TY  - CHAP
M1  - Book, Section
TI  - Chapter 61B. Perspective on Surgery for Exocrine Neoplasms of the Pancreas
A1  - Warshaw, Andrew L.
A2  - Zinner, Michael J.
A2  - Ashley, Stanley W.
PY  - 2013
T2  - Maingot's Abdominal Operations, 12e
AB  - The  last  40  years  have  seen  remarkable  advances  in  what  we  know  about  pancreatic  neoplasms,  their  biology,  how  we  approach  their  management,  and  the  quality  and  safety  of  surgical  treatment.  Some  can  be  attributed  to  better  surgical  technique,  but  most  are  due  to  developments  in  imaging,  along  with  nonsurgical  interventions  such  as  endoscopic  retrograde  cholangiopancreatography  (ERCP),  stenting,  and  percutaneous  or  endoscopic  needle  biopsies.  In  most  cases  the  diagnosis  can  be  made  preoperatively;  the  extent  of  the  tumor  can  be  determined;  and  the  timing  as  well  as  the  nature  of  the  probable  surgical  procedure  can  all  be  planned  before  or  even  instead  of  a  laparotomy.  Pancreaticoduodenectomy  has  become  sufficiently  safe  (2–5%  mortality,  median  postoperative  length  of  stay  8  days  in  high-volume  centers)  that  the  operation  can  be  offered  to  most  patients  without  biopsy  proof  of  malignancy  because  the  risk  of  missing  a  cancer  now  exceeds  the  risk  of  mistakenly  operating  for  a  benign  condition.  This  radical  approach  to  resection  applies  as  well  to  ampullary  neoplasms,  which  contain  cancer  in  up  to  50%  of  villous  adenomas  in  spite  negative  biopsies.  The  conclusion  is  that  a  negative  biopsy  should  not  deter  resection  of  a  lesion  with  significant  malignant  potential.  
SN  - 
PB  - The McGraw-Hill Companies
CY  - New York, NY
Y2  - 2024/04/19
UR  - accesssurgery.mhmedical.com/content.aspx?aid=57021547
ER  -