Pancreaticoduodenectomy with closing the pancreatic stump versus standard Whipple’s procedure: A nonanastomotic technique in surgery of pancreatic cancers

2004 ◽  
Vol 121 (2) ◽  
pp. 319
Author(s):  
K. Ayazi ◽  
S. Ayazi ◽  
M. Davaei
Keyword(s):  
Pancreatic Stump ◽  
Pancreatic Cancers ◽  
Whipple’S Procedure

scholarly journals Postoperative Outcomes Analysis After Pancreatic Duct Occlusion: A Safe Option to Treat the Pancreatic Stump After Pancreaticoduodenectomy in Low-Volume Centers

2021 ◽  
Vol 8 ◽  
Author(s):  
Antonio Giuliani ◽  
Pasquale Avella ◽  
Anna Lucia Segreto ◽  
Maria Lucia Izzo ◽  
Antonio Buondonno ◽  
...  
Keyword(s):  
Pancreatic Duct ◽  
Postoperative Outcomes ◽  
Cyanoacrylate Glue ◽  
Pancreatic Anastomosis ◽  
Pancreatic Stump ◽  
Pancreatic Duct Occlusion ◽  
Duct Occlusion ◽  
Whipple’S Procedure ◽  
The Mean

Background: Surgical resection is the only possible choice of treatment in several pancreatic disorders that included periampullar neoplasms. The development of a postoperative pancreatic fistula (POPF) is the main complication. Despite three different surgical strategies that have been proposed–pancreatojejunostomy (PJ), pancreatogastrostomy (PG), and pancreatic duct occlusion (DO)–none of them has been clearly validated to be superior. The aim of this study was to analyse the postoperative outcomes after DO.Methods: We retrospectively reviewed 56 consecutive patients who underwent Whipple's procedure from January 2007 to December 2014 in a tertiary Hepatobiliary Surgery and Liver Transplant Unit. After pancreatic resection in open surgery, we performed DO of the Wirsung duct with Cyanoacrylate glue independently from the stump characteristics. The mean follow-up was 24.5 months.Results: In total, 29 (60.4%) were men and 19 were (39.6%) women with a mean age of 62.79 (SD ± 10.02) years. Surgical indications were in 95% of cases malignant diseases. The incidence of POPF after DO was 31 (64.5%): 10 (20.8%) patients had a Grade A fistula, 18 (37.5%) Grade B fistula, and 3 (6.2%) Grade C fistula. No statistical differences were demonstrated in the development of POPF according to pancreatic duct diameter groups (p = 0.2145). Nevertheless, the POPF rate was significantly higher in the soft pancreatic group (p = 0.0164). The mean operative time was 358.12 min (SD ± 77.03, range: 221–480 min). Hospital stay was significantly longer in patients who developed POPF (p < 0.001). According to the Clavien-Dindo (CD) classification, seven of 48 (14.58%) patients were classified as CD III–IV. At the last follow-up, 27 of the 31 (87%) patients were alive.Conclusions: Duct occlusion could be proposed as a safe alternative to pancreatic anastomosis especially in low-/medium-volume centers in selected cases at higher risk of clinically relevant POPF.

scholarly journals Pancreatic Remnant Occlusion after Whipple's Procedure: An Alternative Oncologically Safe Method

ISRN Surgery ◽  
2013 ◽  
Vol 2013 ◽  
pp. 1-3 ◽  
Author(s):  
Theodosios Theodosopoulos ◽  
Dionysios Dellaportas ◽  
Anneza I. Yiallourou ◽  
George Gkiokas ◽  
George Polymeneas ◽  
...  
Keyword(s):  
Chronic Pancreatitis ◽  
Postoperative Complications ◽  
Survival Rates ◽  
Anastomosis Group ◽  
Morbidity Rate ◽  
Periampullary Cancer ◽  
Pancreatic Stump ◽  
Pancreatic Remnant ◽  
Whipple’S Procedure ◽  
Duration Of Surgery

Introduction. To present our experience regarding the use of pancreatic stump occlusion technique as an alternative management of the pancreatic remnant after pancreatoduodenectomy (PD). Methods. Between 2002 and 2009, hospital records of 93 patients who had undergone a Whipple's procedure for either pancreatic-periampullary cancer or chronic pancreatitis were retrospectively studied. In 37 patients the pancreatic duct was occluded by stapling and running suture without anastomosis of the pancreatic remnant, whereas in 56 patients a pancreaticojejunostomy was performed. Operative data, postoperative complications, oncological parameters, and survival rates were recorded. Results. 2/37 patients of the occlusion group and 9/56 patients of the anastomosis group were treated for chronic pancreatitis, whereas 35/37 and 47/56 patients for periampullary malignancies. The duration of surgery for the anastomosis group was significantly longer (mean time 220 versus 180 minutes). Mean hospitalization time was 6 days for both groups. The occlusion group had a lower morbidity rate (24% versus 32%). With regard to postoperative complications, a slightly higher incidence of pancreatic fistulas was observed in the anastomosis group. Conclusions. Pancreatic remnant occlusion is a safe, technically feasible, and reducing postoperative complications alternative approach of the pancreatic stump during Whipple's procedure.

scholarly journals Pancreatic Duct Occlusion: A Safe and Valid Alternative to Duct Anastomosis After Pancreaticoduodenectomy in a Low Volume Centre

2020 ◽  
Author(s):  
Antonio Giuliani ◽  
Aldo Rocca ◽  
Anna Lucia Segreto ◽  
Marianna Paccone ◽  
Maria Lucia Izzo ◽  
...  
Keyword(s):  
Pancreatic Fistula ◽  
Pancreatic Duct ◽  
Pancreatic Enzyme ◽  
Postoperative Pancreatic Fistula ◽  
Pancreatic Stump ◽  
Pancreatic Duct Occlusion ◽  
Duct Occlusion ◽  
Whipple’S Procedure ◽  
Low Volume

Abstract Background: Pancreaticoduodenectomy is the only possible choice of treatment for peri-ampoullar neoplasms. Morbidity in pancreatic surgery is mainly related to the development of a postoperative pancreatic fistula (POPF). According to International Study Group on Pancreatic Fistula it is possible to grade POPF based on clinical variables. Three main different surgical strategies have been proposed to deal with the pancreatic stump following pancreaticoduodenectomy: pancreatojejunostomy, pancreatogastrostomy and pancreatic duct occlusion, but none of them has been clearly demonstrated to be superior to the others. The aim of our study is to evaluate the feasibility of duct occlusion and its correlations with postoperative pancreatic fistula, “brittle diabetes” and overall survival in a low volume centre. We decided to review our previous experience in the light of the recent Covid pandemic where, in our country, it has been forced in many regions to displace treatment of oncological patients in low volume hospitals with limited experienceMethods: We retrospectively reviewed 56 consecutive patients, from a prospective maintained database, who underwent Whipple’s procedure from January 2007 to December 2014 in a tertiary Hepatobiliary Surgery and Liver Transplant Unit with a low volume of pancreatic resections. The mean follow-up was 24.5 months. Results: The overall incidence of postoperative pancreatic fistula was 66.6%: 15 patients had a Grade A (31.25%), 13 a Grade B fistula (27.03%), and 4 (8.3%) suffered from a life-threatening Grade C fistula. At the last follow-up, 24 of the 28 patients who were alive (85.6%) habitually used substitutive pancreatic enzyme. Conclusion: Duct occlusion can be a safe alternative to pancreatic anastomosis especially in low volume centres and for those patients (age >75 years, obese, hard pancreatic texture, small pancreatic duct) at higher risk of clinically relevant POPF.Trial registration: 'retrospectively registered'

Searching for hope in brain, lung, and pancreatic cancers: A collaborative qualitative research study

2010 ◽  
Author(s):  
Amy Pearson ◽  
Maureen Rigney ◽  
Anitra Engebretson ◽  
Johanna Villarroel ◽  
Jenette Spezeski ◽  
...  
Keyword(s):  
Qualitative Research ◽  
Research Study ◽  
Qualitative Research Study ◽  
Pancreatic Cancers

Eradication of orhtotopic pancreatic cancers by vaccination with adjuvant-formulated tumor antigen and a TLR ligand

2007 ◽  
Vol 45 (10) ◽  
Author(s):  
M Schnurr ◽  
J Collins ◽  
K Heckelsmiller ◽  
P Düwell ◽  
M Dauer ◽  
...  
Keyword(s):  
Tumor Antigen ◽  
Pancreatic Cancers

Role of Erlotinib in Influencing the Quality of Life of Cancer Patients

2020 ◽  
Vol 07 ◽  
Author(s):  
Deepika Purohit ◽  
Parijat Pandey
Keyword(s):  
Quality Of Life ◽  
Lung Cancer ◽  
Cancer Patients ◽  
Kinase Inhibitors ◽  
Treatment Modalities ◽  
Pancreatic Cancers ◽  
Review Reports ◽  
Causes Of Deaths

Background:: Cancer is one of the significant causes of morbidity and mortality in patients globally. Lung cancer, among other cancers, remains to be one of the principal causes of deaths in both men and women. The most common type of lung cancer is the non-small-cell lung cancer (NSCLC). Apart from lung cancer, pancreatic cancer is also one of the common cancers currently. Objective:: The assessment of QoL in erlotinib-treated patients can also prove to be very useful in the establishment of this drug as the main treatment option for the patients with pancreatic and lung cancer. Methods:: Therapies that target EGFR-mediated signalling are the latest keystones for treating these two types of cancers. They comprise of two main treatment modalities: firstly, against the extracellular fields, that include monoclonal antibodies and secondly, mechanisms that create interferences in the signalling pathways, primarily the small molecule tyrosine kinase inhibitors. Results:: Quality of life (QoL) is one of the key advantages in erlotinib therapy over chemotherapy. Conclusion:: The present review reports the role of erlotinib in improving the quality of life of cancer patients especially in NSCLC and pancreatic cancers. The studies or trials establishing the relations between erlotinib and QoL are discussed in detail in this review.

scholarly journals Wrapping the pancreas with a polyglycolic acid sheet before stapling reduces the risk of fluid collection on the pancreatic stump after distal pancreatectomy

2021 ◽  
Author(s):  
Ji Su Kim ◽  
Seoung Yoon Rho ◽  
Dong Min Shin ◽  
Munseok Choi ◽  
Chang Moo Kang ◽  
...  
Keyword(s):  
Pancreatic Fistula ◽  
Distal Pancreatectomy ◽  
Fluid Collection ◽  
International Study ◽  
Polyglycolic Acid ◽  
Previous Method ◽  
Tertiary Referral ◽  
Tertiary Referral Hospital ◽  
Pancreatic Stump ◽  
Resection Line

Abstract Background Postoperative pancreatic fistula (POPF) and postoperative fluid collection (POFC) are common complications after distal pancreatectomy (DP). The previous method of reducing the risk of POPF was the application of a polyglycolic acid (PGA) sheet to the pancreatic stump after cutting the pancreas with a stapler (After-stapling); the new method involves wrapping the pancreatic resection line with a PGA sheet before stapling (Before-stapling). The study aimed to compare the incidence of POPF and POFC between two methods. Methods Data of patients who underwent open or laparoscopic DPs by a single surgeon from October 2010 to February 2020 in a tertiary referral hospital were retrospectively analyzed. POPF was defined according to the updated International Study Group of Pancreatic Fistula criteria. POFC was measured by postoperative computed tomography (CT). Results Altogether, 182 patients were enrolled (After-stapling group, n = 138; Before-stapling group, n = 44). Clinicopathologic and intraoperative findings between the two groups were similar. Clinically relevant POPF rates were similar between both groups (4.3% vs. 4.5%, p = 0.989). POFC was significantly lesser in the Before-stapling group on postoperative day 7 (p < 0.001). Conclusions Wrapping the pancreas with PGA sheet before stapling was a simple and effective way to reduce POFC.

scholarly journals Macropinocytosis requires Gal-3 in a subset of patient-derived glioblastoma stem cells

2021 ◽  
Vol 4 (1) ◽  
Author(s):  
Laetitia Seguin ◽  
Soline Odouard ◽  
Francesca Corlazzoli ◽  
Sarah Al Haddad ◽  
Laurine Moindrot ◽  
...  
Keyword(s):  
Stem Cells ◽  
Cell Survival ◽  
Small Gtpases ◽  
Molecular Signature ◽  
Carbohydrate Binding ◽  
Pancreatic Cancers ◽  
Galectin 3 ◽  
Pharmacologic Inhibition

AbstractRecently, we involved the carbohydrate-binding protein Galectin-3 (Gal-3) as a druggable target for KRAS-mutant-addicted lung and pancreatic cancers. Here, using glioblastoma patient-derived stem cells (GSCs), we identify and characterize a subset of Gal-3high glioblastoma (GBM) tumors mainly within the mesenchymal subtype that are addicted to Gal-3-mediated macropinocytosis. Using both genetic and pharmacologic inhibition of Gal-3, we showed a significant decrease of GSC macropinocytosis activity, cell survival and invasion, in vitro and in vivo. Mechanistically, we demonstrate that Gal-3 binds to RAB10, a member of the RAS superfamily of small GTPases, and β1 integrin, which are both required for macropinocytosis activity and cell survival. Finally, by defining a Gal-3/macropinocytosis molecular signature, we could predict sensitivity to this dependency pathway and provide proof-of-principle for innovative therapeutic strategies to exploit this Achilles’ heel for a significant and unique subset of GBM patients.

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