China
Africa
Explore chapters and articles related to this topic
Resectable Pancreatic Cancer Post Roux-en-Y Gastric Bypass for Obesity
Published in Savio George Barreto, Shailesh V. Shrikhande, Dilemmas in Abdominal Surgery, 2020
Sarah Bormann, Savio George Barreto
A complete surgical resection with negative microscopic margins and a standard lymphadenectomy offers the best chance of cure in patients with pancreatic and periampullary cancer. In patients with a pancreatic head or periampullary cancer, the appropriate operation is a pancreatoduodenectomy while patients with cancers of the body and tail would require a distal pancreatectomy with splenectomy.
Stomach and duodenum
Published in Professor Sir Norman Williams, Professor P. Ronan O’Connell, Professor Andrew W. McCaskie, Bailey & Love's Short Practice of Surgery, 2018
Professor Sir Norman Williams, Professor P. Ronan O’Connell, Professor Andrew W. McCaskie
Patients with familial polyposis, which is due to a mutation in the APC gene on chromosome 5, are predisposed to periampullary cancer, which is one of the most common causes of death in patients who have had their colon removed. Other duodenal malignancies include GISTs (see above) and neuroendocrine tumours.
Palliative Gastrojejunostomy and the Impact on Nutrition in Cancer
Published in Victor R. Preedy, Handbook of Nutrition and Diet in Palliative Care, 2019
Dorotea Mutabdzic, Poornima B. Rao, Jeffrey M. Farma
The concept of prophylactic gastrojejunostomy in the context of upper gastrointestinal malignancy has been the subject of significant debate and investigation. Prophylactic gastrojejunostomy for advanced gastric cancer has not been studied presumably because if a gastric cancer is deemed unresectable, there is almost certainly an element of GOO. Initial reports on patients with unresectable pancreatic adenocarcinoma as determined by laparoscopic staging suggested that they seldom developed gastroduodenal obstruction that required therapeutic intervention. The rate of development of obstruction was determined to be less than 20%, and as a result, the performance of a laparotomy for creation of a gastrojejunal bypass with the risks associated with both in the context of unresectable cancer were determined to be too great to advocate in the setting of palliative therapy (Espat et al., 1999). Subsequent studies have demonstrated that the perioperative morbidity and mortality of gastrojejunostomy in the setting of unresectable pancreatic or periampullary cancer are relatively low. Of the patients whose biliary obstruction is treated with surgical bypass, approximately 20%–30% will go on to develop GOO as a result of either local tumor growth or the development of progressive metastatic disease if a gastric bypass is not performed concomitantly (Shyr et al., 2000; Sohn et al., 1999). Two meta-analyses including randomized and retrospective data have shown no difference in perioperative morbidity and mortality with significant reduction in long-term GOO. These studies suggest that patients who are found to have unresectable pancreatic or periampullary cancer should have prophylactic gastrojejunostomy at the time of the operation as it adds little perioperative risk and has significant benefit in preventing GOO (Gurusamy et al., 2013; Huser et al., 2009; Lillemoe et al., 1999; Van Heek et al., 2003).
Pancreaticoduodenectomy for periampullary cancer: does the tumour entity influence perioperative morbidity and long-term outcome?
Published in Acta Chirurgica Belgica, 2018
Georg Wiltberger, Felix Krenzien, Georgi Atanasov, Hans-Michael Hau, Moritz Schmelzle, Michael Bartels, Christian Benzing
All patients who underwent pancreatic resection at the Department of Visceral, Transplantation, Thoracic, and Vascular Surgery, University Hospital Leipzig, Leipzig, Germany from June 1994 to September 2013 were retrospectively analysed using an established database. We included all patients who received a Kausch–Whipple procedure or pylorus-preserving PD (PPPD) with curative intent (R0 or R1) with histopathologically confirmed periampullary cancer (i.e. cancer of the pancreas, distal bile duct, and ampulla). With regards to the surgical technique, standard reconstruction was performed with a retrocolic end-to-side pancreaticojejunostomy with pancreatic drainage at the surgeon’s discretion. Somatostatin was not routinely used. Patients were excluded in cases where the medical history and patient data were incomplete or unavailable. For the follow-up, we analysed the medical records of each patient. In case the patient did not come to the follow-up examinations in our institution, we gathered the follow-up information by contacting the patient or the patient’s family physician. Patients with an incomplete documentation were excluded from the analysis.
Emerging treatment options for cholangiocarcinoma
Published in Expert Opinion on Orphan Drugs, 2018
Malcolm H. Squires, Ingrid Woelfel, Jordan M. Cloyd, Timothy M. Pawlik
Despite the significant risk of disease recurrence, the role of adjuvant therapy following resection of cholangiocarcinoma remains controversial. Previously, the largest trial to address this issue was the ESPAC-3 study, which randomized patients with resected periampullary cancer (22% eCCA) to observation, adjuvant 5-FU, or adjuvant gemcitabine. While there was no difference in OS in the primary analysis, adjuvant chemotherapy was associated with a survival benefit on multivariable analysis after adjusting for high-risk features [12]. The recently completed PRODIGE-12/ACCORD-18 (UNICANCER GI) phase III trial from France randomized 196 patients after resection of biliary tract malignancy to 6 months of adjuvant combination chemotherapy with gemcitabine/oxaliplatin (GEMOX) versus observation alone [13]. These results failed to demonstrate a significant improvement in recurrence-free survival associated with adjuvant therapy (HR 0.83, 95% CI: 0.58–1.19, p = .31).
Prognostic Value of Pretreatment Skeletal Muscle Mass Index in Esophageal Cancer Patients: A Meta-Analysis
Published in Nutrition and Cancer, 2022
Li Yao, Lei Wang, Yuanyuan Yin, Guowei Che, Mei Yang
The prognostic value of SMI in malignancies has been widely explored and verified. Bekki et al. enrolled 139 hepatocellular carcinoma (HCC) patients who received surgery and demonstrated that a low SMI is an independent prognostic factor for poor OS (HR = 2.006, 95% CI: 1.012–3.974, P = 0.046) (38). Schaffler-Schaden et al. enrolled 85 colon cancer patients who received surgery with a body mass index (BMI) <30 kg/m2 and showed that preoperative SMI better predicted one-year recurrence of disease (HR = 0.9, 95% CI: 0.81–1, P = 0.0467) (39). In addition, Sui et al. reviewed 335 patients who received pancreaticoduodenectomy and reported that SMI is significantly associated with the OS of periampullary cancer patients (P = 0.009) (40).