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Abdominal trauma
Published in Mark Davenport, James D. Geiger, Nigel J. Hall, Steven S. Rothenberg, Operative Pediatric Surgery, 2020
Steven Stylianos, Mark V. Mazziotti
Duodenal diverticularization is an effective procedure for combined proximal duodenal and pancreatic injury. Resection and closure of the duodenal stump with decompressive tube duodenostomy, biliary drainage via tube cholecystectomy, gastrojejunostomy, and multiple closed suction drains are depicted in Figure 84.11a and b. A feeding jejunostomy should be strongly considered (not depicted). No matter what repair the surgeon selects, a summary of the literature demonstrates that protecting the duodenal closure (drain and exclusion) and a route for enteral feeds (gastrojejunostomy ± feeding jejunostomy) reduces morbidity and length of hospital stay. A pancreaticoduodenectomy (Whipple procedure) should rarely be required. Although occasionally reported in the literature, pancreaticoduodenectomy should be reserved for the most severe injuries to the duodenum and pancreas when the common blood supply is destroyed and any possibility of reconstruction is impossible.
Preoperative Nutrition Assessment and Optimization in the Cancer Patient
Published in Victor R. Preedy, Handbook of Nutrition and Diet in Palliative Care, 2019
Shalana O'Brien, Allison Bruff, Jeffrey M. Farma
Infections: Surgical site infections (SSIs) are common postoperative complications associated with significant morbidity and cost. Poor nutritional status is associated with increased rates of SSI in many types of cancer. Colorectal cancer patients in the National Surgical Quality Improvement Program (NSQIP) database with hypoalbuminemia have increased rates of superficial and deep SSIs (Hu et al. 2015). In addition, malnourished pancreatic cancer patients undergoing pancreaticoduodenectomy had significantly higher rates of SSI (Shinkawa et al. 2013).
Abdominal trauma
Published in Brice Antao, S Irish Michael, Anthony Lander, S Rothenberg MD Steven, Succeeding in Paediatric Surgery Examinations, 2017
Marianne Beaudin, Rebeccah L Brown
The management of pancreatic trauma is still somewhat controversial. Some groups advocate non-operative management even for complete ductal disruption while others advocate distal pancreatectomy for distal ductal disruption. When facing isolated pancreatic injury, non-operative management should be considered. However, when a patient is in the operating room for another reason and a distal ductal injury is found, spleen-preserving distal pancreatectomy should be strongly considered. A more conservative approach is always used for injuries involving the head of the pancreas. Closed-suction drains can be left in place with further investigations in the postoperative period. A Whipple’s procedure (pancreaticoduodenectomy) should be considered only in the haemodynamically stable patient with complete disruption of the duodenum and head of the pancreas with vascular involvement.
Prognostic Value and Molecular Mechanisms of Proteasome 26S Subunit, Non-ATPase Family Genes for Pancreatic Ductal Adenocarcinoma Patients after Pancreaticoduodenectomy
Published in Journal of Investigative Surgery, 2022
Caifu Zhou, Haixia Li, Xiao Han, Hongbing Pang, Manya Wu, Yanping Tang, Xiaoling Luo
We screened some pivotal genes may have association with the prognosis of early-stage PDAC, and expression data was downloaded from the TCGA database (accessed at April 20,2017) [23]. Correspondingly, clinical data were obtained from the University of California, Santa Cruz Xena. The transcriptome profiles were normalized using the DESeq package by R platform [24–26]. As for the survival analysis, patients were eventually set in high and low expression groups according to the level of gene expression at a cutoff value of median expression. We established the following four inclusion criteria for enhancing the confidence level and reducing interference factors in our study: 1) histological validation; 2) pathological stage I or II according to the 7th American Joint Committee on Cancer (AJCC) [27]; 3) availability of complete survival data; 4) after a procedure of pancreaticoduodenectomy. In our previous study, PDAC patients with stage III or IV or who underwent other surgical resection techniques were excluded [28,29]. Finally, 112 early-stage PDAC patients were admitted into the next analysis.
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
Laparotomy with “artery-first approach” was performed to assess resectability. [11] Pancreaticoduodenectomy (Whipple procedure) was carried out for tumours located in the pancreatic head and distal pancreatectomy with splenectomy for those located at pancreatic tail. Total pancreatectomy was carried out in case of involvement of head and tail. Vascular resection was performed according to intraoperative findings. Circumferential margins including Superior Mesenteric Vein (SMV) groove, Superior Mesenteric Artery (SMA), Portal Vein and posterior margins were inked before being sent for pathological analysis [12]. As recommended by ISGPS, lymph node dissection was performed [13]. Postoperative complications were analysed according to the Clavien–Dindo classification [14]. Grade ≥ 3 complications were considered as severe.
When a metastatic breast cancer is mimicking a pancreatic cancer: case report and review of the literature
Published in Acta Clinica Belgica, 2020
Françoise Derouane, Jean-Cyr Yombi, Jean-François Baurain, Etienne Danse, Mina Komuta, Halil Yildiz
The treatment of pancreatic metastases depends on different criteria as nature of the primary tumor, widespread disease and the general state of health of the patient. Even if no guidelines have been established, an isolated pancreatic metastases may, in some conditions, be removed by surgery with successful outcome, even in breast carcinoma [2,6]. In our review, 36 cases had surgery treatment, and in these cases, 21 cases benefited from pancreaticoduodenectomy and 6 cases from distal pancreatectomy. In 23 cases, patient underwent chemotherapy or hormonotherapy regimen alone or as adjuvant treatment after pancreatic surgery. The average overall survival (OS), all treatment include, (in the cases where it was described [n = 32]) was 21 months (ranged from 0 to 72 months). Based on this review there was no significant difference in OS if the treatment was surgery alone, chemotherapy or homonotherapy alone, or a combination of surgery, chemotherapy/hormonotherapy and radiotherapy (OS with surgery alone: 26 months [on the 12 described cases] ranged from 4 to 60 months, OS for combination therapy: 20 months [on the 13 described cases] ranged from 2 to 72 months, OS for chemotherapy alone or hormonotherapy alone: 24 months [on the 4 described cases] ranger from 12 to 50 months).