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PubMed1992

[Lymph node dissection around the splenic artery for gastric cancer--a comparative study of pancreatectomy and pancreas-preserving operation].

From 1977 to 1988, four hundred and sixty-five patients received total or proximal gastrectomy for advanced gastric cancer without leaving a tumor mass at National Cancer Center Hospital. Of these, 182 patients received distal pancreatectomy (PS) and 123 received pancreas-preserving operation with removal of the splenic artery (PP). The 5-year survival rate for the PS group (32.0%) was significantly lower than 61.0% for the PP group. Concerning grades of cancer stage, the 5-year survival rates for the PP group were better than those for the PS group in stages 1, 2 and 3. Seventy-four of the 465 patients were found to have histologically proven metastatic nodes around the splenic artery. Their 5-year survival rates were 9.2% for the PS group (n = 46) and 32.7% for the PP group (n = 13) respectively. Considering the difference in the background factors, these data suggest the effectiveness of the pancreas-preserving operation for advanced gastric cancer even with microscopic lymph node metastasis around the splenic artery. The pancreas-preserving operation with removal of the splenic artery might be indicated for the patient without definite macroscopically metastatic lymph node around the splenic artery.

Gastrectomy↗
PubMedDate not supplied

Spleen-preserving distal pancreatectomy following neoadjuvant chemotherapy for papillary solid and cystic neoplasm of pancreas.

Papillary solid and cystic neoplasm (PSCN) is a rare neoplasm of the pancreas with low-grade malignant potential and favorable prognosis. We report an 18-year-old girl with PSCN presenting with advanced disease. The tumor regressed with six cycles of gemcitabine and cisplantin-based neoadjuvant chemotherapy; spleen-preserving distal pancreatectomy was then done. She is disease-free at 13 months' follow-up.

Abdominal Pain↗
PubMedDate not supplied

[Proximal pancreatectomy in a case of nesidioblastosis].

A 19 moth-old child who presented seizures secondary to intractable hypoglycemia, fulfilling the clinical and biochemical criteria for hyperinsulinism was studied. Histopathological findings of the pancreas showed the presence of small clusters of b cell islets throughout acinar tissue near ducts, in both the head and the proximal third of the body. Proximal pancreatectomy (60%) and distal pancreatic-jejunostomy (Roux-in-Y) were performed. This procedure was effective in reverting hypoglycemia and constitutes the first successful alternative treatment.

Diagnostic Techniques, Endocrine↗
PubMed2005

EIPL (extensive intraoperative peritoneal lavage) therapy significantly reduces peritoneal recurrence after pancreatectomy in patients with pancreatic cancer.

One standing problem in the therapy for pancreatic cancer is peritoneal recurrence after pancreatectomy. We have established EIPL (extensive intra-operative peritoneal lavage) therapy as a very simple and non-aggressive prophylactic treatment for peritoneal dissemination of gastric cancer patients with peritoneal free cancer cells. In this study, the impact of EIPL therapy in preventing peritoneal recurrence in patients with pancreatic cancer after a curative surgical operation is analyzed. This study was based on 39 consecutive patients with invasive ductal adenocarcinoma of the pancreas who underwent curative surgical treatment. The patients were divided into two groups: the non-EIPL group, patients without EIPL therapy (from 1995 to 2000) (n=24); and the EIPL group, patients with EIPL therapy (from 2001 to 2003) (n=15). Clinicopathological findings, recurrence patterns and cancer-free survival were compared between the two groups. In addition, to identify free cancer cells during the operation, both carcinoembryonic antigen (CEA)- and cytokeratin 20 (CK20)-specific intraoperative real-time RT-PCR was performed immediately after laparotomy, lymph node dissection and removal of the pancreas in six patients with curative pancreatic cancer. Peritoneal, hepatic, lymphatic, local, and extra-abdominal recurrence rates in the EIPL and non-EIPL groups were 6.7, 40.0, 26.7, 13.3 and 13.3%, and 45.8, 50.0, 20.8, 29.2 and 20.8%, respectively. Among these recurrence patterns, the peritoneal recurrence rate of the EIPL group was significantly lower than that of the non-EIPL (P=0.013). Real-time RT-PCR analysis identified intra-peritoneal free cancer cells in 0, 33 and 67% of patients immediately after laparotomy, lymph node dissection and removal of the pancreatic cancer, respectively. After EIPL therapy, however, no cancer cell was detected in the peritoneal cavity. EIPL therapy was the independent negative risk factor for peritoneal recurrence (P=0.044), and the cancer-free 2-year survival of the EIPL group showed improvement compared with that of the non-EIPL group and was near statistical significance (P=0.097). EIPL therapy significantly prevented peritoneal recurrence after curative operation of pancreatic cancer, and it may contribute to reducing the mortality rate of this aggressive disease. Continued investigation of this promising treatment regimen is warranted.

Aged↗
PubMed2005

Regeneration of pancreatic islets after partial pancreatectomy in mice does not involve the reactivation of neurogenin-3.

Understanding the factors and mechanisms involved in beta-cell regeneration will guide therapeutic efforts to augment beta-cell mass in patients with diabetes. Neurogenin-3 (Ngn3) is a bHLH transcription factor that responds to Notch signaling and whose expression marks endocrine progenitors. During fetal development, all endocrine cells are derived from Ngn3(+) precursors. Although expression of Ngn3 in the adult pancreas has not been reported, it has been suggested that islet regeneration in adult organisms recapitulates embryonic developmental pathways. Here, we investigated whether beta-cell regeneration in adult mice recapitulates the embryonic pathway involving Ngn3 activation. Despite full recovery of beta-cell mass after 50% partial pancreatectomy (Ppx) in BALB/c mice, no pancreatic Ngn3 immunoreactivity was detected, even when the beta-cell trophic glucagon-like peptide-1 receptor agonist exendin-4 was administered after the procedure. Even when we used the stable expression of enhanced green fluorescent protein (EGFP) in Ngn3(EGFP/+) mice to trace Ngn3 expression after Ppx, no pancreatic Ngn3 expression was detected. Although ectopic expression of Ngn3 can promote an endocrine transcriptional program in adult cells and may thus have therapeutic potential in the development of surrogate beta-cells, our studies indicate that a reactivation of endogenous Ngn3 expression is not required for adult beta-cell regeneration in vivo.

Animals↗
PubMedDate not supplied

[Central pancreatectomy--indications, technique, outcomes].

Central pancreatectomy is a conservative resectional procedure indicated for benign and low malignant tumors located in the neck and/or body of the pancreas. We report our experience on 5 patients and some considerations about this surgical technique from medical literature.

Adolescent↗
PubMed2006

Total pancreatectomy for the treatment of chronic pancreatitis: indications, outcomes, and recommendations.

Total pancreatectomy (TP) for chronic pancreatitis (CP) has not gained widespread acceptance because of concerns regarding technical complexity, diabetic complications, and uncertainty with respect to long-term pain relief. Records of patients having TP from 1997 to 2005 were reviewed. Patient presentation, etiology of disease, and the indication for TP were examined. Operative results were analyzed. Long-term results were critically assessed, including narcotic usage and the need for re-admission. Postoperative quality of life (QOL) was assessed by the SF-36 health survey. During the study period, 7 patients with CP had TP, and 28 had other operations. The etiology of CP was alcohol in four and hereditary pancreatitis in three. The indication for surgery was pain and weight loss. Preoperatively, all patients used narcotics chronically and two had insulin-dependent diabetes. Four had TP after failed previous surgical procedures. Endoscopic retrograde cholangiopancreatography and computed tomography demonstrated small ducts and atrophic calcified glands. The mean length of the operation was 468 minutes, and only two patients required transfusion. There were no biliary anastomotic complications. The mean length of stay was 14 days. Major morbidity was limited to a single patient with a leak from the gastrojejunal anastomosis. Thirty-day mortality was zero, with one late death unrelated to the surgical procedure or diabetes. The mean length of follow-up was 46 months. All patients remained alcohol and narcotic free. No patient was readmitted with a diabetic complication. When compared with the general population, QOL scores were diminished but reasonable. We conclude that TP is indicated in hereditary pancreatitis and in those with an atrophic, calcified pancreas with small duct disease; that TP is technically arduous but can be completed with very low morbidity and mortality; and that on long-term follow-up, pain relief and abstinence from alcohol and narcotics was excellent with an acceptable QOL.

Adult↗
PubMedDate not supplied

Median pancreatectomy: a report of three cases.

Conventional pancreatic resections may be unnecessary for tumors of the pancreas that are benign or of low malignant potential and can place the patient at increased risk of developing postoperative exocrine and endocrine complications. Median pancreatectomy is an option that has been investigated in the management of such tumors located in the body of the pancreas. We present our experience with three women who underwent this procedure successfully for neuroendocrine tumors (2) and cystadenoma (1).

Adult↗
PubMed2006

[A patient with pancreatic cancer and multiple liver metastases after total pancreatectomy who showed a partial response to combination chemotherapy with gemcitabine and UFT].

A 69-year-old man underwent a complete pancreatectomy in March 2002 because of cancer of the body of the pancreas. Two months after surgery, the patient had multiple metastases to the liver, abdominal recurrence, and an elevated cancer antigen (CA) 19-9 level. Combination chemotherapy with gemcitabine and UFT was administered on an outpatient basis. Chemotherapy consisted of biweekly gemcitabine (1,000 mg/m(2)) and daily UFT (300 mg). After 3 months of treatment, a computed tomographic scan of the liver showed marked shrinkage of metastatic lesions, accompanied by a decrease in the CA19-9 level. The patient spent most of his time at home and worked as usual; his quality of life was maintained. The only adverse event was transient leukopenia (grade 2). He died of peritoneal dissemination in August 2003 (15 months after recurrence). Our experience suggests that combination chemotherapy with gemcitabine and UFT may promote tumor dormancy and relieve symptoms in patients with liver metastasis after surgery for pancreatic cancer or with recurrence of metastasis.

Aged↗
PubMedDate not supplied

[Neonatal hypoglycemia due to hyperinsulinism secondary to Langerhans' polyadenomatosis. Recovery after pancreatectomy].

Report of a case of a neonatal hypoglycemia detected at the 11th hour of life, secondary to a Langherans polyadenomatosis in a girl with an hemihypertrophy. Pre- and post-operative tests are reported. In case of neonatal hypoglycemia, the criteria leading to the diagnosis of hyperinsulinism, i.e. the only neonatal hypoglycemia with surgical treatment are reviewed. Except in the case of adenoma, the pancreatectomy should be performed subtotally. The best time for surgery is as soon as the 3rd week, in order to preserve the cerebral development.

Adenoma, Islet Cell↗
PubMed2007

Vascular complications of pancreatectomy.

Despite decreased postoperative mortality, pancreatic resections continue to be associated with high morbidity rates. Vascular complications and, in particular, erosive bleeding from the large retroperitoneal vasculature are particularly difficult to treat and account for a large percentage of the residual postoperative mortality of pancreatic resections. We herein analyze the pathogenesis, diagnosis, preventive measures and possible remedies of either hemorrhagic or occlusive complications of pancreatic resections through a review of the literature and of our institutional experience consisting of 818 pancreatectomies.

Adolescent↗
PubMed1992

Injury to the superior mesenteric artery during pancreatectomy for chronic pancreatitis.

Four cases are described of injury to the superior mesenteric artery (SMA) during pancreatectomy for chronic pancreatitis. Review of the literature indicates that this is a rare event. In three patients (arterial ligation, 2; haemorrhage, 1), the injury was immediately recognised and successfully repaired. In the fourth (with probable occlusion of the vessel), the problem was not appreciated at operation and the patient eventually died. Vessels adherent to a pseudocyst are at particular risk of injury, as in two of our patients. Two patients had ectopic origin of the right hepatic artery. Since awareness of such vascular anomalies is important, we now perform selective mesenteric angiography in all patients requiring pancreatic resections, whether proximal or distal.

Adult↗
PubMedDate not supplied

Pancreatectomy and metabolic alterations.

The authors describe problems about anaesthesia management in peri- and post-operative periods in seven patients undergoing total pancreatectomy. They underline that metabolic alterations in these cases show, until now, some unsolved problems. Sometimes artificial pancreas is very useful in post-operative management of these patients.

Adult↗
PubMed1991

Needs and care of patients undergoing subtotal pancreatectomy for cancer.

Charts of 45 patients, who underwent subtotal pancreatectomy for cancer, at the University Hospital in Lund, over a 5-year period, were reviewed. The aim was to determine how the patients' symptoms and needs were assessed and cared for as documented by medical and nursing professionals. Data were collected on 107 items of interest for nursing care. The symptoms the patients experienced had consequences on many aspects of their lives. Basic functions, such as eating and elimination, were seriously disturbed before surgery, as well as after the first 3 weeks and 3 months. Pain and changes in sleeping pattern and in mood state were recorded for a majority of the patients. Due to inadequate notes the study cannot reveal the total care given to assist these patients with symptom control. However, certain insufficiencies could be found. The conclusion is that nurses can take a more active part in caring for patients with pancreatic cancer. By using assessment tools, and in cooperation with the surgeons, nurses can assist the patients with nutritional support, pain management, information and emotional support, as well as with physical training, leading to qualitative improvements in the lives of patients with pancreatic cancer.

Adult↗
PubMed1978

[Autotransplantation of pancreas fragments in dogs with total pancreatectomy without separation of exo and endocrine tissue].

By total pancreatectomy 41 dogs were made diabetic. Of these, 15 dogs remained untreated, served as diabetic controls, and died within x = 7 +/- 1 days postoperatively. In the experimental groups the best results were obtained (as judged by K values of iv glucose tolerance test and iv Tolbutamide test curves) after 20 min of incubation with collagenase and immediate transplantation into the splenic pulp. After 15 min and 25 min of incubation, normoglycemia regularly occurred, but in the 20 min collagenase group the K values resembled most closely those of normal dogs. The animals stayed normoglycemic and were observed for up to 6 months. Splenectomy led to reocurrence of the diabetic state and death within 4.8 +/- 1.5 (S.E.) days.

Animals↗
PubMed1990

[Cardiac arrest episodes by cardiomyopathy following total pancreatectomy, a case report].

A 47-year-old man with advanced pancreatic carcinoma underwent total pancreatectomy with resection of the involved portal vein. His postoperative course was complicated by a couple of cardiac arrest episodes. The first episode occurred seven weeks after surgery during drip infusion of CDDP, and later on during the thirteenth week after surgery. There was no apparent cause for those episodes. On both occasions resuscitation was performed adequately. The second arrest was followed by deep inverted T waves on ECG, however, not by elevation of serum CPK-MB. Because of this, myocardial infarction was ruled out. The diagnosis of cardiomyopathy was made possible through the discovery on the echocardiogram of a hypertrophied left ventricle with thick interventricular septum. Then, on catheterization, myocardial squeezing in the left anterior descending coronary artery was noticed. Finally, histological findings concerning the biopsied cardiac muscle led to the same diagnosis. Cardiac arrest in this case seemed to be due to arrhythmia caused by cardiomyopathy. Echo cardiography should be routinely used as part of the examination prior to extended major surgery.

Cardiomyopathy, Hypertrophic↗
PubMedDate not supplied

[Giovanni Martinotti and experimental pancreatectomy, a century ago].

On July 13th, 1888, Giovanni Martinotti (1857-1928) announced in Torino the feasibility of a total pancreatectomy in the dog. The essential details for a successful outcome of the operation, as described by Martinotti, were employed by Oscar Minkowski (1859-1931) in Strassburg for the demonstration of diabetes after total removal of pancreas in the dog, on May 22nd, 1889. Martinotti's work deserves a reevaluation in the history of diabetology.

Animals↗