胰腺癌治疗进展英文.pptxVIP

胰腺癌治疗进展英文第1页/共49页 Pancreatic CancerEpidemiology 2014 - 46,420 new cases in USA2014 - 39,590 deaths4th most common cancer killer2nd most common GI cancer killer (colon #1)第2页/共49页 Pancreatic CancerEpidemiology New Cancer Deaths , United States, 2014.第3页/共49页 Pancreatic CancerEpidemiology Incidence increasing 1% yearly第4页/共49页 Pancreatic CancerEpidemiology 85% of new cases are advancedLocally advanced: blood vessels (Stage III)Distant spread to liver, lungs (Stage IV)第5页/共49页 Late Presentation - Poor SurvivalHowlander et al, SEER Cancer Statistics Review 2012.American Cancer Society, Cancer Facts Figures 2013.StageIIIIIIIVPercent at diagnosis60%45%30%15%0%第6页/共49页 Late Presentation - Poor SurvivalHowlander et al, SEER Cancer Statistics Review 2012.American Cancer Society, Cancer Facts Figures 2013edian Survival (mos)StageIIIIIIIV0Even “early”stage diseaseis advanced第7页/共49页 No Surgery If..Major blood vessels involved (Stage III)Distant metastases (Stage IV) Some Stage III may be exceptions第8页/共49页 Pancreatic ResectionDistal Pancreatectomy (no Appleby)Whipple operation (Pancreaticoduodenectomy)第9页/共49页 Standard Whipple 第10页/共49页 Standard WhippleRoux-en-Yrarely done第11页/共49页 Pylorus Preserving Whipple Cure rate is same with each.. Most resections arePylorus PreservingWhipples第12页/共49页 Pylorus Preserving Whipple第13页/共49页 Factors Influencing Survival 第14页/共49页 182 consecutive patients underwent a Whipple for pancreatic cancer between 1987 and 2005. Patients from 1987-1995 were compared with those from 1996-2005.Study Design第15页/共49页 Results第16页/共49页 SurvivalBiological factors related to tumorDifferentiationNodal involvementPerineural invasionResection margins第17页/共49页 Degree of Tumor DifferentiationActuarial survival estimate for patients with well, moderately, and poorly differentiated adenocarcinoma of the pancreas (P.001).50%(1987-2005)第18页/共49页 Lymph NodesNegativeP