Evidence-based pancreatic head resection for pancreatic cancer and chronic pancreatitis.

Details

Serval ID
serval:BIB_36F75045EB45
Type
Article: article from journal or magazin.
Publication sub-type
Review (review): journal as complete as possible of one specific subject, written based on exhaustive analyses from published work.
Collection
Publications
Title
Evidence-based pancreatic head resection for pancreatic cancer and chronic pancreatitis.
Journal
Annals of surgery
Author(s)
Schäfer M., Müllhaupt B., Clavien P.A.
ISSN
0003-4932 (Print)
ISSN-L
0003-4932
Publication state
Published
Issued date
08/2002
Peer-reviewed
Oui
Volume
236
Number
2
Pages
137-148
Language
english
Notes
Publication types: Journal Article ; Review
Publication Status: ppublish
Abstract
To review the current status of pancreatoduodenectomy for pancreatic cancer and chronic pancreatitis using evidence-based methodology.
Despite improved results of pancreatoduodenectomy over the recent years, the reputation of the Whipple procedure and its main modifications has remained poor. In addition, the current status of newer modifications of standard pancreatoduodenectomy is still under debate.
Medline search and manual cross-referencing were performed to identify all relevant articles for classification and analysis according to their quality of evidence. The search was limited to articles published between 1990 and 2001.
The mortality rate of pancreatoduodenectomy has declined to less than 5% for chronic pancreatitis and 3% to 8% for pancreatic cancer. In contrast, overall morbidity rates remain high, ranging between 20% and 70%. Delayed gastric emptying represents almost half of all complications. The overall 5-year survival rate for patients with pancreatic cancer remains poor, ranging between 5% and 15%, with a median survival of 13 to 17 months. Mortality and morbidity are not related to the type of pancreatoduodenectomy; however, patients with pancreatic cancer tend to be at increased risk for complications. Extended lymph node dissection and portal vein resection can be performed with similar mortality and morbidity rates as standard procedures, but without apparent survival benefits in the long term. Major relief of pain is achieved in 70% to 100% of patients with chronic pancreatitis.
Pancreatoduodenectomy and its main modifications are safe and effective treatment modalities, especially in experienced centers with a high patient volume. For chronic pancreatitis, surgical resection provides major relief of pain and thus increased quality of life. Overall survival for patients with pancreatic cancer is determined predominantly by the pathology within the resected specimen.
Keywords
Adenocarcinoma/mortality, Adenocarcinoma/surgery, Chronic Disease, Hormones/therapeutic use, Humans, Octreotide/therapeutic use, Pancreatic Diseases/drug therapy, Pancreatic Diseases/etiology, Pancreatic Neoplasms/mortality, Pancreatic Neoplasms/surgery, Pancreaticoduodenectomy/adverse effects, Pancreaticoduodenectomy/methods, Pancreaticoduodenectomy/mortality, Pancreaticoduodenectomy/standards, Pancreatitis/surgery, Quality of Life, Survival Rate, Survivors, Treatment Outcome
Pubmed
Web of science
Create date
11/12/2018 14:18
Last modification date
20/08/2019 13:25
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