2011 Surg 7
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What are the patient and tumour factors to consider in the management of pancreatic cancer?
- Patient: age, functional status, co-morbidities, wishes
- Tumour: stage (CT, MRI, endoscopy, laparotomy), resectability (mets, vaculature invasion), size, resection margins
What is the criteria for resectability in pancreatic cancer?
- NO extra-pancreatic mets
- NO occlusion or encasement of portal-mesenteric vasculature (SMA/SMV, aorta, portal v., celiac plexus)
What is the surgery for the removal of pancreatic cancer?
- +/- pre-op ERCP biliary decompression
- Standard pancreaticoduodenectomy (Whipples procedure): removes pancreatic head, duodenum, CBD, gallblader... etc.
- May be variations of the procedure
How is adjuvant chemoradiotherapy used in pancreatic cancer?
Used for locally advanced pancreatic cancer that's not distally metastatic!
Describe the palliation issues for patients with met. pancreatic cancer (8 issues).
- Pain: opioids, celiac plexus block, radiotherapy
- N & V: anti-emetics
- Obstructive jaundice: biliary decompression (usually endoscopic instead of surgery bypass)
- Gastric outlet obstruction: open gastro-jejunostomy
- Pancreatic insufficiency: lipase & protease replacement
- DM: insulin
- Depression: psych r/v
- Palliative chemotherapy: prolonged survival and improved QoL in 30% of pts
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