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  • 1
    Electronic Resource
    Electronic Resource
    Are There Indications for Palliative Resection in Pancreatic Cancer? (1999)
    Springer
    World journal of surgery 23 (1999), S. 954-959 
    Details
    ISSN: 1432-2323
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract. Controversy exists about the indication for a palliative pancreatoduodenectomy. A palliative resection for patients with a pancreatic carcinoma can be performed safely nowadays with low mortality and acceptable morbidity in centers with experience. The early results in terms of mortality and morbidity are not different from resections with curative intent or even after bypass surgery. The procedure seems effective for controlling symptoms of the disease, and the quality of life after a palliative resection is acceptable and not worse than after bypass surgery. It is, however, still doubtful whether the incidence of symptom recurrence, such as jaundice, obstruction, and pain, is lower after resection than after bypass surgery. The longer survival after palliative resection could also be due to patient selection and postoperative treatment. There are no randomized trials to prove the superiority of palliative resection over bypass surgery. The safety of pancreatic resection for cancer has already changed the policy in centers with experience, and surgeons are more willing to perform a resection because the results are better or at least the same as after bypass surgery. There are, however, no results to confirm that a palliative resection should be performed routinely or to justify resection as a debulking procedure.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s002689900606
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  • 2
    Electronic Resource
    Electronic Resource
    Differential Diagnosis of Focal Pancreatitis and Pancreatic Cancer (1999)
    Springer
    Annals of oncology 10 (1999), S. 85-88 
    Details
    ISSN: 1569-8041
    Keywords: chronic pancreatitis ; distal bile duct carcinoma ; imaging of pancreas ; pancreatic carcinoma ; Whipple resection
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract The differentiation of focal, chronic pancreatitis (CP) and pancreatic cancer (PAC) poses a diagnostic dilemma. Both conditions may present with the same symptoms and signs. The complexity of differential diagnosis is enhanced because PAC is frequently associated with secondary inflammatory changes and CP may develop into PAC. The aim of this study was tot analyze two sets of patients (group A and B) who were misdisagnosed to have either CP or PAC. The clinical and radiographical features of these patients were reviewed. Group A consisted of 22 patients (median age 54.5 years) who were referred with PAC after a previous diagnosis of PC. Eleven patients had a history of CP of 〉 12 mths (mean 40.2 mths) whereas in 11 patients, PAC became apparent within 12 mths (mean 4.9 mths) after the diagnosis of CP was made. The etiology of CP was alcohol abuse in 9 patients, pancreas divisum in 3 patients and was undefined in the remaining 10 patients. Imaging studies showed features of CP (parenchymal calcifications, irregularities and stenoses of the pancreatic duct wall). Pseudocysts were present in 13 patients. A mass lesion was detected in 13 patients. At the time of diagnosis, 20 patients had unresectable tumors and 2 patients underwent a Whipple resection which proved non-radical. Group B consisted of 14 patients (median age 53 years) who underwent a Whipple resection for a presumed PAC that on histopathology of the lesion proved to be CP. These patients accounted for 6% of all 220 patients who had undergone resection for PAC in the same period. Reassessment of clinical presentation and all imaging studies confirmed a high index of suspicion on PAC in these patients. Conclusion: In patients known with CP, misdiagnosis of PAC is a potential pitfall leading to delay of treatment. For any lesion suspicious of PAC an aggressive surgical approach is justified lest a potentially curable lesion is missed. As a consequence, there is at least a 5% chance of resecting a lesion based on CP, mimicking PAC.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1023/A:1008353223014
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  • 3
    Electronic Resource
    Electronic Resource
    Role of Radiotherapy, in Particular Intraluminal Brachytherapy, in the Treatment of Proximal Bile Duct Carcinoma (1999)
    Springer
    Annals of oncology 10 (1999), S. 215-220 
    Details
    ISSN: 1569-8041
    Keywords: cholangiocarcinoma ; intraluminal brachytherapy ; radiotherapy ; surgery
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Purpose: To perform an analysis of the results obtained with radiotherapy in patients with either resectable or unresectable cholangiocarcinoma of the proximal bile ducts. Emphasis will be paid to analyse the role of radiotherapy, particularly brachytherapy Patients and methods: Between 1985 and 1997, 109 patients received radiotherapy. In 71 patients (group I) tumor resection was combined with postoperative irradiation in 52 patients and pre- plus post-operative irradiation in 19 patients. Among this group, 41 patients had a boost of 10 Gy to the biliodigestive anastomosis using intraluminal brachytherapy. Median total dose was between 50-55 Gy. The other 38 patients (group II) had an unresectable tumor at laparotomy (16 patients) or were considered primary unresectable because locoregional tumor extension (22 patients). Brachytherapy boost through a nasobiliary approach was given to 19 patients (22-25 Gy). The median total dose varied between 60 to 68 Gy. Mean follow-up was 25 ± 23 months. Results: In group I, the survival rates at 1, 3, and 5 year were 84%, 37%, and 24%, respectively. Median survival was 24 months. Sixteen patients did live longer than 4 years. Analysis of prognostic factors among resected patients showed the tumor differentiation grade, microscopically involved margins other than the upper (hepatic) and lower (choledocus) resection parameters analysed, only the total dose had influence on margins, and elevated alkaline phosphatase as factors which significantly influence survival. From the different radiotherapy prognosis, patients receiving a total dose above 55 Gy had a shorter survival. It is important to note that patients receiving brachytherapy boost did not have a better survival than patients treated with external beam irradiation alone. Preoperative radiotherapy did not have impact on survival but recurrences in the surgical scars were not observed as compared to 15% recurrences if preoperative radiotherapy was not given. In group II the median survival was 10.4 months. Survival rates at 1 and 2 year were 43% and 10 %, respectively. The only significant prognostic factor found was if unresectability was defined primarily or during laparotomy. As it was the case in group I, brachytherapy boost did not have influence on prognosis as compared to external beam irradiation alone. Observed late complications consisted of duodenal stenosis, upper digestive tract bleeding and cholangitis. Probably these complications were not only attributable to radiotherapy, as tumor relapse was also present in the majority of the cases. Conclusions: The role of radiotherapy either as adjuvant or as primary treatment remains to be demonstrated in prospective randomised studies. From our results, it seems that high radiation doses could be dangerous and could detriment prognosis. Brachytherapy boost was not superior to treatment with external beam irradiation alone.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1023/A:1008339709327
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  • 4
    Electronic Resource
    Electronic Resource
    Local Resection of Biliopancreatic Cancer (1999)
    Springer
    Annals of oncology 10 (1999), S. 243-246 
    Details
    ISSN: 1569-8041
    Keywords: bile duct carcinoma ; Klatskin tumor ; local resection ; papillar of Vater tumor
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Biliopancreatic tumors that are potentially amenable to local resection include proximal bile duct tumors (Klatskin tumors), midcholedochal duct tumors and tumors arising from the papilla of Vater. This paper reviews our experience in the AMC, with local resection of these condition. From 1983-1997, 112 patients underwent surgical resection of a carcinoma of the hepatic duct confluence (Klatskin tumor). Local resection was undertaken in 80 patients (52 patients with type I and II tumors, and 28 patients with type III tumors) whereas in 32 patients with type III tumors, hilar resection was performed with liver resection. Negative surgical margins were achieved in 10 patients after local resection of type I and II tumors (19.2%), in 1 patient after local resection of a type III tumor (3.6%), and in 5 patients after hilar resection and liver resection (15.6%). Middle-third carcinomas of the extra-hepatic biliary tract are less common than proximal or distal bile duct tumors. From 1993-1998, 12 patients underwent resection of a mid-choledochal duct carcinoma. In 8 patients, local resection was performed and in 4 patients, subtotal pancreatoduodenectomy (PPPD) because of the close relationship of the tumor and the pancreas. Four patients had negative surgical margins, 2 after local resection (25%) and 2 after PPPD (50%). Although accepted for villous adenomas located in the ampulla, local resection for ampullary carcinoma is controversial. Nine patients underwent local resection of a presumed adenoma that proved to be an ampullary carcinoma. In 4 patients with T1 tumors, resection of the carcinoma was locally complete (44%). Additional PPPD was performed in 6 patients, including the 4 patients with complete local resections, showing no residual tumor at the previous site of excision, but, lymphnode metastases in two resection specimens (both of patients with presumed T1 tumors). Hence, local resection of a T1 ampullary carcinoma might result in tumor free margins, but does not deal with (usually retropancreatic) lymphnode metastases. In conclusion, local resection is applicable to Klatskin type I and II tumors. Local resection may be considered in the proximally located, mid-choledochal duct carcinomas but, when located closer to the pancreas, PPPD is the preferred treatment. For ampullary adenomas, local resection is feasible unless frozen section examination raises suspicion on a malignancy. Local resection of even limited ampullary carcinomas is not advisable because of lymphatic dissemination of the tumor and consequently, inadequate clearance.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1023/A:1008308213870
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