The use of somatostatin and its analogues does not significantly reduce postoperative complications after pan-creaticoduodenectomy.

AIM:To analyze the factors influencing radical (R0) resection rate and surgical outcome for malignant tumor of the pancreatic body and tail. METHODS:The clinical and operative data and followup results of 214 pancreatic body and tail cancer patients were analyzed retrospectively. RESULTS:One hundred and twenty/214 pancreatic body and tail cancer patients underwent surgical treatment; the overall resection rate was 59.2% (71/120), and the R0 resection rate was 40.8% (49/120). Compared with non-R0 treatment, the patients receiving an R0 resection had smaller size tumor (P < 0.01), cystadenocarcinoma (P < 0.01), less lymph node metastasis (P < 0.01), less peri-pancreatic organ involvement (P < 0.01) and earlier stage disease (P < 0.01). The overall 1-, 3-and 5-year survival rates for pancreatic body and tail cancer patients were 12.7% (25/197), 7.6% (15/197) and 2.5% (5/197), respectively, and ductal adenocarcinoma patients had worse survival rates [15.0% (9/60), 6.7% (4/60) and 1.7% (1/60), respectively] than cystadenocarcinoma patients [53.8% (21/39), 28.2% (11/39) and 10.3% (4/39)] (P < 0.01). Moreover, the 1-, 3-and 5-year overall survival rates in patients with R0 resection were 55.3% (26/47), 31.9% (15/47) and 10.6% (5/47), respectively, significantly better than those in patients with palliative resection [9.5% (2/21), 0 and 0] and in patients with bypass or laparotomy [1.2% (1/81), 0 and 0] (P < 0.01). CONCLUSION:Early diagnosis is crucial for increasing the radical resection rate, and radical resection plays an important role in improving survival for pancreatic body and tail cancer patients.

Computed tomography (CT) scan showed significant free air in the neck, lateral esophagus, and abdominal cavity, which indicated perforation of the esophagus and gastrointestinal tract. In addition, the abdominal CT image showed splenic subcapsular hematorna and swollen pancreatic head caused by strong acid causis. We found the entire gastrointestinal tract from stomach to rectum necrosis in the emergency exploratory laparotomy. Our case suggests that ingestion of a considerable amount (e.g., 500 mL) and concentration of strong acid could result in total gastrointestinal tract necrosis. Emergency laparotomy should be performed as early as possible to benefit this kind of patient.

Purpose To analyze the procedure-related complications after pancreaticoduodenctomy (PD) and their risk factors.Methods One hundred twenty-six patients underwent pancreatoduodenectomy for diseases at region of pancreatic head were reviewed retrospectively. ResultsThe overall surgical morbidity was 40.5% (51/126). Ten (7.9%) of 51 patients were identified as having pancreatic leakage, others included delayed gastric emptying (8.7%, 11), abdominal infection and abscess (7.9%, 10), abdominal bleeding (5.6%, 7), wound infection (4.8%, 6), wound dehiscence (2.4%, 3), biliary fistula (1.6%, 2) and operative death (1.6%, 2). Other postoperative complications were lung inflammation (3.9%, 5) and newly developed diabetes mellitus (2.3%, 3). Age (>60 years), coexisting diabetes mellitus, small main pancreatic duct (≤0.5 cm), and surgeon's experience (<10 patients within 5 years) were demonstrated to be independent risk factors by both univariate and multivariate analysis (p < 0.01).Conclusions Old patients with coexisting diabetes mellitus and small main pancreatic duct undergo pancreatoduodenectomy by a less experienced surgeon may be at high risk of procedure-related complications.