Standard Versus Extended Pancreaticoduodenectomy in Treating Adenocarcinoma of the Head of the Pancreas

Objectives To compare the postoperative complications and survival of standard pancreatoduodenectomy (SPD) and extended pancreatoduodenectomy (EPD) in patients with resectable adenocarcinoma of the head of the pancreas.Methods Between January 1994 and December 2011,165 patients with biopsy-proven adenocarcinoma of the pancreatic head were treated in West China Hospital,among whom 93 underwent SPD and 72 had EPD.Complications and survival after the surgery were analyzed retrospectively.Results The median operation time of the EPD group was longer compared with the SPD group (375 minutes vs.310 minutes,P<0.01),the volume of blood transfusion was larger (700 mL vs.400 mL,P<0.05),while the median hospital stay (13.5 days vs.12 days,P = 0.79) and the total complication rates were comparable (34.7% vs.32.4%,P=0.93).The total recurrence rates of the SPD and EPD groups were not significantly different (52.7% vs.43.1%,P=0.83).No significant differences were found between the SPD and EPD groups in 1-year (81.7% vs.86.1%),3-year (38.7% vs.43.1%),5-year (16.7% vs.19.4%),and median survivals (19.8 months vs.23.2 months,P= 0.52).Conclusion The postoperative complications and survival donot differ significantly between SPD and EPD.

Collagenous nodule mixed simple cyst and hemangioma coexistence in the liver

A 20-year-old female patient presented with two masses located in the left liver.In this patient, a computed tomography(CT) scan revealed a hypodense mass and a second well-defined mass with a calcified nodule in the left hepatic lobe.No enhancements were apparent in or around the masses.A laparotomy was performed due to the patient's symptoms, namely, the atypical CT findings and a risk of rupture of the subcapsular lesion.The operation revealed two masses in the left hepatic lobe and a left liver resection was subsequently performed.One of the masses involved segment Ⅲ and the other mass was located in segment Ⅳ.The histopathologic findings supported a diagnosis of collagenous nodule mixed simple cyst and hemangioma.A diagnosis of collagenous nodule mixed simple hepatic cyst is extremely rare and radiologically mimics a teratoma, hepatolithiasis, parasitic cyst, or hemangioma.Although hepatic hemangiomas are the most common benign tumors found in the liver, the present case showed atypical radiographic features.

Neoadjuvant therapy in resectable pancreatic cancer:A promising curative method to improve prognosis

Currently,15 randomized controlled trials(RCTs)have been designed to investigate whether neoadjuvant therapy(NAT)benefits patients with resectable pancreatic adenocarcinoma(R-PA)compared to surgery alone.Five of them have acquired results so far;however,corresponding conclusions have not been obtained.We speculated that the reason for this phenomenon could be that some prognostic factors had proven to be adverse through upfront surgery curative patterns,but some of them were not regarded as independent baseline characteristics,which is important to obtaining comparability between the NAT and upfront surgery groups.This fact could cause bias and lead to the difference in the outcomes of RCTs.In this review,we collate data about risk factors(such as tumor size,resection margin,and lymph node status)influencing the prognoses of patients with R-PA from five RCTs and discuss the possible reasons for the varying outcomes.