A study of forty-nine consecutive whipple resections for periampullary adenocarcinoma

Sung, James P.; Stewart, Robert D.; OʼHara, Vincent S.; Westhpal, Kean F.; Wilkinson, Jack E.; Hill, John J.

doi:10.1016/s0002-9610(97)00045-7

Cited by 13 publications

(8 citation statements)

References 21 publications

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“…The best technique for pancreatic anastomosis is still a challenge for the pancreatic surgeon. The pancreatojejunal anastomosis is carried out either as an end-to-end anastomosis with invagination of the pancreatic stump into the jejunum or as an end-to-side anastomosis with or without duct-to-mucosa suturing [21]. The pancreatogastric anastomosis is performed to the gastric lumen through either the gastric stump or through an anterior wall gastrostomy (in the case of pylorus-preserving PD).…”

Section: Discussionmentioning

confidence: 99%

Reconstruction by Pancreaticogastrostomy versus Pancreaticojejunostomy following Pancreaticoduodenectomy: A Meta-Analysis of Randomized Controlled Trials

Shen

Jin

2012

Gastroenterology Research and Practice

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Objectives. The aim of our study was to evaluate and compare the results of pancreaticogastrostomy (PG) and pancreaticojejunostomy (PJ) after pancreaticoduodenectomy (PD). Methods. Published data of randomized clinical trials (RCTs) comparing the clinically relevant outcomes of PG versus PJ after PD were analyzed. Two reviewers assessed the quality of each trial and collected data independently. The Cochrane Collaboration's RevMan 5.0 software was used for statistical analysis. Proportions were combined, and the odds ratio (OR) with its 95% CI was used as the effect size estimate. Results. Four RCTs published in 1995 or later were included in this meta-analysis, in which 276 patients underwent PG and 277 patients underwent PJ followed PD. In the combined results of PG versus PJ, a significant difference in the morbidity of intra-abdominal complications (OR, 0.34; 95% CI, 0.23–0.49; P < 0.00001) was found, but no significant difference could be found for pancreatic fistula (OR, 0.69; 95% CI, 0.42–1.12 , P = 0.13) mortality (OR, 1.09; 95% CI, 0.42–2.83; P = 0.87), recovery with no complications (OR, 1.26; 95% CI, 0.90–1.78; P = 0.18), biliary fistula (OR, 0.55; 95% CI, 0.22–1.35; P = 0.19), or in delayed gastric emptying (OR, 0.55; 95% CI, 0.33–1.01; P = 0.06). Conclusions. Current RCTs suggest that PG is better than PJ for pancreatic reconstruction after PD.

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Section: Discussionmentioning

confidence: 99%

Reconstruction by Pancreaticogastrostomy versus Pancreaticojejunostomy following Pancreaticoduodenectomy: A Meta-Analysis of Randomized Controlled Trials

Shen

Jin

2012

Gastroenterology Research and Practice

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“…Several recent series, however, have shown operative mortality of less than 5% for the Whipple procedure. 5,15,16 Survival following resection has improved in recent years with 5-year survival rates rang-…”

Section: Commentmentioning

confidence: 99%

Endoscopic Ultrasound and Fine Needle Aspiration for the Evaluation of Pancreatic Masses

Suits

Frazee²,

Erickson³

1999

Arch Surg

123

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Hypothesis: Endoscopic ultrasound (EUS) and endoscopic ultrasound-guided fine needle aspiration (EUS-FNA) are accurate for the preoperative staging of pancreatic ductal carcinoma.Design: Retrospective medical record review.Patients: A prospective registry of 98 patients having EUS-FNA for peripancreatic masses from April 1994 to April 1998 was analyzed.Main Outcome Measure: The accuracy of EUS-FNA for preoperative diagnosis and staging of peripancreatic neoplasms.Results: Ninety-eight patients, aged 41 to 91 years (mean age, 67 years) with peripancreatic masses were evaluated by EUS-FNA. All patients had initial computed tomography scanning with a mass seen in 49 patients, "fullness" to the pancreas in 28 patients, and no mass seen in 21 pa-tients. Evaluation with EUS-FNA revealed 22 benign lesions, 18 T2 masses, 37 T3 masses, 1 T4 mass, and 20 masses representing nonpancreatic tumors. Results of EUS-FNA of adjacent lymph nodes were positive in 27 patients. Twenty-seven patients had surgical resection or palliation permitting operative and pathologic staging. On comparison of EUS-FNA staging with surgical staging, 12 patients were the same stage, 14 patients were upstaged, and 1 patient was downstaged. The remaining patients who did not have surgery have been followed up for a mean of 15 months. Overall accuracy of EUS-FNA for differentiating benign from malignant masses was 96%.Conclusions: Endoscopic ultrasound-guided fine needle aspiration is a useful technique for the evaluation of pancreatic masses. It is highly accurate for differentiating between benign and malignant lesions and for predicting T stage, but is limited for predicting nodal status.

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“…Long-term survival in patients with a proven histologic diagnosis is found to be virtually confined to those undergoing tumor resection. Among these, patients with small tumors had a 5-year survival improvement that reached about 35% [31, 32, 33, 34, 35, 36, 37, 38, 39, 40, 41, 42, 43, 44, 45, 46, 47, 48, 49, 50, 51](table 5). …”

Section: Discussionmentioning

confidence: 99%

Improved Survival in Small Pancreatic Cancer

Pantalone

Ragionieri²,

Nesi³

2001

Dig Surg

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Background: Although the incidence of pancreatic cancer is relatively low compared with other tumors (2.4%), the death rate is high. Tumor detection and treatment at an early stage is necessary to improve the poor prognosis of patients, as is demonstrated by some reports showing a 5-year survival rate varying between 19 and 41% for patients undergoing radical pancreatectomy with the highest survival in patients with small tumors. Methods: In our study we retrospectively reviewed the histologic and demographic data of 596 patients who were admitted to the surgical units of the Careggi Hospital (University of Florence-AOC of Florence) between 1988 and 1994 with the incoming diagnosis of pancreatic cancer. Results: Results are reported as the mean ± standard deviation. The postoperative survival rate was calculated by the Kaplan-Meier method and statistical analysis was performed by the log rank test (significance p < 0.05). 247 patients had surgery, 110 with a curative intent. Postoperative mortality was 5.45%. The crude 5-year survival rate for patients who underwent curative surgery was 16.36% (18 patients), but for patients with small lesions confined to the pancreas (T1N0M0, 29 patients) this was even 31.03% (9 patients; p < 0.01, χ² test). Conclusions: Our results indicate that it seems reasonable to consider these cancers as ‘small’, with survival reported in literature from 35 to 41%, so they probably represent the only curable condition at the present time.

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A study of forty-nine consecutive whipple resections for periampullary adenocarcinoma

Cited by 13 publications

References 21 publications

Reconstruction by Pancreaticogastrostomy versus Pancreaticojejunostomy following Pancreaticoduodenectomy: A Meta-Analysis of Randomized Controlled Trials

Reconstruction by Pancreaticogastrostomy versus Pancreaticojejunostomy following Pancreaticoduodenectomy: A Meta-Analysis of Randomized Controlled Trials

Endoscopic Ultrasound and Fine Needle Aspiration for the Evaluation of Pancreatic Masses

Improved Survival in Small Pancreatic Cancer

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