Abstract
The results of surgical treatment of pancreatic exocrine cancer are poor. There exists a definite small group of patients with early cancers in the head of the pancreas that are potentially curable. It is generally agreed that prolonged survival is obtained only with resection as opposed to a palliative bypass procedure. The only real controversy that remains concerns the extent of the resection. The 3 options available to the surgeon are Whipple pancreatoduodenectomy, total pancreatectomy, and the more radical regional pancreatectomy. Our opinion, based on previous experience, is that total pancreatectomy is the operation of choice for cancer in the head of the pancreas. This operation excludes many of the risk factors associated with the Whipple operation, with no evidence of increased morbidity or mortality. We feel that the case for extended total pancreatectomy is tenuous and yet to be proven, and that there is little or no place for this operation.
Résumé
Les résultats globaux du traitement chirurgical du cancer du pancréas sont décevants mais il existe un petit groupe de cancers de la tête peu évolués qui sont susceptibles d'être guéris. Il est admis que la survie la plus longue est obtenue davantage par les méthodes radicales d'exérèse que par les méthodes palliatives de drainage. Le point qui prête encore à controverse est l'étendue de l'exérèse. Trois possibilités s'offrent au chirurgien: la duodénopancréatectomie type Whipple, la pancréatectomie totale, la pancréatectomie régionale. D'après notre expérience, la pancréatectomie totale représente l'opération de choix pour traiter le cancer de la tête du pancréas. Elle permet d'éviter les risques inhérents à l'opération de Whipple sans augmentation du taux de la morbidité et de la mortalité. En revanche, la pancréatectomie totale élargie n'a pas fait ses preuves et ses indications sont des plus limitées.
Resumen
Los resultados del tratamiento quirúrgico del cáncer pancreático exocrino son pobres. Existe un pequeño grupo definido de pacientes con cánceres tempranos de la cabeza del páncreas que son potencialmente curables. Generalmente se acepta que una supervivencia prolongada sólo puede lograrse con la resección quirúrgica en contraposición a los procedimientos paliativos de derivación. La real controversia reside en lo referente a la magnitud de la resección. Las tres opciones disponibles para el cirujano son: 1) la pancreatoduodenectomía o procedimiento de Whipple, 2) la pancreatectomía total y, 3) la pancreatectomía regional o super-radical propuesta por Fortner.
Nuestra opinión basada en experiencia previa, es que la pancreatectomía total es la operación de escogencia para cáncer de la cabeza del páncreas. Esta operación excluye muchos de los factores de riesgo asociados con el procedimiento de Whipple, sin que haya evidencia de una mayor mortalidad o morbilidad. Creemos que las razones para favorecer la pancreatectomía regional super-radical son débiles y aún no comprobadas, y que existe una indicación muy limitada, o ninguna, para esta operación.
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Moossa, A.R., Scott, M.H. & Lavelle-Jones, M. The place of total and extended total pancreatectomy in pancreatic cancer. World J. Surg. 8, 895–899 (1984). https://doi.org/10.1007/BF01656030
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DOI: https://doi.org/10.1007/BF01656030