Diagnostic and palliative treatment of head of pancreas cancer

Abstract

Introduction. Despite all improvements in both surgical and other conservative therapies, pancreatic cancer is steadily associated with a poor overall prognosis and remains the fourth leading cause of cancer-related mortality in the world. About 80% of patients who have received a diagnosis of pancreatic cancer already have other organ metastasis, as well as local tumor in the late stage. Therefore, appropriate palliation for the main symptoms, such as obstructive jaundice, duodenal obstruction, and pain, is most important. The role of palliative surgery in locally advanced pancreatic cancer mainly involves patients who are found unresectable during open surgical exploration and consists of combined biliary and duodenal bypass procedures. Aim of the study. Analysis of clinical and paraclinical methods of diagnosis and palliative surgical treatment of patients with cephalopancreatic cancer. Materials and methods. The current study presented 548 cases with malignant obstructive jaundice from the Gastrology Clinic of IMSP IO Chișinău, between 2007-2019. Excluded from this research were any patients who underwent resection, had no obstructive jaundice at the time of diagnosis, or had other periampullary cancer (distal bile duct, ampulla of Vater, and duodenum). Results. We identified 424 cases with histologically proven with cephalopancreatic cancer (263 males-58,31 % and 188 females-41,68%) who underwent palliative treatment with cancer of the head of the pancreas aged between 32 and 84, requiring palliation.Following the retrospective study, we found: the diagnosis of cephalopancreatic tumor was clinically and paraclinically established using the diagnostic methods: USG (100%), CT (86,79%); Retrograde endoscopic cholangiopancreatography (23,11%). The tumors of these patients were unresectable because of local vascular invasion to the superior mesenteric vein, portal vein, superior mesenteric artery, hepatic artery, or celiac artery. The tumor size was 5.4±2.2 cm. The tumors of these patients were all in stage 2b-4 according to the NCCN guideline of pancreatic cancer.No cases were diagnosed using preoperative biopsy. Of the 424 cases with a reported histological subtype pancreatic ductal adenocarcinoma 417(98,34%) ,Moderately differentiated-207,Well-differentiated-107,Badly differentiated-87 Solid neoplasm-4(0,98%) Acinar carcinoma 3(0,7%). All the patients underwent palliative surgery , of whom 109 (25,7%) biliar by-pass, 152 (35,84%) biliar + gastric by-pass , 65 (15,3%) stent and 23 (5,42%) external bile drainage. The postoperative mortality did not exceed 5%, the rate of postoperative complications was below 23%, an acceptable value and equivalent to the world data. Conclusions. 1. The goal of therapy for these patients is to obtain the most complete and prolonged remission of symptoms possible, with the least intervention-related morbidity and mortality. CT . 2. The gold standard in the diagnosis of cephalopancreatic tumor is abdominal