Neoplastic disease

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Pancreatic cancer is an aggressive neoplastic disease, with overall 5-years survival rate from all stages of less than 5%, making it, the4th cause of cancer related death in the United States of America. Despite the innovation of diagnostic and therapeutic modalities during the year 2013 it was estimated that approximately [45] 2200 peoplewere diagnosed with pancreatic adenocarcinoma and 38,460 died from it. With the majority of patients presenting with unrespectable tumor, locally advanced or metastatic disease and around 80% ofpatients are jaundiced. For those with respectable tumor withoutevidence of metastasis, pancreaticoduodenectomy is the only option for cure, whereas radiation therapy, chemotherapy, and other newer experimental therapeutic modalities such as anti-hormonal therapy orsystemic use of anti-pancreatic cancer cell monoclonal antibodies havenot led to substantial prognostic improvements. Obstructive jaundice is thought to increase the risk of perioperative and postoperative complications. Experimental studies performed on mice assigned to biliary ligation to induce obstructive jaundice showed significant complications in these animals such as coagulopathy, Cholangitis, hepatic dysfunction, intestinal barrier derangement, immunity dysfunction, wound healing retardation, renal dysfunction, cardio- pulmonary insufficiencies as well as end toxemia. Understanding well the pathophysiology of obstructive jaundice related complications in 1935 Sir A.O. Whipple first introduced the concept of preoperative biliary drainage in jaundiced patients with pancreatic head cancer in order to improve postoperative outcomes. Subsequently, Carter contributed with a percutaneous trans hepatic-cholangiography (PTC).

 

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Pancreatic Disorder and Therapy