Preoperative and operative diagnosis of pancreatic cancer

Abstract

The aim of the investigation in the case of pancreatic cancer is to establish the diagnosis and to evaluate resectability. Improved diagnostic methods have made it possible in most cases to diagnose accurately the symptomatic patient with pancreatic cancer. Ultrasonography, computed tomography, endoscopic retrograde cholangiopancreatography (ERCP), and cytology are methods that often complement each other in the diagnostic workup. Percutaneous transhepatic cholangiography (PTC) is useful in the jaundiced patient, but is not as safe for the patient as ERCP. For patients in whom resection is contemplated, angiography is also of interest, as signs of major vessel involvement contraindicate surgery. Pancreatic function tests, tumor markers, and scintigraphy do not contribute enough to be used as diagnostic aids, and laparoscopy is only rarely indicated. At operation the final assessment of resectability is determined by documentation of spread to lymph nodes or to other organs and the invasion of neighboring vessels.

Pancreatic Frozen Section Guides Operative Management With Few Deferrals and Errors

“…In addition, pancreatic resections are also sometimes performed for complicated chronic pancreatitis. 10 Resectability is typically determined by the surgeon at the time of surgery by assessing for possible metastasis and vascular involvement, 34,35 with advanced imaging less reliable. 36,37 Frozen section has proven to be useful, especially when positive 15 and when additional intraoperative findings, not previously documented with imaging studies, are observed.…”