Resection of pancrease

Prepared by: Chong Eunice , 5th year, Group 77

Indications of surgical treatment of pancreas

• Benign
• Cystadenoma : acinar cell cystadenoma, serous
• Intermediate
• IPMN, carcinoid , etc
• Malignant
• Ductal adenocarcinoma
• Acinar-neuroendocrine cancer, etc
Risk factors
• Hereditary pancreatitis
• Hereditary brest/ovarian cancer
• Peutz Jeghers syndrome
• Mutation of BRCA2 gene
Signs & Symptoms : non -specific

• Obstruction of bile ducts – if • Abdominal pain

the adenocarcinoma is located
at the head of the pancreas • Indigestion

• Weight loss • Pain & smelly stool

• Hyperglycemia • Jaundice

• Mid-back pain

• fatigue
Dx:
• Medical anamnesis
• CBC
• Instrumental dx: US, MRI, CT, PET scan
• Oncomarker (non-specific) : PK, CA50, CA19-9, CA125, CA12-4, CA242,
AFP, CEA
Criteria for surgery: resectable stage:
stage 1-3 pancreatic
cancer

* surgery is
contraindicated if there
is metastasis of the
cancer cell because it
doesn't really help to
elongate the life of the
patient
 Procedure : laparoscopic innervation
Pancreatectomy with splenic
vessels preservation:
1. 4 points are made for the
insertion of the trocar.
2. dissect of lienorenal
ligament >> splenocolic
ligament
3. Dissection of inferior
border of pancrease to detach
the pancrease
4. Coagulation of small
pancreatic veins using ligasure
device, and transect the neck
of pancreas with linear stapler
Spleen‐preserving distal pancreatectomy
without splenic vessels preservation
• Splenic vein is clipped to
devide
• transection of pancrease
• Splenic artery is clipped for
devision
• transect the area between
end of the tail of pancrease
and splenic hilum
Post operative care:
• Always check and manage for postoperative pancreatitis
Prognosis
• 1- year survival rate : 8-10%
• 2- year survival rate : nul
• Median life expectancy : not longer than 8 months

The life expectancy for pancreatic neoplasms is very low because it

was mostly found in a very late stage, without any specific signs and
symptoms. They were found by accident most of the time.