Malignant tumors of the pancreas are very insidious diseases which are usually discovered late in the course and with bad long term prognosis. Most of the patients are not even aware of the carcinoma until jaundice or pain occurs. However, if the diagnosis is made on time, surgical treatment is the only possible curative solution. We were discussing most important aspects of treatment of pancreatic carcinoma with Đorđe Knežević, MD, who is an expert in pancreatic surgery at “Atlas” General Hospital.
Doctor, please tell us, what are the symptoms that are bringing the patients to doctors office when it comes to pancreatic carcinoma?
Patients are usually complaining on vague, undetermined painful sensations in epigastric region and bellow the right costal arch. That alone would prompt us to look at pancreas as well. Considering the nature of development of malignant tumor of the pancreas, patients are usually seeking doctors attention when painless jaundice occurs, which points us to the head of the pancreas. When the tumor is localized in body or the tail of the pancreas, the first symptom will usually be pain. Patient also frequently complain on loss of appetite and weight loss as well.
Atlas General Hospital successfully performs surgical treatment of pancreatic carcinoma. What is necessary to set a diagnosis?
After physical exam, it is very important to ask for complete lab analysis with tumor markers, especially CA 19-9. After that, we get a pancreas tumor protocol CT scan, after which we can set a diagnosis of pancreatic carcinoma. Sometimes, when tumors are small, we would use endoscopic ultrasound examination (EUS) which is very helpful in borderline cases. Our surgical team in Atlas General Hospital is completely capable of doing full diagnostic measures when it comes to pancreatic carcinoma.
Are all patients candidates for surgical intervention?
Unfortunately, most of the patients are in the advanced stage of the disease when surgical intervention has no benefits. However, a significant number of patients can be candidates for one or another surgical technique.
You say that there are various surgical techniques. Can you explain that in more details, please?
Certainly. Which surgical technique will be used depends primarily on staging and localization of the tumor. When a patient has pancreatic head carcinoma operation of choice is cephalic duodenopancreatectomy, or Whipple procedure. This procedure implies removal of pancreatic head, gallbladder and duodenum, and creation of anastomosis between stomach, pancreatic remnant main bile duct and small intestine. This is a very demanding procedure that requires experienced team of pancreatic surgeons.
When tumor is located in body or tail of the pancreas, we perform distal pancreatectomy, when we remove the tumor with preservation of the spleen. In smaller pancreatic tumors, procedures like enucleation can be performed.
In all cases when patient is jaundiced, and is not a candidate for resection procedure, we would perform endoscopic stent placement or surgical derivation procedure, when a bypass is created between main bile duct and small bowel.
These extensive pancreatic procedures were not performed in private hospitals in Serbia until recently. Team of experts in „Atlas“ General Hospital led by Prof. Srbislav Knežević and Prof. Slavko Matić are performing these procedures regularly, and I am happy to say that our outcomes are excellent.