The blood supply of the posterior optic nerve was investigated in 10 monkeys after an injection of synthetic resin into the carotid arteries. The posterior intraorbital and intracanalicular optic nerves were supplied by a centripetal vascular system, formed by the pial vessels arising from the first branches of the ophthalmic artery. Superior and inferior vascular semicircles were detected in the intracanalicular optic nerve. The intracranial optic nerve was supplied by branches of the internal carotid artery, anterior cerebral artery and/or anterior communicating artery, and ophthalmic artery.
The incidence of R1 resection is high in pancreatic cancer despite of a good quality surgery. Amongst various techniques of mesopancreas excision, SMD is applicable to pancreatic and other periampullary carcinoma. This study has been conducted to compare the perioperative outcomes, the lymph node yield and the margin status in patients who underwent standard pancreaticoduodenectomy and SMD pancreaticoduodenectomy for pancreatic and periampullary carcinoma. Methods: A retrospective comparative study was conducted in a single unit of Gastrointestinal and Hepatopancreatobiliary surgery at Tribhuvan University Teaching Hospital, Nepal. The demographics, indication of surgery, duration of surgery, intraoperative blood loss, incidence of procedure-specific complications according to ISGPS, length of hospital stay, perioperative mortality, lymph node yield and margin status were compared. Results: Total of 17 patients underwent SMD pancreaticoduodenectomy. The demographic data was comparable with the historical data of 45 patients who underwent standard pancreaticoduodenectomy. The duration of surgery was longer in SMD pancreaticoduodenectomy (354.7AE51.1 mins vs 276.2 AE 43.1 mins), however, the blood loss was less (502.9 AE 178.1 ml vs 701.1 AE 354.6 ml). The incidence of POPF and perioperative mortality were less as compared to the patients who underwent standard pancreaticoduodenectomy (11.5% vs 14.6% and 5.9% vs 8.5% respectively). The rate of margin negative resection was comparable (88.2% vs 90%). The median lymph node yield was significantly high in patients who underwent SMD pancreaticoduodenectomy (15 vs 6, p < 0.05). Conclusion: SMD pancreaticoduodenectomy is feasible and should be performed not only for pancreatic carcinoma but also for other periampullary carcinoma.
Aims: To report overall and progression-free survival among patients who underwent synchronous resection of primary colorectal cancer and liver metastases with or without preoperative treatment. Methods: We performed a retrospective analysis of patients who underwent liver resection for synchronous colorectal metastases. We analyzed patient characteristics and baseline investigations following tumour board review. Recurrence and mortality were examined using Kaplan-Meier survival curves. Results: Between 2010 and 2017, 111 patients underwent liver resection for colorectal adenocarcinoma of which 33 patients had synchronous resection of primary and metastatic liver tumour. 10 patients underwent preoperative treatment and 23 patients had upfront surgery. Median age was 58.1 vs 65.8 years respectively (p=0.0086). 3-year and 5-year overall survival for all patients were 64.7% and 30.8%, respectively, with no difference between both groups (HR 1.971, 95%CI: 0.466-8.332, log rank test p=0.3). Patients with preoperative treatment had poorer progression-free survival (log rank test p=0.0527). Median progression-free survival was 12.2 months in pretreatment group vs 19.0 months for patients with upfront surgery. Patients with upfront surgery had fewer instances of extrahepatic recurrence compared to those with pretreatment (27.3% vs 87.5%, p=0.0198). More patients with pretreatment had rectal cancer (70.0% vs 4.35%, p=0.0002). The overall and progression-free survival for patients with rectal and colon cancer was similar.
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