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Oncological problems in pancreatic cancer surgeryNakao, Akimasa 05 1900 (has links)
No description available.
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Gastroduodenopancreatectomia: análise da morbidade e mortalidade / Gastroduodenopancreatectomy: analysis of morbidity and mortalityPACHECO, Jairo Sousa 10 September 2012 (has links)
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Previous issue date: 2012-09-10 / Objective: To determine the major complications in patients undergoing gastroduodenopancreatectomy for pancreatic cancer and periampullary region, possible
determinant factors and associated mortality. Methods: Retrospective study including
patients diagnosed with pancreatic cancer and periampullary region undergone GDP from January 1987 to December 2007. Epidemiological and clinical data, laboratory and
disease-related data and the procedure were reviewed. Results: 105 patients were
included. Males represented 52%. Signs and/or symptoms more frequent were pain and
jaundice. Jaundice was observed in 78.89%. Most didn´t have diabetes, and the use of
alcohol and smoke was less frequent. Most were submitted to classical resection with
median operative time of 440 minutes. Duct-to-mucosa pancreatic reconstruction was
carried out in 69 patients. Complications were observed in 54 patients (51.4%). The
mortality rate was 7.6% (eight patients). Pancreatic fistula was observed in 21 cases
(20%), with 9 cases (8.5%) grade A, 2 (1.9%) grade B, and 10 (9.5%) grade C. Other
complications observed were biliary fistula (5.7%), operative wound infection (5.7%), intraabdominal abscess/collection (5.7%) and hemoperitoneum (2.8%). Clinical complications observed were pneumonia (3.8%) and urinary tract infection (1.9%). High CA 19-9 tumor marker and duct-to-mucosa pancreatic enteric reconstruction technique presented a statistically significant result. Conclusion: Pancreatic fistula remains the most important complication associated with higher mortality. The surgical technique used and CA 19-9 were prognostic factors. In this study, the pancreatic reconstruction technique using ductto-mucosa anastomosis type presented less failure. / Objetivo: Determinar as principais complicações em pacientes submetidos a gastroduodenopancreatectomia por câncer de pâncreas e região periampolar, possíveis fatores determinantes e mortalidade associada. Métodos: Estudo retrospectivo incluindo pacientes com diagnóstico de câncer de pâncreas e região periampolar submetidos a gastroduodenopancreatectomia no período de janeiro de 1987 a dezembro de 2007. Dados clínicos e epidemiológicos, laboratoriais e dados
relacionados a doença e ao procedimento foram revistos. Resultados: Foram incluídos 105 pacientes. Sexo masculino correspondeu a 52%. Sinais e/ou sintomas mais freqüentes foram dor e icterícia. Icterícia foi observada em 78,89%. A maioria não apresentava diabetes, e o uso de álcool e fumo foi menos freqüente. A maioria foi submetida a ressecção clássica com mediana do tempo operatório de 440
minutos. A reconstrução pancreática ducto-mucosa foi realizada em 69 pacientes. Complicações foram observadas em 54 pacientes (51,4%). A mortalidade foi de 7,6% (oito pacientes). Fístula pancreática foi observada em 21 casos (20%), sendo 9 casos (8,5%) grau A, 2 (1,9%) grau B e 10 (9,5%) grau C. Outras complicações observadas foram fístula biliar (5,7%), infecção de ferida operatória (5,7%), coleção/abscesso intra-abdominal (5,7%) e hemoperitônio (2,8%). Complicações clínicas observadas foram pneumonia (3,8%) e infecção do trato urinário (1,9%). Marcador tumoral CA 19-9 elevado e a técnica de reconstrução pancreatoentérica ducto mucosa apresentaram resultado estatisticamente significativo. Conclusão: Fístula pancreática permanece a complicação mais importante, associada a maior
mortalidade. A técnica cirúrgica empregada e CA 19-9 foram fator prognóstico. Nesse estudo, a técnica de reconstrução pancreática utilizando a anastomose tipoducto-mucosa apresentou menor falha.
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Hyperspectral Imaging (HSI)—A New Tool to Estimate the Perfusion of Upper Abdominal Organs during PancreatoduodenectomyMoulla, Yusef, Buchloh, Dorina Christin, Köhler, Hannes, Rademacher, Sebastian, Denecke, Timm, Meyer, Hans-Jonas, Mehdorn, Matthias, Lange, Undine Gabriele, Sucher, Robert, Seehofer, Daniel, Jansen-Winkeln, Boris, Gockel, Ines 26 April 2023 (has links)
Hyperspectral imaging (HSI) in abdominal surgery is a new non-invasive tool for the assessment of the perfusion and oxygenation of various tissues and organs. Its benefit in pancreatic surgery is still unknown. The aim of this study was to evaluate the key impact of using HSI during pancreatoduodenectomy (PD). In total, 20 consecutive patients were included. HSI was recorded during surgery as part of a pilot study approved by the local Ethics Committee. Data were collected prospectively with the TIVITA® Tissue System. Intraoperative HS images were recorded before and after gastroduodenal artery (GDA) clamping. We detected four patients with celiac artery stenosis (CAS) caused by a median arcuate ligament (MAL). In two of these patients, a reduction in liver oxygenation (StO2) was discovered 15 and 30 min after GDA clamping. The MAL was divided in these patients. HSI showed an improvement of liver StO2 after MAL division (from 61% to 73%) in one of these two patients. There was no obvious decrease in liver StO2 in the other two patients with CAS. HSI, as a non-invasive procedure, could be helpful in evaluating liver and gastric perfusion during PD, which might assist surgeons in choosing the best surgical approach and in improving patients’ outcomes.
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Evaluation of survival in patients after pancreatic head resection for ductal adenocarcinomaDistler, Marius, Rückert, Felix, Hunger, Maximilian, Kersting, Stephan, Pilarsky, Christian, Saeger, Hans-Detlev, Grützmann, Robert 28 November 2013 (has links) (PDF)
Background: Surgery remains the only curative option for the treatment of pancreatic adenocarcinoma (PDAC). The goal of this study was to investigate the clinical outcome and prognostic factors in patients after resection for ductal adenocarcinoma of the pancreatic head.
Methods: The data from 195 patients who underwent pancreatic head resection for PDAC between 1993 and 2011 in our center were retrospectively analyzed. The prognostic factors for survival after operation were evaluated using multivariate analysis.
Results: The head resection surgeries included 69.7% pylorus-preserving pancreatoduodenectomies (PPPD) and 30.3% standard Kausch-Whipple pancreatoduodenectomies (Whipple). The overall mortality after pancreatoduodenectomy (PD) was 4.1%, and the overall morbidity was 42%. The actuarial 3- and 5-year survival rates were 31.5% (95% CI, 25.04%-39.6%) and 11.86% (95% CI, 7.38%-19.0%), respectively. Univariate analyses demonstrated that elevated CEA (p = 0.002) and elevated CA 19–9 (p = 0.026) levels, tumor grade (p = 0.001) and hard texture of the pancreatic gland (p = 0.017) were significant predictors of a poor survival. However, only CEA >3 ng/ml (p < 0.005) and tumor grade 3 (p = 0.027) were validated as significant predictors of survival in multivariate analysis.
Conclusions: Our results suggest that tumor marker levels and tumor grade are significant predictors of poor survival for patients with pancreatic head cancer. Furthermore, hard texture of the pancreatic gland appears to be associated with poor survival.
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Evaluation of survival in patients after pancreatic head resection for ductal adenocarcinomaDistler, Marius, Rückert, Felix, Hunger, Maximilian, Kersting, Stephan, Pilarsky, Christian, Saeger, Hans-Detlev, Grützmann, Robert 28 November 2013 (has links)
Background: Surgery remains the only curative option for the treatment of pancreatic adenocarcinoma (PDAC). The goal of this study was to investigate the clinical outcome and prognostic factors in patients after resection for ductal adenocarcinoma of the pancreatic head.
Methods: The data from 195 patients who underwent pancreatic head resection for PDAC between 1993 and 2011 in our center were retrospectively analyzed. The prognostic factors for survival after operation were evaluated using multivariate analysis.
Results: The head resection surgeries included 69.7% pylorus-preserving pancreatoduodenectomies (PPPD) and 30.3% standard Kausch-Whipple pancreatoduodenectomies (Whipple). The overall mortality after pancreatoduodenectomy (PD) was 4.1%, and the overall morbidity was 42%. The actuarial 3- and 5-year survival rates were 31.5% (95% CI, 25.04%-39.6%) and 11.86% (95% CI, 7.38%-19.0%), respectively. Univariate analyses demonstrated that elevated CEA (p = 0.002) and elevated CA 19–9 (p = 0.026) levels, tumor grade (p = 0.001) and hard texture of the pancreatic gland (p = 0.017) were significant predictors of a poor survival. However, only CEA >3 ng/ml (p < 0.005) and tumor grade 3 (p = 0.027) were validated as significant predictors of survival in multivariate analysis.
Conclusions: Our results suggest that tumor marker levels and tumor grade are significant predictors of poor survival for patients with pancreatic head cancer. Furthermore, hard texture of the pancreatic gland appears to be associated with poor survival.
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