4 surgical treatments for pancreatic cancer

The radical cure for pancreatic cancer is surgical resection. Since early diagnosis of pancreatic cancer is difficult, the time from the first symptom to the diagnosis is about 4-9 months, and the surgical resection rate is below 24%. Therefore, most reported 5-year survival rates are below 10%. Indications: ① Age < 70 years old, stage I and II pancreatic head cancer; ② No liver metastasis, no ascites; ③ Intraoperative exploration shows that the tumor is limited to the pancreas and has not invaded important blood vessels such as the portal vein and superior mesenteric vein; ④ No distant metastasis and spread. There are several surgical resection methods for pancreatic cancer.

1. Pancreaticoduodenectomy (Whipple) is suitable for pancreatic head cancer and ampullary cancer. Since Whippie used this surgery in 1935, there have been many improvements, including the scope of resection and the method of reconstruction. The scope of resection of pancreaticoduodenectomy should generally include part of the stomach, duodenum, pancreatic head and lower common bile duct.

2. Pancreaticoduodenectomy (PPPD) with preservation of stomach and pylorus emphasizes frozen section examination of each cutting edge before anastomosis during surgery, with special attention paid to the proximal cutting edge of the duodenum to ensure complete removal of the tumor. Its advantages are: ① Large stomach capacity, partial prevention of gastrointestinal reflux, and improved nutritional status; ② Shortened operation time, no need for gastrectomy, and simpler duodenal jejunal anastomosis. The quality of life of patients who adopt this method is significantly better than that of patients who undergo standard whipple (PD) surgery with subtotal gastrectomy, and the postoperative survival rate is also slightly higher than that of standard PD, so PPPD has been widely recognized and accepted worldwide.

3. Total pancreatectomy (TP) In recent years, the multicenter incidence of pancreatic cancer has attracted more and more attention. In addition to the main cancer lesion located in the pancreatic head, multiple small cancer lesions can also be found in other parts of the pancreatic tissue. This discovery provides an important theoretical basis for total pancreatectomy.

4. Distal pancreatectomy (DP) Indications: Patients with no cancer metastasis in the pancreatic body and tail. Methods: Resection of the pancreatic body and tail tumor and surrounding lymph nodes together with the spleen. The operation is simple, with few complications and low mortality.