Endoscopic and Operative Palliation Strategies for Pancreatic Ductal Adenocarcinoma

Stark, Alexander P.; Hines, Oscar J.

doi:10.1053/j.seminoncol.2014.12.014

Cited by 61 publications

(57 citation statements)

References 64 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Of the 10% who qualify for resection, two thirds develop a recurrence by two years and the five year survival ranges from 3 to 25%. While treatment of the symptoms and complications of the tumor have evolved dramatically [5], the overall survival not improved significantly because of late presentation.…”

Section: Case Reportmentioning

confidence: 99%

See 1 more Smart Citation

Complications from Stents and Lack of Conversations

Gallagher¹

2016

JGPLD

View full text Add to dashboard Cite

was decompressed. Significant biliary duct dilatation, not present on his last CT scan, was noted and there were two irregular fluid collections containing small bubbles of air -probable liver abscesses -that had also developed. The liver metastases had all grown in size in the interim. Clostridium perfringens and Streptococcus anginosus grew in his blood and were susceptible to the antibiotics.The fentanyl infusion was titrated to effective pain relief but he remained delirious and died three days later.The oncologist called the wife several days after he became aware he was in the hospital and was surprised to find he had died. He notes that the wife was angry and told him that both the patient and she felt let down by the medical system and the physicians and nurses who had seen them for his illness. The physician noted "unfortunately clinical deterioration in such as this is all too common in the context of metastatic pancreatic cancer". This case is instructive for two reasons: the risk of serious sepsis in patients with stents and the bereavement reaction of the spouse.Clostridium perfringens is an anaerobic normal inhabitant of the bowel and genital tract. Septicemia from this bacteria usually occurs in patients who are immunocompromized (malignancy, diabetes etc) and have had a recent abdominal or pelvic procedure [1]. The mortality rate is extremely high. Streptococcus anginosus is also associated with abscesses in those who are immunocompromized.Therapy for the complications of pancreatic cancer has evolved tremendously over the last 20 years with the introduction of stenting by endoscopy. Complications such as the liver abscesses, are being reduced by the use of covered self expandable metal stents that have a lower risk of cholangitis and infection [2]. Stenting shows a shortened time to resumption of fluids and food, reduced hospital stay and costs when compared with surgery [3].A recent review [4] of pancreatic cancer noted that on diagnosis 90% of tumors are already locally or systemically involved and therefore not operable. The average survival for those who are not operable is 4 months with the range of 3-11 Case ReportA 59 year-old man had several months of epigastric distress and pain radiating to the back before presenting with obstructive jaundice. CT scan of the abdomen showed a 4cm mass in the pancreas. The biliary obstruction was located 4cm above the ampulla and resolved with the insertion of a Cotton Leung plastic stent. Lesions in the liver, seen on ultrasound, could not be confirmed as metastases on CT scan. Biopsy of the liver lesions by laparoscopy confirmed them as metastases so he was referred for chemotherapy.One month later he developed increasing epigastric pain and vomiting. CT scan showed duodenal obstruction secondary to local tumor growth. An expanding metal stent was inserted via endoscopy and the vomiting stopped the next day. X-ray confirmed good position of the duodenal stent and since he was tolerating fluids he was discharged home the next day.Fatigue, weakness and p...

show abstract

Section: Case Reportmentioning

confidence: 99%

“…A CT scan showed that both stents were in normal position and the stomach months. Those with metastatic disease account for the lower survival range [5] . Of the 10% who qualify for resection, two thirds develop a recurrence by two years and the five year survival ranges from 3 to 25%.…”

Section: Case Reportmentioning

confidence: 99%

Complications from Stents and Lack of Conversations

Gallagher¹

2016

JGPLD

View full text Add to dashboard Cite

show abstract

“…40 Overall recurrent obstruction rates varies from 3% to 46% with an average of 19.6%. 33,35,39 As palliative chemoradiotherapy regimens improve survival, the problem of stent dysfunction becomes an even more significant. Stent dysfunction can be related to incomplete stent expansion, stent collapse, stent migration, stent fracture (Fig.…”

Section: Stent Dysfunctionmentioning

confidence: 99%

“…30,34 Recent recommendations suggest that surgery may be a better option for patients where the expected survival is longer than 2 months, while patients with advanced disease, metastasis, severe malnutrition, concomitant biliary obstruction or poor performance status may benefit more from SEMS. 35,36 Nonetheless, SEMS placement is still considered the treatment of choice over surgical palliation in many institutions due to its less invasive nature.…”

Section: Gastric Outlet Obstruction (Goo) Is a Common Complicationmentioning

confidence: 99%

Enteral stents: Complications and their management

Lopera

Gregorio

Laborda

et al. 2016

Int J Gastrointest Interv

View full text Add to dashboard Cite

The treatment of malignant colonic and gastric outlet obstruction with self-expanding metallic stents (SEMS) is an established technique that can be performed by radiologic or a combination of radiologic and endoscopic guidance. The procedure is very effective to relieve the obstructive symptoms of advanced malignancies, with important clinical benefits and significant improvement in quality of life for the patients. Despite much advancement in the designs of SEMS, enteral stent placement is still associated with some significant early and late complications. Stent dysfunction mainly caused by tumor ingrowth/over growth, and stent migration when covered stent are used, are relatively common complications and many times require reinterventions.

show abstract

“…Persistent pain is positively correlated with the tumour size and infiltration of the intra-and extra-pancreatic nerves [169]. Opioid analgesics have been used for chronic pain [170]. Celiac plexus block has been a common procedure to alleviate pain in patients with unresectable PDAC with potentially fewer adverse events than traditional opioid management [171].…”

Section: Palliative Carementioning

confidence: 99%

Scientific rationale for integrative and personalised strategies for pancreatic ductal adenocarcinoma management

Korhan¹,

Verkerk²,

Critchley³

2017

Integr Mol Med

View full text Add to dashboard Cite

Pancreatic ductal adenocarcinoma (PDAC) arises from epithelia of pancreas. Despite its low incidence, it is the most lethal cancer type. Although the poor outcome is largely secondary to the high proportion of patients who are diagnosed with advanced disease, the prognosis of PDAC is also influenced by the inherent biological aggressiveness and the high metastatic potential of this malignancy. Treatment options remain limited with little progress over the last decades. Some improvements in surgical outcome occur in patients who also receive chemotherapy and/or radiotherapy, however, the impact on long-term survival has been minimal owing to the intense resistance of PDAC to all extent treatments regimen. Hence, there is an urgent need to 1) gain better understanding of the biology of PDAC; 2) to develop early detection and prevention programs; 3) to identify new therapeutic strategies to improve quality of life and survivorship. In this review, first, we will summarise the state of knowledge of PDAC pathogenesis with a particular the focus on the molecular characteristics causing therapeutic resistance. Then, we will briefly review current and emerging approaches in the PDAC care. Lastly, we will highlight the integrative approaches in the light of new experimental and clinical research conducted with the aim of moving towards personalised therapy in patients with PDAC.

show abstract

Endoscopic and Operative Palliation Strategies for Pancreatic Ductal Adenocarcinoma

Cited by 61 publications

References 64 publications

Complications from Stents and Lack of Conversations

Complications from Stents and Lack of Conversations

Enteral stents: Complications and their management

Scientific rationale for integrative and personalised strategies for pancreatic ductal adenocarcinoma management

Contact Info

Product

Resources

About