Carcinoma of body and tail of pancreas: A clinical and pathological entity

Eight cases of carcinoma of the body and tail of the pancreas encountered in 3,500 autopsies have been reviewed.Six of the eight cases were in men and the ages varied from seventy-eight down to eighteen. Two were in women, aged thirty four and sixty-five. The average age was 53.7 and one case was encountered in an eighteen year old boy.Pain was the usual presenting symptom, in some instances occurring in attacks, but not constant enough in type or location to indicate the site of the growth.An abdominal mass was felt in five patients.The duration of symptoms before entering the hospital varied from two to six months in the seven cases in which the history was reliable.Rapid weight loss was present in four cases.Jaundice was absent in seven cases, and occurred late in one.Carcinoma of the body and tail of the pancreas deserves more consideration when differential diagnosis of pancreatic lesions is considered. It occurs about one-third as frequently as carcinoma of the head. It presents a suggestive clinical picture with upper abdominal pain, weight loss, absence of jaundice, often the presence of a mass and confusing symptoms suggesting involvement of other intra-abdominal viscera. The pathological findings reveal massive and widespread metastases compared to those of carcinoma of the head, explaining the confusing symptoms.     

Carcinoma of the body and tail of the pancreas: is curative resection justified?

BACKGROUND. The role of resection in the treatment of carcinoma of the distal pancreas remains unclear. The less frequent occurrence of tumor in the distal gland, advanced tumor stage at diagnosis, and a lack of reported success have combined to produce therapeutic nihilism in the minds of many surgeons. The goal of this review was to assess long-term survival after distal pancreatectomy for carcinoma of the pancreas. METHODS. The records of all patients undergoing distal pancreatectomy at the Mayo Clinic for a primary pancreatic malignant tumor during the 25-year period from 1963 to 1987 were reviewed. Forty-four patients undergoing potentially curative distal pancreatectomies were identified: 26 patients for ductal adenocarcinoma, 12 patients for islet cell carcinoma, and six patients for cystadenocarcinoma. RESULTS. Major postoperative morbidity occurred in 9% of the patients and operative death in 2% of the patients. Patients with ductal adenocarcinoma frequently were admitted with advanced disease (stage II or III). The median overall survival for patients with ductal adenocarcinoma was 10 months. Fifteen percent of the patients survived 2 years after operation, and 8% of the patients survived 5 years. In contrast, the 5-year survival after resection of islet cell carcinomas and cystadenocarcinomas was excellent (83% and 100%, respectively). CONCLUSION. The prognosis for patients with ductal adenocarcinoma in the distal pancreas who were treated with potentially curative distal pancreatectomy is poor; however, the results are not substantially different from those reported after pancreaticoduodenectomy for malignant tumors of the proximal pancreas. Some patients with adenocarcinoma of the distal pancreas who were treated with resection may be long-term survivors. We recommend resection of carcinoma of the distal pancreas when the disease is limited to the gland and believe that all patients with ductal adenocarcinoma should be considered for postoperative adjuvant radiation and chemotherapy.     

Management of adenocarcinoma of the body and tail of the pancreas.

OBJECTIVE: The authors examined the resectability, operative morbidity mortality, and survival of patients with pancreatic adenocarcinoma of the body and tail compared with lesions in the head. SUMMARY BACKGROUND DATA: Adenocarcinoma of the body and tail of the pancreas is characteristically thought of as a disease that presents late and rarely is operable or resectable. METHODS: In an 11-year period, 1981 patients were admitted and entered into a prospective database at Memorial Sloan-Kettering Cancer Center with a diagnosis of peripancreatic cancer, 1363 of whom had adenocarcinoma of the pancreas, 75% with lesions in the head and 25% with lesions in the body and tail. RESULTS: Of 271 patients resected, 237 (23%) had lesions in the head and 34 (10%) had body and tail lesions. Perioperative mortality was 4% for patients with pancreatic lesions in the head and 0% for patients with pancreatic lesions in the body and tail. Five-year actuarial survival for body and tail lesions was projected at 14% for 5 years. Actual survival was 19%, with three patients alive for more than 5 years. CONCLUSIONS: Adenocarcinoma of the body and tail of the pancreas, although less likely to be resectable at presentation than lesions in the pancreatic head, have similar postresection survival.     

Improved detection of cancer of the body or tail of the pancreas.

Ultrasonography (US), computed axial tomography (CT) and endoscopic retrograde cholangiopancreatography (ERCP) have not improved detection or prognosis of carcinoma of the pancreatic head. We investigated the influence of these imaging techniques on detection, and consequently prognosis of carcinoma of the pancreatic body or tail, where the symptoms are less specific (seldom jaundice or vomiting) and imaging techniques may be more important. Of 139 patients, 29 were treated in 1972-1977, when US, CT and ERCP were not used, 27 in 1978-1980, when US was occasionally performed, and 83 in 1981-1989, when all three methods were common. In 1978-1980 and 1980-1981 correct ante-mortem diagnosis was more common than in 1972-1977, and the diameter and stage of tumour were significantly reduced at laparotomy. The resectability rate was not increased, however, and the incidence of exploratory laparotomy was not reduced. The survival time in the last study period was significantly longer only in the non-operatively treated patients. The reason was not earlier diagnosis, but possibly better general management.     

胰体尾癌患者的预后因素分析

目的 探讨影响胰体尾癌患者预后的相关因素.方法 回顾性分析1998年1月至2008年12月天津医科大学附属肿瘤医院收治的64例行根治性切除术的胰体尾癌患者的临床资料.患者术前均行腹部超声、CT检查及肿瘤标志物检测了解疾病情况,术前未接受新辅助化疗,采用根治性手术方案,术后进行化疗、生物治疗和放射治疗.收集患者的性别、年龄、腰背疼痛、肿瘤部位、肿瘤最大直径、分化程度、手术方式、淋巴结转移、淋巴结转移率、胰腺内神经浸润、胰腺外神经浸润、胰腺被膜浸润、脾动脉浸润、脾静脉浸润、腹膜后软组织浸润、小静脉浸润、TNM分期等指标.采用Kaplan-Meier法绘制生存曲线,生存情况分析采用Log-rank检验,单因素分析采用x2检验,采用COX风险模型进行多因素预后分析.结果 64例患者均接受Ro切除,平均清扫淋巴结数目为15枚(12～22枚).64例患者中,术后发生胰液漏5例、胃排空障碍3例、腹腔感染1例、下肢深静脉血栓形成1例,无围手术期死亡.64例患者均为导管腺癌或囊腺癌,其中高分化9例、中分化35例、低分化20例;TNM Ⅰ A期4例、ⅠB期9例、ⅡA期17例、ⅡB期34例.44例患者死于肿瘤复发或转移,其中26例为局部复发、18例为远处转移.患者1、3、5年生存率分别为42.2％、17.2％、15.6％,中位生存时间为19.0个月.单因素分析结果表明:腰背疼痛、肿瘤最大直径、分化程度、淋巴结转移、淋巴结转移率、胰腺外神经浸润、脾动脉浸润和TNM分期是影响患者预后的因素(x2=10.658,8.371,18.910,6.605,28.382,14.571,19.476,32.155,P＜ 0.05);多因素分析结果表明:肿瘤的分化程度、淋巴结转移率、胰腺外神经浸润、脾动脉浸润、TNM分期是影响患者预后的独立危险因素(RR=2.509,2.107,6.692,5.109,4.784,P＜0.05).结论 分化程度、淋巴结转移率、胰腺外神经浸润、脾动脉浸润、TNM分期是影响胰体尾癌患者预后的危险因素.     

Appleby手术治疗恶性胰体尾肿瘤六例报告

目的探讨胰体尾肿瘤整块切除联合腹腔干切除(Appleby手术)的安全性及可行性。方法对6例接受Appleby手术的侵犯腹腔干的胰腺肿瘤患者的临床资料进行分析。结果6例患者中。5例为原发性胰体尾癌,1例为胰体尾转移瘤(腹膜后神经鞘瘤术后),行胰体尾肿瘤整块切除联合腹腔干切除术,均未行血管重建。6例手术均获得成功。手术时间4～6 h,术中出血400～1200 ml,术后肝功能一过性升高,经保肝治疗,2周内全部恢复正常,肝脏和胆囊均有正常动脉血供,无手术死亡,无严重并发症发生。结论胰体尾肿瘤整块切除联合腹腔干切除手术是安全可行的,它可以提高肿瘤的切除率并可缓解疼痛。     

胰腺体尾部癌的外科治疗

目的探讨胰腺体尾部癌患者的外科治疗及预后。方法回顾性研究1996年1月至2006年6月我院外科治疗的87例胰体尾癌患者的临床资料,分析R0切除、姑息性切除、短路手术和未手术治疗对患者近期和远期疗效的影响。结果本组手术探查59例,肿瘤切除27例,其中R0切除21例,姑息切除6例。R0切除组中联合脏器或血管切除9例。短路手术13例,仅行开腹探查、活检19例。各组围手术期死亡率无差异,联合脏器切除组合并症发生率高于其他各组。87例胰体尾癌患者总中位生存期为7.9个月。R0切除组、姑息性切除组、短路手术组与未切除组中位生存期分别为17.2个月、7.3个月、4.7个月和5.2个月。肿瘤切除组患者疼痛缓解率高于姑息手术组及短路手术组（P=0.03）。结论对胰体尾癌患者应提倡积极手术治疗,即使姑息切除,亦可缓解疼痛症状。     

胰体尾腺癌的外科治疗

目的研究胰体尾腺癌的临床特点、肿瘤行为和外科治疗效果。方法回顾性分析1980年1月至2006年8月我院腹部肿瘤外科收治的有明确病理学诊断的108例胰体尾腺癌病人的临床病理资料。结果84％（91例）为导管腺癌。46%（50例）出现同时性远处转移，血行转移40％（43例）以肝转移为主（41例，38％），种植转移19例（18％）。54％（58例）切除了肿瘤，Ⅰ、Ⅱ、Ⅲ、Ⅳ期病人手术切除率分别为100％（5例）、100％（33例）、5％（1例）和38％（19例），差异显著（χ^2=56.80，P＜0.001）。和未切除肿瘤的病人相比，手术切除病人的男性比例（53％：72％，χ^2=3.92，P=0.048）显著较少，出现上腹痛（66%：84％，χ^2=4.78，P=0.029）、体重下降（22％：42％，χ^2=4.78，P=0.029）和种植转移的比例（0：38％，χ^2=26.74，P＜0.001）显著较低。I、Ⅱ、Ⅲ、Ⅳ期病人中位生存分别为35（11～73）、14（1～83）、6（2～25）和4（1～20）个月，存在显著性差异χ^2=30.07，P＜0.001）。Ⅲ、Ⅳ期胰体尾腺癌手术切除后中位生存8（2～25）个月，显著长于未切除病人的4（1～13）个月（χ^2=17.06，P＜0.001）。结论胰体尾腺癌手术时出现同时性远处转移的几率大。男性、上腹痛、体重下降、种植转移时手术切除的可能性降低。Ⅲ期病人虽然手术切除率较Ⅳ病人为低，但是术后生存无显著差异；对Ⅲ、Ⅳ期胰体尾癌而言，原发灶能够切除的病人术后生存期较长。     

Distal pancreatectomy for resectable adenocarcinoma of the body and tail of the pancreas

The study goal was to analyze outcome after distal pancreatectomy for three subtypes of adenocarcinoma to determine the role of en bloc resection in surgical management. A secondary aim was to identify those clinicopathologic factors correlating with survival in an analysis limited to ductal adenocarcinoma. Medical records of consecutive patients undergoing distal pancreatectomy for adenocarcinoma between 1987 and 2003 were reviewed. A comparative analysis was undertaken of the safety and outcome of patients undergoing standard and en bloc resections. Clinicopathologic factors for patients undergoing distal pancreatectomy for ductal adenocarcinoma were subjected to both univariate and multivariate survival analyses. Ninety-three patients underwent resection for ductal adenocarcinoma (66, 71%), mucinous cystadenocarcinoma (18, 19%), or adenocarcinoma associated with intraductal papillary mucinous neoplasm (IPMN) (9, 10%). En bloc resection was required in 33 (35%) patients. There was no operative mortality. Median survival was 15.5 months, 30.2 months, and 50.7 months for ductal adenocarcinoma, mucinous cystadenocarcinoma, and adenocarcinoma associated with IPMN, respectively. Patients undergoing en bloc resection had a higher overall complication rate, required more transfusions and more intensive care unit admissions, and had a higher rate of positive margins; however, there were no deaths. For ductal adenocarcinoma, tumor size greater than 3.5 cm, age greater than 60 years, and stage were factors that correlated with survival on a univariate analysis. None were significant on multivariate analysis. Four patients with ductal adenocarcinoma were actual 5-year survivors. While en bloc resections are associated with a higher rate of complications, the majority are self-limited and mortality is low. Resection, including adjacent organs, should be performed when appropriate. Long-term survival for patients with cystadenocarcinoma or IPMN-associated adenocarcinoma can be anticipated. While rare, long-term survival for patients with ductal adenocarcinoma after distal pancreatectomy can be achieved. Presented at the Thirty-Eighth Annual Meeting of the Pancreas Club, New Orleans, Louisiana, May 16, 2004.     

改良式Appleby手术治疗晚期胰体尾癌

目的: 介绍一种治疗胰体尾癌侵袭肝总动脉、脾动脉及腹腔干的改良式Appleby手术方法 。方法: 腹腔干自起始部接扎切断,将肿瘤及侵袭的动脉整块切除。术中注意保留网膜右和胃右动脉,以维持胃的血供。夹闭肝总动脉后,注意肝固有动脉的搏动情况 。结果: 术后,上腹部及腰背部疼痛消失,七个月后患者死于肝脏及肝门部转移,经影像学检查未见切除部位肿瘤复发 。结论: 该术式可提高胰体尾癌的手术切除率与根治程度,可改善病人术后的生存质量。     

Carcinoma of the pancreas.

Pancreatic carcinoma remains a difficult problem in surgery. High mortality and overall discouraging results of pancreaticoduodenectomy misled some physicians to believe that surgery is ineffective in management of pancreatic carcinoma. Patients with pancreatic carcinoma in two major hospitals from 1963 through 1976 were analyzed. Results of pancreaticoduodenctomies and palliative operations are reported.     

Chronic pancreatitis of the head of the pancreas in hyperplasia of the body and tail of the pancreas]

We report a case of chronic pancreatitis of the head of the pancreas complicated with insulin-requiring diabetes mellitus, in a 44-year-old woman with hypoplasia of the dorsal pancreas. Preoperative ultrasonography, computerized tomography and angiography revealed a calcifying retroperitoneal mass, which on explorative laparotomy proved to be a severe chronic pancreatitis of the head of the pancreas with a finding of abnormal visibility of the confluens venosum and absence of both the corpus and the tail of the pancreas. The postoperative course following pylorus-preserving duodenopancreatectomy was uneventful.     

Carcinoma of the pancreas.

Study of hospital records of 146 patients with carcinoma of the pancreas from 1952 to 1971 revealed that 74 per cent had had abdominal pain and 65 per cent jaundice. Abdominal pain was the commonest symptom of carcinoma of the head as well as of the body and tail. Diabetes mellitus was four times as common among the patients with carcinoma of the pancreas as among the population in general. The interval between the onset of symptoms and diagnosis of the disease was the same in both decades of the 20-year period, but the survival time after operation was longer in the second 10-year period. Pancreatoduodenectomy was possible in only four of the 138 patients operated on, and one of them died postoperatively. The three patients who survived the operation survived significantly longer than the 87 in whom an anastomosis had been established between the bile ducts and the intestine. Forty-one patients were subjected to surgical exploration only. No difference in survival time was found between the two last-mentioned groups.     

保留脾脏的胰体尾癌切除14例分析

目的探讨保留脾脏的胰体尾切除在脾及脾动、静脉未受侵的胰腺癌中的应用。方法回顾性分析1996-2002年我院行保留脾脏的胰体尾切除的14例胰体尾癌病人的临床资料,统计术后并发症、症状改善情况及生存期。结果手术后出现并发症3例,全组病人术后症状消失或明显改善,中位生存时间为46个月。结论保留脾脏的胰体尾切除术损伤小,术后并发症少,病人生存期延长,适用于脾脏及脾动、静脉未受侵的胰体尾恶性肿瘤病人。