الفهرس 
Risk factors & pathology of the Pancreatic tumoursOnly 14 pages are availabe for public view
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Abstract
Pancreatic cancer is rarely diagnosed at an early stage; two-thirds of patients have locally advanced or metastatic disease at the time of diagnosis. At the present time, accurate staging represents, without a doubt, one of the primary objectives to be pursued in the treatment of this disease. The choice of the best therapeutic strategy is, in fact, strictly dependent upon accurate preoperative staging and evaluation of respectability.
A complete clinical evaluation should be performed, with a focus on performance status and optimization of comorbidities. Standard relevant laboratory blood work included serum tumor markers, Preoperative computerized tomography (CT) scans with pancreas protocol also should be performed. Magnetic resonance imaging and/or endoscopic ultrasonography should be selectively performed at the discretion of the surgeon.
Appropriate patient selection is important and appropriate by the surgeon. Inclusion criteria included tumors confined to the pancreatic head or periampullary region and favorable vascular anatomy, as demonstrated on preoperative imaging. Exclusion criteria included multiple prior abdominal surgeries, anticipated hostile abdomen, locally advanced tumors, and inability to withstand prolonged anesthesia. Obese patients also (body mass index >40) are not good candidates for LPD. Presence of excessive adipose tissue in the greater and lesser omenta and retroperitoneal tissues does not augur well for laparoscopic completion of the procedure.
Laparoscopic pancreaticoduodenectomy with resection of the distal stomach (Whipple resection) is the historical standard procedure for tumors of the pancreatic head and during the last two decades, preservation of the pylorus (Pylorus-preserving pancreaticoduodenectomy) has been widely accepted .
The most feared complications after Laparoscopic pancreaticoduodenectomy are pancreatic fistula and leakage, dehiscence of the pancreaticoenteric anastomosis that leads to abscess formation, peritonitis, sepsis, hemorrhage and post operative respiratory complications.
Radiation therapy is usually recommended for patients who have localized pancreatic cancers that cannot be removed. It is also generally recommended either following surgical removal of the pancreatic tumor or before an attempt at removal.
Surgical palliation of unresectable pancreatic tumors can improve the quality of life of these patients.
Laparoscopic pancreaticoduodenectomy is a technically challenging operation. In selected patients, it is safe and feasible with acceptable perioperative results. With all the advantages of minimal access operation, including early mobilization, early return of bowel function, short hospital stay, and early return of capability of independent care, decreased pain, The associated cosmesis is also preferred by most patients, it is possible to obtain a 5-year actuarial survival rate of 30.4%. This operation requires an advanced degree of laparoscopic skills.