Top 10 questions that patients with pancreatic cystic tumors most want to know |

*Only for medical professionals to read and refer to the National Cancer Prevention and Treatment Week.
Specialists from the Department of Pancreatic Surgery from Fudan University Cancer Hospital are invited to answer the most concerned questions of patients with pancreatic cystic tumors.

The pancreas is a magical organ, with both exocrine and endocrine functions.

Once the pancreatic function is impaired, indigestion and abnormal blood sugar regulation may occur at the same time, which affects the quality of life of the patient, and even life-threatening in severe cases.

Pancreatic surgery is one of the causes of impaired pancreatic function, and pancreatic tumors are the most common cause of pancreatic surgery.

With the improvement of people's living standards and the enhancement of health awareness, more and more pancreatic tumors such as pancreatic cystic tumors are found in physical examinations.

At the special time of the National Cancer Prevention and Treatment Week, the "medical community" specially invited Professor Xu Xiaowu of Pancreatic Surgery from Fudan University Cancer Hospital and Ms.
Ma Guiqiu, a pancreatic cystic tumor patient, to have an in-depth conversation on the most concerned issues of pancreatic cystic tumor patients.

I hope this dialogue can help more patients with pancreatic cystic tumors understand the diagnosis and treatment of cystic tumors and encourage more patients.

From 19:00-20:00 on April 18, scan the QR code of the poster to watch the live broadcast ↓↓↓ 1.
How to find pancreatic cystic tumors early? Moderator: What are the clinical manifestations of pancreatic cystic tumors? Are there any means that can be found early? Professor Xu Xiaowu: Pancreatic cystic tumors often do not have particularly obvious clinical symptoms, and most patients are found through physical examinations.

With the popularization of physical examinations, a large number of patients with pancreatic cystic tumors will be discovered and treated.
Generally, they can be detected early through abdominal enhanced CT or MRI, and some people can also be detected through abdominal ultrasound.2.
Which patients need surgery? Which patients can be treated conservatively and followed up regularly? Moderator: Do all pancreatic cystic tumors have to be removed? Which patients can be followed up? Which patients need surgery? Are there any drugs that can make the tumor shrink? Professor Xu Xiaowu: First of all, pancreatic cystic tumors cannot be eliminated by drugs, but not every patient with pancreatic cystic tumors needs surgery.

We should consider the individualized surgical evaluation of patients based on the following points: First, see whether the lesion has symptoms of malignancy or risk of malignancy.

The high-risk risk of malignant transformation includes: the increase of tumor markers such as carbohydrate antigen (CA199), the enhancement of mural nodules in the fine structure of the cyst, the diameter of the tumor is greater than 3cm, the sudden increase of the tumor in a short time, and the pancreas Tube, especially the expansion of the main pancreatic duct, etc.

The second point is that when we consider pancreatic cystic tumor surgery, we must also take into account the patient's personal factors.

First, consider the age of the patient.

Pancreatic cystic tumor is a kind of benign onset, slow development, and potential malignant disease.
Its risk is that it may appear malignant 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 young patients, we recommend aggressive treatment, because with age, the risk of potential malignant transformation will increase.

Surgery is meaningful for young patients, and patients can also benefit from it.

Second, consider the location of the cyst.

Pancreatic surgery is more complicated, and different cyst sites have different surgical methods.

Generally speaking, the closer the lesion is to the tail, the less trauma and cost of the operation, and the higher the safety.

For this type of disease, we can choose a more active treatment.

However, the lesion is close to the head of the pancreas, especially for patients undergoing extensive pancreaticoduodenal resection.
The operation risk is high, and the cost and trauma are also high.

For such patients, we need to balance the risk of malignant transformation and the cost of surgery, and strike a balance between the two.

Therefore, I recommend that patients go to a formal and experienced pancreatic center to receive appropriate treatment strategies.

What should I pay attention to during the third follow-up? Moderator: So if patients with pancreatic cystic tumors can be followed up, what aspects should be paid attention to during the follow-up process? Professor Xu Xiaowu: Pancreatic cystic tumors have no symptoms, and there are not too many areas that require deliberate attention.
Patients can work, live, and socialize normally, but they need regular follow-ups.

Patients who have no high-risk factors or have no clear high-risk factors can be followed up once a year.

During the follow-up, I suggest using CT, magnetic resonance, or endoscopic ultrasound examination methods that can objectively reflect the characteristics of pancreatic cystic tumors.
Ordinary abdominal ultrasound may not achieve very good follow-up results.

What are the four surgical methods? Which is better, robotic surgery or laparoscopic surgery? Moderator: If it is a patient who chooses surgical resection like me, what surgical methods do we have at present? Some doctors recommend robotic surgery.
Which one is better than laparoscopic surgery? Professor Xu Xiaowu: In terms of surgical operation methods, traditional pancreatic surgery focuses on open surgery, but minimally invasive surgery such as laparoscopic surgery and robotic surgery has developed rapidly in the past 20 years.

Pancreatic cystic tumor surgery does not have many oncology requirements (such as lymph node dissection) and is very suitable for minimally invasive surgery.

The difference between laparoscopic surgery and robotic surgery is that laparoscopic surgery relies on the surgeon to directly control surgical instruments, while robotic surgery uses the robotic arm of a robot to complete the surgery.

Compared with laparoscopic surgery, the biggest advantage of robotic surgery is that it has a higher magnification field of view.

Laparoscopic surgery can generally magnify 4 to 6 times, while robotic surgery can achieve magnification of 10 times or even 30 times, 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 that preserves the function of the pancreas requires distinguishing very small structures in the pancreas, so choosing robotic surgery has great advantages. Traditional pancreatic surgery has only two surgical methods, namely pancreaticoduodenectomy for pancreatic head lesions and pancreatic body and tail resection for pancreatic tail lesions.

But cystic tumors of the pancreas may not need to be resected on such a large scale.

As our understanding of the internal structure of the pancreas becomes clearer, and the operations and anatomy become more and more refined, some operations that preserve the function of the pancreas become possible.

As the host experienced, her cystic lesion was on the head of the pancreas.
According to the traditional method, a large pancreaticoduodenectomy was required, but we did a partial resection by a minimally invasive operation.
, Well maintained the pancreatic function of the patient after surgery.

This type of surgery can achieve the best therapeutic effect with minimal trauma, which is also a very important aspect that can truly benefit patients.

Five What are the complications of surgery? How to deal with it? Moderator: For our patients, we are very worried about whether there will be complications and sequelae after the operation.
What are the complications after the operation? How to deal with it? Professor Xu Xiaowu: Any kind of surgical operation has surgical risks and the possibility of complications.

The biggest complication of pancreatic surgery is pancreatic fistula.
The pancreatic fistula that occurs after resection of the body and tail of the pancreas is mainly a simple pancreatic fistula, and its risk is relatively small.

Pancreatic fistula after pancreaticoduodenectomy is relatively serious.

Then we should be more cautious when choosing surgical indications, and we need to consider the risks of surgery and the risk of malignant transformation.

However, the risk of complications of pancreatic surgery is related to the amount of pancreatic center surgery.

The greater the volume of operations, the better the control of complication and the smaller the incidence.
At the same time, they are more experienced in handling complications.

Patients must have a correct attitude toward complications.
Surgical complications cannot be avoided 100%.
However, experienced pancreatic centers have good experience in handling complications, and they can handle complications well even if they occur.

6.
What are the precautions for postoperative diet? Moderator: What should I pay attention to after eating? Can the hair from the mouth of many patients be eaten? Professor Xu Xiaowu: The precautions for life after pancreatic surgery cannot be completely ignored, but there is no need to be too nervous. After pancreatic surgery, it is necessary to focus on the patient's pancreatic function, including exocrine function and endocrine function.

The exocrine function is mainly to help digestion.
When the pancreatic exocrine function is insufficient, eating greasy food will cause diarrhea.

In this case, the symptoms can be improved by adding pancreatin.
At the same time, patients also need to reduce or avoid greasy food intake.

The endocrine function of the pancreas is mainly to secrete insulin to control blood sugar levels, so patients need to monitor blood sugar levels after pancreatic surgery.

If the blood sugar level is normal, no special treatment is needed; if the blood sugar level rises, or even reaches the level of diabetes, you need to go to the endocrinology department and deal with it in accordance with the diet and life>
If these two aspects can be controlled well, the patient can live, work, and socialize normally after the operation.

In the concept of Western medicine, any food that is ingested and digested by the human body will become the most basic food element, such as protein, fat, vitamins, carbohydrates, etc.

Therefore, there is no such concept as "fat", and there is no special requirement in this regard.

Do I need to take medicine after the seventh operation? Moderator: Are there any supplementary medicines to take after pancreatic surgery? Professor Xu Xiaowu: This depends on the patient's postoperative pancreatic function.

If the patient's pancreatic function is normal, there is no need to routinely take medication after surgery.

If the patient's pancreatic exocrine function has problems, the symptoms can be improved by giving exogenous pancreatin.

On the other hand, we must pay attention to the patient's blood sugar problem.

If blood sugar is normal, no need to control; if there is a marginal increase in blood sugar, we recommend life>
8.
Can Chinese medicine be used for conditioning? Moderator: Is it useful to take Chinese medicine for conditioning? Do I need to take Chinese medicine for conditioning? Professor Xu Xiaowu: I don’t think there is a need for routine Chinese medicine conditioning after pancreatic surgery.

For patients who choose traditional Chinese medicine conditioning, I suggest that you go to a regular and relatively large Chinese medicine hospital and take regular Chinese medicine prescriptions.
It is relatively useful, healthy and safe.

Some folk earth and grass recipes may not only have no effect, but may even cause serious liver damage.

What to do if blood sugar rises after ninth operation? Moderator: Many patients have increased blood sugar and poor digestion after surgery.
How long will it take to recover? Will it develop into diabetes? Or diarrhea all day long, indigestion? Professor Xu Xiaowu: This question involves the function of the pancreas.

After pancreatic surgery, the patient’s pancreatic function is slowly restored, but in the end its function depends on how much pancreas is retained.

Only by preserving the patient's pancreatic function as much as possible can this problem be truly avoided.

The increase in blood sugar caused by pancreatic surgery cannot be improved by prolonging time and needs to be adjusted by medication.

Post-eating diarrhea caused by poor pancreatic exocrine function can be improved by adjusting the diet (reducing fat intake, switching to a high-protein, high-fiber diet) and supplementing exogenous pancreatic enzymes.

As for whether patients can achieve symptom improvement through self-adjustment ability, it varies from person to person.

In some patients, the scope of pancreatectomy is relatively wide, so the loss of his pancreatic function cannot be fully compensated, and he still needs to rely on drugs to improve symptoms.

However, long-term drug maintenance has a great impact on the quality of life of patients, so in recent years we have been advocating for function-saving pancreatic surgery.

For this kind of benign lesions, we should choose a more precise resection as much as possible to avoid large-scale resection.

How should I review after the tenth operation? Moderator: Whether the tumor will recur is also a matter of great concern to our patients.

How should patients be reviewed after surgery? Professor Xu Xiaowu: Only malignant tumors have the possibility of recurrence, and patients must be reviewed regularly.

As long as benign tumors are completely removed by surgery, there is no problem of recurrence, and patients only need to undergo routine physical examinations.

Therefore, we actively recommend young patients to undergo surgery, because for this type of patients, lifelong follow-up must be carried out before the tumor is removed, until the surgery cannot be tolerated.

For young patients, this may mean follow-up for decades, and during the follow-up process, the economic and psychological costs are very huge.

Therefore, after removing hidden dangers through minimally invasive surgery, the problem of long-term follow-up of patients after surgery is also avoided.

Finally, Professor Xu Xiaowu emphasized that with the popularization of physical examinations, more and more pancreatic cystic tumors have been discovered.

In fact, pancreatic cystic tumors are benign lesions when they are initially discovered, not malignant tumors with very poor prognosis such as pancreatic cancer, so there is no need to worry.

Secondly, for each patient with pancreatic cystic tumor, there should be an individualized treatment strategy.
It is recommended that patients go to a large pancreatic center to better understand their disease and choose a reasonable surgical method.

Finally, minimally invasive surgery that preserves pancreatic function should be selected as much as possible to maximize the quality of life of patients after surgery and avoid severe pancreatic insufficiency.

Expert profile Professor Xu Xiaowu Chief Physician/Professor/Doctoral Supervisor, Deputy Director of Pancreatic Surgery, Fudan University Tumor Hospital, Director of Pancreatic Minimally Invasive Surgery Center, Fudan University Tumor Hospital, Young Member of the Minimally Invasive Surgery Committee of the Chinese Medical Doctor Association Secretary, Member of the Minimally Invasive Diagnosis and Treatment Group of the Pancreatic Cancer Professional Committee of the Chinese Anti-Cancer Association Member of the Minimally Invasive Group of the General Surgery Branch of the Shanghai Medical Association Member of the Minimally Invasive Group of the General Surgery Branch of the Shanghai Medical Association Deputy Leader of the Youth Group of Medical Cooperation, Member of the Pancreatic Cancer Professional Committee of Shanghai Anti-Cancer Association