scholarly journals Superior Mesenteric-Portal Vein Resection in Patients With Pancreatic Adenocarcinoma Is Safe and May Increase Survival

2017 ◽  
Vol 102 (7-8) ◽  
pp. 356-361
Author(s):  
Wei-Ding Wu ◽  
Hong-Guo Yang ◽  
Jia Wu ◽  
Kai Jiang ◽  
Kun Guo ◽  
...  
Keyword(s):  
Portal Vein ◽  
Pancreatic Adenocarcinoma ◽  
Survival Rates ◽  
Vein Wall ◽  
Venous Resection ◽  
Group A ◽  
Tumor Involvement ◽  
Artery First ◽  
Vein Resection ◽  
Group B

Extension of pancreatic adenocarcinoma into adjacent vasculature often necessitates resection of the portal vein (PV) and or superior mesenteric vein (SMV) during pancreaticoduodenectomy (PD). Our study describes the surgical technique and results of PV/SMV resection in pancreatic adenocarcinoma patients. Between January 2008 and October 2013, 252 patients underwent PD for pancreatic malignancy. A total of 42 PV/SMV resections were performed (28 men, 14 women). Patients were categorized into 2 groups according to the degree of invasion into the portal vein wall: Group A (n = 16), extended compression of the portal vein wall by the surrounding carcinoma without true invasion, and Group B (n = 26), true invasion including intramural and transmural invasion. Morbidity of the 42 patients was 35%; there was no operative mortality, and overall 1-, 3-, and 5-year survival rates were 60%, 21%, and 12%, respectively. No differences in tumor size, margin positivity, nodal positivity, or survival rates were observed between groups. Resection of the PV/SMV is safe and does not increase morbidity or mortality. Tumor involvement of the PV/SMV is not associated with histopathologic signs that are predictive of a poor prognosis. The “artery first” approach should be considered as a means to facilitate safe venous resection and reconstruction.

scholarly journals Extended Venous Resections for Borderline Resectable Pancreatic Head Adenocarcinoma—A Retrospective Studies of Nine Cases

Healthcare ◽  
2021 ◽  
Vol 9 (8) ◽  
pp. 978
Author(s):  
Nicolae Bacalbasa ◽  
Irina Balescu ◽  
Mihai Dimitriu ◽  
Cristian Balalau ◽  
Florentina Furtunescu ◽  
...  
Keyword(s):  
Pancreatic Cancer ◽  
Portal Vein ◽  
Radical Surgery ◽  
Portal Vein Resection ◽  
Resectable Pancreatic Cancer ◽  
Borderline Resectable ◽  
Venous Resection ◽  
Graft Thrombosis ◽  
Borderline Resectable Pancreatic Cancer ◽  
Vein Resection

Background: pancreatic cancer is one of the most lethal malignancies and a leading cause of cancer-related death worldwide. The only chance to improve the long-term outcomes of patients with pancreatic cancer is surgery with radical intent. Methods: in the present paper, we aim to describe a case series of 9 patients submitted to radical surgery for borderline resectable pancreatic cancer. Results: in all cases, negative resection margins were achieved. The types of venous resection consisted of tangential portal vein resection in four cases, circumferential portal vein resection with direct reanastomosis in one case and circumferential resection with graft placement in another four cases; postoperatively, one patient developed a vascular surgery-related complication consisting of graft thrombosis and thus necessitated prolonged anticoagulant therapy. Conclusions: extended venous resections can be a safe and efficient way to maximize the benefits of radical surgery in locally advanced, borderline resectable pancreatic cancer.

scholarly journals The Clinical Outcome in Patients with Peritoneal Metastasis

2020 ◽  
pp. 1-3
Author(s):  
Spiliotis J ◽  
◽  
Farmakis D ◽  
Raptis A ◽  
Kopanakis N ◽  
...  
Keyword(s):  
Systemic Chemotherapy ◽  
Treatment Options ◽  
Survival Rates ◽  
Peritoneal Metastases ◽  
Mortality And Morbidity ◽  
Chemotherapy Group ◽  
Significant Difference ◽  
Group A ◽  
Group B ◽  
Group D

Cytroreductive surgery (CRS) and HIPEC are controversial effective treatment options for selected patients with peritoneal metastases. We retrospectively examined 4.500 patients with peritoneal metastases from different tumors from 2005 to 2020. Patients were divided in 4 groups, surgery plus HIPEC and then systemic chemotherapy: Group A n=730, Group B n=700, R0 surgery plus systemic chemotherapy, Group C n=870, palliative surgery plus systemic chemotherapy and Group D n=2.200, palliative care and best support. The postoperative outcomes, morbidity, mortality were compared between the 4 groups. The mean survival rates Group A=24,4+10,2m, Group B= 18,4+6,3m, Group C=12,3+5,7m, Group D=5,8+2,3m (p<0.05 between Gr A vr Gr B). There was no statistically significant difference in the 30-day mortality and morbidity. In conclusion CRS + HIPEC are feasible in 16% of our patients with peritoneal metastases and are associated with pro-longed survival.

scholarly journals Graft and patient survival in portal vein thrombosis in living donor liver transplantation

QJM ◽  
2020 ◽  
Vol 113 (Supplement_1) ◽  
Author(s):  
A M Ramadan ◽  
N M Hytham ◽  
K K Mamdouh ◽  
A M Fathy
Keyword(s):  
Portal Vein ◽  
Portal Vein Thrombosis ◽  
Lower Survival Rate ◽  
Donor Liver Transplantation ◽  
Vein Thrombosis ◽  
Life Saving ◽  
Significant Difference ◽  
Group A ◽  
Group B ◽  
Stay Hospital

Abstract Background and Rational To date, only few studies have evaluated the benefits of anticoagulation in individuals with cirrhosis. An obvious goal of anticoagulation is PV recanalization: when cirrhotic individuals with PVT are treated with anticoagulation, complete recanalization has been described in 33–45% while partial PV recanalization is observed in 15–35% of cases. LDLT has emerged as the alternative life-saving treatment to DDLT. Over the past 2 decades, the number of LDLTs has steadily increased in many transplant centers, especially in Asia. The separation between occlusive and non-occlusive thrombosis is very important; in patients with partial PVT, post-transplant mortality outcomes are no different from non-PVT patients but it is significantly increased in patients with complete PVT. Patients and Methods This randomized prospective study will include 79 patients who will undergo LDLT in Ain Shams Specialized and Egypt Air hospitals, there are two groups of patients according to presence of portal vein thrombosis or not group A 39 patients of non PVT and group B 40 patient of PVT including different grades of PVT according Yerdel classification. Results In this study, there is no significant difference between groups regard age but Males were significantly associated with group B. In this study, there is no significant difference between groups regard CHILD and MELD scores and this findings. In our study there is no significantly difference between groups A and B regarding ICU stay, hospital stay and cell saver. In this study, comparisons of the PVT patients and controls showed no statistical significant differences regard HA thrombosis, post operative pulmonary embolism and biliary leak but PV rethrombosis is significantly associated with PVT patients, mortality sig associated with PVT patients. Conclusion The outcomes of patients with PVT who underwent LDLT are inferior to those without PVT. Patients with PVT has lower survival rate, higher postoperative PV rethrombosis.

Mechanical ventricular support using pulsatile Abiomed BVS 5000 and centrifugal Biomedicus-pump in postcardiotomy shock

1994 ◽  
Vol 17 (9) ◽  
pp. 492-498 ◽  
Author(s):  
K. Minami ◽  
H. Posival ◽  
A. El-Bynayosy ◽  
M.M. Körner ◽  
H. Schrofel ◽  
...  
Keyword(s):  
Artery Bypass ◽  
Survival Rates ◽  
Valve Surgery ◽  
Ventricular Assist Devices ◽  
Ventricular Assist ◽  
Postcardiotomy Shock ◽  
Group A ◽  
Group B ◽  
Long Term Survivors

Since we started using ventricular assist devices (VAD) in July 1987 up to August 1993, 63 of 15,650 (0.4%) patients (pts) who underwent open heart sugery were supported postoperatively by VAD at out institution. Forty-three were male and 20 female, mean age 55.5 years. In 49 pts coronary artery bypass grafting (CABG), in 8 pts valve surgery, in 3 pts combined CABG and valve surgery and in 3 pts corrective procedures for congenital heart disease were performed. Perioperative myocardial infarction was the most frequent indication (73%). In 37 of the 63 pts (58.7%) a centrifugal (Biomedicus pump (group A) was used and in 26 pts (41.3%) a pulsatile Abiomed BVS 5000 (group B). Fourteen of 37 pts (38%) in group A were weaned from the VAD and all of them were discharged. Twenty-three pts were unable to be weaned and 19 of these pts died. The remaining 4 pts were transplanted successfully and subsequently 3 died and 1 was discharged. In all, 15 pts (39%) were long-term survivors. Sixteen of 26 pts (62%) in group B were weaned from VAD and 13 (50%) of them were discharged of whom 3 died. Ten patients were unable to be weaned and 7 of these died. The remaining 3 pts were transplanted successfully. In all, 16 pts (61.5%) were long-term survivors. The shorter the interval between beginning resuscitation and application of VAD the better the outcome. Younger age, VAD installation in OR, support time between 2 and 7 days and Abiomed pump, influence the survival rate positively. Because of higher recovery and survival rates in patients assisted by Abiomed compared to the Biomedicus pump, we recommend the Abiomed pump in postcardiotomy cardiac failure.

EUS combined with CT in predicting SMV/PV resection in patients with borderline resectable pancreatic carcinoma.

2016 ◽  
Vol 34 (4_suppl) ◽  
pp. 432-432
Author(s):  
Evan Scott Glazer ◽  
Omar Maen Rashid ◽  
Jason Klapman ◽  
Cynthia L. Harris ◽  
Pamela Joy Hodul ◽  
...  
Keyword(s):  
Ct Scan ◽  
Multivariate Logistic Regression Analysis ◽  
Pancreatic Head ◽  
Pet Scan ◽  
Vascular Involvement ◽  
Borderline Resectable ◽  
Curative Intent ◽  
Venous Resection ◽  
Tumor Involvement ◽  
Vein Resection

432 Background: Guidelines recommend pancreatic protocol CT scan (CT) for staging vascular involvement in patients with pancreatic cancer (PC). While endoscopic ultrasound (EUS) has been demonstrated to be effective in venous staging of PC, its role when combined with CT is poorly defined. We evaluated the utility of EUS in addition to CT in staging PC. We hypothesized that EUS complements CT in identifying SMV/PV tumor involvement as measured by the requirement for vein resection. Methods: We reviewed our database of patients with borderline resectable PC who went to surgery with curative intent. Inclusion criteria were pre-operative staging with CT scan, EUS, PET scan, and CA 19-9 levels, as well as completion of neoadjuvant chemotherapy and radiation. Results: We identified 62 patients with 74% of tumors in the pancreatic head. 97% of resections were R0. The average age was 65 ± 9 years; 60% were male. Patients were classified as borderline resectable by EUS alone in 29%, CT alone in 23%, and both modalities in 48% of patients, respectively. 34 patients required vein resection; EUS identified 88% of these patients pre-operatively while CT identified 68%. EUS identified 11 patients who required vein resection that CT did not identify while CT identified 4 patients that EUS did not identify. EUS had higher sensitivity and specificity than CT in identifying patients requiring venous resection (Table). On multivariate logistic regression analysis, EUS was predictive of vein resection (P < 0.02) but CT scan findings, PET scan findings, tumor size, and CA19-9 values were not predictive (each P > 0.1). In margin negative resected patients, median survival was longer when both CT and EUS identified borderline status compared to only 1 modality (43 vs 23 months, P < 0.05). Conclusions: EUS complemented CT in identifying patients with borderline resectable PC requiring vein resection- 29% of patients were identified with EUS alone. This observation supports the use of EUS in addition to CT scan for the vascular staging of patients with PC. [Table: see text]

Progression and hyperprogression after anti-PD1 therapy for unresectable stage III or IV melanoma patients.

2019 ◽  
Vol 37 (15_suppl) ◽  
pp. e21021-e21021
Author(s):  
Elise Colle ◽  
Stéphane Dalle ◽  
Laurent Mortier ◽  
Bernard Guillot ◽  
Caroline Dutriaux ◽  
...  
Keyword(s):  
Survival Rates ◽  
Real Life ◽  
Advanced Melanoma ◽  
First Line ◽  
Best Response ◽  
Unresectable Stage ◽  
Group A ◽  
Similar Survival ◽  
Group B ◽  
Response Group

e21021 Background: Primary progression (PP) and secondary progression (SP) to anti-PD1 therapy (APD) are poorly described in advanced melanoma in real life practice. Hyperprogression with a deleterious effect is reported in many cancers but is poorly assessed in advanced melanoma. Methods: Characteristics of 793 patients treated by APD (nivolumab or pembrolizumab) between July 2014 and May 2018 were collected from MelBase, a prospective French biobank (NCT02828202).We considered: group A (progressive disease as best response), group AHP (hyperprogression) within group A patients (progression/death within 3 months with normal initial LDH and ECOG at baseline, and either ECOG increased from 0 to 3-4, either LDH increased from normal to elevated or both), group B SP (response or stable disease then progression). Characteristics for all and survival for patients alive at progression (AAP) were also described. Results: Median follow-up was 11.3 months (Q1-Q3 4.8–23.6). Characteristics at baseline are in the table. In group A, 14% patients died at progression; within 262 patients AAP, 17% continue APD (the same or switch), 15.1% (CI95 11.1-20.6) were alive 1-year after progression (1YAP); 20.5% for patients in first line and 11.5% for pretreated. In group AHP, 41% patients died at progression; within 48 patients AAP, 12% continue APD, 11.1% (CI95 7.8-13.6) were alive 1YAP. In group B, 11% patients died at progression; within 88 patients AAP, 36% continue APD, 10.3% (CI95 5.2-20.1) were alive 1YAP, 15.9% for patients in first line and 7.0% for pre-treated. Conclusions: Our study shows that PP and SP to APD differ at baseline, but have similar survival rates at progression, while mechanisms involved might be different, providing important landmarks to build second line trials. This study thus highlights the existence of hyperprogressors among which 41% patients died within 3 months, as well as describes their associated characteristics. [Table: see text]

The Short- and Long-Term Outcomes of Pancreatic Resection for Pancreatic Adenocarcinoma in Patients Older Than 75 Years

2016 ◽  
Vol 101 (11-12) ◽  
pp. 554-561
Author(s):  
Toru Aoyama ◽  
Masaaki Murakawa ◽  
Yosuke Atsumi ◽  
Keisuke Kazama ◽  
Manabu Shiozawa ◽  
...  
Keyword(s):  
Elderly Patients ◽  
Pancreatic Adenocarcinoma ◽  
Pancreatic Resection ◽  
The Elderly ◽  
Surgical Mortality ◽  
Long Term Outcomes ◽  
Group A ◽  
Short And Long Term ◽  
Group B

The short- and long-term outcomes of pancreatic resection for pancreatic adenocarcinoma have not been fully evaluated in elderly patients. This retrospective study selected patients who underwent curative surgery for pancreatic cancer at our institution. Patients were categorized into 2 groups: nonelderly patients (age &lt; 75 years; group A) and elderly patients (age ≥ 75 years; group B). The surgical morbidity, surgical mortality, overall survival (OS), and recurrence-free survival (RFS) rates in the 2 groups were compared. A total of 221 patients were evaluated in the study. The overall complication rates were 44.8% in group A and 52.6% in group B. Surgical mortality was observed in 2 patients due to an abdominal abscess and cardiovascular disease in group A (1.1%) and in 1 patient due to postoperative bleeding in group B (2.6%). There were no significant differences (P = 0.379 and P = 0.456, respectively). Furthermore, the 5-year OS and RFS rates were similar between the elderly patients and nonelderly patients (18.55 versus 20.2%, P = 0.946 and 13.1% versus 16.0%, P = 0.829, respectively). The short-term outcomes and long-term survival after pancreatic resection for pancreatic adenocarcinoma were almost equal in the elderly and the nonelderly patients in this study. Therefore, it is unnecessary to avoid pancreatic resection for pancreatic adenocarcinoma in elderly patients simply because of their age.

scholarly journals Oncological and Functional Evaluation of Open Conservation Surgery for Hypopharyngeal Cancer with/without Reconstruction

2018 ◽  
Vol 2018 ◽  
pp. 1-6
Author(s):  
Tsutomu Nomura ◽  
Daisuke Maki ◽  
Sadahiro Kishishita ◽  
Fumihiko Matsumoto ◽  
Seiichi Yoshimoto
Keyword(s):  
Survival Rates ◽  
Oral Intake ◽  
Functional Results ◽  
Hypopharyngeal Cancer ◽  
Transoral Surgery ◽  
Functional Evaluation ◽  
Kaplan Meier ◽  
Conservation Surgery ◽  
Group A ◽  
Group B

Objectives. Oncological and functional results of open conservation surgery for hypopharyngeal cancer have been desired. Methods. We performed a chart review of 33 patients with hypopharyngeal cancer who underwent open conservation surgery. Oncological and functional results were evaluated in surgery with primary closure (Group A) and surgery with reconstruction (Group B). Postoperative functions were evaluated by interval to resumption of oral intake, Functional Outcome Swallowing Scale (FOSS) and Communication Scale (CS). Results. Five-year disease-specific and overall cumulative survival rates by Kaplan-Meier method for all cases were 95.7% and 82.3%, respectively. Duration from surgery to full oral intake was 12 days in Group A and 14 days in Group B. FOSS rates were 83.3 in Group A and 95.5 in Group B. CS was 0 in both groups. Conclusion. Oncological and functional results of open conservation surgery were comparable to those with transoral surgery and chemo/radiotherapy. Our technique represents a reliable treatment for hypopharyngeal cancer.

scholarly journals MORPHOMETRIC EVALUATION, BY ULTRASONOGRAPHIC EXAM, OF THE PORTAL VEIN, CAUDAL VENA CAVA AND ABDOMINAL AORTA IN HEALTHY DOGS OF DIFFERENT BODY WEIGHTS

2010 ◽  
Vol 15 (3) ◽  
Author(s):  
Raquel Sartor ◽  
Maria Jaqueline Maprim ◽  
Regina Kiomi Takahira
Keyword(s):  
Portal Vein ◽  
Abdominal Aorta ◽  
Vena Cava ◽  
The Body ◽  
Important Indicator ◽  
Lateral Abdominal Wall ◽  
Left Lateral Decubitus Position ◽  
Group A ◽  
Healthy Dogs ◽  
Group B

The diameters and areas of portal vein, caudal vena cava and abdominal aorta are useful measurements in dogs. These values can be easily measured by ultrasonographic exam, and variations of normality can be an important indicator of hepatic or extra-hepatic alterations. This study aimed to measure the diameter and areas of portal vein, caudal vena cava and abdominal aorta in healthy dogs, with normal corporal score, divided in groups according to the body weight, and assess whether the data are influenced by animal weight. Thirty dogs were examined and divided into three groups (Group A: ≤ 10 kg Group B: from 10.1 to 20.0 kg; Group C: ≥ 20.1 kg). To measure the diameters and areas of portal vein, caudal vena cava and abdominal aorta, the animal was kept in left lateral decubitus position and the transducer was placed on the right lateral abdominal wall, at approximately the 10th or 11th intercostal space, in the porta hepatis region. The diameters and areas of the portal vein, caudal vena cava and abdominal aorta were significantly lower for dogs in Group A with respect to other groups and the dogs from Groups B and C had similar results with each other. The diameters and areas of the portal vein, caudal vena cava and abdominal aorta may vary with the animal size, and reference values must be specific for small, medium and large dogs.

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