ABSTRACT
Carcinoma of the body and tail of the pancreas considered one of the most challenging tumors due its retroperitoneal location and neighboring major blood vessels. Therefore, it is often presents at an advanced stage and is deemed unresectable in the majority of patients. The traditional approach of left-to-right Pancreato-Splenectomy is associated with a high positive tangential margin rate, is not based on the described lymph node drainage of the organ, and is associated with high recurrence rate. In 2003, Strasberg SM described a novel approach for resection of this part of the pancreas called Radical Antegrade Modular Pancreato-Splenectomy [RAMPS] which was introduced to obtain a higher rate of negative tangential margins and a higher lymph node count. This is a case report of pancreatic tumor with celiac trunk invasion treated by the new RAMPS procedure with celiac trunk resection. Patient discharged home on fifth postoperative day, follow up reveals recurrence free survival one year later
Subject(s)
Humans , Splenectomy , Celiac ArteryABSTRACT
Gastric outlet obstruction is the clinical and pathophysiological consequence of any disease process that produces a mechanical impediment to gastric emptying. It classified into benign and malignant group. Distal gastric cancer form 35% of cases with malignant gastric outlet obstruction. To study the causes of malignant gastric obstruction and how to treat them, in addition the application of gastric outlet obstruction score in our patient pre- and post-treatment. Between January-2012 to January-2014, a prospective study involves all patients with malignant gastric outlet obstruction in the surgical department in the gastrointestinal and Hepatology teaching hospital. A total of 51 cases of malignant gastric outlet obstruction were enrolled in the research, with mean age 53.21 +/- 14.6 years. There were 30 male patients [58.8%] with male to female ratio = 1.4:1. Non-bilious vomiting was present in [100%] of cases. antropyloric region was found in [47.1%] patients. Regarding GOOS, there were improvement in all patients [p value =0.048]. Distal gastrectomy done in 19.6% of patients and gastrojujenostomy performed in 80.3% of patients. Gastric adenocarcinoma found in 15.7%, in 47.05% of patients was found to have metastatic adenocarcinoma. Gastric outlet obstruction poses diagnostic and therapeutic challenges to general surgeons. In recent years malignant cause become more. Gastric outlet obstruction score has a role in management of patients. Distal gastrectomy is the treatment of choice in resectable cases, while gastrojujenostomy can be used in advanced cases