Eric A. Wiebke

A margin-negative R0 resection accomplished with minimal postoperative complications is the surgeon’s contribution to long-term survival in pancreatic cancer

Pancreatic cancer has a poor prognosis with complete surgical resection being the only therapy to offer a realistic chance for long-term survival. The aim of this study is to identify surgery-related variables that influence long-term survival. Between 1990 and 2002, 226 consecutive patients (mean age of 64 ± 11 years) had resection for pancreatic adenocarcinoma. Prognostic variables in these patients were analyzed using univariate and multivariate analysis. Two hundred four patients (90%) had pancreaticoduodenectomy, 13 patients (6%) had distal pancreatectomy, and 9 patients (4%) had a TP. Stage I disease was present in 50 (22%), stage II disease in 170 (75%), and stage III disease in 6 (3%). R0 resections were achieved in 70%. Operative morbidity was 36% and 30-day mortality was 6%. Actual 1-year, 3-year, and 5-year survival rates were 49% (n=111), 14% (n=31), and 4% (n=9). Using multivariate analysis: tumor size, tumor differentiation, obtaining an R0 resection, and lack of postoperative complications were variables associated with long-term survival. Long-term survival in patients with pancreatic cancer after resection remains poor. Achieving a margin negative resection (R0) with no postoperative complications are prognostic variables that can be affected by the surgeon.

Nonocclusive Mesenteric Ischemia Remains a Diagnostic Dilemma

BACKGROUND Despite reports of low mortality and high bowel-salvage rates in nonocclusive mesenteric ischemia (NOMI), our experience has been much less favorable. This study analyzes our experience with NOMI. PATIENTS AND METHODS A retrospective chart review (1979 to 1992) identified 113 patients with acute mesenteric ischemia, of whom 13 (12%) met our criteria for NOMI. RESULTS Patients were grouped into early and late presenters. The 5 early presenters were women, younger (mean age [+/- SD] 50 +/- 5.8 years), with no risk factors, and had vague symptoms leading to a delay in diagnosis. The 7 late presenters were older (mean age [+/- SD] 63 +/- 5.3 years) with identifiable risk factors; all had bowel infarction at the time of initial diagnosis. CONCLUSIONS Vague symptoms and a wide range of patients at risk make early diagnosis of NOMI uncommon. In the absence of early diagnosis, bowel resection with its high morbidity and mortality remains the only applicable treatment option in the vast majority of patients.

Parthenolide and sulindac cooperate to mediate growth suppression and inhibit the nuclear factor-κB pathway in pancreatic carcinoma cells

Activation of the transcription factor nuclear factor-κB (NF-κB) has been implicated in pancreatic tumorigenesis. We evaluated the effect of a novel NF-κB inhibitor, parthenolide, a sesquiterpene lactone isolated from the herb feverfew, in three human pancreatic tumor cell lines (BxPC-3, PANC-1, and MIA PaCa-2). Parthenolide inhibited pancreatic cancer cell growth in a dose-dependent manner with substantial growth inhibition observed between 5 and 10 μmol/L parthenolide in all three cell lines. Parthenolide treatment also dose-dependently increased the amount of the NF-κB inhibitory protein, IκB-α, and decreased NF-κB DNA binding activity. We have previously shown that nonsteroidal anti-inflammatory drugs (NSAID) suppress the growth of pancreatic cancer cells. To determine whether inhibition of the NF-κB pathway by parthenolide could sensitize pancreatic cancer cells to NSAID inhibition, BxPC-3, PANC-1, and MIA PaCa-2 cells were treated with parthenolide and the NSAID sulindac, either alone or in combination. Treatment with the combination of parthenolide and sulindac inhibited cell growth synergistically in MIA PaCa-2 and BxPC-3 cells and additively in PANC-1 cells. In addition, treatment with the parthenolide/sulindac combination lowered the threshold for apoptosis. Increased levels of IκB-α protein were detected, especially in MIA PaCa-2 cells, after treatment with parthenolide and sulindac compared with each agent alone. Similarly, decreased NF-κB DNA binding and transcriptional activities were detected in cells treated with the combination compared with the single agents, demonstrating cooperative targeting of the NF-κB pathway. These data provide preclinical support for a combined chemotherapeutic approach with NF-κB inhibitors and NSAIDs for the treatment of pancreatic adenocarcinoma.

Percutaneous Radiologic, Surgical Endoscopic, and Percutaneous Endoscopic Gastrostomy/Gastrojejunostomy: Comparative Study and Cost Analysis

AbstractPurpose: To compare the results and costs of three different means of achieving direct percutaneous gastroenteric access. Methods: Three groups of patients received the following procedures: fluoroscopically guided percutaneous gastrostomy/gastrojejunostomy (FPG, n= 42); percutaneous endoscopic gastrostomy/gastrojejunostomy (PEG, n= 45); and surgical endoscopic gastrostomy/gastrojejunostomy (SEG, n= 34). Retrospective review of the medical records was performed to evaluate indications for the procedure, procedure technical success, and outcome. Estimated costs were compared for each of the three procedures, using a combination of charges and materials costs. Results: Technical success was greater for FPG and SEG (100% each) than for PEG (84%, p= 0.008 vs FPG and p= 0.02 vs SEG). All patients (n= 7) who failed PEG subsequently underwent successful FPG. Success in placing a gastrojejunostomy was 91% for FPG, and estimated at 43% for PEG and 0 for SEG. Complications did not differ in frequency among groups. For gastrostomy, the average cost per successful tube was lowest in the PEG group (

Pancreatic Fistula Following Pancreaticoduodenectomy: Clinical Predictors and Patient Outcomes

1862, p= 0.02); FPG averaged

An analysis of perioperative cholangiography in one thousand laparoscopic cholecystectomies

1985, and SEG

Mucin-hypersecreting intraductal neoplasms of the pancreas: A precursor to cystic pancreatic malignancies

3694. SEG costs significantly more than FPG or PEG (p= 0.0001). For gastrojejunostomy, FPG averaged

Classification and treatment of local septic complications in acute pancreatitis

2201, PEG

Conversion of laparoscopic to open cholecystectomy

3158, and SEG

Parthenolide cooperates with NS398 to inhibit growth of human hepatocellular carcinoma cells through effects on apoptosis and G0-G1 cell cycle arrest.

3045. Conclusion: Technical success for gastrostomy is higher for FPG and SEG than PEG. Though PEG is the least costly procedure, the difference is modest compared with FPG. For gastrojejunostomy, FPG offers the highest technical success rate and lowest cost. Due to high costs associated with the operating room, SEG should be reserved for those patients undergoing a concurrent surgical procedure.