Diagnosis And Treatment Of Carcinoma Of Body And Tail Of Pancreas

Objective:Deaths from pancreatic ductal adenocarcinoma, also known as pancreatic cancer, rank fourth among cancer-related deaths in the United States. About60%of tumors originate at the head of the pancreas,15%in the body,5%in the tail;20%are diffuse within the pancreas. Pancreatic cancer is one of the most lethal malignancies. The number of new cases diagnosed and the number of deaths each year are almost identical, demonstrating the particularly dismal prognosis for patients affected by this disease. Mortality rates have not changed significantly for decades. Pancreatic cancer is less than20%of patients present with localized, potentially curable tumors. The overall5-year survival rate among patients with pancreatic cancer is<5%.The causes of pancreatic cancer remain unknown. Several environmental factors have been implicated。 In recent years, there have been important advances in the understanding of the molecular biology of pancreatic cancer as well as in diagnosis, staging, and treatment in patients with early-stage tumors. However, Minimal progress has been made in prevention, early diagnosis, and treatment in patients with advanced disease in recent years. The majority of patients with pancreatic cancer of body and tail lack of specific symptoms and with poor prognosis.This article is to discusses the the diagnosis and treatment of pancreatic cancer of body and tail, summarizes recent progress in the understanding and management of this disease.Methods:The data of91patients with carcinoma of pancreatic body and tail from Jan.2002to Jun.2012were reviewed retrospectively. It includes history material perioperative examination and therapy etc. The median survival were calculated by Kaplan-Meier method. The effects of the clinicopathologic parameters on the prognosis of patients were examined by Log rank test.Results:93.4%of the patients were aged more than40years, and the male/female ratio was1.07:1.Fifty-two patients underwent exploratory surgery, among which36had surgical resection and the standard procedure was distal pancreatectomy plus splenectomy. Of the52patients undergoing exploratory surgery,the resection rate was69.2%.Fifty suffered from adenocarcinoma, and2from mucinous adenocarcinoma. As for tumor staging(TNM), it was stage Ⅰ in11patients(21.2%), stage Ⅱ in22(42.3%), stage Ⅲ in10(19.2%) and stage Ⅳ in9(17.3%). The median survival time of patients receiving radical resection were18months, and were5months of patients undergoing nonspecific treatment and palliative therapy. Radical resection was associated with a longer survival period compared with nonspecific treatment or palliative therapy (P<0.01)Conclusion:The majority of patients with pancreatic cancer of body and tail lack of specific symptoms. Early diagnosis is the key to achieve long-term survival. The radical resection plays an important role in improving the effects of surgical treatment.To be vigilant with nonspecific clinical manifestations, early diagnosis, curative surgery are essential for the better prognosis of carcinoma of the body and tail of the pancreas. So it is important that an effective way for early detection is to caution population older than40years with nonspecific clinical manifestations, to combine the use of CT、EUS and Molecular markers,such as CA-199, so as to detect and start surgery early,thus patients can have better outcome.