A Clinicopathological Study And Management Of Carcinoma Pancreas

BACKGROUND Pancreatic cancer is the ninth most common cancer and is fourth most common cause of cancer related death. More than 85% of pancreatic cancers are ductal adenocarcinoma. They arise most commonly from the head. They are mostly scirrhous tumours characterised by neoplastic glands with marked desmoplastic fibrous stroma. Even for patients with a tumour that has been surgically removed, local and systemic recurrence is common and the median survival is only 17 - 23 months. Aims-To study the epidemiology of pancreatic malignancies. To study the time of presentation and operability in the patients with carcinoma pancreas presenting to GGH, Kakinada. Role of various investigative modalities in diagnosing pancreatic cancers. Types of treatment given (curative resections, palliations and chemo and radiotherapy). Morbidity of the patients undergoing surgical treatment. Survival of patients with various modalities of treatment. Post-operative followup.MATERIALS AND METHODSA prospective study was conducted among patients admitted to surgical wards in Government General Hospital, Kakinada with imaging suggestive of mass in pancreas during the time period of July 2014 to October 2016.RESULTSThe mean age of presentation is 49.71 yrs. Pancreatic cancers appear to be more common in men. Of the 38 patients studied 36 patients had adenocarcinoma, 1 patient had pseudopapillary tumour and 1 patient had main duct IPMN. The most common symptom with which patients presented is Jaundice (87%) followed by loss of weight and appetite (79%). Pseudopapillary tumour and cystic neoplasm of pancreas did not present with jaundice. Gallbladder was palpable in 19 cases (50%). Vomiting occurred in 4 patients who developed gastric outlet obstruction. Number of patients in whom CECT was suggestive of an operable tumour, but intraoperatively tumour was inoperable are 9/27. Among the 38 cases studied, only 17 patients had raised CA19-9 levels, which is around 44.73%. Definitive procedure was done in 18 patients, whereas palliative surgery was done in 9 patients. Complications-The most common complication after pancreatic resections is surgical site infection. Other complications encountered are pancreatic leaks, delayed gastric emptying, reactionary haemorrhage and precipitation of other medical conditions like CCF; 2 patients died in post-operative period 3rd and 6th day. In the present study, the mean survival among the operative group is 11.68 months compared to 4.06 months in palliative group. There is a clear overall survival in patients post resection; 12 patients are still in followup, 7 of whom underwent palliative procedure and patients underwent resection.CONCLUSION.Males compared to females suffered more in the ratio of 23: 15.There is steady increase in the incidence of pancreatic malignancies with age with peak incidence between 50 - 60 yrs.Jaundice followed by loss of weight and loss of appetite are the most common symptoms.Elevated bilirubin with palpable gallbladder is seen in 50% of cases only.USG abdomen is a useful screening method for identification of dilated CBD and presence or absence of mass lesion of pancreas and to see for any distension of gallbladder.Dilated CBD with mass in the head of pancreas is the most common imaging finding.Most of the patients present late and more than half (52.63%) presented with a Metastatic disease.Pancreatic protocol CECT abdomen is used for determining preoperative resectability and had significant false positives (9/25).Most common surgery done in our department is PPPD, followed by distal pancreatectomy and high number of palliative procedures.Surgeries for pancreatic malignancies have high morbidity due to the poor patient reserve and advanced stage of presentation.Even after a successful resection of the tumour, in followup the 1 year survival rate is 55.55%.Due to the advanced presentation, most of the patients have poor outcome following pancreatic surgeries. So high index of suspicion should guide towards USG screening in elderly patients with H/o smoking and loss of weight and appetite with or without jaundice.