New role of angiography in management of malignant tumors in the body of the pancreas
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Preoperative arteriography was performed on 45 patients with malignant tumors in the body of the pancreas, which extended to the surroundings far beyond the border of the gland.
According to the pattern of tumor infiltration to the splenic artery, these were divided into the normal appearing type, the smooth tapering type, the rough tapering type and the obstructing type, the incidence of which was six, nine, twenty-one and nine, respectively. The former two types belonged to the expansive group, which consisted of cystadenacarcinoma, nonfunctioning islet cell carcinoma, acinar cell carcinoma, sarcoma and carcinoid as well as ductal cell carcinoma. The latter two belonged to the infiltrative group, all of which were ductal cell carcinomas.
Almost all of the tumors with increased vascularity belonged to the expansive group, on which effect of chemotherapy might be expectable.
On laparotomy, the tumors with the expansive group tended to be associated with liver metastasis, while those with the infiltrative group often showed peritoneal dissemination rather than hematogenous metastasis.
Removal of the main tumor could be performed fairly easily for lesions with the normal appearing type, but none of those with the obstructing type was resected.
The longest survival was in those with the normal appearing type. In contrast, the poorest prognosis was in those with the obstructing type. In the smooth tapering and the rough tapering types, the prognosis was also poor, but removal of the main tumor in the smooth tapering type resulted in prolongation of survival time.
It was found that splenic arteriography can be used as a part of the evaluation of malignant tumors in the body of the pancreas, for which only a few available tools to define its clinical aspects as well as its management have yet been established.
Key Wordsmalignant tumors in the body of the pancreas splenic arteriography tumor extension tumor resectability survival after arteriography
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