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  • Peri-Ampullary Neoplasms

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    Michelle De Freitas
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    The document discusses pancreatic cancer and its treatment. It notes that pancreatic cancer most commonly occurs in the tail of the pancreas due to its distal location. It states that resection is the best option for these cancers since they are very aggressive, though resection had a high mortality rate historically due to limitations in antibiotics, equipment, and supportive care. The document describes a surgery for pancreatic cancer that involves removing the stomach, duodenum, part of the jejunum, gallbladder, common bile duct, and head and neck of the pancreas to achieve very wide margins and an R0 resection. It notes some risks of the surgery like pancreatic fistula formation.

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    class notes

    Original Title

    2. Peri-Ampullary Neoplasms

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    The document discusses pancreatic cancer and its treatment. It notes that pancreatic cancer most commonly occurs in the tail of the pancreas due to its distal location. It states that resection is the best option for these cancers since they are very aggressive, though resection had a high mortality rate historically due to limitations in antibiotics, equipment, and supportive care. The document describes a surgery for pancreatic cancer that involves removing the stomach, duodenum, part of the jejunum, gallbladder, common bile duct, and head and neck of the pancreas to achieve very wide margins and an R0 resection. It notes some risks of the surgery like pancreatic fistula formation.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
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    14 views9 pages

    Peri-Ampullary Neoplasms

    Uploaded by

    Michelle De Freitas
    The document discusses pancreatic cancer and its treatment. It notes that pancreatic cancer most commonly occurs in the tail of the pancreas due to its distal location. It states that resection is the best option for these cancers since they are very aggressive, though resection had a high mortality rate historically due to limitations in antibiotics, equipment, and supportive care. The document describes a surgery for pancreatic cancer that involves removing the stomach, duodenum, part of the jejunum, gallbladder, common bile duct, and head and neck of the pancreas to achieve very wide margins and an R0 resection. It notes some risks of the surgery like pancreatic fistula formation.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Flag for inappropriate content
    of 9

    Wednesday, 2 September 2020 10:01 PM

    Through the head- distal end of common bile duct


    Main duct of Wirsung and accessory duct of Santorini which empty

    glucagon
    insulin
    somatostatin
    Pancreatic polypaptides

    HPB Page 1
    More commonly in tail because of how distal and removed from imortant strucutres it is
    Present with metastitic disease as well

    Tail, body, spleen, splenic artery and splanic vein en bloc

    HPB Page 2
    In gb and hepatic ducts

    States that iin presence in obstructive jaundice, dilated gb is not due to stones
    If it were stones gb would be scarred and non distendible

    HPB Page 3
    States that iin presence in obstructive jaundice, dilated gb is not due to stones
    If it were stones gb would be scarred and non distendible

    Disruption of hepatic plates

    DIRECT HYPERBILIRUBINEMIA

    DEPOSITED IN ALL BODY TISSUES-

    When irritation of cutaneous nerves

    Severe jaundice of malignancy compared to mild jaundice of gallstones

    HPB Page 4
    D
    U
    C
    T
    A
    L ENZYMES

    Disruption of extrinsic clotting system

    Usu screening but little management plans made using this

    GOLD STANDARD - only thing for making management decisions

    HPB Page 5
    Resection withclear margins and no microscopic tumors remained
    Since these carcinomas are very aggressive- resection is the best option

    Bc limitations of his time- abx, equipment, technology, rudimentary supportive care


    Had a high mortality

    HPB Page 6
    Incisure of stomach along with antrum and pylorus
    Common hepatic duct, part of gall bladder and the cystic duct
    The entire duodenum, part of the jejunum
    Head and neck of pancreas- VERY WIDE MARGINS TO ENSURE ALL NEOPLASTIC CELS REMOVED- R0
    RESECTIONS

    All the holes after surgery


    Points of reconstruction

    40 cm down

    HPB Page 7
    Passive closed drain left behind this jejunostomy
    Drain is checked at day 5 and if amylase low, it is removed, If
    Amylase v high- it remains as a controlled fistula

    PE, MI, Stroke, intrabdominal abscess

    Keloid scar, uti, atelectasis,

    Enteric feeding initiated 2-3 days post surgery


    Post surgical monitoring- always monitored for new mets or recurrences
    Yearly CT Scan

    HPB Page 8
    Emerged in the late 1990s

    For pts who are not candidates for R0 resections

    HPB Page 9

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