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A disease in which malignant (cancer) cells are found in the tissues of the pancreas.

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Venous Thromboembolism: Reducing the Risk of Venous Thromboembolism (Deep Vein Thrombosis and Pulmonary Embolism) in Patients Admitted to Hospital

Venous thromboembolism (VTE) is a term used to include the formation of a blood clot (a thrombus) in a vein which may dislodge from its site of origin to travel in the blood, a phenomenon called embolism. A thrombus most commonly occurs in the deep veins of the legs; this is called deep vein thrombosis. A dislodged thrombus that travels to the lungs is known as a pulmonary embolism.

NICE Clinical Guidelines - National Clinical Guideline Centre – Acute and Chronic Conditions (UK).

Version: 2010
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Celiac plexus block (CPB) in patients with unresectable pancreatic cancer‐related pain

Abdominal pain is a major symptom in patients with inoperable pancreatic cancer and is often difficult to treat. Celiac plexus block (CPB) is a safe and effective method for reducing this pain. It involves the chemical destruction of the nerve fibres that convey pain from the abdomen to the brain. We searched for studies comparing CPB with standard analgesic therapy in patients with inoperable pancreatic cancer. We were interested in the primary outcome of pain, measured on a visual analogue scale (VAS). We also looked at the amount of opioid (morphine‐like drugs) patients took (opioid consumption) and adverse effects of the treatment. Six studies (358 participants) comparing CPB with standard therapy (painkillers) met our inclusion criteria. At four weeks pain scores were significantly lower in the CPB group. Opioid consumption was also significantly lower than in the control group. The main adverse effects were diarrhoea or constipation (this symptom was significantly more likely in the control group, where opioid consumption was higher). Endoscopic ultrasonography (EUS)‐guided CPB is becoming popular as a minimally invasive technique that has fewer risks, but we were not able to find any RCTs assessing this method (current medical literature on this subject is limited to studies without control groups). Although the data on EUS‐guided CPB and pain control are promising, we await rigorously designed RCTs that may validate these findings. We conclude that, although statistical evidence is minimal for the superiority of pain relief over analgesic therapy, the fact that CPB causes fewer adverse effects than opioids is important for patients.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2013

Palliative biliary stents for obstructing pancreatic cancer

The majority of patients with cancer of the pancreas are diagnosed only after blockage of the bile ducts has occurred. Surgical by‐pass (SBP) or endoscopic stenting (ES) of the blockage are the treatment options available for these patients. This review compares 29 randomised controlled trials that used surgical by‐pass, endoscopic metal stents or endoscopic plastic stents in patients with malignant bile duct obstruction. All included studies contained groups where cancer of the pancreas was the most common cause of bile duct obstruction. This review shows that endoscopic stents are preferable to surgery in palliation of malignant distal bile duct obstruction due to pancreatic cancer. The choice of metal or plastic stents depends on the expected survival of the patient; metal stents only differ from plastic stents in the risk of recurrent bile duct obstruction. Polyethylene stents and stainless‐steel alloy stents (Wallstent) are the most studied stents.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2011

[Meta-analysis of the long-term efficacy of adjuvant chemotherapy and surgery-only for resectable pancreatic cancer]

Bibliographic details: Zeng W, Zhang X.  [Meta-analysis of the long-term efficacy of adjuvant chemotherapy and surgery-only for resectable pancreatic cancer]. Chinese Journal of Clinical Oncology 2011; 38(21): 1346-1350

Database of Abstracts of Reviews of Effects (DARE): Quality-assessed Reviews [Internet] - Centre for Reviews and Dissemination (UK).

Version: 2011

[Efficacy of adjuvant chemoradiotherapy in pancreatic cancer patients after surgical resection: a meta-analysis]

Bibliographic details: Wang SL, Lin Y, Gao S, Hu TY, Wu R.  [Efficacy of adjuvant chemoradiotherapy in pancreatic cancer patients after surgical resection: a meta-analysis]. World Chinese Journal of Digestology 2011; 19(31): 3272-3276

Database of Abstracts of Reviews of Effects (DARE): Quality-assessed Reviews [Internet] - Centre for Reviews and Dissemination (UK).

Version: 2011

Gemcitabine plus capecitabine as a front-line therapy for advanced pancreatic cancer: a meta-analysis

Bibliographic details: Xie D R, Liang H L, Yang Q, Guo S S, Jiang Z M, Chen D L.  Gemcitabine plus capecitabine as a front-line therapy for advanced pancreatic cancer: a meta-analysis. World Chinese Journal of Digestology 2007; 15(16): 1868-1871

Database of Abstracts of Reviews of Effects (DARE): Quality-assessed Reviews [Internet] - Centre for Reviews and Dissemination (UK).

Version: 2007

Antioxidant supplements cannot be recommended for gastrointestinal cancer prevention

Our body cannot synthesize all compounds that are essential for health. Therefore such compounds must be taken through diet. Oxidative stress may cause cell damage that is implicated in chronic diseases like cancer. Gastrointestinal cancers are among the most common cancers worldwide. The poor prognosis of patients diagnosed with gastrointestinal cancers made primary prevention a potentially attractive approach. The evidence on whether antioxidant supplements are effective in decreasing gastrointestinal cancers is contradictory.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2008

Comparison of the stomach‐preserving 'Whipple' operation with the classic 'Whipple' operation for patients with cancer of the pancreas or the periampullary region (the point at which the ducts from the liver and pancreas enter the small intestine)

Pancreatic cancer is a leading cause of cancer death. Two surgical procedures can lead to a cure: the classic Whipple operation, in which part of the pancreas, the gallbladder, the duodenum, the pylorus (outlet of the stomach) and the distal (lower) part of the stomach are removed, and the so‐called pylorus‐preserving pancreaticoduodenectomy, or pylorus‐preserving Whipple operation, in which the stomach and the pylorus are not removed.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2015

Pancreatic Neuroendocrine Tumors (Islet Cell Tumors) Treatment (PDQ®): Health Professional Version

Expert-reviewed information summary about the treatment of pancreatic neuroendocrine tumors (islet cell tumors).

PDQ Cancer Information Summaries [Internet] - National Cancer Institute (US).

Version: April 30, 2015

Fixed dose rate infusion of gemcitabine as first line therapy for advanced pancreatic cancer: a meta-analysis of randomized controlled trials

Bibliographic details: Yang Q, Jiang Z M, Guo S S, Chen D L, Bi Z F, Xie D R.  Fixed dose rate infusion of gemcitabine as first line therapy for advanced pancreatic cancer: a meta-analysis of randomized controlled trials . Chinese Journal of Cancer Prevention and Treatment 2008; 15(1): 57-60

Database of Abstracts of Reviews of Effects (DARE): Quality-assessed Reviews [Internet] - Centre for Reviews and Dissemination (UK).

Version: 2008

Pancreatic Cancer Treatment (PDQ®): Patient Version

Expert-reviewed information summary about the treatment of pancreatic cancer.

PDQ Cancer Information Summaries [Internet] - National Cancer Institute (US).

Version: April 2, 2015

Pancreatic Cancer Treatment (PDQ®): Health Professional Version

Expert-reviewed information summary about the treatment of pancreatic cancer.

PDQ Cancer Information Summaries [Internet] - National Cancer Institute (US).

Version: February 6, 2015

Pancreatic Neuroendocrine Tumors (Islet Cell Tumors) Treatment (PDQ®): Patient Version

Expert-reviewed information summary about the treatment of pancreatic neuroendocrine tumors (islet cell tumors).

PDQ Cancer Information Summaries [Internet] - National Cancer Institute (US).

Version: March 4, 2015

No evidence to support or refute endoscopic retrograde cholangiopancreaticography (ERCP) with stenting in patients with malignant pancreaticobiliary diseases, awaiting surgery

Pancreatico‐biliary malignancy includes cancers of pancreas, ampulla, duodenum, and cholangiocarcinoma. There is significant morbidity and mortality related to surgery in these patients. Studies have claimed the beneficial role of biliary decompression, which can be performed via endoscopic retrograde cholangiopancreaticography (ERCP) with stent insertion pre‐surgically. The review found that pre‐surgical biliary stenting via ERCP did not improve the morbidity and mortality in patients with pancreatico‐biliary malignancy. Further evidence about its efficiency is needed.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2009

Surgical removal of part of the pancreas and other tissues versus other treatments for patients with pancreatic cancer which invades the surrounding structures

The pancreas is an organ in the abdomen which secretes digestive juices for the digestion of food. It also harbours the insulin secreting cells which maintain the blood sugar levels. Pancreatic cancer is an aggressive cancer. Surgery to remove the cancer improves survival. However, a third of patients with pancreatic cancer have locally advanced cancer involving major blood vessels which are not usually removed because of the fear of increased complications after surgery. Such patients receive palliative treatment. Resection (removing part of an organ) of the pancreas has been suggested as an alternative to palliative treatment for patients with locally advanced pancreatic cancer. However, in this group of patients the benefits and harms of surgical resection versus other treatments are not clear. We set out to answer this question by performing a thorough search of the literature for studies which compared surgical removal with palliative treatments. We included only randomised controlled trials, studies which, if designed appropriately, can help avoid arriving at wrong conclusions. We searched the literature for all studies reported until December 2013. Two authors independently assessed the trials for inclusion and independently extracted data to minimise errors.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2014

No evidence for optimal management of patients with unresectable liver spread originating from intestinal hormone cells

Liver metastases (liver spread) from gastrointestinal neuroendocrine tumours (cancer of intestinal hormone cells which originate from the embryonic nerve cells or the embryonic outer coat) are generally treated with surgery if a complete removal is deemed possible. This is associated with a long‐term survival. However, more than four‐fifths of patients with liver metastases from neuroendocrine tumours cannot undergo resection of all metastatic disease. The treatment of such patients is controversial. Palliative removal of the liver spread (ie, leaving behind a part of the cancerous liver spread) or destroying a significant portion of the cancerous liver spread using radiofrequency waves (collectively called cytoreductive surgeries) are some of the options offering symptomatic relief and possible prolongation of survival. This Cochrane review attempted to answer the question of whether palliative cytoreductive surgery is better than other palliative treatments, but no randomised clinical trials were found, addressing this issue. High‐quality randomised clinical trials may become feasible to perform if their conduct and study design is thoroughly considered in all their practical and methodological aspects. Pilot randomised clinical trials, which can guide the study design of definitive randomised clinical trials, are necessary.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2009

Effectiveness and safety of high-intensity focused ultrasound for pancreatic cancer: a systematic review

Bibliographic details: Li CC, Wang YQ, Li YP, Li XL.  Effectiveness and safety of high-intensity focused ultrasound for pancreatic cancer: a systematic review. Chinese Journal of Evidence-Based Medicine 2014; 14(11): 1332-1342

Database of Abstracts of Reviews of Effects (DARE): Quality-assessed Reviews [Internet] - Centre for Reviews and Dissemination (UK).

Version: 2014

Chemotherapy for advanced or metastatic pancreatic cancer: analysis of 43 randomized trials in 3 decades (1974-2002)

Pancreatic cancer represents a major challenge to oncologists because of its high chemoresistant nature and dismal outcomes, especially in advanced diseases. Clinical trials on the effects of systemic chemotherapy for patients with advanced pancreatic cancer have not been shown to have consistent benefits. A systematic review and meta-analysis was therefore conducted to examine this issue. All randomized trials on chemotherapy treatment for advanced pancreatic cancer published since the 1970's were identified by means of Medline and other major oncology databases. Systematic review of all trials was carefully conducted and data from trials with similar designs and regimens were pooled and grouped together in the benefit outcome analyses. Data for 5,365 patients from 43 randomized controlled trials were identified. Survival benefit over best supportive care was demonstrated in 5-FU-based chemotherapy in 9 randomized trials. However, trials that comparing 5-FU or other cytotoxic agent alone versus 5-FU-based combinations did not show any statistical differences, nor were various 5-FU-combinations comparing among themselves. On the other hand, gemcitabine was shown to improve survival and clinical benefit responses better than 5-FU and other new agents. Overall, these results were encouraging and future research to explore means to optimize drug treatment (especially gemcitabine-based regimens) for advanced pancreatic cancer is warranted.

Database of Abstracts of Reviews of Effects (DARE): Quality-assessed Reviews [Internet] - Centre for Reviews and Dissemination (UK).

Version: 2003

Comparison of ERCP, EUS, and ERCP combined with EUS in diagnosing pancreatic neoplasms: a systematic review and meta-analysis

In the current study, we performed a systematic review of literature pertaining to the diagnostic value of endoscopic retrograde cholangiopancreatography (ERCP), endoscopic ultrasonography (EUS), and combined ERCP plus EUS to pancreatic cancer. We searched MEDLINE, OVID, and the Cochrane Library for studies evaluating diagnostic validity of ERCP, EUS, and ERCP plus EUS between January 1989 and May 2014. We obtained pooled estimates of sensitivity, specificity, and summary receiver operating characteristic curves (SROC). A total of 10 studies that included 669 patients who fulfilled all of the inclusion criteria were considered for inclusion in the analysis. The pooled sensitivities of EUS, ERCP, and EUS plus ERCP were 76.7, 57.9, and 79.9 %, respectively. The pooled specificities were 91.7, 90.6, and 94.2 %, respectively. The *Q index estimates were 0.828, 0.862, and 0.896, respectively. The *Q indices for EUS and EUS plus ERCP were significantly higher compared with ERCP (P = 0.010 and 0.008, respectively). Our meta-analysis showed that ERCP plus EUS was associated with a high diagnostic value for the detection of pancreatic neoplasms compared with ERCP and EUS alone.

Database of Abstracts of Reviews of Effects (DARE): Quality-assessed Reviews [Internet] - Centre for Reviews and Dissemination (UK).

Version: 2014

Tumor M2-pyruvate kinase as tumor marker in exocrine pancreatic cancer: a meta-analysis

OBJECTIVES: Tumor M2-pyruvate kinase, a tumor-associated dimeric form of enzyme pyruvate kinase, is commonly elevated in pancreatic cancers. This meta-analysis aimed to evaluate its diagnostic utility in comparison to carbohydrate antigen 19-9 (CA19-9) in pancreatic cancer.

Database of Abstracts of Reviews of Effects (DARE): Quality-assessed Reviews [Internet] - Centre for Reviews and Dissemination (UK).

Version: 2007

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