Good results after major pancreatic resections in a middle-volume center.

OBJECTIVES: Recently, hospital and surgeon volume is widely discussed as a prognostic factor after major pancreatic surgery. We present our experience regarding major pancreatectomy in a middle-volume center. METHODS: During the last 11 years, 66 patients underwent major pancreatectomy (pancreaticoduodenectomy [n = 52], distal pancreatectomy with splenectomy [n = 13], and central pancreatectomy [n = 1]). Postoperative course and long-term outcome were recorded and analyzed. RESULTS: One patient died after pancreaticoduodenectomy for ampullary cancer (total mortality of approximately 1.5% for the whole group of patients or 1.9% for the group of patients who underwent pancreatoduodenectomy). None of our patients was reoperated on. Transient pancreatic fistula was observed in 46 patients (36 patients after pancreatoduodenectomy [69%] and 10 patients after distal pancreatectomy [77%]). Two patients required percutaneous computed tomography-guided drainage of fluid collections, whereas in another one, a tube thoracostomy was performed to drain a pleuritic fluid collection. Delayed gastric emptying was observed in 6 patients after pancreatoduodenectomy. Median survival for the whole group of patients was 17 months. CONCLUSIONS: Major pancreatic resections can be performed safely, with acceptable morbidity and mortality and good long-term results, even in middle-volume centers. However, experience is required from the part of the operating surgeon. ABBREVIATIONS: PD - pancreatoduodenectomy, DP - distal pancreatectomy, PPPD - pylorus-preserving pancreatoduodenectomy.

Preoperative detection of cervical lymph node metastases in papillary thyroid cancer: a surgical perspective.

Despite its relatively benign biological behavior, papillary thyroid cancer is frequently associated with cervical lymph node metastases at the time of diagnosis. These metastases have a limited impact on overall survival, but are recognized as a significant risk factor for locoregional recurrence of the disease. This may significantly alter quality of life, and may require further therapeutic interventions which may be associated with increased morbidity. Therefore, preoperative identification of cervical lymph node metastases is of particular importance and allows optimal and effective treatment at the time of initial surgery. Clinical examination remains important but lacks sensitivity. Neck ultrasonography is currently the most useful method to detect cervical lymphadenopathy. Fine-needle aspiration (for cytology and thyroglobulin measurement), usually under ultrasonographic guidance, may confirm the diagnosis of lymph node metastases. Other imaging methods (including computed tomography, magnetic resonance imaging, positron emission tomography) should be used selectively. A compartment-oriented cervical lymph node dissection should be performed at the time of thyroidectomy if preoperative evaluation reveals cervical lymphadenopathy.