APPENDECTOMY

This is the removal of the appendix, which is a small organ attached to the large intestine. It can become inflamed or swollen, causing pain and signaling the need to have it removed. The appendix can also develop a small hole. This is known as a perforation. When the appendix perforates, it begins to leak into the abdomen and can cause a major, possibly fatal infection unless it is removed.

Signs you may need an appendectomy

Pain caused by an inflamed appendix (appendicitis) or perforated appendix (perforated appendicitis) is most commonly described as starting right around the belly button and then moving down to the lower right abdomen and increasing in intensity. It can also be accompanied by diarrhea or constipation, nausea, vomiting, a low fever and a loss of appetite. Patients experiencing these symptoms should seek medical help right away.

The surgery

If the surgeon determines you need an appendectomy, you’ll receive general anesthesia and the appendix will be removed through a small incision in your abdomen. Often, appendectomies can be performed laparoscopically, reducing the size of the scar.

Pancreatic Surgery:

Pancreatic Cancer Surgery & Pancreatitis

The pancreas is a complex organ with many different types of cells in it. Each of these cell types may give rise to different types of tumors. The correct diagnosis of the tumor type is important since the prognosis for survival is dependent on the tumor type and surgical removal of some tumors in the pancreas can be associated with a normal life span. Often the type of tumor that is present in the pancreas can be diagnosed from specialized studies such as radioisotope studies and CT scans.

There are many different types of tumors that can develop in the pancreas. A pancreatic specialist can evaluate your tumor and determine which type of tumor is present in your pancreas. Approximately 85% patients have very aggressive type of tumor called adenocarcinoma of the pancreas. In about 15% of patients other tumors in the pancreas are found that are less aggressive types of tumors which are often curable. An evaluation in a center that is experienced in the treatment of pancreatic cancer is important for determining appropriate treatment for pancreatic tumors.

What are the steps in the work up and treatment of the tumor in the pancreas

The following questions are sequentially addressed when a patient is seen at South Mississippi Surgeons with a pancreas mass

  • Where is the tumor in the pancreas
  • What is the likely type of the tumor (adenocarcinoma or a less aggressive tumor type)
  • Is the tumor surgically removable
  • Is laparoscopic approach possible for your tumor type
  • Is chemotherapy and/or radiation therapy indicated

Adenocarcinoma of the pancreas

The most common type of cancer of the pancreas is an adenocarcinoma which is a tumor that arises from the cells that line the duct of the pancreas. 85% of all cancerous tumors of the pancreas are adenocarcinomas. Approximately 30,000 new cases of pancreatic adenocarcinoma are diagnosed each year and approximately 28,000 patients die from pancreatic cancer each year. Only about 20 to 40% of patients with adenocarcinoma of the pancreas have a tumor that is confined to the pancreas at the time of diagnosis. The 5-year survival for patients who undergo surgical resection of adenocarcinoma of the pancreas is about 20 to 40%.

Surgery is a treatment of choice for patients who have adenocarcinoma of the pancreas that is surgically removable. Careful selection of patients for surgery is important. Since surgical removal is associated with the best outcome diagnosing testing to identify patients suitable for surgery is extremely important. Appropriate diagnostic testing will also avoid unnecessary surgeries in patients whose tumors are too advanced for surgical removal.

The surgical procedure that is done depends on the location of the tumor in the pancreas. The results of surgery have dramatically improved in the last two decades such that today the mortality (death) rate from surgery is less than 3 to 4% in tertiary care centers.

Most patients will require chemotherapy and radiation therapy after the surgery. Patients with unresectable tumors are often treated with chemotherapy and radiation therapy, and in some patients response to the treatment may allow subsequent surgical removal of the tumor.

Other tumors in the pancreas

85% of tumors that are found in the pancreas are adenocarcinoma of the pancreas. 15% of tumors that develop in the pancreas are not adenocarcinomas and these tumors often have a far better prognosis. Since many patients with these tumors are often cured after surgery, identification and aggressive treatment of these tumors is important.The tumor types that are found in this group include:

  • cystic tumors or neoplasms including mucinous cystadenoma and serous cyst adenoma
  • islet cell tumors also called neuroendocrine tumors
  • papillary cystic neoplasms
  • lymphoma of the pancreas
  • acinar cell tumors of the pancreas
  • metastatic tumors to the pancreas

The majority of these tumors are non-malignant or benign, however even malignant tumors have five year survival rates in the order of 40 to 80% depending on the tumor type. In view of the excellent outcome, aggressive surgical therapy is indicated for these tumors, and the part of the pancreas that is affected by the tumor is removed.

At SMS our emphasis has been to preserve as much of the pancreas as possible when removing benign and precancerous tumors to minimize the consequences of removal of large amounts of the pancreas such as diabetes and malabsorption (inability to digest food).