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Modern Management of Pancreatic Disease
Modern Management of Benign and Malignant Pancreatic Disease
Preface Modern Management of Pancreatic Disease
Jacques Van Dam, MD, PhD Guest Editor
An issue devoted to the modern management of pancreatic disease? Really? Is there a cure for pancreatic cancer? Well. . . no. Have we found a cure for acute pancreatitis? Well. . .. Can we now prevent post endoscopic retrograde cholangiopancreatography (ERCP) pancreatitis? Can we definitively diagnose one particular type of cystic neoplasm of the pancreas from among the wide variety of potential etiologies? Well. . . no. So what could possibly be so new that a monograph on managing pancreatic disease could deign to use the term “modern” in its title? Read on. . .. Researchers who study benign and malignant pancreatic disease have not hit the homeruns noted above (international readers will please forgive my American baseball analogy in this paragraph). Nonetheless, there are other ways to score major advances against diseases of this particularly enigmatic organ. The following monograph details the base hits and even the doubles and triples that have led to major advances in recent years. The pancreas is unique. It serves both exocrine and endocrine functions. Its anatomy and location deep within the body allow benign and malignant changes to go unrecognized by its host, often until late in the course of a disease. And yet, the pancreas is so fragile that endoscopists can sometimes create havoc by simply working in its vicinity. After reading this monograph, clinicians will learn the most prognostic scoring systems for acute pancreatitis, review the basics for early management of the disease, and see how current practice guidelines have evolved. Advances in radiological imaging when applied to the pancreas have resulted in enhanced staging and improved selection for surgical intervention. Endoscopy of the pancreas via both ERCP and endoscopic ultrasound has led to unprecedented access and potential for nonoperative intervention. Surgical advances have provided the most significant breakthroughs. Pancreatic surgery now takes advantage of both minimally invasive (laparoscopic)
Gastroenterol Clin N Am 41 (2012) xiii–xiv doi:10.1016/j.gtc.2012.01.017 gastro.theclinics.com 0889-8553/12/$ – see front matter © 2012 Elsevier Inc. All rights reserved.
xiv
Preface
approaches and techniques learned from organ transplantation. And noteworthy advances in medical and radiation oncology are extending life expectancy for patients with the most advanced malignant disease while limiting treatment toxicity. I am indebted to the multidisciplinary team of authors, luminaries in their respective fields, who have graciously given their time and considerable expertise to this monograph. They represent gastroenterologists, endoscopists, radiologists, surgeons, oncologists, and radiation oncologists who have advanced the field and together have created a well-written, well-documented, and well-referenced manual for treating patients with benign and malignant diseases of the pancreas. I also wish to thank Kerry Holland for the opportunity to organize and edit this monograph and Lesley Simon for her outstanding editorial skills. Their support and guidance were essential to its success. Jacques Van Dam, MD, PhD Keck School of Medicine University of Southern California 1510 San Pablo Street HealthCare Consultation I; Suite 322R Los Angeles, CA 90033, USA
Preface Modern Management of Pancreatic Disease
Jacques Van Dam, MD, PhD Guest Editor
An issue devoted to the modern management of pancreatic disease? Really? Is there a cure for pancreatic cancer? Well. . . no. Have we found a cure for acute pancreatitis? Well. . .. Can we now prevent post endoscopic retrograde cholangiopancreatography (ERCP) pancreatitis? Can we definitively diagnose one particular type of cystic neoplasm of the pancreas from among the wide variety of potential etiologies? Well. . . no. So what could possibly be so new that a monograph on managing pancreatic disease could deign to use the term “modern” in its title? Read on. . .. Researchers who study benign and malignant pancreatic disease have not hit the homeruns noted above (international readers will please forgive my American baseball analogy in this paragraph). Nonetheless, there are other ways to score major advances against diseases of this particularly enigmatic organ. The following monograph details the base hits and even the doubles and triples that have led to major advances in recent years. The pancreas is unique. It serves both exocrine and endocrine functions. Its anatomy and location deep within the body allow benign and malignant changes to go unrecognized by its host, often until late in the course of a disease. And yet, the pancreas is so fragile that endoscopists can sometimes create havoc by simply working in its vicinity. After reading this monograph, clinicians will learn the most prognostic scoring systems for acute pancreatitis, review the basics for early management of the disease, and see how current practice guidelines have evolved. Advances in radiological imaging when applied to the pancreas have resulted in enhanced staging and improved selection for surgical intervention. Endoscopy of the pancreas via both ERCP and endoscopic ultrasound has led to unprecedented access and potential for nonoperative intervention. Surgical advances have provided the most significant breakthroughs. Pancreatic surgery now takes advantage of both minimally invasive (laparoscopic)
Gastroenterol Clin N Am 41 (2012) xiii–xiv doi:10.1016/j.gtc.2012.01.017 gastro.theclinics.com 0889-8553/12/$ – see front matter © 2012 Elsevier Inc. All rights reserved.
xiv
Preface
approaches and techniques learned from organ transplantation. And noteworthy advances in medical and radiation oncology are extending life expectancy for patients with the most advanced malignant disease while limiting treatment toxicity. I am indebted to the multidisciplinary team of authors, luminaries in their respective fields, who have graciously given their time and considerable expertise to this monograph. They represent gastroenterologists, endoscopists, radiologists, surgeons, oncologists, and radiation oncologists who have advanced the field and together have created a well-written, well-documented, and well-referenced manual for treating patients with benign and malignant diseases of the pancreas. I also wish to thank Kerry Holland for the opportunity to organize and edit this monograph and Lesley Simon for her outstanding editorial skills. Their support and guidance were essential to its success. Jacques Van Dam, MD, PhD Keck School of Medicine University of Southern California 1510 San Pablo Street HealthCare Consultation I; Suite 322R Los Angeles, CA 90033, USA