Laparoscopic pancreatectomy for cancer in high volume centers is associated with an increased use and fewer delays of adjuvant chemotherapy

HPB ◽  
2020 ◽  
Author(s):  
Onur C. Kutlu ◽  
Eduardo A. Vega ◽  
Omid Salehi ◽  
Christopher Lathan ◽  
Sunhee Kim ◽  
...  
Keyword(s):  
Adjuvant Chemotherapy ◽  
High Volume ◽  
Laparoscopic Pancreatectomy

scholarly journals Laparoscopic pancreatectomy for benign or low-grade malignant pancreatic tumors: outcomes in a single high-volume institution

BMC Surgery ◽  
2021 ◽  
Vol 21 (1) ◽  
Author(s):  
He Cai ◽  
Lu Feng ◽  
Bing Peng
Keyword(s):  
Surgical Techniques ◽  
Operation Time ◽  
High Volume ◽  
Long Term Results ◽  
Pancreatic Tumors ◽  
Low Grade ◽  
Central Pancreatectomy ◽  
Laparoscopic Pancreatectomy ◽  
Spleen Preserving

Abstract Objective To investigate the perioperative and long-term outcomes of laparoscopic pancreatectomy for benign and low-grade malignant pancreatic tumors, and further compare the outcomes between different surgical techniques. Methods We retrospectively collected clinical data of consecutive patients with benign or low-grade malignant pancreatic tumors underwent surgery from February 2014 to February 2019. Patients were grouped and compared according to different surgical operations they accepted. Results Totally 164 patients were reviewed and 83 patients underwent laparoscopic pylorus-preserving pancreaticoduodenectomy (LPPPD), 41 patients underwent laparoscopic spleen-preserving distal pancreatectomy (LSPDP) and 20 patients underwent laparoscopic central pancreatectomy (LCP) were included in this study, the rest 20 patients underwent laparoscopic enucleation were excluded. There were 53 male patients and 91 female patients. The median age of these patients was 53.0 years (IQR 39.3–63.0 years). The median BMI was 21.5 kg/m2 (IQR 19.7–24.0 kg/m2). The postoperative severe complication was 4.2% and the 90-days mortality was 0. Compare with LCP group, the LPPPD and LSPDP group had longer operation time (300.4 ± 89.7 vs. 197.5 ± 30.5 min, P < 0.001) while LSPDP group had shorter operation time (174.8 ± 46.4 vs. 197.5 ± 30.5 min, P = 0.027), more blood loss [140.0 (50.0–1000.0) vs. 50.0 (20.0–200.0) ml P < 0.001 and 100.0 (20.0–300.0) vs. 50.0 (20.0–200.0 ml, P = 0.039, respectively), lower rate of clinically relevant postoperative pancreatic fistula [3 (3.6%) vs. 8 (40.0%), P < 0.001 and 3 (7.3%) vs. 8 (40.0%), P = 0.006, respectively], lower rate of postpancreatectomy hemorrhage [0 (0%) vs. 2 (10.0%), P = 0.036 and (0%) vs. 2 (10.0%) P = 0.104, respectively] and lower rate of postoperative severe complications [2 (2.4%) vs.4 (20.0%), P = 0.012 and 0 (0%) vs. 4 (20.0%), P = 0.009, respectively], higher proportion of postoperative pancreatin and insulin treatment (pancreatin: 39.8% vs., 15% P = 0.037 and 24.4%vs. 15%, P = 0.390; insulin: 0 vs. 18.1%, P = 0.040 and 0 vs. 12.2%, P = 0.041). Conclusions Overall, laparoscopic pancreatectomy could be safely performed for benign and low-grade malignant pancreatic tumors while the decision to perform laparoscopic central pancreatectomy should be made carefully for fit patients who can sustain a significant postoperative morbidity and could benefit from the excellent long-term results even in a high-volume center.

scholarly journals Robotic versus Open Pancreatoduodenectomy for Pancreatic and Periampullary Tumors (PORTAL): a study protocol for a multicenter phase III non-inferiority randomized controlled trial

Trials ◽  
2021 ◽  
Vol 22 (1) ◽  
Author(s):  
Jiabin Jin ◽  
Yusheng Shi ◽  
Mengmin Chen ◽  
Jianfeng Qian ◽  
Kai Qin ◽  
...  
Keyword(s):  
Adjuvant Chemotherapy ◽  
Functional Recovery ◽  
High Volume ◽  
Phase Iii ◽  
Postoperative Adjuvant Chemotherapy ◽  
Randomized Controlled ◽  
Link Type ◽  
Robotic Pancreatoduodenectomy ◽  
Large Patient ◽  
Secondary Outcomes

Abstract Background Pancreatoduodenectomy is a complex and challenging procedure that requires meticulous tissue dissection and proficient suturing skills. Minimally invasive surgery with the utilization of robotic platforms has demonstrated advantages in perioperative patient outcomes in retrospective studies. The development of robotic pancreatoduodenectomy (RPD) in specific has progressed significantly, since first reported in 2003, and high-volume centers in pancreatic surgery are reporting large patient series with improved pain management and reduced length of stay. However, prospective studies to assess objectively the feasibility and safety of RPD compared to open pancreatoduodenectomy (OPD) are currently lacking. Methods/design The PORTAL trial is a multicenter randomized controlled, patient-blinded, parallel-group, phase III non-inferiority trial performed in seven high-volume centers for pancreatic and robotic surgery in China (> 20 RPD and > 100 OPD annually in each participating center). The trial is designed to enroll and randomly assign 244 patients with an indication for elective pancreatoduodenectomy for malignant periampullary and pancreatic lesions, as well as premalignant and symptomatic benign periampullary and pancreatic disease. The primary outcome is time to functional recovery postoperatively, measured in days. Secondary outcomes include postoperative morbidity and mortality, as well as perioperative costs. A sub-cohort of 128 patients with pancreatic adenocarcinoma (PDAC) will also be compared to assess the percentage of patients who undergo postoperative adjuvant chemotherapy within 8 weeks, in each arm. Secondary outcomes in this cohort will include patterns of disease recurrence, recurrence-free survival, and overall survival. Discussion The PORTAL trial is designed to assess the feasibility and safety of RPD compared to OPD, in terms of functional recovery as described previously. Additionally, this trial will explore whether RPD allows increased access to postoperative adjuvant chemotherapy, in a sub-cohort of patients with PDAC. Trial registration ClinicalTrials.govNCT04400357. Registered on May 22, 2020

Surgeon and hospital variation in adjuvant chemotherapy delivery to patients with stage III colon cancer.

2017 ◽  
Vol 35 (15_suppl) ◽  
pp. 3596-3596
Author(s):  
Zhaomin Xu ◽  
Carla Francesca Justiniano ◽  
Adan Z Becerra ◽  
Christopher Thomas Aquina ◽  
Francis P. Boscoe ◽  
...  
Keyword(s):  
Colon Cancer ◽  
Adjuvant Chemotherapy ◽  
Adjuvant Therapy ◽  
Cancer Patients ◽  
New York State ◽  
High Volume ◽  
Stage Iii ◽  
Stage Iii Colon Cancer ◽  
Hospital Variation ◽  
Comorbidity Burden

3596 Background: It is well established that age and comorbidities have significant impact on adjuvant chemotherapy delivery to stage III colon cancer patients. This study examines differences in the hospital and surgeon-specific probabilities of adjuvant therapy delivery to stage III colon cancer patients by comorbidity burden and age. Methods: Patients who underwent surgery for stage III colon cancer from 2004-2013 were included from the New York State Cancer Registry and the Statewide Planning and Research Cooperative System. Comorbidity burden was defined with the Charlson Comorbidity Index (CCI). Multilevel logistic regressions characterized variation in adjuvant chemotherapy delivery among individual hospitals and surgeons by CCI and age. Results: 11575 patients met inclusion criteria, of which 59% received adjuvant therapy. Younger age, lower CCI, and high volume surgeons/hospitals were associated with delivery of adjuvant therapy (p < 0.01). Median time to chemotherapy was 43 days among CCI = 0 vs 48 among CCI≥2. The risk adjusted hospital and surgeon-specific probabilities of adjuvant delivery decreased with increasing CCI and age. The proportion of variation attributable to surgeons, vs hospitals, increased with CCI and age. Hospital variation between the highest and lowest hospitals increased from a 6-fold difference among CCI = 0 to an 11 fold difference among CCI≥2. Surgeon variation increased from a 14-fold difference among CCI = 0 to a 40 fold difference among CCI≥2. Conclusions: Variation in adjuvant chemotherapy delivery to stage III colon cancer patients increased with higher comorbidity burden and age. While a larger proportion of variation is attributable to surgeons among patients with the highest CCI and the most elderly, the vast majority of the variation is related to hospital factors. Even taking into account that some patients may be unfit for adjuvant therapy, this variation in treatment is alarmingly high. [Table: see text]

Clinical validation of the 7th AJCC-TNM nodal staging system in lymph node-positive patients undergoing radical cystectomy.

2012 ◽  
Vol 30 (15_suppl) ◽  
pp. 4588-4588
Author(s):  
Eila C. Skinner ◽  
Harman Maxim Bruins ◽  
Ryan Paul Dorin ◽  
Barbara Rubino ◽  
Gus Miranda ◽  
...  
Keyword(s):  
Bladder Cancer ◽  
Lymph Node ◽  
Adjuvant Chemotherapy ◽  
Radical Cystectomy ◽  
Staging System ◽  
High Volume ◽  
Tnm Staging ◽  
Anatomical Location ◽  
Nodal Staging ◽  
N2 Disease

4588 Background: The AJCC TNM staging system for bladder cancer has recently been updated. In the new 7th edition, staging of lymph node (LN) metastases is based on anatomical location instead of size as in the former 6th edition. This study evaluated whether the prognostic value of nodal staging according to the 7th edition is superior to the 6th edition. Methods: Prospectively collected data of patients who underwent radical cystectomy (RC) at a high-volume center between 2002 and 2008 were reviewed. Patients who underwent RC for non-urothelial cancer, received neo-adjuvant therapy or had non-LN metastatic disease at the time of RC were excluded. All patients underwent RC with extended lymphadenectomy up to the inferior mesenteric artery. LNs were submitted in predesignated anatomically defined packets. Detailed data on the number, size and location of LN metastases were recorded. Both the 6th and 7th edition AJCC TNM editions were used to stage LN positive (LN+) disease. Median follow-up time was 2.8 years. Kaplan-Meier analysis was used to estimate overall survival (OS) and recurrence-free survival (RFS). Results: A total of 637 patients were identified of whom 141 patients (22.1%) had LN+ disease. In total, 83 patients (58.9%) received adjuvant chemotherapy. Administration of adjuvant chemotherapy did not differ significantly per N-stage according to both editions. Based on the 6th edition, 31 patients (22.0%) had N1 disease, 105 patients (74.5%) N2 disease and 5 patients (3.5%) N3 disease. Three-year RFS rates for N1, N2 and N3 disease were 51%, 43% and 0% respectively (p = 0.87). Based on the 7th edition, 29 patients (20.6%) had N1 disease, 60 patients (42.6%) N2 disease and 52 patients (36.9%) N3 disease. Three-year RFS rates for N1, N2 and N3 disease were 51%, 42% and 45%, respectively (p = 0.84). Conclusions: Neither the AJCC-TNM 7th edition (location-based) LN staging nor the 6th edition (size-based) staging performed well as a prognostic tool for the patients in this cohort. The new staging system moved a large percent of patients into the N3 category, which did not have a worse prognosis than either the N1 or N2 categories. A better staging system for LN+ bladder cancer patients needs to be developed.

Morphology, Distribution and Identification of Micro-Constituents Along Grain Boundaries in Nickel-Base Alloys

1973 ◽  
Vol 31 ◽  
pp. 176-177
Author(s):  
D. E. Fornwalt ◽  
A. R. Geary ◽  
B. H. Kear
Keyword(s):  
Electron Microscope ◽  
Grain Boundaries ◽  
Volume Fraction ◽  
Rupture Life ◽  
Stress Rupture ◽  
High Volume ◽  
Precipitate Morphology ◽  
Stress Rupture Life ◽  
Nickel Base ◽  
Scanning Electron

A systematic study has been made of the effects of various heat treatments on the microstructures of several experimental high volume fraction γ’ precipitation hardened nickel-base alloys, after doping with ∼2 w/o Hf so as to improve the stress rupture life and ductility. The most significant microstructural chan§e brought about by prolonged aging at temperatures in the range 1600°-1900°F was the decoration of grain boundaries with precipitate particles.Precipitation along the grain boundaries was first detected by optical microscopy, but it was necessary to use the scanning electron microscope to reveal the details of the precipitate morphology. Figure 1(a) shows the grain boundary precipitates in relief, after partial dissolution of the surrounding γ + γ’ matrix.

A Comparison of Tem and Apfim to the Interpretation of Modulated Microstructures

1985 ◽  
Vol 43 ◽  
pp. 70-71
Author(s):  
M.G. Burke ◽  
M.K. Miller
Keyword(s):  
Low Temperature ◽  
Microstructural Characterization ◽  
Superlattice Reflection ◽  
High Volume ◽  
Atom Probe ◽  
Dark Field ◽  
Miscibility Gap ◽  
Second Phase ◽  
Two Phase ◽  
Probe Field

Interpretation of fine-scale microstructures containing high volume fractions of second phase is complex. In particular, microstructures developed through decomposition within low temperature miscibility gaps may be extremely fine. This paper compares the morphological interpretations of such complex microstructures by the high-resolution techniques of TEM and atom probe field-ion microscopy (APFIM).The Fe-25 at% Be alloy selected for this study was aged within the low temperature miscibility gap to form a <100> aligned two-phase microstructure. This triaxially modulated microstructure is composed of an Fe-rich ferrite phase and a B2-ordered Be-enriched phase. The microstructural characterization through conventional bright-field TEM is inadequate because of the many contributions to image contrast. The ordering reaction which accompanies spinodal decomposition in this alloy permits simplification of the image by the use of the centered dark field technique to image just one phase. A CDF image formed with a B2 superlattice reflection is shown in fig. 1. In this CDF micrograph, the the B2-ordered Be-enriched phase appears as bright regions in the darkly-imaging ferrite. By examining the specimen in a [001] orientation, the <100> nature of the modulations is evident.

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