Copyright ©2011 Baishideng Publishing Group Co.
World J Gastroenterol. Feb 21, 2011; 17(7): 867-897
Published online Feb 21, 2011. doi: 10.3748/wjg.v17.i7.867
Table 1 Summary of the terms used singly or in combination for evidence acquisition
Primary MeSH termsSecondary MeSH terms (epidemiology, diagnosis)Secondary MeSH terms (treatment, palliation)
Pancreatic neoplasm(s)EpidemiologyPancreaticoduodenectomy
Pancreatic diseasesDifferential diagnosisTreatment outcome(s)
PancreasRisk factor(s)Surgery
Carcinoma, pancreatic ductalDiagnostic imagingSurgical procedures
Pancreatic duct(s)Magnetic resonance imagingClinical trial(s)
HumansEndosonographyControlled clinical trial(s)
AdultUltrasonographyRandomized controlled trial(s)
Emission computed tomographyClinical trial (phase I)
Radionuclide imagingClinical trial (phase II)
Positron emission tomographyClinical trial (phase III)
TomographyClinical trial (phase IV)
X-ray computedDrug therapy
Biopsy (fine needle)Chemotherapy
Biopsy (needle)Neoadjuvant therapy
CytodiagnosisAntineoplastic combined chemotherapy protocols
Tumor markers (biological) antigen(s)Antineoplastic agent(s)
Carcinoembryonic antigenAntimetabolites, antineoplastic
Ca 19-9 antigenCombined modality therapeutic antineoplastic
Ca 125 antigenCombined chemotherapy protocols neoadjuvant
Antigens, tumor-associated, carbohydrateTherapy
Endoscopic retrograde cholangiopancreatographyRadiotherapy
Computed assisted image processingDrainage
Sensitivity and specificityCholestasis
EndoscopyObstructive jaundice
Celiac plexus
Autonomic nerve block
Nerve block
Injections, intralesional
Epidermal growth factor
Biological products
Neoplasm proteins
Antibodies, monoclonal
Table 2 Known risk factors for pancreatic cancer
Age (more than 60 yr)
Type II
Gestational diabetes
Impaired glucose tolerance
Genetic predisposition
Family history
Hereditary disorders
Hereditary pancreatitis
Puetz-Jeghers syndrome
Familial breast and ovarian cancer
Li-Fraumeni syndrome
Fanconi anaemia
Familial adenomatous polyposis
Cystic fibrosis
Lynch syndrome
Table 3 clinico-pathological features of the most frequent classes of pancreatic cancer
ClassificationFrequency (%)AuthoryrSurvival (5-yr survival after surgical resection)
DIA (incidence per 100 000 patients at risk = 8.37)[69]85-90[1]Conlon et al[70]199610%
Winter et al[71]200618%
Poultsides et al[72]201019%
SPPN (incidence per 100 000 patients at risk = NA)[69]0.1-3[73]Papavramidis et al[74]200595%
IPMN (incidence per 100 000 patients at risk = 0.03)[69]Shin et al[76]2010Benign: 95%
Malignant: 64%
IPMN with simultaneous DIA: (incidence per 100 000 patients at risk = NA)[69]5[75]Poultsides et al[72]201042%
Fan et al[77]201057%
Sohn et al[78]200443%
Pancreatoblastoma (incidence per 100 000 patients at risk = NA)[69]0.50[79]Dhebri et al[80]200450%
Saif et al[79]200780%
Undifferentiated (incidence per 100 000 patients at risk = 0.03)[69]2-7[81]Paal et al[82]20013% (3-yr survival)
Connolly et al[83]19875 mo (average survival)
Medullary carcinoma (incidence per 100 000 patients at risk = NA)[69]NAWilentz et al[84]200011%
14 mo (average survival)
Mucinous cystadenocarcinoma (incidence per 100 000 patients at risk = 0.43)[69]1Ridder et al[85]199656%
Adenosquamous carcinoma (incidence per 100 000 patients at risk = 0.05)[69]4Madura et al[86]19995-7 mo (median survival)
Mulkeen et al[87]2006
Acinar cell carcinoma (incidence per 100 000 patients at risk = 0.02)[69]2Holen et al[88]200238 mo after surgical resection (median survival)
14 mo for unresectable disease (median survival)
Table 4 Presenting symptoms of advanced pancreatic cancer
Abdominal pain78-82
Early satiety62
Sleep disorders54
Weight loss66-84
Back pain48
Nausea and weight loss50-86
Table 5 Summary of the performance characteristics of serum tumor markers for the diagnosis of pancreatic cancer
Serum tumor markerAuthorYrSensitivity (%)Specificity (%)PPV (%)NPV (%)Accuracy (%)
CA19-9Boeck et al[141]200670-9043-91728167
Ni et al[142]2005
Steinberg et al[143]1990
Safi et al[144]1997
Mu et al[162]2003
CEA in pancreatic juiceOzkan et al[155]2003NANA779585
Futakawa et al[154]2000
Ni et al[142]2005
CEA in serumBoeck et al[141]20064575NANANA
CA19-9 + CEANi et al[142]20053784919089
Ozkan et al[155]2003
Ma et al[163]2009
CA 242Nilsson et al[160]19926076636171
Röthlin et al[164]1993
Carpelan-Holmström et al[165]2002
Pålsson et al[166]1993
CEA + CA 242Ni et al[142]20053492679087
Ozkan et al[155]2003
Hall et al[167]1994
CA19-9 + CA 242Ni et al[142]2005597765.387.865.1
Röthlin et al[164]1993
Jiang et al[158]2004
CA19-9 + CA 242 + CEANi et al[142]20052996NANANA
Table 6 Sensitivity, specificity and accuracy of computed tomography findings in pancreatic cancer patients
CT findingSensitivity (%)Specificity (%)Accuracy (%)
Ductal dilatation507870
Ductal interruption458270
Distal pancreatic atrophy459681
Pancreatic contour anomalies159270
CBD dilatation59267
Table 7 Summary of the performance characteristics of imaging tests for the diagnosis of pancreatic cancer
Diagnostic modalityAuthorYrSensitivity (%)Specificity (%)PPV (%)NPV (%)Accuracy (%)
USGiovannini et al[176]199448-9540-919210046-64
Böttger et al[177]1998
Rösch et al[178]1991
Niederau et al[179]1992
Palazzo et al[180]1993
Tanaka et al[231]1996
Doppler USCandiani et al[232]199850-9480-100798881-95
Casadei et al[184]1998
Calculli et al[233]2002
EUSAkahoshi et al[234]199898979410090
Legmann et al[235]1998
Contrast enhanced USDietrich et al[185]2008901001008693
CTBronstein et al[196]200477100NANA73
Megibow et al[197]1995
MDCTPark et al[214]200983-9163-75808785-95
Vargas et al[202]2004
Diehl et al[203]1998
Schima et al[208]2002
MRI-MRCPAndersson et al[212]200583-9263-85957989
PETMaemura et al[217]200687-10067-779410085-95
Delbeke et al[221]1999
Table 8 American Joint Committee on Cancer staging of pancreatic cancer
AJCC 6th edition TNM staging system for pancreatic cancer
TXPrimary tumor cannot be assessed
T0No evidence of primary tumor
TisCarcinoma in situ
T1Tumor limited to the pancreas, 2 cm or less in greatest diameter
T2Tumor limited to the pancreas, greater than 2 cm at greatest diameter
T3Tumor extends beyond pancreas but no involvement of celiac axis or superior mestenteric artery
T4Tumor involves the celiac axis or the superior mestenteric artery (unresectable)
NXRegional nodes cannot be assessed
N0No regional lymph node metastasis
N1Regional lymph node metastasis
MXDistant metastasis cannot be assessed
M0No distant metastasis
M1Distant metastasis
Stage grouping
Stage 0Tis N0 M0Localized within pancreas
Stage IAT1 N0 M0Localized within pancreas
Stage IBT2 N0 M0Localized within pancreas
Stage IIAT3 N0 M0Locally invasive, resectable
Stage IIBT1, 2, or 3 N1 M0Locally invasive, resectable
Stage IIIT4 Any N M0Locally advanced, unresectable
Stage IVAny T Any N M1Distant metastases
Table 9 Stage distribution of pancreatic cancer and 5-year relative survival by stage at diagnosis for 1999-2006, all races and both sexes (SEER registries)
Stage at diagnosisStage distribution (%)5-yr relative survival (%)
Localized (confirmed to primary site)822.5
Regional (spread to regional LNs)268.8
Distant (cancer had metastasized)531.9
Unknown (unstaged)145
Table 10 Published results on laparoscopic pancreaticoduodenectomies
AuthorYrPatient No.Morbidity (%)Pancreatic fistula (%)Mean hospital stayMortality (%)
Kendrick et al[323]201062421871.6
Palanivelu et al[324]20074228.
Dulucq et al[325]20062531.84.516.20
Pugliese et al[326]20081931.615.8180
Table 11 Survival data after resection of pancreatic cancer
AuthorYrResection (n)R0 resection (n)Overall 5-yr survival (%)R0 5-yr survival (%)Median survival (mo)
Fatima et al[371]201061746817.42018
Kato et al[376]20091381159.913.212.3
Raut et al[373]2007360300NANA24.9
Cameron et al[258]20061000NA182333
Shimada et al[372]20068866192622
Howard et al[375]200612615846718
Moon et al[374]2003812010.867.811.8