ABSTRACT
BACKGROUND/AIMS: The aim of this study was to evaluate the influence of standard pancreatoduodenectomy versus pancreatoduodenectomy with extended lymphadenectomy and the role of adjuvant therapy on survival in patients with ductal adenocarcinoma of the pancreatic head. In addition the problems related to resection are discussed. METHODOLOGY: A total number of 124 pts operated on between 1985 and 1999 were divided into three groups according to our different strategies. Standard resection (D1) was performed on 48 patients (group A), extended resection (D2) on 45 patients (group B) and combined treatment (extended resection plus adjuvant therapy) on 31 patients. The outcome of these three groups was compared with regard to postoperative morbidity and survival. RESULTS: There was no significant difference in terms of survival between group A and B, while adjuvant therapy (group C), achieved statistical significance as factor influencing survival, together with tumor stage. CONCLUSIONS: Our data suggest that no further improvement can be obtained on long-term survival by extended retroperitoneal dissection while chemoradiotherapy showed a doubling of median survival.
Subject(s)
Lymph Node Excision/methods , Pancreatic Neoplasms/surgery , Pancreaticoduodenectomy/methods , Adult , Aged , Aged, 80 and over , Chemotherapy, Adjuvant , Combined Modality Therapy , Female , Humans , Male , Middle Aged , Pancreatic Neoplasms/drug therapy , Pancreatic Neoplasms/mortality , Pancreatic Neoplasms/radiotherapy , Radiotherapy, Adjuvant , Survival RateABSTRACT
BACKGROUND/AIMS: To determine the role of p53 mutations on survival after pancreatoduodenectomy for adenocarcinoma of the pancreatic head. METHODOLOGY: Resected specimens were assessed for expression of wild-type or mutated p53. Survival of p53-negative and- positive patients was investigated, and differences noted at 0.05 level. RESULTS: Expression of wild-type p53 is associated with a significant improvement in overall survival, especially for patients without nodal metastases. CONCLUSIONS: Preoperative p53 determination could enable further patient selection for aggressive surgery.
Subject(s)
Carcinoma, Ductal, Breast/genetics , Carcinoma, Ductal, Breast/mortality , Genes, p53/genetics , Pancreatectomy , Pancreatic Neoplasms/genetics , Pancreatic Neoplasms/mortality , Aged , Carcinoma, Ductal, Breast/pathology , Carcinoma, Ductal, Breast/surgery , Female , Humans , Male , Mutation , Neoplasm Staging , Pancreatic Neoplasms/pathology , Pancreatic Neoplasms/surgery , Survival AnalysisABSTRACT
Between 1971 and 1986 11 patients suffering from pulmonary aspergilloma were seen in the thoracic surgery service at Genova-Sampierdarena Hospital. Nine patients underwent thoracotomy. Lobectomy was the most frequent operation. Complications occurred in 3 patients (33%). There were no recurrent symptoms in any of them over a mean follow-up of 4 years. The remaining two patients were treated by instillation of antifungal agents into the aspergilloma cavity. There was no systemic toxicity and in one patient the mycetoma resolved. The authors conclude that pulmonary resection can provide effective long-term treatment, while intracavity infusion of antifungal agent can be a successful nonoperative method in critically ill patients.
Subject(s)
Aspergillosis/surgery , Lung Diseases, Parasitic/surgery , Administration, Topical , Adult , Aged , Amphotericin B/administration & dosage , Aspergillosis/diagnostic imaging , Aspergillosis/drug therapy , Female , Humans , Lung/diagnostic imaging , Lung Diseases, Parasitic/diagnostic imaging , Lung Diseases, Parasitic/drug therapy , Male , Miconazole/administration & dosage , Middle Aged , Pneumonectomy , RadiographyABSTRACT
This study is based on the analysis of the survival data in patients with N2 disease reported by Martini, Pearson, Shields et al. Many factors appear to influence survival of this group of patients. We made a retrospective analysis of a series of 91 patients with N2 disease between January 1980 and March 1985. Sixty-nine patients (71.5%) presented clinically N2 disease; 44 patients (63.7%) were treated with complete resection and postoperative irradiation, the actuarial five year survival was 11%. Twenty-two patients (24.2%) were discovered to have N2 disease at thoracotomy. Twenty-one patients underwent resection and the actuarial five year survival was 29%. We conclude that surgery can be effective in a highly selective group of patients.
Subject(s)
Carcinoma, Bronchogenic/surgery , Carcinoma, Non-Small-Cell Lung/surgery , Lung Neoplasms/surgery , Lymphatic Metastasis , Carcinoma, Bronchogenic/mortality , Carcinoma, Non-Small-Cell Lung/mortality , Humans , Lung Neoplasms/mortality , Mediastinum , Prognosis , Retrospective StudiesABSTRACT
The paper described the treatment of a series of 47 mediastinal goitres. The importance of a thorough preoperative assessment of the lesion and of careful planning of the operative technique are underlined. Cervical collar incision provided adequate exposure in most patients. The Authors conclude that surgical treatment should be recommended in all cases.
Subject(s)
Goiter, Substernal/surgery , Adult , Aged , Female , Goiter, Substernal/diagnostic imaging , Goiter, Substernal/pathology , Humans , Male , Middle Aged , Prognosis , RadiographyABSTRACT
Efficacy of automatic staplers in broncho-pulmonary surgery was evaluated in a series of 316 consecutive patients. The results confirm that utilization of staplers has drastically reduced the incidence of post-resection bronchial fistulae; moreover on parenchymal tissue such instruments guarantee excellent haemostasis and air tightness. On the contrary, indications for their use on pulmonary vessels seem to be very limited.
