has a poor prognosis, with only 15-20% of patients eligible for potentially curative surgery. Recent data shows survival may be improving, especially for those who receive adjuvant chemoradiation therapy after surgery. Diagnosis involves imaging like CT scans and endoscopic ultrasound to stage the cancer and determine if it can be surgically removed. Endoscopic ultrasound is particularly useful for assessing local tumor spread and blood vessel involvement. A tissue biopsy may also be taken during endoscopic ultrasound to identify the type of cancer.
What would you recommend as first line therapy for a 68 y/o woman with local pancreatic cancer and no metastatic disease with ECOG-1?
Chemoradiation: Rachna Shroff, MD
Surgical Resection: Yongyut Sirivatanauksorn, MD
This document summarizes new advances in laparoscopic resection for liver tumors. It discusses the historical challenges of open liver surgery and improved outcomes with laparoscopic techniques. Specific cases are presented of laparoscopic resection for benign cysts and tumors as well as malignant hepatocellular carcinoma and colorectal cancer metastases. The theoretical advantages and solutions for challenges of the laparoscopic approach are reviewed.
Venous thromboembolism (VTE) may be the earliest sign of cancer.
Currently, there is a great diversity in practices regarding screening for occult cancer in a person who has an unprovoked VTE .
We sought to assess the efficacy of a screening strategy for occult cancer that included comprehensive computed tomography(CT) of the abdomen and pelvis in patients who had a first unprovoked VTE .
The document discusses carcinoma of the pancreas. It covers the anatomy, epidemiology, risk factors, genetics, screening, staging, pathologic conditions, clinical presentation, evaluation, management approaches for resectable, borderline resectable, and unresectable disease, surgical procedures including Whipple procedure and distal pancreatectomy, complications, adjuvant therapy approaches studied in trials such as ESPAC-1, and the role of chemoradiation following gemcitabine chemotherapy.
The document discusses several topics related to colorectal cancer including hereditary forms, staging, treatment with surgery and targeted therapies. It presents two case studies, one with a family history of colon cancer who was found to have a genetic mutation, and another with a locally advanced rectal tumor treated with preoperative chemoradiation followed by surgery.
Ovarian cancer is a leading cause of death from gynecologic cancers. Chemotherapy plays an important role in its treatment. For advanced stage disease, the standard treatment is 6 cycles of carboplatin and paclitaxel chemotherapy. Neoadjuvant chemotherapy may be given for very advanced cases to allow for optimal debulking surgery. Prognostic factors like residual tumor size after surgery and tumor stage help determine prognosis and treatment. Maintenance chemotherapy may improve progression-free survival for high risk early stage disease.
This document provides information on Wilms tumor (nephroblastoma), the most common malignant renal tumor of childhood. It discusses the epidemiology, genetics, clinical features, staging, histology, management including surgery, chemotherapy and radiation therapy. Key points include that Wilms tumor arises from nephrogenic rests, affects children aged 3-4 years, and is highly curable with multimodality treatment depending on stage, histology and other risk factors. Radiation therapy is an important component of treatment for local and metastatic disease. Ongoing clinical trials continue to refine risk-adapted therapies to improve survival while reducing long-term effects.
This document provides information on the management of carcinoma of the stomach. It discusses the anatomy, epidemiology, risk factors, pathology, diagnostic workup including imaging and staging, prognostic factors, and treatment options including surgery, chemotherapy, and radiation therapy. The treatment strategies have evolved over time with various clinical trials investigating neoadjuvant and adjuvant approaches.
1) Advances in the management of pancreatic cancers including improved preoperative assessment using CT, MRI, EUS and PET scans to determine resectability.
2) Surgical approaches to resectable pancreatic cancer including pylorus-preserving versus standard Whipple procedure and debates around extent of lymphadenectomy.
3) Outcomes have modestly improved with resection rates around 20%, operative mortality of 9% and 5 year survival of 12%, though pancreatic cancer prognosis remains poor.
This document discusses surgical approaches for esophageal cancer. It covers:
- Esophageal anatomy, blood supply, lymph drainage
- Staging of esophageal cancer and criteria for resection
- Preoperative evaluation including imaging, biopsy, and laparoscopy
- Surgical procedures for cervical, thoracic, and esophagogastric junction cancers including transhiatal esophagectomy, Ivor-Lewis procedure, and tri-incisional esophagectomy
- Oncologic principles for lymphadenectomy and margins during resection
Esophagectomy : APPROACHES, CONTROVERSIES AND CURRENT EVIDENCEDr Amit Dangi
This document discusses esophagectomy, the surgical approaches for esophageal cancer resection. It covers the relevant anatomy, blood supply, lymph drainage, and histology of esophageal cancer. It then discusses pre-treatment evaluation including staging assessments and criteria for resection. The key surgical procedures for cervical, thoracic, and esophagogastric junction cancers are described including the transhiatal, Ivor-Lewis, and tri-incisional approaches. Post-operative outcomes from recent studies comparing these approaches are summarized.
Beat the Odds: New Treatments for Pancreatic Cancer - 12.6.18Summit Health
Presenter(s): Zubin M. Bamboat, MD, FACS, Surgical Oncologist; David Gallinson, DO, Oncologist
Pancreatic cancer is often a silent killer. While surgery provides the only chance for a cure, many patients are inoperable by the time they develop symptoms. Join us to learn all about pancreatic cancer, including risk factors and symptoms. Our experts will discuss how they are combating this deadly disease by using the latest in adjuvant and neoadjuvant therapies, surgery and novel medical treatments.
This document discusses malignant obstructive jaundice, focusing on cancers of the gallbladder and bile duct. It provides details on the etiology, risk factors, staging, clinical presentation, diagnosis, and management of gallbladder cancer. Key points include that gallbladder cancer occurs more commonly in elderly women and is often diagnosed late, when many tumors are unresectable. Surgical resection aims to achieve R0 margins and may involve extended cholecystectomy or liver resection. Prognosis depends on pathological stage, with stage T1a having an excellent prognosis following cholecystectomy alone.
Gastric carcinoma is the fourth most common cancer worldwide and the second leading cause of cancer death globally. It has a poor prognosis except in areas that conduct early screening. Approximately 95% are adenocarcinomas. Risk factors include H. pylori infection, smoking, genetic factors, and precancerous lesions. Staging involves endoscopy, CT, PET, and laparoscopy. Surgery with curative intent plus perioperative chemotherapy may cure early stage tumors. Advanced or metastatic disease is treated with palliative chemotherapy, radiation or surgery.
This document discusses the role of chemotherapy in gynecological malignancies, specifically ovarian cancer. It notes that ovarian cancer is a leading cause of death from gynecologic cancer and chemotherapy has improved 5-year survival rates. For advanced stage ovarian cancer, the standard treatment is primary cytoreductive surgery followed by platinum-based chemotherapy. Optimal debulking to less than 1cm residual disease results in better outcomes. For unresectable tumors, neoadjuvant chemotherapy may be given followed by interval debulking surgery. The combination of carboplatin and paclitaxel is currently the standard first-line chemotherapy regimen.
1. The document discusses carcinoma of the head of the pancreas, including its epidemiology, risk factors, pathology, clinical features, imaging, staging, and surgical management via the Whipple procedure.
2. It provides details of the Whipple procedure, including exposing and dissecting key structures like the superior mesenteric vein, Kocher maneuver, dividing vessels like the gastroduodenal artery, and transecting the stomach and jejunum.
3. The Whipple procedure involves a pancreaticoduodenectomy to resect the pancreatic head tumors while preserving stomach, duodenum, common bile duct, and pancreas.
Pancreatic Biliary Cancer by Dr Mahipal reddyguest407122
The document discusses pathology, risk factors, clinical presentation, diagnosis, staging, and treatment options for pancreatic cancer and cholangiocarcinoma. For pancreatic cancer, the most common type is infiltrating ductal adenocarcinoma. Risk factors include age, smoking, diabetes, and diet. Symptoms include abdominal pain and weight loss. Diagnosis involves imaging like CT/MRI and biopsy. Treatment involves surgical resection if possible or chemotherapy with gemcitabine if unresectable. For cholangiocarcinoma, risk factors include inflammation and parasites. Symptoms are usually painless jaundice. Diagnosis involves imaging and ERCP. Surgery is the main treatment if resectable but prognosis is unclear
Similar to Diagnosis and treatment of pancreatic cancer (20)
Indocyanine green (ICG) in liver surgery.pptxGian Luca Grazi
The use of indocyanine green has now become common practice during liver and biliary tract surgery. This dye helps in defining the anatomy of the liver segments and is able to provide data on the course of the biliary tract. Furthermore, it can detect the presence of small superficial tumors, increasing the cure potential of liver resections in the treatment of liver tumors.
This reading reviews the main uses of indocyanine green in liver surgery, in particular for laparoscopic and robotic surgery, and opens a window on the future clinical developments of indocyanine green in the treatment of liver tumors.
Parenchyma-sparing surgery in the resective treatment of liver metastases, particularly for those originating from colon and rectal tumors, is an approach that has gained great appreciation in recent years. Parenchyma sparing must not be understood only as the sole execution of operations limited to the removal of metastases, but as a real operating strategy aimed at more conservative interventions, which preserve the vascular and iliar structure of the liver itself. For example, the resection of two contiguous segments, despite being an anatomical surgery, can and must still be considered as a liver parenchyma-sparing surgery compared to a major hepatectomy. This presentation retraces the history of liver resections performed for liver metastases and revisits the evolution of surgery that has led to parenchyma-sparing liver surgery being defined as the golden standard.
Liver resections after iatrogenic vasculobiliary lesions or for post traumati...Gian Luca Grazi
Liver trauma is still a condition burdened by significant mortality and high morbidity. Although today the treatment of patients who have suffered liver trauma is essentially conservative, there is still a certain number of patients who require liver resection surgery. The indication in these cases may be due either to the presence of a major lesion of the vascular or biliary pedicles, or to the onset of major phenomena of necrosis of the liver parenchyma (MHN). In this presentation the main aspects of the surgical treatment of these patients are taken into consideration and the indications for performing a hepatectomy are critically revisited.
Cholangiocarcinoma Risk stratification - Prognostic factors related to the pa...Gian Luca Grazi
The prognosis of patients with cholangiocarcinoma generally remains very low. However, patients who manage to have an indication to perform liver resection surgery can hope for a certain increase in survival. In this context, one of the most important problems is the definition of prognostic factors for survival after hepatectomy, in order to avoid useless if not harmful interventions. This presentation revisits the main prognosis systems published in the scientific literature regarding cholangiocarcinoma and performs a critical evaluation of them.
Pancreatic surgery has now established as the only potentially curative therapy for pancreatic adenocarcinoma. However, 3-year survival after radical oncological surgery remains limited to 30-40% and between 20 and 30% after 5 years. To date, there are no aids that have substantially improved these results. This presentation addresses the most debated topics on the subject. The first is related to the pre-operative management of patients. There are now definite scientific evidences that show how the placement of biliary drainages inevitably lead to an increase in post-operative infectious complications. For this reason, if possible, it is now preferable to perform pancreatic resections even in the presence of jaundice. The second argument concerns the role of neo-adjuvant therapy. There is growing data indicating an improvement in results in patients who have performed this therapy, even if the number of patients who do not then undergo surgery remains substantial. Finally, the presentation talks about the centralization of pancreatic surgery, with a marked improvement in the results for patients who are operated on in high-volume centres.
Minimally invasive liver surgery now allows almost all liver resection operations to be performed safely. The advent of robotic surgery has allowed further development of these surgeries. In this field, any artifice that can further benefit the surgeon in performing these particular hepatic resections is certainly desired. Indocyanine green has shown to be extremely useful in verifying the anatomy of the liver and biliary tract, in the discovery of small tumor nodules located in the more peripheral areas of the liver and in the intraoperative definition of liver segmentation.
Liver failure after major hepatic resection.pptxGian Luca Grazi
Liver failure after hepatic resection has a multifactorial origin. However, the volume of the removed liver, technical problems during the procedure and the development of infections in the post-operative period certainly play a primary role.
The surgeon plays an important role in implementing all those surgical and radiological procedures to prevent the onset of this severe complication.
However, the treatment of liver failure that occurs after a hepatectomy requires multidisciplinary management, including intensive care physicians, neurologists, nephrologists, and others.
In order not to incur in the failure to recognize the complication and to avoid not implementing all the therapeutic measures necessary for the treatment of post-resection liver failure, it is essential that the hospital where the operation is performed is equipped with all professionalism and all the necessary technological tools.
These are the characteristics needed to define where liver surgery can be performed safely.
Hepatobiliary surgery - role in liver diseases.pptxGian Luca Grazi
Over the past 40 years, liver surgery has become an independent branch of general surgery and abdominal surgery. Liver resections are now well-coded procedures that require sophisticated planning. There are many diseases that can be treated with surgery in the context of liver diseases. This presentation reviews the indications for surgery in the field of primary liver tumors (mainly hepatocellular carcinoma), in the field of benign hepatic tumors, in the field of acute and chronic biliary diseases.
Performing vascular resections during a liver resection is a complex procedure, that is often carried out for advanced tumor diseases. Certainly, the removal of a tumor recurrence or a residual disease that has infiltrated one of the liver vessels (hepatic artery, portal vein, hepatic vein or inferior vena cava) can allow the patient to enjoy a further period of well-being, independently to the possibility of being able to perform adjuvant chemotherapy. However, in most cases, performing a vascular resection involves an increased risk of mortality and morbidity. Furthermore, the results in terms of long-term survival are often discouraging.
Minimally invasive liver surgery has recently acquired the surgical robot among the available weapons. In particular, the “Da Vinci” Robot currently represents the operative standard. Liver resections are now increasingly performed robotically. The increased experience has made these robotic procedures ever simpler and safer to perform. In this presentation, we review the basic steps for dealing with a robotic liver resection. The tools available to perform a robotic hepatectomy also occur. However, at the present time, the robotic surgical instruments completely studied and realized for their application on the liver are very few.
Treatment of metachronous liver metastases from colorectal cancer sees surgery as the primary therapy. However, in recent years, several factors have emerged that have led to considering liver resection as an increasingly personalized practice. Liver resections are now placed within the "precision surgery". Even if in the presence of different guidelines published in the scientific literature, very often the attitude of the various hepatobiliary surgery centers, and even of the individual surgeons, is not homogeneous and different (sometimes very different) are the attitudes that direct towards the 'one or the other surgery.
Conversion from laparoscopy to open technique during laparoscopic liver resections. Which are the causes and how it might be possible to avoid them. Presented at the Palermo meeting of the Italian register "I Go Mils" on liver resections carried out by a mini-invasive approach (both laparoscopic and robotic)
Minimally invasive pancreatic surgery has led to the identification of new technical challenges.
An important aspect is to verify the possibility of performing vascular resections during pancreatic resection procedures for cancer.
Chemotherapy for liver metastases from colorectal cancer now makes it possible to reduce their size. Sometimes these metastases can even disappear. This does not mean that the metastases are cured and surgical removal is always advisable. The main problem is how to identify these "vanishing" metastases during liver resection and how to perform truly effective interventions from an oncological point of view.
Difficulty scores for laparoscopic liver resectionsGian Luca Grazi
A critical analysis of the scores proposed to define the difficulty of performing laparoscopic liver resections. Four scores are too many. The information they offer differs in content.
State of the art of robotic surgery in the liverGian Luca Grazi
1) Robotic liver surgery offers some technical advantages over laparoscopic liver surgery such as improved ergonomics and dexterity due to wristed instruments and 3D visualization, but is more costly.
2) Meta-analyses have found robotic liver resection has longer operating times but less blood loss compared to open surgery, and similar short-term outcomes as laparoscopic liver resection.
3) While not conclusively proven, robotic surgery may be particularly useful for complex resections such as those in the posterosuperior segments of the liver compared to the laparoscopic approach.
Surgical treatment of colo rectal liver metastasesGian Luca Grazi
The document discusses guidelines for resection of liver metastases from colorectal cancer. It states that the aim of liver resection is to remove all visible cancer while leaving enough healthy liver tissue. Patients with solitary, multiple, or scattered tumors may be candidates for resection if the primary colorectal cancer has been treated. The surgeon should ensure clear margins and leave a minimum of one third of the standard liver volume to minimize risk of liver failure. Overall survival rates are improved with resection compared to chemotherapy alone.
Recomendações da OMS sobre cuidados maternos e neonatais para uma experiência pós-natal positiva.
Em consonância com os ODS – Objetivos do Desenvolvimento Sustentável e a Estratégia Global para a Saúde das Mulheres, Crianças e Adolescentes, e aplicando uma abordagem baseada nos direitos humanos, os esforços de cuidados pós-natais devem expandir-se para além da cobertura e da simples sobrevivência, de modo a incluir cuidados de qualidade.
Estas diretrizes visam melhorar a qualidade dos cuidados pós-natais essenciais e de rotina prestados às mulheres e aos recém-nascidos, com o objetivo final de melhorar a saúde e o bem-estar materno e neonatal.
Uma “experiência pós-natal positiva” é um resultado importante para todas as mulheres que dão à luz e para os seus recém-nascidos, estabelecendo as bases para a melhoria da saúde e do bem-estar a curto e longo prazo. Uma experiência pós-natal positiva é definida como aquela em que as mulheres, pessoas que gestam, os recém-nascidos, os casais, os pais, os cuidadores e as famílias recebem informação consistente, garantia e apoio de profissionais de saúde motivados; e onde um sistema de saúde flexível e com recursos reconheça as necessidades das mulheres e dos bebês e respeite o seu contexto cultural.
Estas diretrizes consolidadas apresentam algumas recomendações novas e já bem fundamentadas sobre cuidados pós-natais de rotina para mulheres e neonatos que recebem cuidados no pós-parto em unidades de saúde ou na comunidade, independentemente dos recursos disponíveis.
É fornecido um conjunto abrangente de recomendações para cuidados durante o período puerperal, com ênfase nos cuidados essenciais que todas as mulheres e recém-nascidos devem receber, e com a devida atenção à qualidade dos cuidados; isto é, a entrega e a experiência do cuidado recebido. Estas diretrizes atualizam e ampliam as recomendações da OMS de 2014 sobre cuidados pós-natais da mãe e do recém-nascido e complementam as atuais diretrizes da OMS sobre a gestão de complicações pós-natais.
O estabelecimento da amamentação e o manejo das principais intercorrências é contemplada.
Recomendamos muito.
Vamos discutir essas recomendações no nosso curso de pós-graduação em Aleitamento no Instituto Ciclos.
Esta publicação só está disponível em inglês até o momento.
Prof. Marcus Renato de Carvalho
www.agostodourado.com
Basavarajeeyam is a Sreshta Sangraha grantha (Compiled book ), written by Neelkanta kotturu Basavaraja Virachita. It contains 25 Prakaranas, First 24 Chapters related to Rogas& 25th to Rasadravyas.
ABDOMINAL TRAUMA in pediatrics part one.drhasanrajab
Abdominal trauma in pediatrics refers to injuries or damage to the abdominal organs in children. It can occur due to various causes such as falls, motor vehicle accidents, sports-related injuries, and physical abuse. Children are more vulnerable to abdominal trauma due to their unique anatomical and physiological characteristics. Signs and symptoms include abdominal pain, tenderness, distension, vomiting, and signs of shock. Diagnosis involves physical examination, imaging studies, and laboratory tests. Management depends on the severity and may involve conservative treatment or surgical intervention. Prevention is crucial in reducing the incidence of abdominal trauma in children.
Osteoporosis - Definition , Evaluation and Management .pdfJim Jacob Roy
Osteoporosis is an increasing cause of morbidity among the elderly.
In this document , a brief outline of osteoporosis is given , including the risk factors of osteoporosis fractures , the indications for testing bone mineral density and the management of osteoporosis
TEST BANK For Community Health Nursing A Canadian Perspective, 5th Edition by...Donc Test
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Muktapishti is a traditional Ayurvedic preparation made from Shoditha Mukta (Purified Pearl), is believed to help regulate thyroid function and reduce symptoms of hyperthyroidism due to its cooling and balancing properties. Clinical evidence on its efficacy remains limited, necessitating further research to validate its therapeutic benefits.
NVBDCP.pptx Nation vector borne disease control programSapna Thakur
NVBDCP was launched in 2003-2004 . Vector-Borne Disease: Disease that results from an infection transmitted to humans and other animals by blood-feeding arthropods, such as mosquitoes, ticks, and fleas. Examples of vector-borne diseases include Dengue fever, West Nile Virus, Lyme disease, and malaria.
5. Pancreatic adenocarcinoma: diagnosis and treatment
Common presenting symptoms of pancreatic cancers
•Jaundice
(for tumours of the head),
•abdominal pain,
•weight loss,
•steatorrhoea, and
•new-onset diabetes.
Tumours can grow locally
into the duodenum (proximal
for tumour of the head and
distal for tumour of the body
and tail) and result in an
upper gastroduodenal
obstruction.
Ducreux M, Ann Oncol 2015: 26 (Supplement 5): v56–v68
6. Pancreatic adenocarcinoma: diagnosis and treatment
What is needed in the radiological diagnosis of
pancreatic cancer ?
Ducreux M, Ann Oncol 2015: 26 (Supplement 5): v56–v68
Tumour size and
Precise burden,
Arterial and Venous local involvement
Presence of distant metastases (liver!)
8. Pancreatic adenocarcinoma: diagnosis and treatment
https://www.chirurgiadelfegato.it/pancreas/tumore-pancreas/tumore-alla-testa-del-pancreas/
Superior Mesenteric Artery
Pancreatic Cancer
Duodenum
10. Pancreatic adenocarcinoma: diagnosis and treatment
Arterial Tumor Contact
Less than or equal
to 180°tumor
contact without
deformity.
More than 180°
tumor contact
without deformity.
Tumor contact with
deformity (arrow).
Al-Hawary MM, Gastroenterology 2014; 146: 291-304
11. Pancreatic adenocarcinoma: diagnosis and treatment
Al-Hawary MM, Gastroenterology 2014; 146: 291-304
Venous Tumor Contact
Less than or equal
to 180°tumor
contact without
deformity.
Less than or equal
to 180°tumor
contact with
deformity (arrows).
More than 180°
tumor contact
without deformity.
Tear drop
deformity (arrows).
12. Pancreatic adenocarcinoma: diagnosis and treatment
Resectable
R
Borderline Resectable
BR
Unresectable
UR
Venous Involvement alone
BR-PV
Arterial Involvement
BR-A
Locally advanced
LA
Metastatic
M
SMV/PV No contact or
unilateral narrowing
Tumor contact 180° or greater
or bilateral
narrowing/occlusion, not
exceeding the inferior border
of the duodenum
Bilateral
narrowing/occlusion,
exceeding the inferior
border of the duodenum
SMA, CA No tumor contact No tumor contact/invasion Tumor contact < 180°
without deformity/stenosis
Tumor contact/invasion
of 180° or more degree
CHA No tumor contact No tumor contact/invasion Tumor contact without
showing tumor contact of
the PHA and/or CA
Tumor/contact/invasion
of the PHA and/or CA
AO Tumor contact or
invasion
M Distant
metastases
Isaji S, Pancreat 2018, 18: 2-11
International Consensus of Classification of Borderline Resectable Pancreatic Tumor
SMV: superior mesenteric vein, PV: portal vein, SMA: superior mesenteric artery, CA: celiac artery,
CHA: common hepatic artery, PHA: proper hepatic artery
14. Pancreatic adenocarcinoma: diagnosis and treatment
We still do not know how many patients progressed under
neoadjuvant chemotheraphy while they were operable or
borderline operable at the beginning.
15. Pancreatic adenocarcinoma: diagnosis and treatment
• An increase in serum levels is seen in almost 80% of the patients with advanced disease.
• In patients not harbouring a functional Lewis enzyme (Lea-b- genotype: 7%–10% of the population),
levels of CA 19-9 are typically undetectable or below 1.0 U/ml.
• The level of CA 19-9 is correlated to the level of bilirubin and any cause of cholestasis is able to induce
false-positive results.
• CA 19-9 has a significant value as a prognostic factor and can be used as a marker to measure disease
burden and potentially guide treatment decisions.
• A preoperative serum CA 19-9 level ≥500 UI/ml clearly indicates a worse prognosis after surgery.
CA 19-9 is not useful for the primary diagnosis of pancreatic cancer.
Ducreux M, Ann Oncol 2015: 26 (Supplement 5): v56–v68
17. Pancreatic adenocarcinoma: diagnosis and treatment
Outcome No PreOp Biliary
Drainage
Plastic Stent Metal stent Percutaneous
catheter
Any Post-operative
complication
80 (79%) 46 (50%) 47 (50%) 27 (22%)
Intraabdominal
infection
62 (64%) 34 (39%) 53 (57%) 52 (41%)
Post-operative
hemorrage
42 (40%) 49 (51%) 52 (58%) 58 (51%)
Wound infection 96 (88%) 19 (22%) 54 (51%) 31 (399%)
The probability that an approach is better than other approaches for a given clinical outcome (i.e. P-scores).
The best approach is highlighted
21. Pancreatic adenocarcinoma: diagnosis and treatment
Patients aged 80 years and older have approximately double the risk of
30-day postoperative mortality and 50% increased rate of complications
following PD.
Careful patient selection is required when offering surgery in this age
group.
26. Pancreatic adenocarcinoma: diagnosis and treatment
Pancreatic resection of pancreatic adenocarcinoma can
be performed safely on elderly patients with acceptable
risks in tertiary centres by experienced specialist
hepatobiliary surgeons.
Age alone should not be the only determinant for the
selection of patients for surgical treatment.
A better understanding of the barriers to the provision of
adjuvant chemotherapy and aggressive surgery (to
achieve clear surgical margins) is needed.
Tan E, Int J Surg 2019; 72: 59-68
27. Pancreatic adenocarcinoma: diagnosis and treatment
Geriatric assessment included the following specific testing, 4 (of
5) components of Fried’s frailty:
1) self-reported unintentional weight loss of 10 lb or more in
the previous 12 months;
2) height-adjusted slow gait speed;
3) muscular weakness as measured by a gender-adjusted grip
strength pressure on a hand dynamometer (lowest 20%); and
4) self-reported patient exhaustion measured by 2 survey
questions.
32. Pancreatic adenocarcinoma: diagnosis and treatment
Avoid unnecessary radiologic tests
(a well done CT could be enough)
Early refer the patients with a suspected pancreatic cancer
to an HepatoPancreatoBiliary Unit with an established HPB
surgical unit
Do not drain the jaundiced patients before having obtained
the opinion on surgical resecatibility
33. Pancreatic adenocarcinoma: diagnosis and treatment
Gian Luca Grazi
Hepato Biliary Pancreatic Surgery
National Cancer Institute “Regina Elena”, Rome, Italy
gianluca.grazi@ifo.gov.it
www.chirurgiadelfegato.it