Search PubMed⌕ Search

SEARCH · Search PubMed

Results for “Resectable”

Search indexed PubMed citations on genomics, clinical trials, systematic reviews and public health. Explore titles, authors and supplied subject terms, then open the PubMed record.

Quote a phrase for an exact phrase match. Source license links do not imply unrestricted reuse.

At least 1,729 records · Page 96Linked to original sources
PubMed2000

[Retrospective analysis of the prognostic significance of the manner of mandibular resection and adjuvant radiotherapy in para-mandibular carcinomas].

The prognostic effect of bone resection (continuous vs non-continuous) was analysed in a retrospective study of 100 patients who were treated for squamous cell carcinoma located close to the lower jaw, between 1983 and 1994. Tumour stage, type of bone resection, extent of lymphatic node resection, dose of radiotherapy and chemotherapy were documented. Prognosis was characterised by the statistical end points "death", "metastasis" and "relapse". Thirty-two stage pT2 carcinomas, half of which were treated by continuous and half by non-continuous resection of the lower jaw, showed the same occurrence of the statistical end points death, metastasis or relapse. There was a trend towards a significantly longer survival time and metastasis-free interval in the group of continuous resection. The hazard ratios, however, showed no effect depending on the type of resection. However, both tumour stage (pTNM) and dose of radiation independently influenced prognosis in multivariate analysis. Consequently, three groups were defined. Univariate analysis of 62 patients without radiotherapy vs 19 with low-dose radiotherapy (36 Gy) and 19 with high-dose (62 Gy) showed a positive effect on the rate and time of survival in the group treated with high-dose radiotherapy. This was confirmed by multivariate analysis showing significantly lower hazard ratios for death and metastasis in the high-dose radiotherapy group after adjusting to cofactors (e.g. tumour stage). The data of this study challenge the current concept of resection of the lower jaw. However, due to the low number of patients and the retrospective character of the study, it is not possible to give suggestions regarding established therapy concepts. The advances of a high-dose radiotherapy in this study should be the subject of further multicentre retrospective and prospective randomised trials.

Adult↗
PubMedDate not supplied

Pediatric intestinal transplantation: the resected allograft.

We reviewed the clinical and pathologic finding of 22 resected allografts from 19 of the 83 children who underwent a variety of small intestinal transplant procedures in the years 1990-2000 at the Children's Hospital of Pittsburgh. Resections were compared with prior mucosal biopsies because resections allow for evaluation of the entire bowel thickness, including the feeding vessels, and obviate the problems of limited sampling. Partial resections that were done soon after the transplant, or soon after additional surgery, were for surgical problems such as leaks, adhesions, and volvulus. None had biopsy features suggestive of rejection or infection. Partial resections done late (6 months or more) after transplantation were more likely to be related to allograft immune biology; two had a sclerosing peritonitis that was confined to the allograft, and one had an obstructing carcinoma arising in the allograft mucosa. One patient had a localized stricture, demonstrated to be due to graft vascular disease at partial resection, and this patient went on to have the allograft removed a year later for chronic rejection. Early complete allograft enterectomies were for refractory acute cellular rejection, 1-2 months following transplant. One was removed for pancreatitis and liver failure from operative complications. Late allograft enterectomies were generally for chronic rejection, some with residual acute rejection, but there were also a number of patients who had multiple superimposed conditions such as cytomegalovirus, Epstein-Barr virus, and post-transplant lymphoproliferative disorder in various combinations. One had idiopathic scarring and developed an adynamic bowel that remains unexplained. Examination of the resected specimens allows for dissection of the multiple contributions to graft failure, especially the vascular disease that can rarely be seen on mucosal biopsy. An unexpected finding was the impressive hypertrophy of neural elements, nerves, and ganglion cells in many of the patients, the significance of which requires further investigation.

Adolescent↗
PubMed2001

Combined resection of invaded organs in patients with T4 gastric carcinoma.

BACKGROUND: To understand the efficacy of gastrectomy combined with the resection of other organs and to refine the indications for this type of surgery, the records of 156 patients with carcinoma of the stomach directly invading adjacent organs or structures (T4 gastric carcinoma) were analyzed retrospectively. METHODS: The patients were divided into three groups, as follows: in group A, curative resection was performed by the combined resection of invaded organs or structures; in group B, although combined resection was performed, curative resection could not be performed because of the extent of lymph node metastasis, liver metastasis, and/or peritoneal metastasis; in group C, combined resection was not performed. RESULTS: In patients with peritoneal or liver metastasis, there was no significant difference in prognosis among the three groups. In patients without peritoneal and liver metastasis, the prognosis of group A was significantly better than that of group B or group C, irrespective of the extent of lymph node metastasis or the number of invaded organs. In these group A patients, the 5-year survival rates of those with localized tumors and no lymph node metastasis, those with localized tumors and lymph node metastasis, those with infiltrating tumors and no lymph node metastasis, and those with infiltrating tumors and lymph node metastasis were 100%, 56.2%, 57.1%, and 13.6%, respectively. CONCLUSIONS: Combined resection of involved organs should be carried out with curative intent in patients with localized gastric cancer or infiltrating gastric cancer without lymph node metastasis.

Adenocarcinoma↗
PubMed2003

Analysis of the extent of astrocytic tumour resection evaluated by magnetic resonance images.

One of the most important prognostic factors in brain tumours is the extent of tumour resection. Its evaluation has been difficult on computed tomography (CT); however, magnetic resonance imaging (MRI) can clearly determine the extent of tumour resection. Using MRI, we analyzed 77 patients with astrocytic tumours that were surgically treated at our department from 1994 to 2001. The tumours were classified into the following types: (a) well-circumscribed: single lesions that can be distinguished from normal brain; (b) localised: single lesions that are localised in one gyrus; and (c) diffuse: other tumours. Our treatment of glioma resection is to use sulcus opening and gyrectomy, a technique based on identification and dissection of the sulcus adjacent to the tumour followed by en bloc tumour resection. Almost total tumour resection (> or =95% resection) was achieved in 76.8% in the well-circumscribed type, 100% in the localised type, and only 10.5% in the diffuse type. Nearly total resection was achieved in 61%, which is considerably more than in the literature of the CT era (10.4-23.5%). The sulcus opening and gyrectomy technique based on MRI achieved radical glioma removal in cases which could be identified by MRI, resulting in a better tumour removal rate than that based on CT.

Adolescent↗
PubMed2003

Cytoreductive surgery combined with organ resection for advanced ovarian carcinoma.

BACKGROUND: The survival effects of combined organ resection in cytoreductive surgery for advanced ovarian carcinoma with regard to the site and the number of organs involved have not yet been clarified. METHODS: Data obtained from 143 patients with stage III/IV ovarian carcinoma were used for analysis. Combined organ resection (COR) was employed in 21 patients in whom optimal cytoreduction (defined as a residuum <or=2 cm in diameter) was expected to be achieved by the procedure. RESULTS: The tumors were optimally cytoreduced in 98 (68.5%) of 143 patients, either in primary surgery ( n = 53) or in interval cytoreductive surgery ( n = 45). The overall survival of patients with optimal cytoreduction was significantly higher than that of patients with nonoptimal cytoreduction ( P < 0.01). There was no significant difference between the survival of patients in the optimal primary cytoreduction group and that of patients in the optimal interval cytoreduction group. The survival of stage III patients who underwent optimal surgery with COR was comparable to that of stage III patients who underwent optimal surgery without COR and was better than that of stage III patients who underwent nonoptimal surgery ( P < 0.01). However, no effect of COR on the survival of stage IV patients was found. In the group of stage III patients who underwent optimal surgery with COR, the survival time tended to be shorter in patients who had upper abdominal organ resections ( P = 0.059), and it was significantly shorter in patients who underwent resections of two or more organs ( P = 0.0299). There was no operative mortality in any of the patients who underwent COR. CONCLUSION: Although COR has therapeutic significance for stage III ovarian carcinoma, the survival periods of patients with stage III ovarian carcinoma who have undergone additional upper abdominal organ resections, or two or more organ resections, may be shorter than the survival periods of patients with stage III ovarian carcinoma who have undergone resection of a single non-upper-abdominal organ.

Adult↗
PubMed2006

Minimally invasive resection for colorectal cancer: perioperative and medium-term results in an unselected patient group at a single institution.

BACKGROUND: The use of laparoscopy for colorectal cancer resection is still controversial. METHODS: We prospectively analyzed the outcome of minimally invasive resection for colorectal cancer, performed at our institution from 1998, when laparoscopic surgery became the treatment of choice for colorectal cancer, until 2004. All patients undergoing elective resection were assessed in terms of perioperative results (duration of surgery, number of lymph nodes removed, length of specimen, rate of conversion, complications) and survival. Patients were assessed yearly with follow-up visits and telephone interviews. RESULTS: In the study period, 302 patients (mean age 66.1 years; range, 32-93 years) underwent 114 left hemicolectomies, 108 low anterior resections, 61 right hemicolectomies, 12 Miles procedures, 4 subtotal colectomies, and 3 transverse colon resections. Surgery took an average of 226 minutes (SD=71 min). The number of lymph nodes removed was 14+/-8. The conversion rate was 10%; most of the conversions were due to locally advanced cancer (15 cases) and bowel distension (7 cases). Fifteen anastomotic leaks were observed (5%). Twenty patients needed reoperation and two died: one of septic shock due to an anastomotic leak; the other of electrolyte imbalance and dehydration after peritonitis due to a bowel loop injury. Follow-up was available for 91% of patients. Cancer-related survival curves showed a 90% survival for stage II, 85% for stage III, and 10% for stage IV disease, 30 months after surgery. CONCLUSIONS: Minimally invasive laparoscopic resection for colorectal cancer enables an oncologically adequate resection with complication and survival rates that are no worse than are to be expected after traditional open surgery. Locally advanced tumor and bowel distension are the most frequent reasons for conversion to open surgery.

Adenocarcinoma↗
PubMed2004

Comparison of functional results and quality of life between intersphincteric resection and conventional coloanal anastomosis for low rectal cancer.

PURPOSE: The technique of intersphincteric resection permits sphincter preservation with good oncologic results in very low rectal cancer. This study aimed to investigate functional results and quality of life after intersphincteric resection compared with conventional coloanal anastomoses. METHODS: From 1990 to 2000, 170 patients underwent total mesorectal excision with coloanal anastomosis for low rectal tumors. Questionnaires were obtained from 77 patients alive without colostomy: 37 had a conventional coloanal anastomosis and 40 had intersphincteric resection. Both groups were similar according to age, gender, anastomotic stenosis, colonic pouch, anastomotic leakage, preoperative radiotherapy, and follow-up (median, 56 months). Assessment included one functional and two quality-of-life questionnaires: the SF-36 Health Status and the Fecal Incontinence Quality of Life score. RESULTS: There was no difference in stool frequency, fragmentation, urgency, dyschesia, and alimentary restriction between patients with and without intersphincteric resection. Patients with intersphincteric resection had significantly worse continence (Wexner score, 10.8 vs. 6.9; P < 0.001) and needed more antidiarrheal drugs (60 vs. 35 percent; P = 0.04) than those without. Compared with conventional coloanal anastomoses, quality of life was altered by intersphincteric resection for the subscale embarrassment ( P < 0.01) in the Fecal Incontinence Quality of Life score, whereas no difference of quality of life was observed with SF-36. CONCLUSIONS: Compared with conventional coloanal anastomoses, patients with intersphincteric resection have a higher risk of fecal incontinence and a slightly altered quality of life.

Adult↗
PubMed2002

Predictors of survival in recurrent rectal cancer after resection and intraoperative radiotherapy.

PURPOSE: This study was designed to determine predictors of survival after surgery and intraoperative radiotherapy for recurrent rectal cancer. METHODS: From a prospective database, 634 patients undergoing resection for recurrent rectal cancer between January 1990 and June 2000 were identified. Of these, 111 received intraoperative radiotherapy with curative intent, and 100 were available for follow-up. Clinicopathologic variables from both the primary and recurrent operations were evaluated as predictors of disease-free and disease-specific survival by multivariate Cox regression and log-rank test. RESULTS: There were 54 males and 46 females, with a median age of 57 (range, 37-83) years. With a median follow-up of 23.2 months, 60 patients (60 percent) recurred: 20 (33 percent) locally, 27 (45 percent) distantly, and 13 (22 percent) at both sites. Of all variables analyzed, only complete resection with microscopically negative margins and the absence of vascular invasion in the recurrent specimen predicted improved disease-free and disease-specific survival (P < 0.01 for all). Median disease-free survival and median disease-specific survival were 31.2 and 66.1 months, respectively, for complete resection compared with 7.9 and 22.8 months for resection with microscopic or grossly positive margins (P < 0.01 for both). Median disease-free survival and median disease-specific survival were 6.4 and 16.1 months, respectively, in the presence of vascular invasion in the recurrent specimen compared with 23.3 and 57.3 months in the absence of vascular invasion (P < 0.01 and P < 0.05, respectively). Complete resection and the absence of vascular invasion were the only predictors of improved local control as well (P < 0.05 and P < 0.01, respectively). CONCLUSION: Resection with negative microscopic margins and absence of vascular invasion are independent predictors of local control and improved survival after resection and intraoperative radiotherapy for recurrent rectal cancer.

Adult↗
PubMed2003

Oncologic results following abdominoperineal resection for adenocarcinoma of the low rectum.

PURPOSE: The role of abdominoperineal resection for rectal cancer has changed because of advances in sphincter-preserving surgery. Our aim was to evaluate the results of this operation in the five-year period following introduction of the concept of total mesorectal excision METHODS: Data on all patients undergoing abdominoperineal resection for very low rectal cancer between 1992 and 1997 were collected prospectively. All patients had had total mesorectal excision. Curative resection was defined as absence of macroscopic disease after resection and local recurrence as any infiltration or tumor identified in the pelvis, alone or combined with distant disease. Survival and local recurrence rates were calculated using the Kaplan-Meier method and log-rank analysis. RESULTS: Of 165 abdominoperineal resections performed, 106 were for primary adenocarcinoma of the rectum. The male:female ratio was 50:56, with a median age of 65 (range, 33-85) years. There was one postoperative death. Twenty-seven patients received short-course preoperative radiotherapy (25 Gy over 1 week), whereas 22 had a longer course, with concomitant chemotherapy in 2. Postoperative chemotherapy was administered in 29, postoperative radiotherapy in 4, and combined therapy in 8. After curative resection (n = 91), survival at five years was 76 percent and differed significantly by stage. Recurrence at any site was 7 percent (3/34) for Stage I, 27 percent (6/26) for Stage II, and 53 percent (16/31) for Stage III. Nine patients presented with local recurrence, with an overall rate at five years of 10 percent. Isolated locale recurrence was observed in only 5 percent of patients CONCLUSIONS: After abdominoperineal resection and total mesorectal excision, good rates of local control may be achieved provided surgical technique is meticulous.

Adenocarcinoma↗
PubMed2002

Influence of experience on laparoscopic ileocolic resection for Crohn's disease.

PURPOSE: The technical difficulties that are frequently encountered in surgery for Crohn's disease have led some authors to suggest Crohn's cases should not be attempted early in one's laparoscopic colorectal surgery experience. This article reviews one surgeon's experience with laparoscopic terminal ileal resections for Crohn's disease to assess the safety of beginning laparoscopic colorectal resections with these procedures. METHODS: A retrospective review of all laparoscopic ileocolic resections performed by a single surgeon was performed. RESULTS: Sixty-nine (82 percent) of 84 procedures were completed laparoscopically. Reasons for conversion were dense adhesions (n = 5) and complex masses (n = 10). The mean operating time for the entire group was 145 +/- 39 (range, 87-289) minutes. Postoperative length of stay was 5.6 +/- 2.4 (range, 2-21) days. The mean incision length in the laparoscopic group was 4.5 +/- 1.15 cm. If the series is examined in three equal intervals, the number of patients with multiple difficulties (abscess, fistula, and previous resection or mass) increased in the final part of the study, without affecting complication or conversion rates. Despite the increased case complexity, average length of stay was significantly reduced between the second and third time periods (P = 0.008). CONCLUSIONS: Despite its technical demands, laparoscopic ileocolic resection was a safe procedure with potential advantages to patients. Laparoscopic resection is possible in the vast majority of patients with ileocolic Crohn's disease, regardless of the nature of the pathology. Previous resections, abscesses, fistulas, and phlegmons do not preclude success, although these cases should likely not be the first attempted.

Adult↗
PubMed2006

Stapled transanal rectal resection under laparoscopic surveillance for rectocele and concomitant enterocele.

PURPOSE: Stapled transanal rectal resection recently became a recommended surgical procedure for obstructed defecation syndrome. One problem when using a transanal stapling device for rectal surgery is the potential threat to structures located in front of the anterior rectal wall. We decided to perform a combined procedure of transanal rectal resection with a simultaneous laparoscopy for patients with obstructed defecation syndrome and an enterocele. METHODS: Between November 2002 and May 2005 a total of 41 patients were treated surgically for obstructed defecation syndrome. Four patients with concomitant enterocele underwent stapled transanal rectal resection under laparoscopic surveillance. Before surgery all patients underwent preoperative assessment, including clinical examination, colonoscopy, conventional video defecography, dynamic magnetic resonance imaging defecography, gynecology examinations, and psychologic evaluation. RESULTS: The mean operative time was 50 (+/-16.5) minutes for the conventional stapled transanal rectal resection and 67 (+/-14.1) minutes for combined laparoscopy and stapled transanal rectal resection (P < 0.01). Three major complications were observed: two had bleeding in the staple line (one from each group) and one had a late abscess in the staple line. CONCLUSIONS: The combination of the stapled transanal rectal resection procedure and laparoscopy provides the opportunity to perform transanal rectal resection without the threat of intra-abdominal lesions caused by enterocele.

Digestive System Surgical Procedures↗
PubMed2006

Endoscopic mucosal resection of large sessile colorectal polyps with submucosal injection of hypertonic 50 percent dextrose-epinephrine solution.

PURPOSE: Before endoscopic mucosal resection of large sessile colorectal polyps, injection of solution into submucosa cushions and isolates the tumor, although there is little information as to which solution with optimal effect should be used. This study investigated the effectiveness of endoscopic mucosal resection by use of a hypertonic dextrose plus epinephrine solution for large sessile colorectal polyps. METHODS: We removed 59 large sessile colorectal polyps in 59 patients by introducing an endoscopic submucosal hypertonic dextrose plus epinephrine injection technique. Endoscopic evaluations were repeated at 3, 6, and 12 months or longer. If no residual tumor was observed endoscopically and histologically at one year or more, the patient was considered to be "cured." The main outcome measurements were the mean amount of solution injected, mean disappearance time of solution, safety, complications, and recurrence at follow-up. RESULTS: Of the 59 large sessile colorectal polyps, 23 (39 percent) were resected en bloc and 36 (61 percent) piecemeal. The mean amount of hypertonic dextrose plus epinephrine solution injected was 24.42 +/- 17.52 ml, and its mean disappearance time was 13.61 +/- 5.21 (range, 7-21) minutes. Of the 36 patients treated with piecemeal resection, 18 (50 percent) required additional endoscopic interventions. In patients who entered the follow-up surveillance protocol for one year or longer, the cure rate by en bloc resection was 100 percent (23/23) and that by piecemeal intervention was 96.78 percent (30/31). Four patients (6.8 percent) had local bleeding after endoscopic mucosal resection that was mainly controlled endoscopically. CONCLUSIONS: Endoscopic mucosal resection after submucosal hypertonic dextrose plus epinephrine solution injection, with an intensive follow-up program, seems to be a safe and effective treatment for large sessile colorectal polyps.

Aged↗
PubMed2006

What is the optimal time of surgical intervention after an acute attack of sigmoid diverticulitis: early or late elective laparoscopic resection?

PURPOSE: This prospective study was designed to check the ideal time of surgical intervention by comparing the results of early elective laparoscopic sigmoid resection after an inflammatory attack with those of late elective resection during the inflammation-free interval. METHODS: A total of 210 patients (114 males) underwent laparoscopic resection for acute sigmoid diverticulitis between 1999 and 2005. They were prospectively divided into two groups: Group I with an early elective sigmoid resection (5-8 days after initial antibiotic treatment); Group II in the inflammation-free interval (4-6 weeks after initial hospitalization). RESULTS: There was no difference between the groups with regard to age (55.7 years), American Society of Anesthesiologists score (1.86), previous diseases, and extent of inflammation. After surgery, 156 patients (74.3 percent) were complication-free. There was a total of ten conversions (Group I, 9; Group II, 1; P<0.05). Minor complications developed in 42 patients (abdominal wall abscess=24, intestinal atony=6, hematoma=9, urinary tract infection=2). Eight patients in Group I (P<0.05) developed anastomotic leaks. None of the patients died. CONCLUSIONS: In the majority of patients, laparoscopic sigmoid resection in sigmoid diverticulitis can be performed without conversion. Patients who underwent surgery in the inflammation-free interval had a lower complication rate than those submitted to early elective resection. In our patient population, we were able to show that surgery in the inflammation-free interval significantly reduces postoperative morbidity. It is thus preferable for patients with sigmoid diverticulitis to receive initial antibiotic treatment and then undergo late elective laparoscopic sigmoid resection.

Acute Disease↗
PubMed2001

Prolonged survival after extracranial metastasectomy from synchronous resectable lung cancer.

BACKGROUND: Combined resection of solitary synchronous brain metastases and non-small-cell lung cancer has been shown to be successful. Thus, we proposed combining the surgery of solitary, extracranial metastases, and resectable lung cancer. METHODS: Between March 1987 and December 1994, surgery was performed on nine patients with non-small-cell lung cancer with synchronous, solitary, extracranial, or distant metastasis: adrenal (n = 5), cutaneous (n = 2), axillary lymph node (n = 1) and kidney (n = 1). Criteria for operating on these patients included: primary tumor that was locally resectable in a radical manner, non-small-cell histology, no preoperative evidence of N2 disease, complete resection of histologically proven metastasis, and absence of other metastases found with computed tomography or bone scan. RESULTS: Resection of the primary tumor and solitary metastases was achieved in all patients. Primary tumor was always resected by lobectomy. No mortality or major morbidity was reported. Five-year survival rate was 55.6%. Five patients who had adrenal (n = 3), or skin (n = 1), or axillary (n = 1) metastases, survived more than 5 years. All N2 patients (n = 2) died. CONCLUSIONS: The presence of solitary, distant metastasis should not be considered, per se, a factor for denying surgery for locally resectable, non-small-cell lung cancer. Unexpected, prolonged survival was demonstrated in our limited series.

Adrenal Gland Neoplasms↗
PubMed2005

Intentional limited resection for small peripheral lung cancer based on intraoperative pathologic exploration.

OBJECTIVE: The aim of this study was to assess the adequacy of our intentional limited resection for small peripheral lung cancer based on intraoperative pathologic exploration. METHODS: Patients who had stage IA non-small cell lung cancer (NSCLC) with a maximum tumor diameter of 2 cm or less were candidates for limited resection. If bronchioloalveolar carcinoma (BAC) was suspected on computed tomography and intraoperative pathologic exploration revealed the lesion as BAC without foci of active fibroblastic proliferation (Noguchi type A and B), wedge resection was performed. If the tumor was not suspected of being Noguchi type A or B, extended segmentectomy with intraoperative lymph node exploration was performed. RESULTS: Limited resection was performed in 34 patients, wedge resection in 14, and extended segmentectomy in 20. The median follow-up period after wedge resection was 36 months, and all patients are alive with no signs of recurrence. The median follow-up period after extended segmentectomy was 54 months. No local recurrences were found, but distant metastasis was diagnosed in one patient. The 5-year survival rate after extended segmentectomy was 93%. In the same period, lobectomy was performed in 57 patients with stage IA NSCLC with a maximum tumor diameter of 2 cm or less, and the 5-year survival rate was 84%. There were no significant differences in 5-year survival between extended segmentectomy and lobectomy. CONCLUSIONS: Careful selection of patients based on high-resolution computed tomography findings and intraoperative pathologic exploration makes intentional limited resection an acceptable option for the treatment of small peripheral NSCLC.

Adenocarcinoma, Bronchiolo-Alveolar↗
PubMed2005

Borderline resectable pancreatic cancer.

Rigorous criteria to define "borderline resectable" pancreatic cancer are required for appropriate patient accrual into clinical trials that examine the utility of chemotherapy and/or chemoradiation that will be delivered prior to pancreatic resection for exocrine cancer. At our institution, tumor abutment of less than or equal to 180 degrees (< or = 50% of the vessel circumference) of the superior mesenteric artery, short segment abutment or encasement (> or = 50% of the vessel circumference) of the common hepatic artery (typically at the gastroduodenal artery origin), or segmental venous occlusion are used to categorize a pancreatic tumor as borderline resectable. These patients are at a high risk for margin positive resection with initial surgery; therefore, we favor a treatment schema that incorporates preoperative (neoadjuvant) therapy with systemic chemotherapy and chemoradiation. Patients whose tumors show radiographic stability or regression that are often accompanied by an improvement in serum tumor markers are candidates for pancreaticoduodenectomy. A prospective multicenter clinical trial with well-defined eligibility criteria may help decide the best overall treatment strategy for these patients. Vascular resection and reconstruction may be required in patients with borderline resectable tumors, and surgery should be performed at centers with expertise in such complex pancreatic resections.

Journal Article↗
PubMed1981

Hepatic resection: the logical approach to surgical management of major trauma to the liver.

Recent reports on the management of hepatic trauma have discouraged hepatic resection and supported hepatic artery ligation, "resectional debridement" and even packing. These nonresectional procedures are based on misguided principles and should never replace resection. Traditional methods of conducting hepatic resection in an emergency as used in the West probably cause delay in achieving immediate hemostasis, thus contributing to mortality. Compared with Western reports, our mortality for major hepatic resections is considerably low. This is probably due to faster resection and achievement of hemostasis by our clamping techniques. We conclude that it is quite logical to perform resection as the first line of treatment in major hepatic trauma.

Humans↗
PubMed1989

Treatment of chronic alcoholic pancreatitis by pancreatic resection.

Forty-one patients with chronic pancreatitis caused by alcoholism were selected for resective surgery on the basis of clinical criteria and findings on pancreatography. Five patients had Whipple resections, 32 had 80 percent resections, and 7 had total pancreatectomies (3 previously had subtotal pancreatectomies). One perioperative and three late deaths accounted for the overall mortality of 10 percent. Complete freedom from pain on long-term follow-up was achieved in all of the patients who had total pancreatectomy, in half of the patients who had 80 percent resection, and in only one of five patients who had Whipple resection. Diabetes occurred in only one patient after Whipple resection, in nearly half of the patients after 80 percent pancreatectomy, in a gradually accelerating manner, up to 5 years, and in all patients after total resection, where it was frequently complicated by recurrent alcoholism. Jaundice was a rare complication of disease progression in the overall treatment group; none of these patients presented with cholestasis preoperatively. Recurrent alcoholism was reported in 32 percent of the patients and contributed to two deaths.

Alcoholism↗