B. Bonadimani

Ductal adenocarcinoma of the pancreas: clinicopathologic features and survival.

Aims and Background The prognosis after surgical resection for pancreatic cancer has not been clearly defined because conflicting results have been reported. Methods Fifty-five patients who underwent surgical resection for pancreatic carcinoma between 1970 and 1987 were retrospectively reviewed to determine factors influencing long-term survival. Results The actuarial 5-year survival rate for all 55 patients was 12.5 %. Type of operation, tumor stage, direct extension into adjacent organs, grading and lymph node involvement were found to significantly influence survival. Age, sex, tumor site, size, invasion into peripancreatic tissue, invasion of lymphatic vessels and small veins, perineural Infiltration, tumor necrosis, round cell infiltrate at the tumor margin, associated chronic pancreatitis, and atypia of pancreatic ductal epithelium demonstrated no predictive capacity. No 5-year survival was observed among the patients who underwent vascular resection. Three of 9 patients who underwent left-sided pancreatectomy for cancer of the tail of the pancreas survived more than 5 years. Multivariate analysis confirmed that lymph node involvement, moderate-poor histologic tumor differentiation, and treatment with total pancreatectomy were signicantly associated with a worse prognosis. Conclusions Lymph node status, grading of the tumor and type of operation have a significant impact on prognosis in resected pancreatic cancer.

Central Venous Catheter Guidewire Replacement According to the Seldinger Technique: Usefulness in the Management of Patients on Total Parenteral Nutrition

While on total parenteral nutrition (TPN), 37 patients underwent replacement of a central venous catheter (CVC), during which a wire introducer was used, according to the Seldinger technique. In 25 patients, the CVC was placed in the superior cava via the subclavian, and, in 12, via the jugular vein. Overall, 82 CVC changes were performed.: 74 for assumed CVC sepsis, 6 as preventive treatment, and 2 for partial catheter displacement. Catheter tip culture proved to be positive in 25 of 119 CVC examined. The catheters were defined as sterile when the tip culture was negative; contaminated, when the tip culture was positive and peripheral blood culture was either negative or positive for different bacteria; septic when both tip and blood were positive for the same bacteria. The results indicated that 10 catheters were contaminated and 17 were septic. Eight previously sterile CVC were found positive after the exchange: 3 were removed at the end of TPN in asymptomatic patients, and 5 were successfully resterilized by means of one more change. Guidewire replacement allowed CVC sterilization of 22 of 24 catheters (91.6%). No complications due to the catheter-changing method were seen.

Forecast of surgical risk in pancreatic cancer

Over a 22 year period, 305 patients underwent operations for pancreatic cancer. Seventy-one patients who only underwent a laparotomy and 60 patients with defective data were excluded from our study. The remaining 174 patients were analyzed to find a clinically applicable algorithm to allow the preoperative surgical risk to be evaluated in a single patient. One hundred twenty-six had undergone a bypass operation (Group I) and 48, a potentially curative resection (Group II). The two groups were divided into the following three risk groups according to the postoperative course: D, patients who died during the first postoperative month; C, patients with postoperative complications; and U, patients with an uneventful course. Preoperative weight loss, duration of jaundice, serum bilirubin level, total protein level, and age of every patient were collected and transformed into a three-score ordinal scale. Stepwise discriminant analysis of these data enabled us to correctly classify 88 percent of the patients who underwent palliative operations and 83 percent of those who had pancreatic resection. This method is useful in identifying the risk group for a single patient using individual preoperative variables. It may, moreover, suggest the most suitable treatment for each patient with pancreatic cancer.

Evaluation of surgical risk in palliation and resection of pancreatic cancer

SummaryHigh morbidity and mortality rates are reported for bypass and resective surgery of pancreatic cancer. In a retrospective study we correctly predicted the postoperative course in 88% of the patients who underwent bypass surgery and 83% of those who had a resection for pancreatic cancer. Before starting with clinical application of this scoring system, we undertook a prospective study to confirm its predictive value. Sixtyseven consecutive patients with pancreatic cancer were included: 42 patients underwent bypass surgery and 25 pancreatic resections. The operative mortality was 14% for palliative surgery and 0% for resective surgery. Surgical team and nurses were totally unaware of the predicted risk. The preoperative forecast proved to be correct in 81% of bypass surgery and in 88% of resective surgery, although surgical mortality had decreased from 21 to 14% for bypass surgery and from 17 to 0% for resective surgery. Tables are included to calculate the surgical risk for each of 162 combinations of the risk factors considered in the predictive model (81 for bypass surgery and 81 for resective surgery). Calculation of surgical risk is important when evaluating different treatments for pancreatic cancer are available.