Ovid: Mastery of Surgery
Sir Andrew Watt Kay wrote in 1978,
For me, the tiger country is removal of the pancreas.The anatomy is very complex and one encounters anomalies.
The embryogenesis of thepancreas and its deep retroperitoneal anatomy are responsible for the
In additionto the normal anatomy of the pancreas, before starting surgery the surgeon should knowwhether the patient's pancreas has any anomalies such as pancreas divisum or obstruction of the pancreatic duct, or variations in the duct's location or depth, or in the overall vascularstructure of the pancreas. No other organ is so closely surrounded by so many anatomic entities(e.g., the duodenum, stomach, spleen, left adrenal, transverse mesocolon and colon, leftkidney, right ureter, and jejunum). Figures 1, 2 and 3 show anterior and posterior relations.The proximity of the pancreas to so many organs means that it is prone to invasion by carcinoma.A study by Deziel found that metastases to the pancreas occur most frequently from thelung, followed by the breast, melanoma, stomach, colon or rectum, kidney, and ovary.Similarly, pancreatic cancer is likely to invade other organs. Tables 1 and 2 show twoimportant considerations in pancreatic cancer: organs directly invaded by pancreatic ductalcancer, and areas most likely to be involved by metastatic lesions from pancreatic cancer.In a study of 7,145 patients, cancer of the pancreas was located in the head in 73.2%, in thebody in 19.9%, and in the tail in 6.8%. Partial pancreatectomy and
pancreatectomy, first described by Barrett and Bowers and popularized by Frey and Child, areused instead of total pancreatectomy whenever possible because of the high mortality of total pancreatectomy.The pancreas lies transversely in the retroperitoneal space, between the duodenum on the rightand the spleen on the left. It is related anteriorly to the omental bursa above, the greater sacbelow, and the transverse mesocolon. For all practical purposes, it is a fixed organ.
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