Outcome of surgical management of carcinoma of the pancreas

ABSTRACT

Majority of the pancreatic tumours arise from ductal epithelium and practically the term pancreatic cancer is reserved for that tumour. Mates are predominantly the victims with male to female ratio of 31 in this study. A number of etiological factors have been blamed to be associated but smoking and diabetes mellitus are closely related. Fifty percent patients in this study were found to be either current smokers or have been smoking till last five years. The tumour is notorious for its silent growth and non specific presentation. The most common symptom being jaundice when the tumour arises from head region of the gland, associated with anorexia, vomiting weight loss and malaise. Migrating thrombophlebitis is another unusual feature in some cases. The tumours of body and tail present as mass in the epigastrium. In the present study 90% turnours were arising from the head of the gland and 10% from the body. Cystic neoplasms are common in female patients and arise from the body and tail. Silent spread of the tumour involves the lymph nodes and peripancreatic tissues making it most of the time unresectable at the time of presentation. In the text 10% is the usual resectabte rateIn our study the resectability rate was 25%. Management of the case depends upon the stage of the tumour at time of presentation. Surgical management is the best suitable with chance of curative resection of the tumour. Various modifications in pancreaticoduodenectomy have been done since the Whipples procedure was introduced. Pylorus preserving pancreaticoduodenectomy is one such modification. Pancreatic stump is associated most of the time with complications of leakage. Although the techniques of pancreaticoduodenectomy have been improved with better pre operative evaluation, anaesthetic facilities and post operative care of the patient, the long term five year survival is still not much increased. Moreover, post operative hospital stay and complication rate is still high. Alternatively, bypass procedure especially where the disease i s advanced and the tumour is not resectable, are applied. These palliative procedures are associated with short hospital stay, less post operative complications, early relief of symptoms and better quality of life. Short term survival is rather better in these patients as compared to those undergoing resection. Six months survival in our study was 66.6% as compared to 60% in resected cases. Supportive therapies including chemotherapy, radiotherapy and hormone therapy at present are not of much help