Current controversies in pancreatic surgery for malignant….pdfVIP

Current controversies in pancreatic surgery for malignant diseases Yoram Kluger MD, FACS Facts and figures- pancreatic cancer • In 2010, 43140 patients diagnosed with PDA • 36180 died from PDA • In Israel- 5 new cases/year • Median survival 4-6 months • Overall 5 years survival- 5% • Operable cases- median survival- 11-22 months • 65% head and neck tumors • 15% body and tail tumors • 20% diffuse tumors Cellular Classification of Pancreatic Cancer Malignant Duct cell carcinoma (90% of all cases) Acinar cell carcinoma Papillary mucinous carcinoma Signet ring carcinoma Adenosquamous carcinoma Undifferentiated carcinoma Mucinous carcinoma Giant cell carcinoma Mixed type (ductal-endocrine or acinar-endocrine) Small cell carcinoma Cystadenocarcinoma (serous and mucinous types) Unclassified Pancreatoblastoma Papillary-cystic neoplasm (Frantz tumor) Invasive adenocarcinoma associated with cystic mucinous neoplasm or intraductal papillary mucinous neoplasm Borderline Malignancies Mucinous cystic tumor with dysplasia Intraductal papillary mucinous tumor with dysplasia Pseudopapillary solid tumor Survival - PDA First Author (yr) Number of Patients Follow-up, (mo) Median Survival (mo) Estimated 4- or 5-yr Survival (%) † Spitz(1997) 60 19 20.2 NA † Yeo(1997) 282 12 18 NA ‡ Nitecki(1995) 174 22 17.5