Surgical Therapy Of Carcinoma Of Body And Tail Of The Pancreas: Analysis Of 42 Cases

Background:Pancreatic carcinoma is one kind of the malignant tumors of digestive tract tumors with poor prognosis, which may occur in various parts of the pancreas. According to the statistic of clinical data, the carcinoma in the head of pancrea accounts for about 70%-80%, carcinoma of body and tail of pancreas account for only 20%-30% or so. Pancreatic ductal adenocarcinoma accounting for over 90% is more common. Although pancreatic ductal adenocarcinoma with well-differentiated and moderately differentiated adenocarcinoma is more common, it has the characteristics of invading the peripheral vascular and nerve obviously, and easily shifing through the blood circulation and lymphatic system. Carcinoma of body and tail of pancrea is more likely to occur invasion outside the pancreatic carcinoma.As the carcinoma of body and tail of pancrea is lack of specific symptoms at the early stage, the patients see a doctor when they have lumbar back and upper abdominal pain or upper abdominal mass. Well at this time, invasion and metastasis have occured in lymph nodes, surrounding organs and blood vessels, therefore, the resection rate is low with poor prognosis. In recent years, the incidence of carcinoma of body and tail of pancrea showed an upward trend year after year. Carcinoma of body and tail of pancrea as one of the malignant tumors has become a serious threat to human life. So how to diagnose early, improve the resection rate, prolong survival prognosis and improve the quality of life of patients has become the focus of the study in pancreatic surgery. In this paper,42 cases of carcinoma of body and tail of pancrea at General Surgery of Shandong University Qilu Hospital right from September 2005 to April 2009 would be analyzed retrospectively in order to discuss the early diagnosis and the effect of surgical treatment of carcinoma of body and tail of pancrea.Objective:To discuss the early diagnosis and the effect of surgical treatment of carcinoma of body and tail of pancrea.Methods:Summary a series of 42 cases of carcinoma of body and tail of pancrea at General Surgery Department of Shandong University Qilu Hospital right from September 2005 to April 2009. The clinical manifestations, surgical treatment and prognosis of survival of these patients would be analyzed retrospectively in order to discuss the early diagnosis and the effect of surgical treatment of carcinoma of body and tail of pancrea.Results:The group of 42 patients, including27 males64.3%) and 15 females (35.7%), aged 36-82 years, mean age 53.4 years. Preoperative examination, CA19-9 positive rate was 77.8%(28/36), CA-125 positive rate was 63.9%(23/36), CEA positive rate was 69.4%(25/36); B-type ultrasonicinspection positive rate was 81.0%(34/42), CT examination positive rate was 90.5%(38/42), MRI and MRCP examination positive rate was 88.9%(16/18).14 cases were treated with radical resection,3 cases with palliative resection,8 cases with Palliative bypass surgery drainage,11 cases with laparotomy, and 6 cases had no chance for surgical treatment according to the examination because of the metastasis. Surgical resection rate was 40.1%, and radical resection rate was 33.3%.Intraoperative biopsy in 29 patients,26 cases were adenocarcinoma, and 2 cases of quamous cell carcinoma,1 case of cystadenocarcinoma. Pancreatic leakage occurred in one patients after surgery, abdominal infection occurred in 1 patient, wound infection occurred in two cases, no perioperative deaths occurred. The patients treated with radical resection have much better prognosis than the ones treated without radical resection(p<0.05). TNM stagingâ… andâ…¡of the patients have no significant difference in prognosis(P> 0.05).TNM stagingâ…¢andâ…£of the patients have no significant difference in prognosis(P> 0.05).The prognosis of TNM stagingâ… was much better than TNM stageâ…¢andâ…£of the patients(P <0.05); The prognosis of TNM stagingâ…¡was much better than TNM stageâ…¢andâ…£of the patients(P<0.05).In surgery group, the average survival time of patients without lymph node metastasis is significantly longer than which with lymph node metastasis(p<0.05); and the average survival time of patients with well-differentiated adenocarcinoma, squamous cell carcinoma and cystadenocarcinoma is significantly longer than that with poorly differentiated adenocarcinoma (p<0.05);With or without vascular invasion did not affect the prognosis of the patients; although patients without vascular invasion have longer median survival time than those who have vascular invasion, it had no statistically significant difference. Gender, age, time of onset, with or without weight loss did not affect the prognosis of the patients.Conclusions:1.Early diagnosis and early treatment is the only way to improve the prognosis of patients with carcinoma of body and tail of pancreatic. Radical resection of the tumor is still the only way for the patients to receive long-term survival time.2.The size of the tumor, the metastasis of surrounding organs and blood vessels and distant metastasis are the important factors to affect radical resection and prognosis.3. TNM staging is important prognostic indicators.4.Lymph node metastasis and the pathological type of tumor are the important factors to affect prognosis of patients with surgical treatment.