Sistema gastrointestinal y digestivo

Abstracto

Pancreas Cancer: Epidemiological, Clinical, Morphological Aspects, and Therapeutic Modalities: Result of a Moroccan University Centre

Aomari A, Firwana M, Rahaoui A, Bakkali M, Afifi R and Essaid EA

Introduction: Cancer of the pancreas is one of the most aggressive solid tumors often discovered at a locally advanced or metastatic. Adenocarcinoma is the most common histological type. The aim of our study was to analyze the profile of pancreatic cancer by the various imaging techniques.

Materials and methods: Descriptive retrospective study over a period of 7 years including all patients who were followed for pancreatic cancer. The epidemiological data, clinical, morphological and treatment were collected, all the patients were hospitalized. The therapeutic decision was taken after a multidisciplinary meeting between the different specialists in the Department of Gastroenterology and liver diseases, medicine C, ibn sina hospital, Rabat, Morocco.

Results: Over a period of 7 years, 67 patients were collected. These 37 men and 30 women with a sex ratio of 1.23. The average age was 60 years (26-93 ans). 37% of patient’s had a history of diabetes. Clinically 43% of patients had cholestatic jaundice, 28% had abdominal pain. Clinical examination revealed an abdominal mass in 23% of cases. Abdominal ultrasound showed dilatation of the biliary tract in 67% of cases, the abdominal scanner allowed the diagnosis of pancreatic cancer in 88% of cases. The tumor site was cephalic in 67% of cases, corporeal in 7% of cases and caudal in 25% of cases. Magnetic resonance imaging (MRI) was reported in 11% of patients for suspected intra-ductal papillary mucinous neoplasms (IPMNs) or as a complement to the diagnosis. Echoendoscopy was performed in 11% of the patients as part of the locoregional extension. The average size of the tumor was 48 mm. CA19-9 was only dosed in 26 patients. It was positively positive in 65% of patients and normal in 35% of patients. Histologically, 83% had adenocarcinoma, 3% had lymphoma, 3% had neuroendocrine tumors, and 5% had degenerated IPMNs. Cancer was resectable in 9 patients (13%). The main operative contraindications were vascular and lymph node invasion in 6 patients (8%) and pulmonary or peritoneal liver metastases in 53 patients (80%). For patients with non-resectable cancer, palliative treatment was indicated either by surgical biliary drainage in 4% patients or by endoscopic insertion of biliary prosthesis in 14% of cases or by external biliary drainage in 4% of cases. Chemotherapy was indicated in 78% of patients. Therapeutic abstention was indicated in 10 patients.

Conclusion: In our study 82% of pancreatic cancers were diagnosed in the metastatic stage and 10% in locally advanced stage. The only curative treatment currently exists is surgery that has been achieved only in 8% of our patients.