الفهرس 
Aim of the workOnly 14 pages are availabe for public view
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Abstract
Pancreas is a deep seated organ that is difficult to access, it lies across the spinal column at the level of the 2nd lumbar vertebra extending from the C- loop of the doudenum to the hilus of the spleen.
Cancer pancreas is a common disease but large majority of patients have tumours that are irresectable at time of diagnosis. The annual incidence rate for all types of pancreatic cancer is approximately 9 new cases per 100,000 people, ranking it 11th among cancers.
Risk factors of pancreatic tumours include: cigarette smoking, lack of exercise, diabetes, chronic pancreatitis, high fat and cholesterol diet, previous cholecystectomy, etc.
Ductal adenocarcinoma accounts for the vast majority of malignant pancreatic neoplasms, others include pancreaticoblastoma, acinar cell carcinoma and solid pseudopapillay neoplasm.
Jaundice is an early symptom with pre-ampullary carcinoma (which has better prognosis).Abdominal pain, weight loss, recent onset of diabetes and anorexia are other symptoms.
Despite clear evidence that high quality computed tomography (CT) predicts resectability accurately, many patients undergo laparotomy for pancreatic cancer without adequate preoperative assessment .Some patients are found to have unresectable tumours intraoperatively when such a conclusion might have been possible prior to surgery. Conversely, because of lack of adequate preoperative imaging and surgical experience, many patients with tumours which are resected with ’curative intent’ have been left with gross residual disease which is not recognized by the the surgeon intraoperatively or documented in the operative note.
In deciding whether to operate with a view to resecting a pancreatic cancer, the surgeon must take into account factors related to the patient, the tumour, the institution and the team responsible for the patient’s care. Computed tomography (CT) remains the single most useful staging modality, but MRI continues to have a role in staging .Diagnostic cholangiography, ERCP, percutaneous biopsy, peritoneal cytology and diagnostic laparoscopy are other helpful diagnostic modalities.
For tumours of the pancreatic head, neck or uncinate process, pancreaticodoudenectomy (Whipple’s procedure) remains the only potential curative modality. Modifications of the classic Whipple’s procedure have emerged over years e.g: The pylorus preserving pancreaticoduodenectomy. The role of palliative pancreaticodudenectomy is another subject of debate. The main objectives of palliation are relief of obstructive jaundice, prevention or relief of gastro-intestinal obstruction, and management of pain.