Background: Pancreatic ductal adenocarcinoma(PDAC) has the worst prognosis of all malignant tumors due to unavailable screening methods, late diagnosis with a low proportion of resectable tumors and resistance to syst...Background: Pancreatic ductal adenocarcinoma(PDAC) has the worst prognosis of all malignant tumors due to unavailable screening methods, late diagnosis with a low proportion of resectable tumors and resistance to systemic treatment. Complete tumor resection remains the cornerstone of modern multimodal strategies aiming at long-term survival. This study was performed to investigate the overall rate of long-term survival(LTS) and its contributing factors. Methods: This was a retrospective single-center analysis of consecutive patients undergoing pancreaticoduodenectomy(PD) for PDAC between 2007 and 2014 at the St. Josef Hospital, Ruhr University Bochum, Germany. Clinical and laboratory parameters were assessed and evaluated for prediction of LTS with Cox regression analysis. Results: The overall rate of LTS after PD for PDAC was 20.4%(34/167). Median survival was 24 months regardless of adjuvant treatment. Carbohydrate antigen 19-9 levels, tumor grade, lymph vessel invasion, perineural invasion and reduced general condition were significantly associated with LTS in univariate analysis( P<0.05). Serum levels of carbohydrate antigen 19-9, American Joint Committee on Cancer stage, tumor grade, abdominal pain, male, exocrine pancreatic insufficiency and duration of postoperative hospital stay were independent predictors of cancer survival in multivariable analysis. Conclusions: Cancer related characteristics are associated with LTS in multimodally treated patients after curative PDAC surgery.展开更多
Background:Aberrant right hepatic arteries(aRHA)are frequently encountered during pancreaticoduodenectomy(PD).Their effects on surgical morbidity and resection margin are still debated.This study aimed to compare the ...Background:Aberrant right hepatic arteries(aRHA)are frequently encountered during pancreaticoduodenectomy(PD).Their effects on surgical morbidity and resection margin are still debated.This study aimed to compare the short term and long term outcomes in patients with and without aRHA.Methods:A single-center retrospective analysis of 353 consecutive PD during a 5-year period was done.The type of arterial supply was determined preoperatively by CT and confirmed at surgery.Hiatt types III-VI included some type of aRHA and comprised the study group.Hiatt types I and II were considered irrelevant for PD and used as controls.Primary endpoints were the rates of major postoperative complications and the rate of R0-resection in cases of malignant disease.Secondary endpoints included duration of surgery,postoperative stay,number of harvested lymph nodes and survival in patients with pancreatic cancer.Own results were compared to existent data using a systematic review of the literature.Results:No aRHA had to be sacrificed or reconstructed.Surgical morbidity and specific complications such as post-pancreatectomy hemorrhage(PPH),pancreatic fistula and bile leak were the same in patients with and without aRHA.There was no significant difference in operative time,blood loss,length of ICU-and hospital stay.Patients with malignancy had similar high rates of R0-resection and identical number of harvested lymph nodes.Survival of patients with pancreatic cancer was not affected by aRHA.Conclusions:aRHA may be preserved in virtually all cases of PD for resectable pancreatic head lesions without increasing surgical morbidity and without compromising oncological radicality in patients with cancer,provided the variant anatomy is being recognised on preoperative CT and a meticulous surgical technique is used.展开更多
文摘Background: Pancreatic ductal adenocarcinoma(PDAC) has the worst prognosis of all malignant tumors due to unavailable screening methods, late diagnosis with a low proportion of resectable tumors and resistance to systemic treatment. Complete tumor resection remains the cornerstone of modern multimodal strategies aiming at long-term survival. This study was performed to investigate the overall rate of long-term survival(LTS) and its contributing factors. Methods: This was a retrospective single-center analysis of consecutive patients undergoing pancreaticoduodenectomy(PD) for PDAC between 2007 and 2014 at the St. Josef Hospital, Ruhr University Bochum, Germany. Clinical and laboratory parameters were assessed and evaluated for prediction of LTS with Cox regression analysis. Results: The overall rate of LTS after PD for PDAC was 20.4%(34/167). Median survival was 24 months regardless of adjuvant treatment. Carbohydrate antigen 19-9 levels, tumor grade, lymph vessel invasion, perineural invasion and reduced general condition were significantly associated with LTS in univariate analysis( P<0.05). Serum levels of carbohydrate antigen 19-9, American Joint Committee on Cancer stage, tumor grade, abdominal pain, male, exocrine pancreatic insufficiency and duration of postoperative hospital stay were independent predictors of cancer survival in multivariable analysis. Conclusions: Cancer related characteristics are associated with LTS in multimodally treated patients after curative PDAC surgery.
文摘Background:Aberrant right hepatic arteries(aRHA)are frequently encountered during pancreaticoduodenectomy(PD).Their effects on surgical morbidity and resection margin are still debated.This study aimed to compare the short term and long term outcomes in patients with and without aRHA.Methods:A single-center retrospective analysis of 353 consecutive PD during a 5-year period was done.The type of arterial supply was determined preoperatively by CT and confirmed at surgery.Hiatt types III-VI included some type of aRHA and comprised the study group.Hiatt types I and II were considered irrelevant for PD and used as controls.Primary endpoints were the rates of major postoperative complications and the rate of R0-resection in cases of malignant disease.Secondary endpoints included duration of surgery,postoperative stay,number of harvested lymph nodes and survival in patients with pancreatic cancer.Own results were compared to existent data using a systematic review of the literature.Results:No aRHA had to be sacrificed or reconstructed.Surgical morbidity and specific complications such as post-pancreatectomy hemorrhage(PPH),pancreatic fistula and bile leak were the same in patients with and without aRHA.There was no significant difference in operative time,blood loss,length of ICU-and hospital stay.Patients with malignancy had similar high rates of R0-resection and identical number of harvested lymph nodes.Survival of patients with pancreatic cancer was not affected by aRHA.Conclusions:aRHA may be preserved in virtually all cases of PD for resectable pancreatic head lesions without increasing surgical morbidity and without compromising oncological radicality in patients with cancer,provided the variant anatomy is being recognised on preoperative CT and a meticulous surgical technique is used.