China
Africa
Explore chapters and articles related to this topic
Aberrant Methylation of UC Promoters in Human Pancreatic Ductal Carcinomas
Published in Surinder K. Batra, Moorthy P. Ponnusamy, Gene Regulation and Therapeutics for Cancer, 2021
Michiyo Higashi, Seiya Yokoyama
Pancreatic ductal adenocarcinoma (PDAC) is still a lethal disease in spite of the improvement in diagnosis and treatment. The overall five-year survival rate for all patients with or without pancreatectomy after diagnosis is 13% in Japan [1]. On the other hand, patients with a successful resection of PDAC at an early stage (Stage TA: tumors located within pancreas; tumor size <2 cm, without metastasis) have a 46% five year survival rate [1, 2]. However, most patients with PDAC are diagnosed in the advanced stages because of the anatomical location of the pancreas, lack of specific symptoms, infiltration to the surrounding organs, or distant metastasis even from a small primary tumor less than 2 cm in diameter. Thus, a diagnostic technique for small pancreatic adenocarcinomas without symptoms is urgently needed.
Acute Necrotizing Pancreatitis Post-Pancreatoduodenectomy
Published in Savio George Barreto, Shailesh V. Shrikhande, Dilemmas in Abdominal Surgery, 2020
Ibrahim Büdeyri, Onur Bayram, Christoph W. Michalski, Jörg Kleeff
Generally speaking, there are two surgical approaches [5]. The first approach involves taking down the pancreatic anastomosis with externalization of the pancreatic duct. Alternatively, and if technically feasible, a completion pancreatectomy should be performed. Both are valid options and the final decision can often only be made intraoperatively. Factors in favor of a completion pancreatectomy include sepsis, organ failure, leakage, and bleeding from the pancreatico-enteric anastomosis [3]. Mortality after late revisions is higher than after early revisions due to destruction of the operating field by pancreatitis and necrosis and due to severe sepsis. Early diagnosis of postoperative acute pancreatitis is therefore a key to better outcomes, yet even after an early revision a prolonged recovery from disease must be expected [3]. It must be appreciated that completion pancreatectomy may be technically demanding, and rapid deterioration of the patient frequently requires damage control surgery. In such cases, disintegration of the pancreatic anastomosis and externalization of the pancreatic duct (e.g. using an infant nasogastric tube) may be warranted.
Abdominal surgery
Published in Roy Palmer, Diana Wetherill, Medicine for Lawyers, 2020
This form of surgery is again carried out in specialist units. Surgery for the pancreas is carried out for inflammatory conditions (pancreatitis) and for malignant conditions (carcinoma of the pancreas). Pancreatitis can be a very severe condition with a very significant mortality. Following recurrent attacks of pancreatitis some patients are left with severe chronic pain. A pancreatectomy can be carried out under these circumstances but, having removed the pancreas, the patients then require insulin and digestive enzyme supplements. Pancreatic surgery is major surgery, again with a very high mortality rate. There are few long-term survivors among patients who develop cancer of the pancreas. Some justification for operating on the pancreas may be that it improves the severe pancreatic pain that these patients experience in the later stages of their illness.
Total pancreatectomy with intraportal islet autotransplantation for pancreatic malignancies: a literature overview
Published in Expert Opinion on Biological Therapy, 2022
Mohamed Ali Chaouch, Piera Leon, Gianluca Cassese, Caroline Aguilhon, Salah Khayat, Fabrizio Panaro
Totalization of pancreatectomy as a salvage procedure during relaparotomy was required in some cases of POPF grade C or refractory bleeding [43]. Balzano et al. reported the different strategies provided for POPF grade C after PD, including 31 patients [12]. They performed a completion of pancreatectomy in 14 patients, while 17 patients had a conservative approach. The mortality rate, blood loss, and transfusion requirement were similar for the two groups, and further laparotomies were significantly less frequent (7% versus 59%, P < 0.01) after pancreatectomy totalization as compared to pancreatic stump preservation. Intensive care unit length of stay was reduced (p = 0.058) in patients with no residual pancreatic stump. POPF persisted in two out of three patients (66%) who were discharged after performing the pancreas-preserving technique. Moreover, seven patients out of 14 (50%) had IAT after pancreatectomy completion; one of them died postoperatively. Long-term endocrine graft function was maintained in four out of six patients; one was insulin-independent at 36 months after transplantation.
The impact of nutritional status on pancreatic cancer therapy
Published in Expert Review of Anticancer Therapy, 2022
Gabriele Capurso, Nicolò Pecorelli, Alice Burini, Giulia Orsi, Diego Palumbo, Marina Macchini, Roberto Mele, Francesco de Cobelli, Massimo Falconi, Paolo Giorgio Arcidiacono, Michele Reni
Pancreatic resection is one of the most challenging abdominal operations characterized by significant postoperative morbidity and a prolonged recovery period even in experienced centers. Pancreatectomy represents a major trauma for patients due to the great extent of dissection, resection, and the duration of surgery. The neuro-hormonal stress response and the inflammatory cascade elicited by tissue damage induce insulin resistance and a catabolic state with protein loss, ultimately leading to muscle depletion and loss of function that may persist until adequate nutritional substrates are introduced [50]. Therefore, perioperative nutritional status is a key aspect for any patient undergoing pancreatic surgery. Malnourished patients have very limited nutritional reserves resulting in poor healing and delayed functional recovery after surgery. Additionally, pancreatic cancer patients are often older and carry preexisting comorbidities such as diabetes, obesity, subclinical organ dysfunction and may have experienced a long course of chemotherapy, which all decrease physiological reserves further contributing to poor postoperative recovery. Thus, the nutritional status of all patients scheduled for pancreatic surgery should be initially screened and thoroughly evaluated to guide possible nutritional interventions.
Neoadjuvant treatment for borderline resectable pancreatic adenocarcinoma is associated with higher R0 rate compared to upfront surgery
Published in Acta Oncologica, 2021
Mario Terlizzi, Etienne Buscail, Olayidé Boussari, Sarah Adgié, Nicolas Leduc, Eric Terrebonne, Denis Smith, Jean-Frédéric Blanc, Bruno Lapuyade, Christophe Laurent, Laurence Chiche, Geneviève Belleannée, Karine Le Malicot, Renaud Trouette, Claudia Pouypoudat, Véronique Vendrely
Fifty-five (69.6%) tumours were resected, 16 (29.1%) upfront and 39 (70.9%) after completion of NAT. Surgical procedure consisted in pancreaticoduodenectomy, distal pancreatectomy with splenectomy, and total pancreatectomy in 90.9%, 1.8%, and 7.3%, respectively. No patients in the US group had contraindications to resection during laparotomy. There was no significant difference regarding vascular resection rates between groups (53.8% in the NAT group vs. 62.5% in US group, p = 0.77). The rate of complications (major Dindo-Clavien grade III–V [14]) was 9.1% (n = 5) for the entire resected population. Length of hospital stay was similar between groups and postoperative outcomes did not differ either. Pancreatic fistula only occurred in three patients (5.5%), without any difference between groups (Table 2). Adjuvant CT (gemcitabine 95%, FLX 5%) was administered in 23 (41.8%) patients (68.8% patients in the US group vs. 30.7% in the NAT group, p = 0.015). In the US group, four patients (25%) with R1 margins received salvage CRT.