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Transperitoneal Laparoscopic Radical Nephroureterectomy
Published in Qais Hooti, Sung-Hoo Hong, Minimally Invasive Urologic Surgery, 2023
The tail of pancreas is further released from the adrenal gland and upper pole of the kidney, taking care to avoid injury to the pancreatic tissue or the splenic vessels (Figure 6.14).
Post-Colonic Anastomotic Leak
Published in Savio George Barreto, Shailesh V. Shrikhande, Dilemmas in Abdominal Surgery, 2020
Marginal arterial supply from the middle colic is usually good enough if descending or transverse colon are being used for a colorectal/coloanal anastomosis, but it may be insufficient for the sigmoid colon. If the sigmoid colon is used for anastomosis, then the left colic artery should be preserved. There is some data to suggest that it is not just the point of arterial ligation but the site of transection in the colon that impacts the blood supply at the anastomosis. Especially in patients who have received preoperative radiation, it may be necessary to remove the sigmoid and mobilize the descending colon to the pelvis. The splenic flexure should be completely mobilized and the greater omentum dissected off the transverse colon. Also, the retroperitoneal attachments at the tail of pancreas should be completely freed. The inferior mesenteric vein must be ligated just lateral to the ligament of Treitz, as this allows gain of length of several centimeters. For a transverse colon anastomosis, both hepatic and splenic flexures should be mobilized.
The Pancreas and the Periampullary Area
Published in E. George Elias, CRC Handbook of Surgical Oncology, 2020
While total pancreatectomy, as well as regional pancreatectomy, eliminates the pancreati-cojejunal anastomosis, eradicates foci of multicentricity that seem to be in 20 to 30% of the patients, and permits easy accessability for extensive lymphadenectomy, yet it results in endocrine and exocrine functional loss, a brittle type diabetes which is not easy to control, and the risk of peptic ulceration, and all of this with no improvement in long-term results when compared to the classic pancreaticoduodenectomy.9 However, I believe that the standard one stage Whipple operation remains to be the procedure of choice for carcinoma of the head of the pancreas. It preserves pancreatic endocrine function and gave the same survival as total pancreatectomy. However, the Whipple procedure should be converted to a total pancreatectomy if the frozen section on the resected edge of the pancreas reveals a tumor or if there are multiple tumors in the body and tail of pancreas. Another indication for total pancreatectomy is in the case where the surgeon feels that the remaining pancreas is not suitable or safe for a pancreatojejunal anastomosis.
Effects of exercise in combination with autologous bone marrow stem cell transplantation for patients with type 1 diabetes
Published in Physiotherapy Theory and Practice, 2019
Marwa Taher Mohamed, Eman Ahmed Embaby, Awatif Labib, Mohammed El-Husseiny, Hazem Khamis, Ahmed El-Demery, Mohamed Mounir Shoukry
As we used a heterogeneous BMMNCs mixture rather than a single type of cells it is still unknown which specific cell type contributed to combating hyperglycemia and reversing insulin antibodies to a negative state. If we had solely infused purified HSCs or MSCs, the molecular mechanism may have been illustrated more clearly. Some studies represented direct intra-pancreatic delivery as a safe and promising therapeutic approach in T1D patients because arteries that supply the pancreas in T1D patients could be affected after long disease duration which gives an advantage to direct intra-pancreatic delivery way (Bell, Putman, Hughes-Large, and Hess, 2012; Li et al., 2016). Furthermore, the direct access ensures the localization of cells in the pancreas, which could not be achieved without possible complications. We selected the tail of pancreas because the islet concentration in this area may be significantly greater than in other parts of the pancreas (Katuchova et al., 2012; Wittingen and Frey, 1974).
Impact of Weight Loss During Chemotherapy in Chinese Patients with Unresectable Pancreatic Cancer
Published in Nutrition and Cancer, 2019
Henry C. Y. Wong, Kwan Y. Lam, Charing C. N. Chong, Anthony W. H. Chan, Stephen L. Chan
Univariate analysis identified five parameters associated with poorer overall survival, namely tumors located at the body and tail of pancreas, NLR > 5, serum albumin < 35 mg/dl and CA19-9 ≥ 1,000 U/ml and CWL (Table 2). Multivariate analyses showed that three factors, namely CA19-9 ≥ 1,000 U/ml (HR 1.92 [95% CI 1.07–3.45] P = 0.03), albumin < 35 mg/dl (HR 2.47 95% [CI 1.06–5.76]; P = 0.04) and CWL (HR 2.50 [95% CI 1.20–5.20]; P = 0.01) to be independent prognostic parameters (Table 2). For TTF, tumors located at the body and tail of pancreas, NLR > 5, serum albumin < 35 mg/dl, metastatic disease and critical weight loss were prognostic factors in the univariate analysis, while CWL remained the only independent adverse factor for TTF (HR 2.71 [95% CI 1.33–5.52]; P < 0.01) (Table 3).
Gastric cancer: factors affecting survival
Published in Acta Chirurgica Belgica, 2019
Suleyman Orman, Haci Murat Cayci
Lymph node dissection may support the philosophy that cancer surgery is a lymph pathway surgery rather than an organ surgery. Although extensive LND is recommended in resectable GCs, its effect on survival is still under debate [9]. Early studies have reported high morbidity and mortality rates in cases where routine resection of the tail of pancreas and spleen were performed and D2 LND was carried out. No significant difference was reported between D1 and D2 LND in terms of survival advantage; however, these studies reported lower rates of locoregional recurrence in the long term and lower rates of cancer-related deaths [8,21,22]. Randomized controlled studies reported a higher rate of postoperative mortality after D2 LND compared to D1 LND, but there was no significant difference with respect to overall survival rate [12,23]. In a Dutch study, D2 LND, splenectomy, pancreatectomy, and advanced age (>70 years) were found to be associated with increased rate of morbidity and mortality [24]. No difference was reported between D2 LND and D2 LND + paraaortic LND in terms of survival [7].