Special therapeutic procedures
Pancreatic cancer is one of the most frequently diagnosed digestive tumors. For a very long time it was considered to have a dismal prognosis, and surgical treatment seemed to be a good therapeutical option, although with high surgical risks.
The important progress made in surgical techniques and the wide experience of surgical departments of the field, have permitted improving the results of the treatment with this medical procedure. The fact that the new and promising chemotherapy drugs, which are more efficient in the control of this kind of tumors, have also contributed to this improvement, is unquestionable.
There are many prediction factors that have an influence in the evolution of the disease. The most important of them all is obtaining “free margins” in surgery. This is why the main aim in the surgical treatment must be a total resection of the tumor and its different disemination vias. However, there are different factors that determine the complexity of this surgical technique, such as the morphological characteristics of the pancreas, its anatomic location and, most importantly, the way pancreatic tumors are diseminated.
Thanks to the experience that we have gained in the last years, we have incorporated a new attitude when treating this kind of tumors. With the aim we have just described, we have increased the radicality of the surgery.
Our concept of extended surgery in the treatment of pancreatic cancer intends to do a comprehensive work on the rest of the pancreatic gland in order to treat the possible multicentricity (18%). This is done by resecting the retroperitoneal tissue and the loco-regional lymphatic and perineural lynphatic extension (para-aortic area, celiac axis area and superior mesenteric artery area), as well as the vascular structures (the superior mesenteric vein and, less frequently, the superior mesenteric artery) in case they were affected. In patients with favourable preoperative radiologic tests, this technique unquestionably ensures a complete resection of the tumor as well as it prevents hematogenous spread.
The results obtained in over 40 patients treated in our Department do not show an increase of the postoperative morbimortality with the “standard” surgical procedure. The functional consequences of this type of surgery (exocrine and endocrine pancreatic failure) can be easily controlled with pancreatic enzymes and the new types of insulin. In terms of survival, the extended surgery and adjuvant chemotherapy are excellent options that offer better perspectives to patients suffering from ductal pancreatic tumors.
Carcinoma of the head of the pancreas with involvement of the superior mesenteric artery.
Total spleno-pancreaticoduodenectomy with resection of the superior mesenteric artery.
Carcinoma of the head of the pancreas with involvement of the superior mesenteric vein.
Total spleno-pancreaticoduodenectomy with resection of the superior mesenteric vein.
Non-functioning neuroendocrine tumor of the head of the pancreas with involvement of the artery (5 cm) and superior mesenteric vein.
Total spleno-pancreaticoduodenectomy with resection of the superior mesenteric vein and artery.