(no Appleby)
• Whipple operation
(Pancreaticoduodenectomy)
Standard Whipple
Standard Whipple
Roux-en-Y rarely done
Pylorus Preserving Whipple
Cure rate is same with each.. Most resections are Pylorus Preserving Whipples
Lymph Nodes
Survival
Lymph Nodes
100% 80% 60% 40% 20% 0% 0
Negative
Positive
12
24
36
Months of Follow Up
28% 22%
48
(1987-2005)
Negative
Positive
Actuarial survival for node-negative (solid line) and node-positive (dotted line) patients with adenocarcinoma of the pancreas undergoing a pancreaticoduodenectomy (P<.001).
Survival
100% 80% 60% 40% 20% 0% 0
(1987-2005)
Tumor Differentiation
50%
12
24
36
48
60
Months of Follow Up
Well
Moderate
Poor
Actuarial survival estimate for patients with well, moderately, and poorly differentiated adenocarcinoma of the pancreas (P<.001).
60%
Percent at diagnosis
45% 30% 15%
0%
I
II
III
IV
Stage
Howlander et al, SEER Cancer Statistics Review 2012. American Cancer Society, Cancer Facts & Figures 2013.
Late Presentation - Poor Survival
24
Even “early” stage disease is advanced
18
Median 12 Survival
(mos)
6
0
I
0
II
III
IV
Stage
Howlander et al, SEER Cancer Statistics Review 2012. American Cancer Society, Cancer Facts & Figures 2013.
Results
Survival
Biological factors related to tumor
• Differentiation • Nodal involvement • Perineural invasion • Resection margins
Degree of Tumor Differentiation
36%
60
Actuarial survival for patients with adenocarcinoma of the pancreas undergoing pancreaticoduodenectomy (P<.001).
(colon #1)
Pancreatic Cancer
Epidemiology
New Cancer Deaths , United States, 2014.
Pancreatic Cancer
Epidemiology
Incidence increasing 1% yearly
Pancreatic Cancer
Pylorus Preserving Whipple
Factors Influencing Survival
Study Design
182 consecutive patients underwent a Whipple for pancreatic cancer between 1987 and 2005. Patients from 19871995 were compared with those from 1996-2005.
Pancreatic Cancer
Epidemiology
• 2014 - 46,420 new cases in USA • 2014 - 39,590 deaths • 4th most common cancer killer • 2nd most common GI cancer killer
38%
60
Perineural Invasion
Survival
100% 80% 60% 40% 20% 0% 0
(1987-2005)
PeriNeural Invasion
Negative
36%
PositiveΒιβλιοθήκη 122413%
36
48
Months of Follow Up
Absent
Present
Epidemiology
• 85% of new cases are advanced • Locally advanced: blood vessels
(Stage III)
• Distant spread to liver, lungs
(Stage IV)
Late Presentation - Poor Survival
No Surgery
If..
• Major blood vessels involved
(Stage III)
• Distant metastases (Stage IV) • Some Stage III may be
exceptions
Pancreatic Resection
• Distal Pancreatectomy
Pancreatic Cancer Surgical Approach in the
USA - 2014
Howard A. Reber, MD Professor of Surgery UCLA School of Medicine
Agi Hirshberg Center for Pancreatic Diseases at UCLA