Role of Angiotensin Receptor Blockers in Post-Ercp Pancreatitis

Abstract

Aim: Following implementation of Improvement Outcome Guidance (IOG), pancreatic cancer surgery is now mostly performed in major pancreatic referral centers. This may have affected selection for surgery and outcome. We report the effect on workload and mortality rate of centralizing pancreatic surgery for a population of about 3.5 millions to a single Centre. Method: We reviewed activity in 2003 and 2007 (before and after implementation of IOG). Pancreatic surgery was done in 3 hospitals in 2003. In 2007 centralization affected 2.3M population form January, and an additional 1.2M from April 2007. Before centralization the surgical HDU was expanded from 3 to 8 beds. Results: In 2003, there were 67 pancreatic procedures of all types performed by 7 surgeons. In 2007 102 patients diagnosed with a neoplasm were deemed operable, and underwent laparotomy. Only one patient on a cancer pathway failed to meet the 62 day target. Two patients were found to be inoperable, and had palliative bypass. Three surgeons performed 100 resections. A further 10 patients had pancreatic necrosectomy. Of the elective resections 94% were managed in surgical HDU (level 2 critical care). Neo-adjuvant treatment was attempted in 12 borderline pancreatic cancers, 4 were successfully resected, 3 are currently receiving chemotherapy, and in 5 cases there was no improvement and palliative chemoYradio therapy was stopped. Conclusion: Centralization has increased the numbers of patients in this Network offered pancreatic resection for tumor. This has enabled new approaches such as laparoscopic distal pancreatectomy and neoadjuvant treatment for borderline resectable tumors. The inoperability rate is low. Despite wider indications for surgery, the mortality rate has fallen. We conclude that centralization has enabled more patients to benefit from safe surgery for pancreatic neoplasm. emerged as a treatment for pancreatic cancer. One decade has elapsed since its institution. The aim of the study is to detect whether adjuvant G improves survival. Methods: A prospective surgical database from 1985 to 2007 with 1637 records was reviewed and identified 579 patients who underwent resection for PDAC. Median, mean and 1, 3, and 5 year survival were calculated for the entire group; by decades regardless of adjuvant treatment; and by treatment with or without G. Results: The 1, 3 and 5 year survival of resected patients (579) was 66, 26 and 15% respectively, with a mean of 30.8 mo. No significant differences were identified over two decades. Patients who received G (n = 199, 34.5%) compared to NG (n = 379, 65.6%) had a statistically significant increase in survival at 1(80 vs. 55%), 3(35 vs. 20%) and 5(20 vs. 12%) years, with a mean of 37 vs. 27.6 (p G 0.0001). G improved survival in patients with tumors that were moderately differentiated (mean 36.5 vs. 25.5, p G 0.0007), Flavanoids are important components of many fruits and vegetables and are believed to have preventive and therapeutic effects in various human malignancies. We hypothesize that flavanoids may...