Palliative Surgery in Pancreatic Cancer - EChin

Palliative Surgery in Pancreatic Cancer - EChin -...

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Palliative Surgery in Pancreatic Cancer Edward Chin, MD March 24, 2005
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Case 53M with jaundice x 3 weeks Mild abdominal pain 9/04 PMH: negative No abd masses, nontender Bilirubin 22 CT: pancreatic mass @ head
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Hospital Course ERCP 9/24/05
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Hospital Course CT biopsy 9/27/05 adenoca
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Operative Course OR at Mount Sinai 9/28/05 pancreatic mass with ? SMV invasion Enlarged LNs within porta hepatis Double bypass Gastrojejunostomy Cholecystogastrostomy D/c’d POD#8
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Outpatient Course Completed chemotherapy, XRT Repeat CT 3/9/05
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Pancreatic Ca: Incidence 2003: 30,700 cases
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Mortality 2003: 30,000 deaths 5-yr survival 0.4-5% After resection 7-25%
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Resectable? At presentation: 50% with metastatic disease 40% locally advanced 10% confined disease Only 20% deemed resectable 80% unresectable: Local invasion 6 month median survival Stage IV 3 months
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Palliation Primary goal for majority of patients Obstructive jaundice Gastric outlet syndrome Pain
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Jaundice Surgical : Hepaticojejunostomy Choledochojejunostomy Choledochoduodenostomy Cholecystojejunostomy Non-surgical : ERCP (plastic or metal) Transhepatic (12 Fr, 7 Fr)
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Which to Choose? Median survival = 6 months
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Palliative Surgery in Pancreatic Cancer - EChin -...

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