1. © 2008 Luzerner Kantonsspital Advanced Pancreatic Cancer Swiss Tumorboard, Berne 26.3.2009 www.magendarm-zentrum.ch 04.10.2015 PD Dr. J. Metzger Chefarzt Viszeralchirurgie

2. © 2008 Luzerner Kantonsspital Patient: male, 55 y epigastric pain, itching (jaundice), loss of weight (5kg) D.m.; BMI 30.4 kg/m 2 (5 kg ↓↓) diagnostic: CT (abdomen) MRI ERCP papillotomy & stent 23.12.2008 www.magendarm-zentrum.ch

3. © 2008 Luzerner Kantonsspital CT-scan

4. © 2008 Luzerner Kantonsspital MRI

5. © 2008 Luzerner Kantonsspital ERCP

6. © 2008 Luzerner Kantonsspital Questions to the panel any further diagnostic (biopsy?) would you consider neoadjuvant treatment?

7. © 2008 Luzerner Kantonsspital Surgery intraoperative findings:

8. © 2008 Luzerner Kantonsspital pancreas remnant A.hepatica com. portal vein infiltration

9. © 2008 Luzerner Kantonsspital Questions to the panel resection of the portal vein extension of lymphadenectomy

10. © 2008 Luzerner Kantonsspital Final Histology adenocarcinoma; G3 primary Tumor: 2.5x3.5 cm pN1: (1|16) resection margins: pancreas:free duodenumfree bile ductfree retroperitoneal? closed to the margin pT 3 pN 1 M0, G3

11. © 2008 Luzerner Kantonsspital

12. Questions to the panel adjuvant treatment? Cx alone? Cx and RT?