Sunday, January 31, 2016

Treatment For Pancreatic Cancer is best done in Tertiary Referral Centre

Since I left for private practice in 2004,I actively avoid doing Whipples Operation for Periampullary Cancers.

Periampullary Cancers are a collection of cancers within a narrow area of anatomy in the second part of the Duodenum called The Ampulla of Vater.
They are made of;
1.Cancer of the Head of Pancreas
2.Cancer of the Ampulla of Vater
3.Cancer of the Lower Bile Duct(Cholangiocarcinoma)
4.Cancer of the Duodenum



Whipple Operation is considered Radical because of 2 reasons:
1.the removal of adjacent lymph nodes
2.the removal of many adjacent organs which may alter the body's physiological function at a later date

Despite my avoidance of Whipples operation over the last 11 years, I still ended up doing two cases who had been rejected by a few tertiary referral centres that I referred to on the grounds of;

1.patients were too old(both in their later 60s and early 70s)
2.high surgical risk

After obtaining a high risk informed consent from patients and family members, and passed by the preoperative Anaesthetic assessment, I performed the Whipples operations.

One patient had no complication after surgery.The other patient developed Pancreatic Fistula postoperatively but recovered after medical treatment.

I strongly believe Whipples operations and other pancreatic operations are best done in Tertiary Referral Centres which are usually high volume centres for a few reasons;

1.doing many operations will sustain the surgical skills of the surgical team and hence,
2.the risk of major complications will be minimised
3.the database can be maintained and be a source of audit and research


http://www.cancernetwork.com/pancreatic-cancer/treatment-high-volume-center-improved-pancreatic-cancer-survival