Use of Whipple Pancreaticoduodenectomy in a 54-Year-Old Male with Pancreatic Cancer
Alex McColloster
UNTHSC TEXAS COLLEGE OF OSTEOPATHIC MEDICINE
CASE REPORT
SURGERY CORE CLINICAL CLERKSHIP
Introduction Pancreatic cancer remains a highly lethal malignancy due to its clinically silent nature. Patients most often present with jaundice due to compression of the common bile duct, pain that develops insidiously and weight loss. Treatment is accomplished surgically; however, only 15-20 percent of patients are candidates for surgery and 5-year survival post surgery is only 25-30 percent in node-negative and 10 percent in node positive patients 1. Due to its aggressive nature, it is imperative that early …show more content…
The other less common subtypes include: Intraductal papillary mucinous neoplasm with an associated invasive carcinoma, mucinous cystic neoplasms with an associated invasive carcinoma, solid-pseudopapillary neoplasms, acinar cell carcinoma, pancreatoblastoma, and serous cystadenocarcinoma5. These other malignant pancreatic cancers only account for 1-2 percent of all pancreatic cancers 5. As stated above, the cancer generally does not present itself clinically until it is quite advanced due to the insidious nature of the cancer. In our patient, the only symptoms that the patient presented with were those associated with obstruction of the common bile duct; pain was never a concern. This presentation of pancreatic cancer is actually favorable since it allowed us to quickly obtain the correct tests and identify that an underlying cancer was most likely present. Should the cancer have initially started in the pancreatic tail, then the findings of jaundice would occur much later in the disease process, often after the cancer has already metastasized to liver …show more content…
However, as stated above, the overall survival rate post surgery is still dismal. The pancreaticoduodenectomy (Whipple procedure) is the conventional surgical treatment for pancreatic cancer in the head or uncinate process of the pancreas 3. The traditional Whipple procedure included removal of the pancreatic head, duodenum, first 15 cm of the jejunum, common bile duct, and gallbladder, and a partial gastrectomy 3. Newer variants such as subtotal stomach-preserving pancreaticoduodenectomy and the pylorus-preserving pancreaticoduodenectomy are now used to minimize morbidity 3. The pylorus-preserving variant was utilized in our patient. Adjuvant therapy is also necessary in all patients with pancreatic cancer, even if complete resection of the cancer has occurred 4. Therapy usually includes chemotherapy, chemoradiotherapy, and gemcitabine plus capecitabine 4. CA 19-9 levels are checked ever 3-6 months for at least 2 years in order to monitor regression or progression of the disease
Alex McColloster
UNTHSC TEXAS COLLEGE OF OSTEOPATHIC MEDICINE
CASE REPORT
SURGERY CORE CLINICAL CLERKSHIP
Introduction Pancreatic cancer remains a highly lethal malignancy due to its clinically silent nature. Patients most often present with jaundice due to compression of the common bile duct, pain that develops insidiously and weight loss. Treatment is accomplished surgically; however, only 15-20 percent of patients are candidates for surgery and 5-year survival post surgery is only 25-30 percent in node-negative and 10 percent in node positive patients 1. Due to its aggressive nature, it is imperative that early …show more content…
The other less common subtypes include: Intraductal papillary mucinous neoplasm with an associated invasive carcinoma, mucinous cystic neoplasms with an associated invasive carcinoma, solid-pseudopapillary neoplasms, acinar cell carcinoma, pancreatoblastoma, and serous cystadenocarcinoma5. These other malignant pancreatic cancers only account for 1-2 percent of all pancreatic cancers 5. As stated above, the cancer generally does not present itself clinically until it is quite advanced due to the insidious nature of the cancer. In our patient, the only symptoms that the patient presented with were those associated with obstruction of the common bile duct; pain was never a concern. This presentation of pancreatic cancer is actually favorable since it allowed us to quickly obtain the correct tests and identify that an underlying cancer was most likely present. Should the cancer have initially started in the pancreatic tail, then the findings of jaundice would occur much later in the disease process, often after the cancer has already metastasized to liver …show more content…
However, as stated above, the overall survival rate post surgery is still dismal. The pancreaticoduodenectomy (Whipple procedure) is the conventional surgical treatment for pancreatic cancer in the head or uncinate process of the pancreas 3. The traditional Whipple procedure included removal of the pancreatic head, duodenum, first 15 cm of the jejunum, common bile duct, and gallbladder, and a partial gastrectomy 3. Newer variants such as subtotal stomach-preserving pancreaticoduodenectomy and the pylorus-preserving pancreaticoduodenectomy are now used to minimize morbidity 3. The pylorus-preserving variant was utilized in our patient. Adjuvant therapy is also necessary in all patients with pancreatic cancer, even if complete resection of the cancer has occurred 4. Therapy usually includes chemotherapy, chemoradiotherapy, and gemcitabine plus capecitabine 4. CA 19-9 levels are checked ever 3-6 months for at least 2 years in order to monitor regression or progression of the disease