scholarly journals Pancreatic Resection for Carcinoma of the Pancreas and the Periampullary Region. A Twenty-Year Experience

HPB Surgery ◽  
1990 ◽  
Vol 2 (1) ◽  
pp. 57-67 ◽  
Author(s):  
M. I. Kairaluoma ◽  
M. Ståhlberg ◽  
H. Kiviniemi
Keyword(s):  
Pancreatic Resection ◽  
Survival Rates ◽  
Morbidity Rate ◽  
Periampullary Cancer ◽  
Limiting Factor ◽  
Minimal Risk ◽  
Tumour Histology ◽  
Periampullary Region ◽  
Radical Removal ◽  
Long Term Prognosis

410 patients were treated for pancreatic and periampullary carcinoma in 1968–1987 of whom 89 (21.5%) underwent resection. Hospital mortality decreased from 33% in 1968–1972 to 0% in 1983–1987, but the morbidity rate remained unchanged. The trends were similar in patients ≥ 70 and < 70 years of age. The pylorus-saving technique did not increase mortality, morbidity, operative blood loss or the incidence of delayed gastric emptying, but it did reduce the operative time by one hour (p< 0.01). The real 5 year survival for periampullary cancer was 52%, but none of the patients with pancreatic carcinoma survived for 5 years.It is concluded that age as such is not a limiting factor for pancreatic resection. Resection can be performed with acceptable mortality and survival rates even in patients over 70 years of age if enough attention is paid to careful patient selection and proper preparation. The long-term prognosis is nevertheless related to tumour histology. The recent decline in operative mortality is mostly due to the resections being performed by the same group of surgeons. The best biopsy, and also palliation, is radical removal of the suspicious mass, provided that this can be performed with minimal risk.

scholarly journals Surgical exploration without resection in pancreatic and periampullary tumors: report from a national database

2020 ◽  
pp. 145749692091366
Author(s):  
E. Sahlström ◽  
J. Nilsson ◽  
B. Tingstedt ◽  
M. Bergenfeldt ◽  
R. Andersson ◽  
...  
Keyword(s):  
Pancreatic Resection ◽  
Advanced Disease ◽  
Benign Lesion ◽  
Survival Rates ◽  
Palliative Surgery ◽  
National Database ◽  
Periampullary Cancer ◽  
Surgical Exploration ◽  
Periampullary Tumors ◽  
Time Period

Background and Aims: Pancreatic and periampullary cancers are sometimes found to have a too advanced disease during surgery to allow resection. The aim was to describe characteristics, treatment, outcome, and time trends for patients that were planned for pancreatic surgery but found unresectable during surgery. Material and Methods: Data from the Swedish National Pancreatic and Periampullary Cancer Registry were used. All patients registered between January 2010 and August 2018 were included. The patient cohort was divided in two halves based on year of diagnosis. Results: In total, 12,377 patients were included in the registry and finally 4568 patients were scheduled for surgery. During surgical exploration, 3879 (84.9%) patients underwent pancreatic resection, 658 (14.4%) patients were found unresectable, and 31 (0.7%) had no pancreatic resection due to other reasons (e.g. benign lesion, comorbidity). More patients underwent surgical exploration and resection during the second time period, but exploration without resection was unchanged (15.7% vs 13.7%; p = 0.062). Survival rates were lower among the unresectable patients with pancreatic and periampullary tumors compared to the resectable patients, including 30-day mortality (n = 17 (3.5%) vs n = 39 (1.6%), p = 0.004) and 90-day mortality (n = 72 (15.0%) vs n = 70 (2.8%), p < 0.001). Palliative surgery became less common during the second half of the time period (p < 0.001). Conclusion: Unresectability is associated with an unfavorable prognosis. The frequency did not decrease during the study period, but palliative surgical procedures became less common.

scholarly journals Pancreatic Remnant Occlusion after Whipple's Procedure: An Alternative Oncologically Safe Method

ISRN Surgery ◽  
2013 ◽  
Vol 2013 ◽  
pp. 1-3 ◽  
Author(s):  
Theodosios Theodosopoulos ◽  
Dionysios Dellaportas ◽  
Anneza I. Yiallourou ◽  
George Gkiokas ◽  
George Polymeneas ◽  
...  
Keyword(s):  
Chronic Pancreatitis ◽  
Postoperative Complications ◽  
Survival Rates ◽  
Anastomosis Group ◽  
Morbidity Rate ◽  
Periampullary Cancer ◽  
Pancreatic Stump ◽  
Pancreatic Remnant ◽  
Whipple’S Procedure ◽  
Duration Of Surgery

Introduction. To present our experience regarding the use of pancreatic stump occlusion technique as an alternative management of the pancreatic remnant after pancreatoduodenectomy (PD). Methods. Between 2002 and 2009, hospital records of 93 patients who had undergone a Whipple's procedure for either pancreatic-periampullary cancer or chronic pancreatitis were retrospectively studied. In 37 patients the pancreatic duct was occluded by stapling and running suture without anastomosis of the pancreatic remnant, whereas in 56 patients a pancreaticojejunostomy was performed. Operative data, postoperative complications, oncological parameters, and survival rates were recorded. Results. 2/37 patients of the occlusion group and 9/56 patients of the anastomosis group were treated for chronic pancreatitis, whereas 35/37 and 47/56 patients for periampullary malignancies. The duration of surgery for the anastomosis group was significantly longer (mean time 220 versus 180 minutes). Mean hospitalization time was 6 days for both groups. The occlusion group had a lower morbidity rate (24% versus 32%). With regard to postoperative complications, a slightly higher incidence of pancreatic fistulas was observed in the anastomosis group. Conclusions. Pancreatic remnant occlusion is a safe, technically feasible, and reducing postoperative complications alternative approach of the pancreatic stump during Whipple's procedure.

scholarly journals Comparison of clinicopathological features and long-term prognosis between mixed predominantly differentiated-type and pure differentiated-type early gastric cancer

BMC Cancer ◽  
2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Yutaka Okagawa ◽  
Tetsuya Sumiyoshi ◽  
Hitoshi Kondo ◽  
Yusuke Tomita ◽  
Takeshi Uozumi ◽  
...  
Keyword(s):  
Gastric Cancer ◽  
Early Gastric Cancer ◽  
Vascular Invasion ◽  
Survival Rates ◽  
Malignant Potential ◽  
Clinicopathological Features ◽  
Node Metastasis ◽  
Group 5 ◽  
Long Term Prognosis

Abstract Background Recent studies have shown that mixed predominantly differentiated-type (MD) early gastric cancer (EGC) might have more malignant potential than pure differentiated-type (PD) EGC. However, no study has analyzed all differentiated-type EGC cases treated endoscopically and surgically. This study aimed to compare the differences in clinicopathological features and long-term prognosis between MD- and PD-EGC. Methods We evaluated all patients with differentiated-type EGCs who were treated endoscopically and surgically in our hospital between January 2010 and October 2014. The clinicopathological features and long-term prognosis of MD-EGC were compared with those of PD-EGC. Results A total of 459 patients with 459 lesions were evaluated in this study; of them, 409 (89.1%) and 50 (10.9%) were classified into the PD and MD groups, respectively. Submucosal invasion was found in 96 (23.5%) patients of the PD group and in 33 (66.0%) patients of the MD group (p < 0.01). The rates of positive lymphatic and vascular invasion and ulceration were significantly higher in the MD group than in the PD group (p < 0.01). The proportion of patients with lymph node metastasis was also significantly higher in the MD group than in the PD group (5 (10%) vs 6 (1.5%), p < 0.01). The 5-year overall and EGC-specific survival rates in the PD group were 88.3 and 99.5%, respectively, while they were 94.0 and 98.0% in the MD group, respectively. Conclusions MD-EGC has more malignant potential than PD-EGC. However, the long-term prognosis of MD-EGC is good and is not significantly different from that of PD-EGC when treated appropriately.

scholarly journals Impact of Pancreatic Resection on Survival in Locally Advanced Resectable Gastric Cancer

Cancers ◽  
2021 ◽  
Vol 13 (6) ◽  
pp. 1289
Author(s):  
Shih-Chun Chang ◽  
Chi-Ming Tang ◽  
Puo-Hsien Le ◽  
Chia-Jung Kuo ◽  
Tsung-Hsing Chen ◽  
...  
Keyword(s):  
Lymph Node ◽  
Pancreatic Resection ◽  
Locally Advanced ◽  
Survival Rates ◽  
Disease Free Survival ◽  
Complication Rates ◽  
Lymph Node Yield ◽  
Whipple’S Operation ◽  
Whipple's Operation ◽  
The Impact

Whether gastric adenocarcinoma (GC) patients with adjacent organ invasion (T4b) benefit from aggressive surgery involving pancreatic resection (PR) remains unclear. This study aimed to clarify the impact of PR on survival in patients with locally advanced resectable GC. Between 1995 and 2017, patients with locally advanced GC undergoing radical-intent gastrectomy with and without PR were enrolled and stratified into four groups: group 1 (G1), pT4b without pancreatic resection (PR); group 2 (G2), pT4b with PR; group 3 (G3), positive duodenal margins without Whipple’s operation; and group 4 (G4), cT4b with Whipple’s operation. Demographics, clinicopathological features, and outcomes were compared between G1 and G2 and G3 and G4. G2 patients were more likely to have perineural invasion than G1 patients (80.6% vs. 50%, p < 0.001). G4 patients had higher lymph node yield (40.8 vs. 31.3, p = 0.002), lower nodal status (p = 0.029), lower lymph node ratios (0.20 vs. 0.48, p < 0.0001) and higher complication rates (45.2% vs. 26.3%, p = 0.047) than G3 patients. The 5-year disease-free survival (DFS) and overall survival (OS) rates were significantly longer in G1 than in G2 (28.1% vs. 9.3%, p = 0.003; 32% vs. 13%, p = 0.004, respectively). The 5-year survival rates did not differ between G4 and G3 (DFS: 14% vs. 14.4%, p = 0.384; OS: 12.6% vs. 16.4%, p = 0.321, respectively). In conclusion, patients with T4b lesion who underwent PR had poorer survival than those who underwent resection of other adjacent organs. Further Whipple’s operation did not improve survival in pT3–pT4 GC with positive duodenal margins.

La chirurgia conservativa renale nell'anziano: Kidney preserving surgery in the elderly

1998 ◽  
Vol 65 (2) ◽  
pp. 243-245
Author(s):  
C. Tallarigo ◽  
G. Novella ◽  
F. Mastroeni ◽  
L.G. Luciani ◽  
V. Ortalda
Keyword(s):  
Renal Function ◽  
Survival Rates ◽  
The Elderly ◽  
Conservative Surgery ◽  
Limiting Factor ◽  
Renal Neoplasm ◽  
Renal Surgery ◽  
Surgery In The Elderly ◽  
Disease Free ◽  
Dialytic Treatment

Conservative renal surgery has recently been extended to elderly patients who have decreased renal function and reduced survival rates in the case of dialytic treatment. Furthermore, age is no longer a limiting factor despite the increased anethesiological risk. Fifteen cases of renal neoplasm in patients over 70, who had undergone conservative surgery, were reviewed: 14 are alive and disease-free after 14-135 months and 1 died from unrelated causes. It is concluded that conservative renal surgery has a role even in the elderly.

Isolated Caudate Lobe Resection for Huge Hepatocellular Carcinoma (10 cm or greater in diameter)

2014 ◽  
Vol 80 (2) ◽  
pp. 159-165 ◽  
Author(s):  
Wei-Dong Dai ◽  
Jiang-Sheng Huang ◽  
Ji-Xiong Hu
Keyword(s):  
Hepatocellular Carcinoma ◽  
Survival Rates ◽  
Intraoperative Ultrasound ◽  
Caudate Lobe ◽  
Morbidity Rate ◽  
Safe Procedure ◽  
Caudate Lobectomy ◽  
En Bloc ◽  
Main Trunk ◽  
Huge Hepatocellular Carcinoma

Isolated caudate lobectomy for huge hepatocellular carcinoma (HCC) (10 cm or greater in diameter) is a technically demanding surgical procedure that entails the surgeon's experience and precise anatomical knowledge of the liver. We describe our clinical experiences and evaluate the results of partial or total isolated caudate lobectomy for HCC larger than 10 cm in the caudate lobe. En bloc excisions combined with adjacent hepatic parenchyma (as part of extended hepatectomies) were excluded. Twenty-seven patients were included in the study (24 male, three3 female). Median age was 43 years (range, 18 to 81 years). All primary diagnoses were HCC. Twenty-one patients had surgical margins lesser than 1 cm. Tumor embolus within the main trunk of the portal vein was found in five patients by intraoperative ultrasound. Median operative time was 288 minutes (range, 160 to 310 minutes), and estimated intraoperative blood loss was 2260 mL (range, 200 to 7000 mL). Median blood transfusion was 1460 mL (range, 0 to 7200 mL). Postoperative morbidity rate was 44.4 per cent. There were no postoperative deaths. Overall survival rates at 1, 3, and 5 years were 80.2, 52.1, and 27.1 per cent, respectively. Nineteen patients (70.4%) had tumor recurrence as of the last follow-up. The recurrence lesion was treated in most of these patients. Isolated caudate lobectomy for huge HCC is a technically demanding but safe procedure, although the procedure is sometimes extremely difficult.

scholarly journals Genetics and prognosis of ALL in children vs adults

Hematology ◽  
2018 ◽  
Vol 2018 (1) ◽  
pp. 137-145 ◽  
Author(s):  
Kathryn G. Roberts
Keyword(s):  
Tyrosine Kinase ◽  
Kinase Inhibitors ◽  
Lymphoblastic Leukemia ◽  
Diagnostic Testing ◽  
Survival Rates ◽  
Philadelphia Chromosome ◽  
Genetic Alterations ◽  
Tyrosine Kinase Signaling ◽  
Disease Biology ◽  
Long Term Prognosis

Abstract Acute lymphoblastic leukemia (ALL) is characterized by genetic alterations that block differentiation, promote proliferation of lymphoid precursor cells, and are important for risk stratification. Although ALL is less common in adolescents and young adults (AYAs) and adults than children, survival rates are inferior, and long-term prognosis for adults is poor. Thus, ALL remains a challenging disease to treat in the AYA and adult populations. A major contributing factor that influences prognosis in this population is the reduced prevalence of genetic subtypes associated with favorable outcome and a concomitant increase in subtypes associated with poor outcome. Recent advances in genomic profiling across the age spectrum continue to enhance our knowledge of the differences in disease biology between children and adults and are providing important insights into novel therapeutic targets. Philadelphia chromosome-like (Ph-like) ALL is one such subtype characterized by alterations that deregulate cytokine receptor or tyrosine kinase signaling and are amenable to inhibition with approved tyrosine kinase inhibitors. One of the greatest challenges now remaining is determining how to implement this breadth of genomic information into rapid and accurate diagnostic testing to facilitate the development of novel clinical trials that improve the outcome of AYAs and adults with ALL.

The impact of adjuvant delayed radiotheraphy (RT) on survival in patients with resected periampullary adenocarcinomas.

2013 ◽  
Vol 31 (15_suppl) ◽  
pp. e15168-e15168
Author(s):  
Suayib Yalcin ◽  
Neyran Kertmen ◽  
Deniz Yuce ◽  
Ferah Yildiz ◽  
Erhan Hamaloglu
Keyword(s):  
Cancer Patients ◽  
Survival Rates ◽  
Tumor Resection ◽  
Disease Free Survival ◽  
Ampullary Carcinoma ◽  
Periampullary Cancer ◽  
Periampullary Tumor ◽  
Complete Surgical Resection ◽  
The Difference ◽  
The Impact

e15168 Background: Postoperative prognosis for ampullary carcinoma (AC) is superior to that of pancreatic cancer (PC), the former exhibiting higher complete surgical resection, lower recurrence and longer survival rates (1). Despite all the major recent advances in surgery, chemotherapy (CT) and RT, PC is still one of the most lethal malignancies, overall survival (OS) rates being as low as 5% at 5 years (2). This study was intended to evaluate survival in patients with resected periampullary cancer treated with adjuvant Gemcitabine (Gem) and cisplatin (Cis) with or without delayed RT (with Gem). Methods: This retrospective study involved 91 patients diagnosed and treated with periampullary cancer. Patients with adenocarcinoma of periampullary region with gross total tumor resection and lymph node dissection (R0 and R1 resections only) were included. Of 59 patients with PC, 38 received Gem and Cis for 3 cycles (3 months) before CRT. When delivered after Gem /RT, Gem and Cis were usually given for another 1-3 cycles. Twenty-seven patients received Gem and Cis alone over 6 cycles. Of 32 patients with non-pancreatic periampullary 23 received CT+CRT and 9 patients received CT alone. Results: Patients with non-pancreatic periampullary cancer had better OS (p:0.017) and disease free survival (DFS) ( p<0.001 ) compared to patients with PC. Median OS of patients with PC was 21 months. Both OS and DFS were superior in the RT arm compared to nonRT arm (p: 0.043 and p <0.001). In non-pancreatic periampullary cancer patients OS was 31 months in RT group and 51 months in non-RT group (p: 0.709). DFS was 29 months and 49.8 months respectively, p:0.504). Conclusions: The prognosis of PC was worse than non–pancreatic periampullary tumor. In PC adjuvant delayed RT improved patient outcome. Although OS and DFS were better in patients receiving CT alone, the difference was not statistically significant in non–pancreatic periampullary tumors.

scholarly journals Stereotactic body radiotherapy for T3 and T4N0M0 non–small cell lung cancer

2016 ◽  
Vol 57 (3) ◽  
pp. 265-272 ◽  
Author(s):  
Takahisa Eriguchi ◽  
Atsuya Takeda ◽  
Naoko Sanuki ◽  
Shuichi Nishimura ◽  
Yoshiaki Takagawa ◽  
...  
Keyword(s):  
Lung Cancer ◽  
Small Cell Lung Cancer ◽  
Cell Lung Cancer ◽  
Stereotactic Body Radiotherapy ◽  
Vital Capacity ◽  
Survival Rates ◽  
Forced Expiratory Volume ◽  
Small Cell ◽  
Morbidity Rate ◽  
Small Cell Lung

Abstract To evaluate the outcomes and feasibility of stereotactic body radiotherapy (SBRT) for cT3 and cT4N0M0 non–small cell lung cancer (NSCLC), 25 patients with localized primary NSCLC diagnosed as cT3 or cT4N0M0, given SBRT between May 2005 and July 2013, were analyzed. All patients had inoperable tumors. The major reasons for tumors being unresectable were insufficient respiratory function for curative resection, advanced age (&gt;80 years old) or technically inoperable due to invasion into critical organs. The median patient age was 79 years (range; 60–86). The median follow-up duration was 25 months (range: 5–100 months). The 2-year overall survival rates for T3 and T4 were 57% and 69%, respectively. The 2-year local control rates for T3 and T4 were 91% and 68%, respectively. As for toxicities, Grade 0–1, Grade 2 and Grade 3 radiation pneumonitis occurred in 23, 1 and 1 patient, respectively. No other acute or symptomatic late toxicities were reported. Thirteen patients who had no local, mediastinal or intrapulmonary progression at one year after SBRT underwent pulmonary function testing. The median variation in pre-SBRT and post-SBRT forced expiratory volume in 1 s (FEV1) values was –0.1 (–0.8–0.8). This variation was not statistically significant ( P = 0.56). Forced vital capacity (FVC), vital capacity (VC), %VC and %FEV1 also showed no significant differences. SBRT for cT3 and cT4N0M0 NSCLC was both effective and feasible. Considering the favorable survival and low morbidity rate, SBRT is a potential treatment option for cT3 and cT4N0M0 NSCLC.

Sign in / Sign up

Export Citation Format

Share Document