Objective: The purpose of this study was to determine the factors affecting survival in patients who underwent pancreaticoduodenectomy for periampullary cancers and to discuss the outcomes of our findings. Material and Methods:This retrospective study included 79 patients who underwent pancreaticoduodenectomy for periampullary cancers between September 1987 and October 2011 in the Department of General Surgery at Ondokuz Mayis University School of Medicine. The factors of age, tumor localization, tumor size, lymphovascular invasion, status of lymph node metastasis, tumor differentiation, preoperative CA 19-9 levels, preoperative total bilirubin levels, preoperative albumin levels, and preoperative biliary drainage were investigated to determine their influence on survival. The survival periods were calculated using the Kaplan-Meier method. The log-rank test was used for comparison of the prognostic factors. The independent prognostic factors affecting survival were determined by Cox hazard regression analysis and hazard ratios (HR) and 95% confidence intervals (CI) were calculated. P<0.05 was considered as significant. Results:The following were identified as independent prognostic factors adversely affecting survival: tumor size ≥2 cm (HR: 2.0, 95% CI: 0.27-0.90), lymphovascular invasion (HR: 2.9, 95% CI: 0.18-0.60), CA 19-9 levels ≥100 U/mL (HR: 2.0, 95% CI: 0.26-0.90), and albumin levels <2.5 mg/dL (HR: 2.7, 95% CI: 1.14-6.66). Conclusion:The independent prognostic factors identified in this study can be used for selection of patients for whom pancreaticoduodenectomy should be applied for periampullary cancers. These factors could help us to estimate survival rates.
SUMMARYObjective: Low flow anesthesia is an inhalation anesthesia technique applied through a semiclosed rebreathing system in which the rate of rebreathing is at least 50%. When modern rebreathing systems are used, low anesthesia could be uttered if the speed of gas flow is decreased below 2 L/min. Method: In the present study, the comparison between minimal flow, low flow and high flow anesthesia practices of the effects of BIS controlled desfluran anesthesia on hemodynamic and costs has been aimed. Of the cases randomized divided into three groups within first 10 minutes after the anesthesia induction in all cases, in group Y, fresh gas flow in anesthesia maintenance was kept at 4.0 L/min; in group D, the flow speed was decreased to 1 L/min after the 10th minute; in group M, it was decreased to 0,5 L/min; anesthesia maintenance with desfluran ( 4-6%) was continued in all three groups. Results: In the comparison between the three groups received high, low and minimal flow, no significant differences had been noticed in heart rate, average arterial pressures, oxygen saturation and end-tidal carbon dioxide values in all three groups. The recovery was found to be earlier in low flow and minimal flow groups (p<0.05). Significant decrease in volatile anesthetic consumption and costs was observed in low flow and minimal flow groups (p<0.05). Conclusions: Low and high flow desfluran anesthesia application provided sufficient anesthesia depth, hemodynamic stability and respiration parameters during intraoperative period as well as had positive effects on postoperative recovery under sufficient conditions.
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