Treatment of pancreatic cancer and the advantages and disadvantages

1. Surgical treatment:

Radical surgery: there is still the only effective cure pancreatic cancer, but the complicated surgery, trauma large, the high incidence of complications.

Pancreatic head cancer: mainly Pancreaticoduodenectomy (Whipple operation), to retain the stomach and pylorus in pancreaticoduodenectomy (PPPD operation), and the expansion of pancreaticoduodenectomy. Whipple surgery is one of the most classic of pancreatic head cancer, radical surgical excision normally encompasses the distal part of the stomach, duodenum, pancreatic head and the lower common bile duct, cleaning before and after the head of pancreas, superior mesenteric artery around the transverse mesocolon root Department and the hepatic artery and around hepatoduodenal ligament lymph nodes. PPPD with preservation of normal physiological function of the stomach, gastrointestinal reflux are part of the block, improved nutritional status; another without partial resection of gastric and duodenal jejunal anastomosis is relatively simple, shorter operation time. However, scholars believe that the operative procedures for Helicobacter pylori and hepatic artery under the surrounding lymph node dissection is not adequate, may affect the postoperative results, and thus advocate only applies to small pancreatic head cancer, duodenal bulb and pylorus is not invaded by the Ministry of ; In addition, the clinic can be found that a small number of patients developed post-operative gastric retention. Duocheng invasive growth of pancreatic cancer, easy to violations of the surrounding adjacent portal vein and superior mesenteric artery and vein, in the past many scholars would be whether the tumor invaded superior mesenteric vein, portal vein resection for judging whether a sign of pancreatic cancer, the resection rate is low. With the recent improvements in surgical methods and techniques, as well as the improvement of perioperative management, some involving the superior mesenteric vessels, portal vein were extended pancreaticoduodenectomy implemented, will be involving the tumor and vascular resection in conjunction with autologous blood vessels or artificial blood vessel reconstruction of vascular access. However, the surgical whether it can improve the survival rate still controversial. Pancreaticoduodenectomy due to the expansion of major surgical trauma, long duration and high technical requirements, may increase the incidence of complications and should choose carefully.

Pancreatic body and tail cancer: There is a simple resection of pancreatic body and tail, extended resection of pancreatic body and tail and the joint organ resection.

Total pancreatectomy: pancreatic cancer lines total pancreatectomy-style multi-center incidence of pancreatic cancer based on doctrine, the whole pancreatic resection fundamentally eliminate pancreatic leakage after pancreaticoduodenectomy the possibility of complications, but diabetes and pancreatic exocrine insufficiency due to digestion and absorption disorders after-effects. Studies have shown that near-total pancreatectomy, no significant long-term efficacy advantages, and should be strictly controlled indications, until the whole is an absolute indication for pancreatic cancer.

Internal drainage surgery:

Single-bypass surgery: biliary-enteric anastomosis, mainly gallbladder duodenum, gallbladder and common bile duct jejunum anastomosis jejunum anastomosis. Benefits can drain bile to relieve jaundice, to prepare for chemotherapy and radiotherapy; drawback is that some patients with duodenal obstruction may occur in the future, and enteric drainage can not solve the problem.

Double-bypass surgery: biliary-enteric + gastrointestinal anastomosis for patients with duodenal obstruction. Benefits can be lifted duodenal obstruction; drawback is lack of pancreatic juice, digestive function to reduce internal and external secretory function affected.

3 bypass surgery: biliary-enteric + GI + Pancreaticojejunostomy. Advantage is that the problem is resolved pancreatic juice; drawback is that surgery is relatively complex and difficult high and postoperative pancreatic fistula problem.

External drainage surgery:

Gallbladder fistula or bile duct T tube drainage: can not be used for tumor resection patients, simple operation and the exact effect of drainage. In preparation for radical surgery, in addition can improve the liver and kidney function, improve blood clotting function, reduce the risk of infection, improve immunity, it can also detect cancer in the initial surgery, clear whether the line of two radical surgery.

Endoscopic biliary stent or drainage (ERCP + ENBD): advantages of trauma; drawback is a serious postoperative edema around the bile duct to increase the two surgical difficulty, and because of intraoperative guide wire, catheter or stent repeated through the tumor site, may lead to tumor metastasis.

PTCD or ITCD: are generally used for relatively poor general condition and can not tolerate surgery, or patients who can not OK ERCP and drainage inaccurate results.

2. Chemotherapy:

Intravenous chemotherapy: commonly used chemotherapy drugs 5-Fu, MMC, cisplatin, etc. In recent years, gemcitabine as first-line pancreatic cancer clinical drug began to be used to obtain a better efficacy of drugs than ever before, but whether it is single - drug, or combination therapy, intravenous chemotherapy, the overall effect is not satisfactory.

Interventional chemotherapy: Huashan Hospital, the first in China will be involved in chemotherapy used in the treatment of pancreatic cancer found that the treatment can increase the local drug concentration to reduce the systemic toxicity of chemotherapy drugs. We also based on many years of clinical practice, was found involved in pancreatic cancer chemotherapy can not only improve the effectiveness of postoperative adjuvant therapy, but also can improve the preoperative application of large pancreatic cancer resection rate and prolong patient's survival, is the preferred adjuvant therapy for method.