Results: A total of 20 retrospective studies, including 263 patients, were included. The methodological quality of the studies ranged from poor to moderate. The radical resection rate was 77%, major morbidity 27%, ischemic morbidity 10% and 90-day mortality 2.7%. Overall, 47% (74/157) of patients underwent PHAE and 42% (93/223) patients underwent portal vein (PV) resection. Ischemic morbidity rate was 13% (15/116) in series where >50% of patients underwent PHAE. Median overall survival was 15.4 months (range 9e48), whereas survival was 17.9 months (range 10e26) in series where >50% of patients received adjuvant therapy. Conclusions: In selected patients, DP-CAR for pancreatic cancer with celiac axis involvement seems safe with acceptable mortality and survival. The benefit of PHAE is unclear and should be determined by prospective studies. Conclusion: LPD is a comparable in safety, feasibility and early oncological outcomes to OPD.
To report a case with advanced IHCC treated with chemoembilization as an alternative method. Case report: A 50 y.o. female presented with epigastric pain, anicteric, an with an epigastric palpable mass extending to the hight upper quadrant, slightly painful. Abdominal Ultrassound and upper digestive endoscopy revealed a large liver bulky mass with extrinsic compression of the anterior wall of the stomach. CT scan and MR exams suggested an IHCC. Tumours markers were negative. A diagnostic laparoscopy was performed and confirmed a large mass occupying the entire left hepatic lobe and invading right lobe, with intrahepatic metastatic nodules near main tumor. Biopsy was performed showing a moderate differentiated IHCC. A drug-eluding bead trascatheter arterial chemoembolization was performed and the patient is well with no complications after 32weeks of the procedure. Discussion: Surgery is the main treatment for IHCC because is the only option with curative potential. However, in advanced stages of the disease, surgery can be controversial due to the high morbility and risk of complication. There is no evidence that chemoterapy is a good alternative and chemoembolization seems to be the best choice of treatment in these cases, with about 50% of response rate with 12e15 months of survival, comparing with 3.3 months with chemotherapy. Conclusion: Chemoembolization seems to be the best alternative for advanced IHCC, with better survival and lower rates of complications than other treatments.
Introduction: Clinically relevant postoperative pancreatic fistula (POPF) after pancreatoduodenectomy is often accompanied by bacterial infection. To elucidate the mechanism of bacterial infection associated with POPF, we investigated the relationship between POPF and perioperative bacteria status. Methods: Subjects were 181 patients who had undergone pancreatoduodenectomy. Microbial culture was performed for bile juice at preoperative biliary drainage and ascitic fluid obtained from drains from postoperative day (POD)1 to POD4 and after POD7. We examined the relation between perioperative culture and POPF. Results: The incidence of POPF GradeA; 55cases (30.4%), GradeB/C; 25cases (13.8%). Preoperative cholangitis was observed in 46 patients (25.4%), and bile juice culture was positive in 38 patients in that 46 patients. Identified bacteria were Enterococcus faecalis, Enterococcus fecium etc. And in group of preoperative cholangitis, SSI is higher(28.3%) than that of the other group(5.9%).In 38 patients(20.1%), microbial cultures were positive on POD 1. In 8 patients, preoperative bile juice culture and asctic fluid culture were both positive and same bacteria were detected between pre and postoperative culture in all patients. Among patients with grade B/C POPF, bacteria were detected on POD 1 in 68.0%. In contrast, only 5.4% of patients with grade A POPF were positive on POD 1. In eight cases that bacteria has disappeared, the incidence of POPF B/C is lower than that of the others. The number of bacteria isolated from drains removed after POD7 significantly increased compared with those of removed on POD4. Conclusion: Bacterial status is associated with SSI causes POPF. Therefore, it is important to using appropriate antibiotics and early drain removal.
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