Pancreatic head and duodenum resection

The incidence of pancreatic cancer is increasing, and pancreatic cancer is reported to be the fourth most common cause of cancer-related deaths in the United States. Cancer of the pancreatic head, cancer of the lower bile duct, cancer of the ampulla or duodenal mucosa around the ampulla occurred within 3 cm in diameter of the head of the pancreas. The symptoms and signs of these tumors are similar, but the prognosis is different. Although pancreaticoduodenectomy is a more effective treatment for this type of tumor, its efficacy is still not satisfactory. Pancreatic head cancer is the worst. The other types of cancer are slightly better, but the total surgical resection rate is only 30%, and the surgical mortality and five-year cure rate after resection are only about 10%. The reason for this is that the common bile duct is compressed early in the head of the pancreas, and progressive obstructive jaundice occurs, which seriously damages liver function. In addition, the early spread and metastasis of cancer causes many postoperative patients to die of metastatic cancer. Therefore, early diagnosis and treatment is still the key to improve the efficacy of pancreatic head cancer. Pancreaticoduodenectomy consists of three main steps: exploration, resection, and digestive tract reconstruction. Exploration is a necessary step to determine whether resection is possible. Resection is to remove the pancreatic head, gastric pylorus, all the duodenum, and the lower bile duct and regional lymph nodes [Figure 1]; reconstruction is to separate the common bile duct, pancreatic duct and stomach from Jejunum anastomosis.