Q 1. What is true about PET- CT in cases of Carcinoma head of pancreas
a) PET CT is advocated in all cases of Carcinoma head of pancreas as it stages the disease locally and detects metastas.
b) PET CT is not the alternative for CECT abdomen done with pancreatic protocol
c) PET CT is not indicated in pre operative work up for resection in Carcinoma Head of Pancreas
Q2. What is not true for Borderline Resectable tumors in Carcinoma Head of Pancreas
a) Tumor abutment of Superior Mesenteric artery not exceeding 180 degree of vessel wall
b) Tumor abutment of Gastro duodenal artery without extension to coeliac artery
c) Tumor abutment of SMV/PV (Superior mesenteric vein/Portal vein) without encasement of nearby artery
d) Tumor thrombus in a short segment of Portal vein without suitable length distal and proximal to it
Q3. What is not an indication for diagnostic laparoscopy in surgery for carcinoma head pancreas
a) Borderline Resectable disease
b) Elevated CA19.9
c) Resectable disease
d) Large tumor size
Q4. Which of the following has not been used as an adjunct to decreae the pancreatic fistula rate
a) Fibrin glue
b) Octreotide
c) Pancreatic stent
d) Porcine plugs
Answers
1. b
According to the NCCN guidelines
PET CT is not recommended in all cases but in those cases of pancreatic head malignancy who are considered high risk. In this way it can detect extra hepatic metastasis. PET CT is not the alternative for CECT abdomen.
2. d
Tumor thrombus in the short segment of Portal vein with suitable segment proximal and distal to it is considered borderline resectable. The portal vein can be clamped, cut and reconstructed
Above three choices (a,b,c ) are other characterstics of Borderline Resectable lesions
3. There is level 2 evidence to suggest that diagnostic laparoscopy before definitive surgery avoids 10-12% of unnecessary laparotomies.
Diagnostic laparoscopy is not generally done for resectable lesions in the head of pancreas.
It may be done in patients who are at high risk of having metastasis.. These are
CA19.9 more than 100
Borderline resectable disease
Large primary tumors
4. d
Results of randomized trials suggest that pancreatic fistula rates can be entirely dimnished by using duct to mucosa anastomoses with loops and giving attention to blood supply.
Stents are being used since 1930s but they do not decrease the leak rates
Octreotide did not decrease the fistula rate as shown by two randomized control trials
Fibrin glue sealants also did not have any particular effect
