Search PubMed⌕ Search

Biomedical subjects

H Obertop

Publications and source records attributed to H Obertop.

At least 73 records · Page 4Linked to original sources
PubMed2000

Evaluation of morbidity and mortality after resection for hilar cholangiocarcinoma--a single center experience.

BACKGROUND: Hilar resection, especially in combination with liver resection, results in substantial morbidity and mortality, which clearly influences the overall outcome. In the present study, patients who underwent resection of a proximal bile duct tumor were analyzed with the aim of identifying risk factors for morbidity and mortality. METHODS: Between 1983 and 1998, 112 consecutive patients underwent a local resection, which in 32 patients was combined with a hemihepatectomy (11 extended resections). Eighty-four percent of the patients underwent preoperative (endoscopic) drainage. For evaluation of different treatment strategies during the study, the period was divided in three 5-year intervals. RESULTS: Postoperative complications occurred in 65% of the patients. The overall hospital mortality was 15% for local resections and 25% for hemi-hepatectomies. There was a significantly lower morbidity and no mortality after hilar resection during the last 5 years. A higher Bismuth classification showed significant correlation with postoperative morbidity. Extended liver resections and vascular resections and a preoperative albumin level below 35 g/L were found to be significant predictors of increased mortality in univariate analysis. CONCLUSIONS: The overall morbidity and mortality rate in this series is higher than most recently published series. More (extended) liver resections resulted in an increased rate of microscopic tumor-free resections, at the cost of higher hospital morbidity and mortality. Improved preoperative work-ups will result in a selection of patients who might benefit from these extensive resections.

Adult↗
PubMed2000

Injury to the major airways during subtotal esophagectomy: incidence, management, and sequelae.

OBJECTIVE: The objective of this study was to gain insight into the incidence and sequelae of injury to the major airways during subtotal esophagectomy. METHODS: We performed an analysis of 383 consecutive patients undergoing this procedure between 1993 and 1999. Indications were adenocarcinoma (220), squamous cell carcinoma (121), and other (42). Transhiatal resection was done in 269 (70%) patients and transthoracic resection in 114 (30%). RESULTS: There were 4 men and 2 women (median age 57 years; range 45 to 68 years) with injury to the major airways, recognized during surgery in 5 patients and on the first postoperative day in the other. Five lesions occurred during transhiatal resection (5 of 269 = 1.8%) and 1 during transthoracic resection (1 of 114 = 0.8%; P =.67). The injury occurred proximal to the carina in 5 patients and in the left main bronchus in the other. All injuries could be closed primarily. The defect was covered with pericardium in 1 patient and with pleura in 2 patients. In all cases the gastric tube was placed over the defect. Pulmonary complications developed in 4 patients. Patients with tracheal injury required artificial ventilation for a longer period (median 6 days vs 1 day; P =.02) and stayed longer in the intensive care unit (median 11 vs 3 days; P <.01) than patients without such injury, although hospital time was not significantly prolonged (median 23 vs 16 days; P =.09). There was no associated mortality. CONCLUSION: Tracheobronchial injury is a rare complication of subtotal esophagectomy. It can be managed effectively by primary closure and apposition of vital tissue (gastric tube) to the defect. It is associated with pulmonary complications, leading to prolonged assisted ventilation and stay in the intensive care unit, but mortality is rare.

Adenocarcinoma↗
PubMed2000

Laparoscopy and laparoscopic ultrasonography in staging carcinoma of the gastric cardia.

OBJECTIVE: To investigate the role of diagnostic laparoscopy and laparoscopic ultrasonography in the staging of carcinoma of the gastric cardia that is involving the distal oesophagus. DESIGN: Retrospective consecutive case series. SETTING: Tertiary care centre, The Netherlands. SUBJECTS: 48 patients (34 men and 14 women, median age 63 years, range 39-84) who presented with tumours of the gastric cardia that involved the distal oesophagus and in whom non-invasive staging had not shown unresectable locoregional disease or distant metastases. INTERVENTIONS: In addition to laparoscopy and laparoscopic ultrasonography, biopsy of all suspected lesions outside the area of potential resection. MAIN OUTCOME MEASURES: Number of patients in whom the findings obviated the need for exploratory laparotomy. RESULTS: There were no complications related to the laparoscopy. The investigation showed distant metastases (which were histologically verified) in 11 patients (23%, 95% confidence interval (CI) 16 to 30). These patients had non-operative palliation. Seven were identified by laparoscopy, and laparoscopic ultrasonography showed the other four. In three patients whose distant metastases had already been identified by laparoscopy, ultrasonography was omitted. Three additional patients had suspect lesions, but these were not confirmed histologically. However, these lesions were shown to be cancerous at laparotomy. One additional patient had an intra-abdominal metastasis which was missed by laparoscopy with ultrasonography. CONCLUSIONS: Laparoscopy with ultrasonography safely detected metastases that had not been shown by conventional staging investigations in 23% of 48 patients with carcinoma of the gastric cardia. The investigation should therefore be added to the standard staging procedures in patients with carcinoma of the gastric cardia that is involving the distal oesophagus.

Adult↗
PubMed2000

Hospital admissions of patients aged over 80 with acute abdominal complaints.

OBJECTIVE: Evaluation of the outcome of patients aged over 80 with acute abdominal complaints, who were admitted to the hospital through the emergency department. DESIGN: Retrospective study. SETTING: City hospital, the Netherlands. PATIENTS: 132 patients aged over 80 with acute abdominal complaints who were admitted through the emergency department in 1997. MAIN OUTCOME MEASURES: Diagnosis at admission and discharge or necropsy, diagnostic tests, treatment, morbidity, and mortality. RESULTS: In 27 of 132 patients (20%) the diagnosis on discharge or at necropsy differed from the initial diagnosis in the emergency department; in 18 patients (14%) an important diagnosis was missed and the severity was underestimated. Within the first 24 hours, 97% (n = 128) had blood tests, 63% (n = 83) urine tests, 58% (n = 76) plain radiograph of the abdomen, 20% (n = 26) ultrasonography, and 3% (n = 4) computed tomography (CT) of the abdomen. Of all the patients admitted, 35 (27%) were operated on. The hospital mortality of the admitted patients was 17% (n = 23) and of those operated on 34% (n = 12). The mortality in the 27 misdiagnosed patients was 59% (n = 16). The morbidity among the 109 surviving patients was 22%. CONCLUSIONS: Mortality was high among those aged over 80 with acute abdominal complaints who were admitted through the emergency department, particularly among those who were operated on and those who were misdiagnosed. Guidelines for an earlier and more comprehensive diagnostic approach could lead to better insight into the prognosis and thereby to more adequate and better-targeted treatment.

Abdomen, Acute↗
PubMed2000

Hyaluronic acid/carboxymethylcellulose membrane surrounding an intraperitoneal or subcutaneous jejunojejunostomy in rats.

OBJECTIVE: To investigate the healing of intra-abdominal and extra-abdominal jejunal anastomoses that were surrounded by a hyaluronic acid/carboxymethylcellulose membrane (Seprafilm) in rats. DESIGN: Laboratory study. SETTING: University hospital, The Netherlands. ANIMALS: 56 male Wistar rats. INTERVENTIONS: 28 rats had jejunojejunostomies placed subcutaneously and 28 had them placed intra-abdominally. Half of each group of anastomoses were surrounded by Seprafilm. MAIN OUTCOME MEASURES: After 3 or 7 days, the anastomoses were tested for bursting pressure, tensile strength, and hydroxyproline concentrations. RESULTS: There were numerous strong adhesions around the anastomoses in the subcutaneous position and Seprafilm had no influence on their extent. Bursting pressure and hydroxyproline concentrations were not affected by position or Seprafilm treatment. Tensile strength was significantly higher in the subcutaneous position (p < 0.01), but was unaffected by Seprafilm. CONCLUSION: Anastomotic healing was not impaired in the subcutaneous or intraperitoneal position in this model. Seprafilm had no effect on the anastomosis.

Anastomosis, Surgical↗
PubMed2000

Tonic motor activity of the narrow gastric tube used as an oesophageal substitute.

OBJECTIVE: To assess the compliance, the existence of basal tone, the sensory response to distension, and the integrity of the neurohumoral enterogastric inhibitory reflex of the narrow gastric tube as an oesophageal substitute. DESIGN: Explanatory experimental study. SETTING: University hospital, The Netherlands. PATIENTS: Eight patients after oesophagectomy, formation of a narrow gastric tube, and cervical gastro-oesophagostomy. INTERVENTIONS: Measurements of intragastric tonic motor activity with a Barostat. MAIN OUTCOME MEASUREMENTS: Compliance, sensations during stepwise pressure increments, and changes in tone induced by glucagon and intraduodenal feeding. RESULTS: The compliance of the narrow gastric tube was found to be low (median 13.5 ml/mmHg (range 5-21)). Most of the patients perceived minimal sensation on distension. All patients had phasic tonic contractions during distension of the gastric tube. The median (range) relaxation after glucagon had been given intravenously was 14 ml (range 3-57) (p < 0.05). The tonic reaction to nutrients in the duodenum was not significant. CONCLUSIONS: The compliance of the narrow gastric tube is low. Postprandial symptoms are not caused by distension of the proximal part of the narrow gastric tube. Basal gastric tone and phasic activity were at least partially restored over time after operation. The enterogastric inhibitory reflex is eliminated by oesophageal resection and reconstruction of a gastric tube.

Adult↗
PubMed2000

Continuous or intermittent vascular clamping during hemihepatectomy in pigs: hyaluronic acid kinetics in the assessment of early microvascular liver damage.

OBJECTIVE: To assess the uptake of hyaluronic acid (HA) as a marker of microvascular damage in a model of hemihepatectomy in pigs having continuous or intermittent vascular inflow occlusion. DESIGN: Prospective, animal study. SETTING: Laboratory for experimental surgery, University hospital, The Netherlands. INTERVENTIONS: Total liver ischaemia was achieved during 90 minutes by continuous (n = 5) or intermittent (n = 5) occlusion of the portal vein and hepatic artery followed by 120 minutes of reperfusion. In a second series of pigs (n = 8) a left hemihepatectomy was added to the protocol. MAIN OUTCOME MEASURES: Uptake of exogenous HA was assessed before ischaemia and after 120 minutes of reperfusion, together with the galactose elimination capacity. Plasma activities of aspartate aminotransferase (AST), alanine amino transferase, and lactate dehydrogenase were measured and specimens of liver were obtained for histopathological examination. RESULTS: HA uptake was slightly reduced after reperfusion in unresected livers compared with uptake before ischaemia. After hemihepatectomy HA uptake after reperfusion was significantly reduced after both continuous and intermittent occlusion, but more HA was taken up after continuous occlusion (p = 0.02). Release of AST after reperfusion was increased only after hemihepatectomy. CONCLUSIONS: Microvascular damage, as assessed by HA uptake capacity, significantly contributed to normothermic ischaemia and reperfusion injury in porcine liver. Vascular inflow occlusion during 90 minutes in combination with hemihepatectomy resulted in less liver damage when vascular occlusion was continuous rather than intermittent.

Animals↗
PubMed2000

Rates of complications and death after pancreaticoduodenectomy: risk factors and the impact of hospital volume.

OBJECTIVE: To perform a two-part study of pancreaticoduodenectomy in the Netherlands, focusing on the effects of risk factors on outcomes in a single high-volume hospital and the effect of hospital volume on outcomes. SUMMARY BACKGROUND DATA: Hospital volume and surgeon caseload can be related to the rates of complications and death, and the influence of risk factors can be volume-dependent. Provision of regionalized care should take this into account. METHODS: In part A, a single-institution database on 300 consecutive patients undergoing pancreaticoduodenectomy was divided into two periods with similar numbers of patients. Overall complications, deaths, hospital stay, and risk factors were analyzed in the two periods and compared with an historical reference group. In part B, Netherlands medical registry data on age and postoperative death of patients who underwent partial pancreaticoduodenectomy from 1994 to 1998 were analyzed for the influence of hospital volume on death. RESULTS: Between the time periods, the institutional death rate decreased from 4.9% to 0.7%, the complication rate from 60% to 41%. Median hospital stay decreased from 24 to 15 days. The death rate was not related to patient age and did not differ between surgeons. Serum creatinine levels, need for blood transfusion, and period of resection were independent risk factors for complications. The death rate after pancreaticoduodenectomy in the Netherlands was 12.6% in 1994 and 10.1% in 1998; it was greater in patients older than age 65. During the 5-year period, 40% of the procedures were performed in hospitals performing fewer than five resections per year, and the death rate was greater than in hospitals performing more than 25 resections per year. CONCLUSIONS: The overall death rate after pancreaticoduodenectomy did not decrease significantly during the period, and it was greater in low-volume hospitals and older patients. The lower death and complication rates in high-volume hospitals, including the single-center outcomes, were similar to those reported in other countries and may be due to better prevention and management of complications. Pancreaticoduodenectomy should be performed in centers with sufficient experience and resources for support.

Data Interpretation, Statistical↗
PubMed2000

Intestinal and pancreatic metaplasia at the esophagogastric junction in patients without Barrett's esophagus.

OBJECTIVES: A distinctive type of columnar epithelium with intestinal metaplasia is considered diagnostic for Barrett's esophagus. The neoplastic potential of pancreatic metaplasia at the esophagogastric junction is unknown. The aims of the present study were: 1) to characterize both forms of metaplasia at the esophagogastric junction, and to estimate their prevalence; 2) to investigate c-erbB-2 expression and K-ras mutations in pancreatic metaplasia; and 3) to study the relationship between metaplasia, inflammatory changes in the cardiac mucosa, and presence of H. pylori. METHODS: A total of 76 esophagogastrectomy specimens of patients with a normally located squamocolumnar junction, were investigated immunohistochemically. K-ras mutations were evaluated using PCR. RESULTS: Intestinal metaplasia in the cardia was found in 12% of patients: six complete-type, and three incomplete-type. Pancreatic metaplasia was demonstrated in 14% of patients, and neither c-erbB-2 expression nor K-ras mutations were found. Intestinal and pancreatic metaplasia were associated with mucosal inflammation. In contrast to generalized gastritis, isolated "carditis" was not associated with H. pylori infection. CONCLUSIONS: When intestinal metaplasia occurs in a biopsy from the esophagogastric junction, it is not necessarily a marker for Barrett's esophagus. No indication was found that pancreatic metaplasia has neoplastic potential. Both forms of metaplasia reflect mucosal inflammation. Carditis may be a distinct inflammatory condition of the gastric mucosa that is not related to H. pylori infection.

Adenocarcinoma↗
PubMed2000

Endotoxin, cytokines, and endotoxin binding proteins in obstructive jaundice and after preoperative biliary drainage.

BACKGROUND: Obstructive jaundice is associated with postoperative complications related to increased endotoxaemia and the inflammatory response. In animals obstructive jaundice is associated with endotoxaemia and cytokine induction, which are reversed by internal biliary drainage. AIMS: To study endotoxaemia and the subsequent inflammatory response in obstructive jaundiced patients and after endoscopic biliary drainage. METHODS: In 15 patients with malignant distal obstructive jaundice, inflammatory and bacteriological parameters were assessed before endoscopic stent placement and after three weeks endoscopic drainage. RESULTS: Drainage reduced bilirubin from 252.5 to 45.1 micromol/l. At baseline low level endotoxaemia was detected (4.3 pg/ml) which was not affected after drainage (4.5 pg/ml). Serum interleukin 8 (IL-8) and endotoxin binding proteins were increased in jaundice and reduced after drainage (IL-8 113.6 to 20.7 pg/ml; lipopolysaccharide binding protein 24.2 to 16.5 microg/ml; sCD14 17.4 to 7.6 microg/ml; bactericidal/permeability increasing protein 2.9 to 1.8 ng/ml). Levels of other cytokines, augmented in animals, were only slightly increased and not changed after drainage (tumour necrosis factor (TNF): 21.7 and 18.4 pg/ml; sTNFr p55/75: 2.9/7.0 and 2.7/5.6 ng/ml; IL-6: 4.2 and 6.1 pg/ml; IL-10: 4.5 and 2.7 pg/ml). Elastase and lactoferrin tended towards reduction after drainage. All bile cultures were positive after stenting. CONCLUSIONS: The effects of obstructive jaundice in humans on endotoxin and cytokines are different from those in animal models. Obstructive jaundice causes alterations in circulating endotoxin binding proteins and IL-8. Concentrations of other mediators (TNF, previously suggested as being responsible for systemic endotoxaemia effects) are low and not affected by drainage.

Bile Duct Neoplasms↗
PubMed2000

Improved healing of extraperitoneal intestinal anastomoses in the early phase when surrounded by omentum.

BACKGROUND: The extra-anatomical position of a cervical oesophagogastrostomy is a reason for impaired anastomotic healing, but transposition of the omentum that is covered with mesothelial cells may be a way to improve that. METHOD: This hypothesis was tested in a rat model. An end-to-end jejuno-jejunostomy was placed subcutaneously in group I (n = 29), subcutaneously surrounded by omentum in group II (n = 29) and intra-abdominally surrounded by omentum in group III (n = 20). After 3, 7 or 14 days, the rats were sacrificed and bursting pressure (BP) of the anastomosis or jejunum was measured and the hydroxyproline (HP) level was determined. RESULTS: In group I 5/29, in group II 2/29 and in group III 0/20 rats died following anastomotic leakage (nonsignificant) and were excluded from other measurements. BP was decreased after 3 days in group I (60+/-9 mm Hg) compared with group II (101+/-8 mm Hg) and group III (107+/-11 mm Hg) (p = 0.002). After 7 days, BP in groups I (122+/-10 mm Hg) and II (132+/-10 mm Hg) were lower as compared with group III (230+/-8 mm Hg) (p<0.001). Differences in HP levels were not statistically significant between the groups after 3, 7 and 14 days. CONCLUSION: The healing of intestinal anastomoses in an extraperitoneal position is improved in the early phase only when surrounded by omentum.

Anastomosis, Surgical↗
PubMed2000

Surveillance of Barrett's oesophagus: physicians' practices and review of current guidelines.

BACKGROUND: Endoscopic biopsy surveillance of Barrett's oesophagus is generally recommended. However, optimal patient selection and frequency of follow-up are subject to ongoing discussion. OBJECTIVE: To investigate current surveillance practices for Barrett's oesophagus in the Netherlands and to explore their concordance with the guidelines for Barrett's oesophagus surveillance as recommended by the International Society for Diseases of the Esophagus (ISDE). METHODS: An anonymous questionnaire was mailed to 269 specialist physicians working in the field of gastroenterology. RESULTS: The response rate was 88% (238/269). Most of the respondents (84%) performed regular endoscopic follow-up of Barrett's oesophagus. In 52%, endoscopic biopsy sampling corresponded to the ISDE guidelines (four-quadrant biopsies at 2 cm intervals). Agreement was 60% regarding the interval of surveillance for no dysplasia (every 2 years), 52% regarding the interval for low-grade dysplasia (every year) and 54% for management of high-grade dysplasia (oesophagectomy if diagnosis confirmed by a second pathologist or re-biopsy in the short term). When combining these three items, consistency with the ISDE guidelines decreased to 25%. Criteria to select patients for surveillance included age, presence of symptoms, length of Barrett's oesophagus and type of Barrett epithelium. CONCLUSIONS: The survey indicates widespread practice of cancer surveillance for patients with Barrett's oesophagus in the Netherlands. However, there is limited uniformity in the frequency and intensity of endoscopic histological follow-up. This variability in clinical practice may result from conflicting data and recommendations in the literature. Updated consensus is needed in this area.

Age Factors↗
PubMed1999

Extended lymph-node dissection for gastric cancer.

BACKGROUND: Curative resection is the treatment of choice for gastric cancer, but it is unclear whether this operation should include an extended (D2) lymph-node dissection, as recommended by the Japanese medical community, or a limited (D1) dissection. We conducted a randomized trial in 80 Dutch hospitals in which we compared D1 with D2 lymph-node dissection for gastric cancer in terms of morbidity, postoperative mortality, long-term survival, and cumulative risk of relapse after surgery. METHODS: Between August 1989 and July 1993, a total of 996 patients entered the study. Of these patients, 711 (380 in the D1 group and 331 in the D2 group) underwent the randomly assigned treatment with curative intent, and 285 received palliative treatment. The procedures for quality control included instruction and supervision in the operating room and monitoring of the pathological results. RESULTS: Patients in the D2 group had a significantly higher rate of complications than did those in the D1 group (43 percent vs. 25 percent, P<0.001), more postoperative deaths (10 percent vs. 4 percent, P= 0.004), and longer hospital stays (median, 16 vs. 14 days; P<0.001). Five-year survival rates were similar in the two groups: 45 percent for the D1 group and 47 percent for the D2 group (95 percent confidence interval for the difference, -9.6 percent to +5.6 percent). The patients who had R0 resections (i.e., who had no microscopical evidence of remaining disease), excluding those who died postoperatively, had cumulative risks of relapse at five years of 43 percent with D1 dissection and 37 percent with D2 dissection (95 percent confidence interval for the difference, -2.4 percent to +14.4 percent). CONCLUSIONS: Our results in Dutch patients do not support the routine use of D2 lymph-node dissection in patients with gastric cancer.

Aged↗
PubMed1999

[Bile duct injuries after a laparoscopic cholecystectomy].

Eight years after the introduction of laparoscopic cholecystectomy a decrease of the incidence of bile duct injuries is reported in the literature. The incidence of a bile duct injury after laparoscopic cholecystectomy is now slightly higher than after open cholecystectomy. A minority of these injuries are detected during surgery. Most patients have a delayed identification of the bile duct injury, even after discharge from the hospital. An early diagnostic work-up with ultrasound and endoscopic retrograde cholangiopancreatography (ERCP) is mandatory in every patient with persisting symptoms (more than 48 hours) after laparoscopic cholecystectomy. Still, one-third of the patients are subjected to a 'diagnostic' exploratory laparotomy without preoperative visualization of the biliary tract by ERCP or percutaneous transhepatic cholangiography. Minor lesions are mostly treated successfully by endoscopy with a stent. After transection of the bile duct surgical reconstruction by a hepaticojejunostomy has to be performed. A delayed elective reconstruction was associated with fewer complications than acute repair under suboptimal circumstances such as local inflammatory changes and bile leakage.

Adult↗
PubMed1999

[Prospective follow-up of patients with abdominal symptoms treated by emergency room physicians].

In order to evaluate the functioning of emergency room (ER) physicians, patients seen at the ER of the Onze Lieve Vrouwe Gasthuis. Amsterdam, the Netherlands, for abdominal symptoms without having been referred by the GP, were questioned by letter about the course of events two weeks after their visit. Of the 1853 patients with abdominal symptoms attending the ER in July-December 1997, 1221 had no referral letter; of these, 933 were treated independently by the ER physician. Of the latter, 814 were sent a letter, to which 663 of them responded. 307 of them had visited the GP and 48 an ER. Of these 48 patients, 17 had been admitted and 14 of them had been operated. In seven of the 17 patients, the condition had not been recognized by the ER physician at the first visit.

Abdominal Pain↗
PubMed1999

Microcirculatory perfusion of the canine esophagus before and after blind longitudinal dissection and thoracoscopic distal transsection.

In the treatment of distal esophageal pathology, surgical mobilization and exteriorization of the thoracic esophagus can be necessary. This may threaten its vascularization. We investigated the effect of longitudinal dissection and distal transsection on the microcirculatory perfusion of the canine esophagus. Esophageal perfusion and muscular oxygenation were investigated in 11 dogs using laser Doppler fluxmetry and oxygen pressure measurements before and up to 2 weeks after longitudinal dissection with and without distal thoracoscopic transsection. Histological examination was performed at the end of the follow-up period. Distal esophageal perfusion was higher than proximal. Longitudinal dissection caused an insignificant reduction, whereas additional transsection significantly lowered esophageal perfusion, which was restored only partially during follow-up. After transsection distal muscular oxygen pressure was also significantly lower than proximal. Histologically, no significant ischemic cell damage was observed. Laser Doppler perfusion measurement is a feasible technique to measure (changes in) microcirculatory circulation of the esophageal wall. This may be useful in clinical settings to monitor the viability of the esophagus after surgical interventions. Distal transsection substantially reduces esophageal perfusion without apparent short-term histological damage.

Animals↗
PubMed1999

Are there indications for palliative resection in pancreatic cancer?

Controversy exists about the indication for a palliative pancreatoduodenectomy. A palliative resection for patients with a pancreatic carcinoma can be performed safely nowadays with low mortality and acceptable morbidity in centers with experience. The early results in terms of mortality and morbidity are not different from resections with curative intent or even after bypass surgery. The procedure seems effective for controlling symptoms of the disease, and the quality of life after a palliative resection is acceptable and not worse than after bypass surgery. It is, however, still doubtful whether the incidence of symptom recurrence, such as jaundice, obstruction, and pain, is lower after resection than after bypass surgery. The longer survival after palliative resection could also be due to patient selection and postoperative treatment. There are no randomized trials to prove the superiority of palliative resection over bypass surgery. The safety of pancreatic resection for cancer has already changed the policy in centers with experience, and surgeons are more willing to perform a resection because the results are better or at least the same as after bypass surgery. There are, however, no results to confirm that a palliative resection should be performed routinely or to justify resection as a debulking procedure.

Gastric Outlet Obstruction↗