National Patterns of Care for Pancreatic Cancer

Janes, Rebecca; Niederhuber, John E.; Chmiel, Joan S.; Winchester, David P.; Ocwieja, Kathy; Karnell, Johan; Clive, Rosemarie E.; Menck, Herman R.

doi:10.1097/00000658-199603000-00006

Cited by 145 publications

(38 citation statements)

References 4 publications

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“…Thirty-five lesions were located in the pancreatic head (60%), 11 in the body (19%), and 1 in the tail of the gland (2%); there were 9 tumors of the ampulla (16%) and 2 of the distal common duct (3%). All five staging methods were completed in 36 patients.…”

Section: Resultsmentioning

confidence: 99%

Ultrafast Magnetic Resonance Imaging Improves the Staging of Pancreatic Tumors

Trede

Rumstadt²,

Wendl³

et al. 1997

Annals of Surgery

154

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ObjectiveThis prospective study was undertaken to evaluate the accuracy of a noninvasive "all-inone" staging method in predicting surgical resectability in patients with pancreatic or periampullary tumors. Summary Background DataDespite progress in imaging techniques, accurate staging and correct prediction of resectability remains one of the chief problems in the management of pancreatic tumors. Staging algorithms designed to separate operable from inoperable patients to save the latter an unnecessary laparotomy are becoming increasingly complex, expensive, timeconsuming, invasive, and not without risks for the patient. MethodsBetween August 1996 and February 1997, 58 consecutive patients referred for operation of a pancreatic or periampullary tumor were examined clinically and by 5 staging methods: 1) percutaneous ultrasonography (US); 2) ultrafast magnetic resonance imaging (UMRI); 3) dual-phase helical computed tomography (CT); 4) selective visceral angiography; and 5) endoscopic cholangiopancreatography (ERCP). The assessment of resectability by each procedure was verified by surgical exploration and histologic examination. ResultsThe study comprised 40 male and 18 female patients with a median age of 63 years. Thirty-five lesions were located in the pancreatic head (60%), 11 in the body (19%), and 1 in the tail of the gland (2%); there were 9 tumors of the ampulla (16%) and 2 of the distal common duct (3%). All five staging methods were completed in 36 patients. For reasons ranging from metallic implants to contrast medium allergy or because investigations already had been performed elsewhere, US was completed in 57 (98%), UMRI in 54 (93%), CT in 49 (84%), angiography in 48 (83%), and ERCP in 49 (84%) of these 58 patients. Signs of unresectability found were vascular involvement in 22 (38%), extrapancreatic tumor spread in 16 (26%), liver metastases in 10 (17%), lymph node involvement in 6 (10%), and peritoneal nodules in only 2 patients (3%). These findings were collated with those of surgical exploration in 47 patients (81 %) and percutaneous biopsy in 5 (9%); such invasive 393

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Section: Resultsmentioning

confidence: 99%

Ultrafast Magnetic Resonance Imaging Improves the Staging of Pancreatic Tumors

Trede

Rumstadt²,

Wendl³

et al. 1997

Annals of Surgery

154

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“…The survival rate of patients after PPPD for pancreatic malignancies after 3 and 5 years is respectively 10 and 5% for tumors larger than 4 cm, and 56 and 40% for tumors smaller than 2 cm [10]. Patients with a histopathological stage-I tumor (T1–2N0M0) have a 3- and 5-year survival rate of respectively 45 and 15–26% [2,10], compared to stage-II tumors (T3 or N1M0) with a 3-year survival rate of 8% and no survivors after 5 years [10]. Some authors propose that EUS is particularly useful for the detection of smaller tumors (<2 cm), but insufficient data are present to support this [4,6].…”

Section: Discussionmentioning

confidence: 99%

“…The only curative treatment is surgical resection, however most patients present at an advanced stage and only approximately 15% of patients are eligible for resection at the time of diagnosis [2,3]. It is important to detect pancreatic tumors at an early locoregional stage because these patients are most likely to benefit from resection.…”

Section: Introductionmentioning

confidence: 99%

Role of Endoscopic Ultrasonography in Patients Suspected of Pancreatic Cancer with Negative Helical MDCT Scan

Deerenberg¹,

Poley²,

Hermans

et al. 2011

Dig Surg

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Background: In some patients suspected of pancreatic cancer, no mass can be detected by multidetector computed tomography (MDCT) scan as the cause of biliary obstruction. Methods: All patients suspected of pancreatic cancer between January 2007 and 2009 with a negative MDCT were identified from a database. Results: MDCT was performed for suspected pancreatic cancer in 290 patients, and in 258 a pancreatic mass was found. MDCT failed to establish a diagnosis in 32 patients (11%). In 23 patients (74%) with complete endoscopic ultrasonography (EUS), the cause of the obstruction was correctly diagnosed. A mass in the pancreatic head was found in 15 patients; 13 patients had a malignant tumor, and 2 patients a benign cause of obstruction. Further, EUS diagnosed 3 patients with a superficial adenoma of the papilla and 8 patients with a benign cause of the obstruction. In 5 patients EUS could not detect the cause of obstruction but finally a pancreatic malignancy was diagnosed. The positive predictive value of EUS was 86% and the negative predictive value 63%. Accuracy of MDCT and EUS decreased in the presence of pancreatitis or a biliary endoprosthesis. Conclusion: In patients suspected of pancreatic cancer in whom MDCT fails to demonstrate the cause of obstructive jaundice, EUS identifies 74% of the underlying diseases correctly.

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“…Long-term survival in patients with a proven histologic diagnosis is found to be virtually confined to those undergoing tumor resection. Among these, patients with small tumors had a 5-year survival improvement that reached about 35% [31, 32, 33, 34, 35, 36, 37, 38, 39, 40, 41, 42, 43, 44, 45, 46, 47, 48, 49, 50, 51](table 5). …”

Section: Discussionmentioning

confidence: 99%

Improved Survival in Small Pancreatic Cancer

Pantalone

Ragionieri²,

Nesi³

2001

Dig Surg

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Background: Although the incidence of pancreatic cancer is relatively low compared with other tumors (2.4%), the death rate is high. Tumor detection and treatment at an early stage is necessary to improve the poor prognosis of patients, as is demonstrated by some reports showing a 5-year survival rate varying between 19 and 41% for patients undergoing radical pancreatectomy with the highest survival in patients with small tumors. Methods: In our study we retrospectively reviewed the histologic and demographic data of 596 patients who were admitted to the surgical units of the Careggi Hospital (University of Florence-AOC of Florence) between 1988 and 1994 with the incoming diagnosis of pancreatic cancer. Results: Results are reported as the mean ± standard deviation. The postoperative survival rate was calculated by the Kaplan-Meier method and statistical analysis was performed by the log rank test (significance p < 0.05). 247 patients had surgery, 110 with a curative intent. Postoperative mortality was 5.45%. The crude 5-year survival rate for patients who underwent curative surgery was 16.36% (18 patients), but for patients with small lesions confined to the pancreas (T1N0M0, 29 patients) this was even 31.03% (9 patients; p < 0.01, χ² test). Conclusions: Our results indicate that it seems reasonable to consider these cancers as ‘small’, with survival reported in literature from 35 to 41%, so they probably represent the only curable condition at the present time.

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National Patterns of Care for Pancreatic Cancer

Cited by 145 publications

References 4 publications

Ultrafast Magnetic Resonance Imaging Improves the Staging of Pancreatic Tumors

Ultrafast Magnetic Resonance Imaging Improves the Staging of Pancreatic Tumors

Role of Endoscopic Ultrasonography in Patients Suspected of Pancreatic Cancer with Negative Helical MDCT Scan

Improved Survival in Small Pancreatic Cancer

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