Cirujano General

Contents by Year, Volume and Issue

Table of Contents

General Information

Instructions for Authors

Message to Editor

Editorial Board

>Journals >Cirujano General >Year 2017, Issue 3

Aragón QC, Guevara LJA, Casas GJC, Castillo FA
Experience in handling pancreatic cancer with laparoscopic Whipple at the General and Central Hospital of Chihuahua
Cir Gen 2017; 39 (3)

Language: Español
References: 30
Page: 152-156
PDF: 4. Kb.

Full text


Pancreatic cancers are usually aggressive malignancies with high mortality rates, which can be solid or cystic. The most common solid pancreatic neoplasms are pancreatic ductal adenocarcinoma (PDAC) and pancreatic neuroendocrine tumors (PNET). In Mexico, pancreatic cancer is the fifth most common malignancy in men and seventh in women. The clinical presentation of pancreatic cancer depends primarily on the location of the tumor within the pancreas. Most (85%) of pancreatic cancers develop inside the head of the pancreas. About 10% occur in the pancreatic body and 5% in the tail. Diagnosis of pancreatic cancer is established may be difficult to diagnose, in those patients who present with obstructive jaundice, suspicion of pancreatic cancer is very high are performed various imaging studies such as abdominal ultrasound or CT scan of the abdomen, or both. Whipple surgery or pancreatoduodenectomy is the only potentially curative therapy for the treatment of resectable pancreatic cancer. The operative mortality rate in experienced surgeons is less than 5% and high as 20%-30%. Postoperative deaths are due to complications such as pancreatic and biliary fistulas, bleeding and infection. Studies comparing open pancreatoduodenectomy (OPD) and laparoscopic pancreatoduodenectomy (LPD) found decreased blood loss, longer surgical time, similar rate of post-operative complications, decreased pain and shorter length of hospital stay in patients undergoing LPD. In this study, 8 patients with a mean age of 53 years (52.87) and a diagnosis of resectable pancreatic cancer were involved. The imaging studies obtained were computed tomography and endoscopic retrograde cholangiopancreatography. Pancreatoduodenectomy was performed in 5 patients (average operating time 280 minutes and blood loss of 837.5 ml), 2 of the patients were converted to open surgery, 2 of the patients died. Complications of the procedure included: high expenditure pancreatic fistula, biliary leakage and intra-abdominal abscesses. The average hospital stay was 11 days.

Key words: Pancreatic cancer, Whipple’s surgery or pancreatoduodenectomy, treatment of resectable pancreatic cancer, open versus laparoscopic pancreatoduodenectomy.


  1. Decker GA, Batheja MJ, Collins JM, Silva AC, Mekeel KL, Moss AA, et al. Risk factors for pancreatic adenocarcinoma and prospects for screening. Gastroenterol Hepatol (N Y). 2010; 6: 246-254.

  2. Novotný I. Precancerous conditions and risk factors for pancreatic and bile duct cancer. Klin Onkol. 2013; 26: S29-33.

  3. Becker AE, Hernandez YG, Frucht H, Lucas AL. Pancreatic ductal adenocarcinoma: risk factors, screening, and early detection. World J Gastroenterol. 2014; 20: 11182-11198.

  4. Robles DG, Fastag D. Cáncer de páncreas: epidemiología y factores de riesgo. Memorias. Cáncer de páncreas. Rev Gastroenterol Mex. 2007; 72: 154-159.

  5. Del Chiaro M, Segersvärd R, Lohr M, Verbeke C. Early detection and prevention of pancreatic cancer: is it really possible today? World J Gastroenterol. 2014; 20: 12118-12131.

  6. Shroff RT, Wolff RA, Javle MM. Pancreatic cancer. En: Kantarjian HM, Wolff RA, Koller CA. eds. The MD Anderson Manual of Medical Oncology, Chapter 18. 2e. New York, NY: McGraw-Hill; 2011. pp. 321-339.

  7. Stern SC, Cifu AS, Altkorn D. Jaundice and abnormal liver enzymes. En: Stern SC, Cifu AS, Altkorn D, eds. Symptom to diagnosis: an evidence-based guide, 3e. New York, NY: McGraw-Hill; 2014. pp. 234-241.

  8. Merkow J, Paniccia A, Edil BH. Laparoscopic pancreaticoduodenectomy: a descriptive and comparative review. Chin J Cancer Res. 2015; 27: 368-375.

  9. Al-Hawary MM, Francis IR, Anderson MA. Pancreatic solid and cystic neoplasms: diagnostic evaluation and intervention. Radiol Clin North Am. 2015; 53: 1037-1048.

  10. Tempero M, Arnoletti JP, Ben-Josef E, Bhargava P, Casper ES, Kim P, et al. Pancreatic adenocarcinoma. Clinical practice guidelines in oncology. J Natl Compr Canc Netw. 2007; 5: 998-1033.

  11. Boyle J, Czito B, Willett C, Palta M. Adjuvant radiation therapy for pancreatic cancer: a review of the old and the new. J Gastrointest Oncol. 2015; 6: 436-444.

  12. Herman JM, Swartz MJ, Hsu CC, Winter J, Pawlik TM, Sugar E, et al. Analysis of fluorouracil-based adjuvant chemotherapy and radiation after pancreaticoduodenectomy for ductal adenocarcinoma of the pancreas: results of a large, prospectively collected database at the Johns Hopkins Hospital. J Clin Oncol. 2008; 26: 3503-3510.

  13. Correa Rovelo JM, Castillo V, José V. Cirugía gastrointestinal: guía práctica. México: Editorial Alfil. 2012. pp. 246-256.

  14. Tempero MA, Arnoletti JP, Behrman SW, Ben-Josef E, Benson AB 3rd, Casper ES, et al. National Comprehensive Cancer Networks. Pancreatic adenocarcinoma, version 2.2012: featured updates to the NCCN Guidelines. J Natl Compr Canc Netw. 2012; 10: 703-713.

  15. Visser BC, Ma Y, Zak Y, Poultsides GA, Norton JA, Rhoads KF. Failure to comply with NCCN guidelines for the management of pancreatic cancer compromises outcomes. HPB (Oxford). 2012; 14: 539-547.

  16. Robles Díaz G, Fastag D. Cáncer de páncreas: epidemiología y factores de riesgo. Memorias. Cáncer de páncreas. Rev Gastroenterol Mex. 2007; 72: 154-159.

  17. Whipple AO. The rationale of radical surgery for cancer of the pancreas and ampullary region. Ann Surg. 1941; 114: 612-615.

  18. Sharma A. Chapter 28. Tumors of the Pancreas. En: Greenberger NJ, Blumberg RS, Burakoff R. eds. CURRENT Diagnosis & Treatment: Gastroenterology, Hepatology, & Endoscopy, 2e. New York, NY: McGraw-Hill; 2012. pp. 345-360.

  19. Ballehaninna UK, Chamberlain RS. Biomarkers for pancreatic cancer: promising new markers and options beyond CA 19-9. Tumour Biol. 2013; 34: 3279-3292.

  20. Ferlay J, Soerjomataram I, Ervik M, Dikshit R, Eser S, Mathers C, et al. GLOBOCAN 2012 v1.0, Cancer Incidence and Mortality Worldwide: IARC CancerBase No. 11 [Internet]. Lyon, France: International Agency for Research on Cancer. 2013. Available in: http://globocan.iarc.fr.

  21. Partensky C. Epidemiology of pancreatic adenocarcinomas. Rev Prat. 2015; 65: 364-6, 369-70.

  22. Doherty GM. Pancreas. En: Doherty GM, eds. CURRENT Diagnosis & Treatment: Surgery, 14e. New York, NY: McGraw-Hill; 2015. pp. 567-575.

  23. Chang DK, Johns AL, Merrett ND, Gill AJ, Colvin EK, Scarlett CJ, et al. Margin clearance and outcome in resected pancreatic cancer. J Clin Oncol. 2009; 27: 2855-2862.

  24. — Chong I, Cunningham D. Cáncer de páncreas. En: Longo DL, Kasper DL, Jameson J, Fauci AS, Hauser SL, Loscalzo J. eds. Harrison. Principios de Medicina Interna, 18e. New York, NY: McGraw-Hill; 2012. pp. 1164

  25. — Fisher WE, Andersen DK, Windsor JA, Saluja AK, Brunicardi F. Pancreas. En: Brunicardi F, Andersen DK, Billiar TR, Dunn DL, Hunter JG, Matthews JB, Pollock RE. eds. Schwartz’s Principles of Surgery, 10e. New York, NY: McGraw-Hill; 2014. pp. 987-999.

  26. — Rosenthal MH, Lee A, Jajoo K. Imaging and endoscopic approaches to pancreatic Cancer. Hematol Oncol Clin North Am. 2015; 29: 675-699.

  27. — Munroe CA, Fehmi SM, Savides TJ. Endoscopic ultrasound in the diagnosis of pancreatic cancer. Expert Opin Med Diagn. 2013; 7: 25-35.

  28. — Jackson NA, Enzinger PC. Chapter 98. Gastrointestinal Malignancies. En: Halter JB, Ouslander JG, Tinetti ME, Studenski S, High KP, Asthana S. eds. Hazzard’s geriatric medicine and gerontology, 6e. New York, NY: McGraw-Hill; 2009. pp. 876-882.

  29. — Popescu I, Dumitrascu T. Total meso-pancreas excision: key point of resection in pancreatic head adenocarcinoma. Hepatogastroenterology. 2011; 58: 202-207.

  30. — Corsini MM, Miller RC, Haddock MG, Donohue JH, Farnell MB, Nagorney DM, et al. Adjuvant radiotherapy and chemotherapy for pancreatic carcinoma: The Mayo Clinic experience (1975-2005). J Clin Oncol. 2008; 26: 3511-3516.

>Journals >Cirujano General >Year 2017, Issue 3

· Journal Index 
· Links 

Copyright 2019