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Pancreatic cystic tumors that have no obvious symptoms and come "quietly"
With the popularity of medical examinations
More and more patients are being examined
Check it out
Cystic tumors
The word "tumor" stands out
Let quite a few patients
Panicked, more troubled
Cystic tumors of the pancreas
Should it be removed or not?
What should I pay attention to after surgery?
Will I get diabetes or indigestion?
The experts are here for you today
Interpret these questions in detail!
What are the clinical manifestations of pancreatic cystic tumors?
How to achieve early detection?
Pancreatic cystic tumors often have no particularly obvious clinical symptoms, and most patients are found through physical examination. With the popularity of physical examination, a large number of patients with pancreatic cystic tumors will be found and treated, generally through abdominal enhancement CT or MRI can be detected early, and some people can also be detected by abdominal B ultrasound.
Do all pancreatic cystic tumors have to be removed?
Should I choose follow-up? Or surgery?
First, pancreatic cystic tumors cannot be eliminated by drugs, but not every patient with pancreatic cystic tumors needs surgery. We should consider an individualized surgical evaluation of the patient based on the following points:
First, whether the lesion has symptoms or risk of malignancy. The high-risk risk of malignancy includes: elevation of tumor markers such as carbohydrate antigen (CA199), strengthening of appendage nodules in the fine structure of cysts, tumor diameter greater than 3 cm, sudden tumor enlargement in a short period of time, accompanied by dilation of the pancreatic duct, especially the main pancreatic duct.
Second, when we consider surgery for pancreatic cystic tumors, we should also take into account the patient's personal factors.
First, the age of the patient is taken into account. Pancreatic cystic tumors are a benign onset, slow-developing, potentially malignant disease that is at risk of developing malignancy after several years. Therefore, for elderly patients, we generally choose a more conservative plan, because the risk of surgery may be more problematic for elderly patients.
For younger patients, aggressive treatment is recommended because the risk of potential malignancy increases with age. Surgery is meaningful for younger patients, and patients can benefit from it.
Second, consider the cyst site. Pancreatic surgery is more complicated, and the surgical method is different for different cyst sites. In general, the closer the lesion is to the tail, the trauma and cost of surgery are relatively small, and the safety is relatively high. For such lesions, a more aggressive treatment is usually available.
The lesion is close to the pancreatic head, especially in patients who want to undergo extensive excision of the pancreatic duodenum, the surgical risk is large, the cost and trauma are also large. For such patients, we need to strike a balance between the risk of malignancy and the cost of surgery. Therefore, patients are advised to go to a regular, experienced pancreatic center for appropriate treatment strategies.
Patients during follow-up
What do I need to pay attention to?
Pancreatic cystic tumors themselves have no symptoms, there are not many places that need to be paid attention to deliberately, and patients can work, live, and socialize normally, but they need regular follow-up. Patients with no or no clear risk factors are followed up once a year. At follow-up, ct, magnetic resonance or ultrasound endoscopy are recommended to compare the characteristics of pancreatic cystic tumors, and ordinary abdominal B ultrasound may not achieve a very good follow-up effect.
What are the current surgical modalities?
Robotic surgery versus laparoscopic surgery
Which one is better?
In terms of the way of surgical operation, traditional pancreatic surgery is mainly open surgery, but in the past 20 years, minimally invasive surgery such as laparoscopic surgery and robotic surgery has developed rapidly. Pancreatic cystic tumor surgery does not have many oncological requirements (e.g., lymph node dissection) and is ideal for minimally invasive surgery.
The difference between laparoscopic surgery and robotic surgery is that laparoscopic surgery relies on the surgeon to directly control the surgical instruments, while robotic surgery uses the robot's robotic arm to complete the operation.
The biggest advantage of robotic surgery over laparoscopic surgery is that it has a higher magnification field of view. Laparoscopic surgery can generally be magnified by 4 to 6 times, while robotic surgery can achieve 10 times or even 30 times magnification, which is basically equivalent to achieving the effect of microsurgery. Of course, the surgical cost of robotic surgery may also increase.
We can choose laparoscopic surgery or robotic surgery according to the surgical method, for example, surgery to preserve pancreatic function requires the resolution of very small structures in the pancreas, then choosing robotic surgery has a very big advantage.
Traditional pancreatic surgery has only two surgical modalities, namely pancreatic duodenal resection of pancreatic head lesions and pancreatic tail resection of pancreatic tail lesions. But pancreatic cystic tumors can be removed on such a large scale.
As our understanding of the internal structure of the pancreas becomes clearer and the surgery and anatomy become more elaborate, some surgeries that preserve the function of the pancreas become possible. Minimally invasive surgery achieves the best therapeutic results with minimal trauma, which is also an important aspect that can really benefit patients.
What are the complications after surgery?
What should I do?
Any surgical procedure carries surgical risks and complications. The biggest complication of pancreatic surgery is pancreatic fistula, which occurs after tail resection of the pancreatic body is mainly simple pancreatic fistula, and its risk is relatively small. Pancreatic fistula that occurs after pancreatic duodenal resection is relatively severe. Then we should be cautious when choosing surgical indications, and we need to consider the risk of surgery and the risk of malignancy.
However, the risk of complications from pancreatic surgery is related to the amount of surgery at the pancreatic center. The greater the amount of surgery, the better the control of central surgical complications and the smaller the proportion of occurrences, and at the same time, they are more experienced in the management of complications. Patients should have a correct mentality for dealing with complications, surgical complications cannot be avoided 100%, but experienced pancreatic centers have good experience in handling complications, and even if complications occur, they can handle them well.
What should I pay attention to in my postoperative diet?
Can hair be eaten in the end?
For the precautions of life after pancreatic surgery, it cannot be completely ignored, but it is not necessary to be too nervous. Pancreatic function, including exocrine and endocrine function, needs to be focused on after pancreatic surgery.
Exocrine function is mainly to help digestion, when the pancreatic exocrine function is insufficient, eating greasy food can lead to diarrhea. Symptoms can be improved by adding pancreatic enzymes, and patients may also need to reduce or avoid greasy food intake.
Pancreatic endocrine function is mainly to secrete insulin to control blood glucose levels, so patients need to monitor blood glucose levels after undergoing pancreatic surgery. If the blood glucose level is normal, there is no need to deal with it specifically; if the blood glucose level rises, or even reaches the level of diabetes, it is necessary to go to the endocrinologist and treat it according to the diet and lifestyle habits of diabetes. If these two aspects can be controlled, patients can live, work and socialize normally after surgery.
In the concept of Western medicine, any food that is ingested and digested by the human body will become the most basic food elements, such as protein, fat, vitamins, carbohydrates, etc. Therefore, there is no concept of "hair", and there is no special requirement in this regard.
After pancreatic surgery
What complementary medications do I need to take?
This depends on the pancreatic function of the patient after surgery. If the patient's pancreas is functioning normally, there is no need to routinely take the drug after surgery. If the patient has problems with pancreatic exocrine function, symptoms can be improved by giving exogenous pancreatin.
On the other hand, we need to pay attention to the patient's blood sugar problem. If the blood sugar is normal, it does not need to be controlled; if there is a critical increase in blood sugar, we recommend lifestyle improvement, that is, controlling the diet and increasing exercise; if the blood sugar cannot be controlled through a normal diet, it is necessary to control it according to the treatment plan of diabetes, first use hypoglycemic drugs, and if the hypoglycemic drugs are not effective, insulin is needed.
Is Herbal Conditioning Really Useful?
Can I take Herbal Remedies?
After pancreatic surgery, traditional Chinese medicine is not routinely performed. For patients who choose traditional Chinese medicine conditioning, it is recommended that you go to a regular, relatively large Traditional Chinese medicine hospital for treatment, and take a regular Traditional Chinese medicine prescription, which is relatively useful, healthier and safer. Some folk earthwork and grass remedies may not only have no effect, but even lead to more serious liver function damage.
After the operation, blood glucose rises and digestion deteriorates
Will it "escalate" to diabetes and indigestion?
This question relates to the function of the pancreas. There is a slow process of recovery of pancreatic function in patients after pancreatic surgery, but ultimately its function depends on how much pancreas is retained. This problem can only be truly avoided if as much pancreatic function as possible is preserved.
The increase in blood glucose caused by pancreatic surgery does not improve through prolongation of time and needs to be adjusted by means of medication. Post-dietary diarrhea due to poor exocrine function of the pancreas can be improved by dietary modifications (reducing fat intake and switching to a high-protein, polycellulose diet) and supplementation with exogenous pancreatic enzymes.
Whether a patient can achieve improvement in symptoms entirely through self-regulation varies from person to person. Some patients have a wide range of pancreatic resection, so their loss of pancreatic function cannot be fully compensated, or they need to rely on drugs to improve symptoms.
However, long-term drug maintenance has a great impact on the quality of life of patients, so we have been advocating pancreatic surgery for functional preservation in recent years. For this type of benign lesion, we should choose more accurate resection as much as possible and avoid large-scale resection.
How should I review it after surgery?
Only malignant tumors are likely to recur, and patients must undergo regular re-examinations. As long as the benign tumor is completely removed by surgery, there is no recurrence problem, and the patient only needs to undergo a routine physical examination. That's why we actively recommend surgery for younger patients.
For this type of patient, lifelong follow-up is required before the tumor is removed until surgery cannot be tolerated. This can mean decades-long follow-up for young patients, and the cost of follow-up is enormous, both financially and psychologically. Therefore, after removing the hidden dangers through minimally invasive surgery, the long-term follow-up problem after the operation of the patient is also avoided.
With the popularity of physical examinations, more and more pancreatic cystic tumors have been discovered. In fact, pancreatic cystic tumors are benign lesions at the time of initial discovery, not malignant tumors with a very poor prognosis such as pancreatic cancer, so there is no need for anxiety.
Secondly, for each patient with pancreatic cystic tumor, there should be an individualized treatment strategy, and it is recommended that patients go to a large pancreatic center to better understand their own disease and choose a reasonable surgical approach.
Finally, minimally invasive surgery to preserve pancreatic function should be selected as much as possible to maximize the quality of life after surgery and avoid severe pancreatic insufficiency.
Source: Medical Oncology Channel
Image: Source: Affiliated Cancer Hospital of Fudan University
Editor-in-charge: Zheng Huaju
Proofreader: Zang Hengjia
Plate making: Xue Jiao