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PubMed1983

Modification of pancreatic carcinogenesis in the hamster model. 2. The effect of partial pancreatectomy.

The effect of partial pancreatectomy (PP) on the pancreatic carcinogenicity of N-nitrosobis (2-oxopropyl)amine (BOP) was investigated in Syrian golden hamsters by subcutaneous injection of a single dose of BOP (20 mg/kg, body weight) given 30 minutes after (Group 1), 1 week after (Group 2), or 1 week before 70% PP (Group 3). Additional groups consisted of animals with PP alone (Group 4), sham operation (laparotomy) followed 30 minutes later by BOP treatment (Group 5), and BOP treatment only (Group 6). The experiment was terminated 46 weeks after BOP administration in each group. The pancreas and extrahepatic bile ducts, including the common duct and gallbladder, were examined histologically. Tumor patterns were compared in hamsters with PP and in the corresponding segments of the pancreas in BOP-treated control groups. The pancreatic cancer incidence was highest (31%) in Group 2 and lowest in Group 1 (3%), a difference that was statistically significant (P less than 0.01). Also, a statistically highly significant larger number of tumors occurred in Group 2, compared with group 1, 3, or 5 (P less than 0.0005). In a comparison of the number of carcinomas per tumor-bearing hamster, there were greater numbers of carcinomas in Group 2 (2.6 carcinomas) than in Groups 1, 3, 5, and 6 (1.0, 1.0, 1.3, and 2.6 tumors, respectively). Moreover, pancreatic tumors in Group 2 hamsters were larger (average diameter, 10 mm) than in Group 1 (4 mm), Group 3 (3.5 mm), Group 5 (4 mm), and Group 6 (average, 9mm). The incidence of extrapancreatic tumors did not vary among the PP groups but was equally lower than those in BOP-treated control groups. The data indicated BOP carcinogenesis was inhibited by surgery (regardless of whether PP was per formed) when the carcinogen was given 30 minutes after the surgery but was significantly enhanced when BOP was administered 1 week after PP. The possible reasons for these conflicting results are discussed. Morphologically all tumors were of ductular, ductal, and mixed ductular-insular patterns and most developed at the resected margins, where proliferation of islets, ducts, and ductules, but not of acinar cells, occurred. The results confirm our view that the ductal and ductular cells are the progenitor cells for BOP-induced pancreatic tumors in hamsters.

Animals↗
PubMed1984

Surgical treatment of idiopathic hyperinsulinemic hypoglycemia in children. First successful subtotal pancreatectomy with preservation of spleen reported by Evarts A. Graham (1934).

The first successful subtotal pancreatectomy for idiopathic hypoglycemia in a child was performed by Dr. Evarts Graham in 1934. He did an extended resection and preserved the spleen. Although both of these aspects of the operation are now identified as important principles, it is apparent from a review of the literature that their importance was not recognized for many years.

Child↗
PubMed1984

Subtotal pancreatectomy in the male Wistar rat.

Subtotal pancreatectomy was performed in the male Wistar rat in order to obtain a model for the study of pancreatic regeneration. Adherence to previously published techniques caused an unacceptably high operative mortality due to duodenal necrosis. The operation was modified after a detailed study of the duodenal vasculature was performed and this modification together with meticulous haemostasis enabled the procedure to be performed with an acceptable operative mortality. The procedure ensured that between 73 and 83% of the total pancreatic mass was removed.

Animals↗
PubMed1983

Surgical treatment of chronic pancreatitis by distal pancreatectomy.

No consensus exists on the best surgical treatment for chronic pancreatitis. In a retrospective study on 29 patients it was found that pain caused by chronic pancreatitis can be treated effectively by a 95% DP or a 40-80% DP. However, after a 40-80% DP the incidence of endocrine and exocrine pancreatic insufficiency is less frequent than after a 95% DP. Therefore, distal pancreatectomy can be advised as a treatment of pain, caused by chronic pancreatitis. In order to minimize the chance of pancreatic insufficiency resection should be done as conservatively as possible.

Chronic Disease↗
PubMed1982

Management of the transected pancreas following distal pancreatectomy.

Fifty-six patients are reported upon in whom distal pancreatectomy had been performed for pancreatic trauma with presumed major injury to the pancreatic ductal system. The transected pancreas was compressed with sutures in 27 patients and with a stapler in 29 patients. The postoperative morbidity was comparable in the two groups--three abscesses and four pancreatic fistulas with suture of the pancreas and three of each when the pancreas was stapled. Death was due to perioperative hemorrhage from associated injury in five patients and to severe neurologic damage in three patients. The mortality was 14 per cent.

Humans↗
PubMed1981

[Problems and technical procedures of total pancreatectomy for adenocarcinoma. Consequences of lymphadenectomy (author's transl)].

In cancer recognized less than one month after first signs, frequently by pancreatography via fiberoptic endoscopy, in a young patient patient with no other major disease, total pancreatectomy with systematic lymphadenectomy must be proposed. Total splenopancreatoduodenectomy carried out from left to right provides the longest delay for the final section stages. Simultaneous study of lymph nodes enables one to estimate the survival to approximately two years in case of involvement and hopefully five, if they are intact.

Adenocarcinoma↗
PubMed1980

Management of penetrating pancreatic injuries: subtotal pancreatectomy using the auto suture stapler.

Penetrating injuries of the pancreas have been accompanied by significant morbidity and mortality. A technique using the TA-55 Auto Suture Stapler (United States Surgical Corp., Stamford, CT) in patients with pancreatic trauma has been developed and employed clinically. The technical aspects of this simplified technique and its role in the prevention of postoperative complications of pancreatectomy are reviewed. This approach supports an aggressive and complete surgical evaluation of pancreatic injuries.

Adult↗
PubMed1980

[Section of the pancreas in left-side pancreatectomy and cephalic duodenopancreatectomy. Two technical details (author's transl)].

An oblique section of the pancreatic isthmus, directed internally and posteriorly, facilitates anastomosis between the pancreatic stump and the jejunal loop in cephalic duodenopancreatectomy. In left-side pancreatectomy a bevelled section makde it possible for the pancreatic edge to fold in easily. Such technical details may contribute to easier and safer sutures after excision of pancreatic tissue.

Duodenum↗
PubMed1994

Survival 13 years after pancreatectomy for ductal adenocarcinoma of the head of the pancreas.

In dealing with a lethal disease such as cancer of the pancreas, an all out attack is necessary for an early lesion. The general trend seems to be toward radical en bloc resections, usually, but not always, with a total pancreatectomy. A digestive supplement with a higher proportion of lipase provides better nutrition. Diabetes can be controlled in patients with no pancreas. Reports of long-term survivors should be better documented as to details of previous reporting, care, procedure and pathology.

Carcinoma, Ductal, Breast↗
PubMed1975

[Balanced parenteral nutrition following total pancreatectomy. (Metabolic data)].

The replacement of components of normal metabolism getting lost during operation is an important problem for the clinician. On the basis of a case of total pancreatectomy because of carcinoma of the pancreas this essential problem for the postoperative treatment is demonstrated. After control of the predominant metabolic parameters of the patient over a relatively long postoperative period, we want to formulate our conclusion as follows: In spite of the massive surgery we found only relatively small destruction of the patient's metabolic system. The evident variations in blood sugar level were probably caused by the often changing kinds of nutrition (the patient having been some weeks at home). As the most distinctive sign of a well performed therapy we regard the results of the daily weight control. In spite of the heavy physical stress over many months we could stabilize the patient's body weight after a short postoperative loss.

Aged↗
PubMed1993

[Evaluation of intra-arterial infusion chemotherapy and radical pancreatectomy in patients with locally advanced pancreatic cancer].

This is a retrospective study to evaluate arterial infusion chemotherapy and resection for locally advanced pancreatic cancer involving retro-peritoneal organs or large vessels such as superior mesenteric artery or celiac trunks. Intra-arterial chemotherapy was performed for 19 patients, and 15 underwent pancreatectomy. Patients in the intra-arterial chemotherapy group could live 11 months out of the hospital, against 4 months in the resected cases (p < 0.05). The period of over 2nd degree in performance status was 11 months in the arterial chemotherapy group and 3 months in resected groups (p < 0.05). The survival rates were 53, 18 and 9% at 1, 2 and 3 years in the patients with arterial chemotherapy, respectively, against 22, 15 and 15% in the resected patients (p < 0.05). These results suggested that intra-arterial chemotherapy was significantly effective in prolonging the survival period with a better quality of life.

Angiotensin II↗
PubMed1977

Pancreatectomy in a teleost fish, Anguilla rostrata (American eel).

A technique for pancreatectomy was described for the American eel. In this fish, the operation was not followed by the typical signs of diabetes mellitus. Histodensitometric determination of liver glycogen showed no major differences between operated controls and pancreatectomized eels. The absence of a specific hyperglycemia, previously reported with the hexokinase method, was confirmed with the glucose oxidase technique; however, the more specific hexokinase method gave consistently lower values. Breakdown of adipose tissue and hyperlipemia were absent.

Animals↗
PubMedDate not supplied

Surgical techniques of cytology-guided pancreatectomy for occult neoplasm of the pancreas.

BACKGROUND/AIM: In recent years, we have succeeded in treating an occult cancer of the pancreas by making the most of cytodiagnosis for the pure pancreatic juice. MATERIALS AND METHODS: Even for the patients in whom obvious tumor was not depicted by imaging techniques, the pure pancreatic juice was collected during endoscopic retrograde pancreatography and it was cytologically examined. RESULTS: When cancer cell was detected, both the location of occult lesion and the range of pancreatectomy were determined by the intraoperative cytology for the pancreatic juice which was collected separately from the cranial and caudal segments (2-segmental cytology). More recently, using a balloon catheter, the pancreatic juice of the head, body and tail, (3-segmental cytology) was examined. The former method was effective to prevent the blind resection of the entire pancreas, and the latter provided us with the opportunities to preserve much more pancreatic function. CONCLUSIONS: This method was a useful aid in resecting potentially curable cancer of the pancreas. The present paper introduces the detailed techniques of this method.

Humans↗
PubMedDate not supplied

[Distal pancreatectomy with conservation of the spleen].

Conventional resection of the body and tail of the pancreas usually involves splenectomy. There are evidence that spleen removal can lead to septic and hematological complications and should, therefore, be avoided when possible. Distal pancreatectomy with spleen conservation has been described by specialized centers with good results. This report describes our experience in 8 cases with conservation of the spleen during the resection of the body and tail of the pancreas. The technique has been applied in patients with pancreatic neuroendocrine tumors (n = 4), cystic tumors (n = 3) and cystic-papillary tumor (n = 1) with no complications and good late results in all cases.

Adolescent↗
PubMed1976

[Postoperative treatment of patients after pancreatectomy. Closely meshed monitoring of blood sugar (author's transl)].

A report is presented on the postoperative treatment of 4 patients who had undergone duodeno-pancreatectomy because of chronic pancreatitis. When the patients co-operate well satisfactory metabolic compensation can be achieved with small doses of insulin. Replacement of the pancreatic enzymes with the appropriate preparations can be particularly well monitored by means of the fat content of the faeces. The substitution of vitamins A, D, K, and B12 parenterally at intervals of several weeks is also advisable as a safety measure. A method is described for the closely meshed monitoring of the blood sugar. This method is suitable in co-operative patients who are capable of collecting capillary blood for achieving a particularly good control of the metabolic state.

Adult↗
PubMedDate not supplied

[Total pancreatectomy. Which indications?].

This a review of the different topics held by literature for and against total pancreatectomy (TP) for adenocarcinoma of the pancreas. Technical and oncological aspects are discussed as are the metabolic effects of TP; metabolic data of our series of 6 TP are also referred. Postoperative mortality and morbidity decreased to less than 5% during the last decade both for TP and the Whipple procedure; long term survival is also similar for the two procedures. Even if the metabolic consequences of both exocrine and endocrine function deprivation are generally well compensated, they can still threaten the patient's life; furthermore their long term effects are only partially known. These are the reasons that force most authors to choose TP only in selected patients in which a multifocal neoplasia is demonstrated or whose pancreatic remnant is particularly soft and friable with high risk of pancreatojejunostomy complication. A pancreatic remnant in fact grants the hormonal milieu that makes easy the pharmacological control of any pancreatic function deficiency.

Carcinoma↗
PubMed1998

Hand-assisted laparoscopic distal pancreatectomy for pancreatic cystadenoma.

A cystic lesion in the body of the pancreas was detected during staging workup of a 59-year-old woman with T-cell lymphoma of the tongue. After six cycles of chemotherapy the pancreatic lesion was unchanged. Suggestive ulceration of the vulva with edema appeared at the end of chemotherapy. After right vulvar excision, distal pancreatic resection with splenectomy was carried out by a hand-assisted laparoscopic technique utilizing a small muscle-splitting right lower quadrant incision. This allowed for palpation of the peritoneal cavity for evidence of tumor and allowed for safe and expeditious pancreatectomy. The pancreatic tumor was found to be a serous cystadenoma without evidence of malignancy. T-cell lymphoma was identified in the spleen and the vulva. The patient was discharged home on the fifth postoperative day and returned to normal activity within 2 weeks after operation. Two months after the surgery, computed tomography demonstrated a 3-cm pseudocyst in the region of the tail of the pancreas. As the patient was asymptomatic, this required no further therapy. Minimally invasive surgery together with hand assistance combines the advantages of both laparotomy and laparoscopy in the surgical management of selected lesions in the pancreas.

Cystadenoma↗
PubMedDate not supplied

Distal pancreatectomy--does it have a role for pancreatic body and tail cancer.

BACKGROUND/AIMS: Pancreatic resection is the only hope for clinical improvement for patients with carcinoma of the body and tail of the pancreas. However, it is unclear whether palliative pancreatic resection is effective or not for patients with carcinoma of the body and tail of the pancreas. METHODOLOGY: To determine the appropriate treatment for patients with pancreatic body and tail cancer, we analyzed the records of 74 patients with ductal carcinoma of the body or tail of the pancreas who were treated at Kanazawa University Hospital between 1970 and 1995. RESULTS: Using a multivariate Cox proportional-hazard model (factors: age, sex, chemotherapy, radiotherapy, hepatic metastasis, peritoneal dissemination, operative procedure), the presence of hepatic metastasis, peritoneal dissemination, and the type of operative procedures (resection or not) were found to be significant prognostic factors. Surgical resection was the most important prognostic factor. The patients with surgical resection had a significantly higher survival rate than those without resection (p < 0.0001). The survival rate of the patients with palliative resections was also significantly higher than that of the patients without resection, except for the patients with advanced liver metastasis (H3). The survival rate of the patients with palliative resections was also higher than that of the patients without resection, even in patients with peritoneal dissemination. CONCLUSIONS: Surgical resection prolongs the average survival for patients with carcinoma of the body and tail of the pancreas, except for the patients with multiple liver metastasis. These data support the role of palliative pancreatectomy in patients with carcinoma of the body and tail pancreas.

Adult↗