Considerations on early diagnosis of carcinoma of the pancreas.

BACKGROUND/AIMS: Pancreas carcinoma is seldom recognized at an early stage. Through an attentive retrospective evaluation of the patient's history a frequent pattern of early presentation is sought. METHODOLOGY: A series of 64 patients (36 males; 28 females) with histologically proven pancreas carcinoma seen in the Department of Surgery and the Oncology Department of the University of Milan (Ospedale "L. Sacco") in the years 1992 through 2001, is closely scrutinized, tracing the very initial signs and symptoms in each individual case. RESULTS: Weight loss is by far the most frequent early complaint, being the presenting symptom in more than 79% of cases, either alone or associated with one or more additional symptoms, followed by pain (56%), anorexia (28%), jaundice (25%) and asthenia (23%). However it appears that weight loss is often overlooked until other more suggestive symptoms ensue. In particular, slowly developing jaundice was the most common indication for ultrasound scan or computed tomography study, although jaundice was the presenting symptom in only 25% of cases. CONCLUSIONS: In patients presenting with unexplained weight loss, a more liberal use of diagnostic imaging techniques in the upper abdomen might be advisable.

Repeated liver resection for recurrent metastases from colorectal cancer.

BACKGROUND/AIMS: Repeat hepatectomy is the most effective treatment for recurrent colorectal liver metastases. We aim to assess how repeated liver resections increase survival, without unacceptable surgical risk. METHODOLOGY: Between December 1992 and December 1998, among 19 patients, 5 underwent secondary resection of recurrent metastatic disease. Following the primary liver surgery, three patients had systemic chemotherapy with 5-fluorouracil and two locoregional chemotherapy via Port-a-cath in the gastroduodenal artery. We evaluated survival and we compared time of surgery, duration of Pringle maneuver, blood losses and postoperative stay in the hospital between first and second liver surgery. RESULTS: Perioperative mortality at second liver resection was nil; morbidity minor; mean duration of surgery 320 vs. 260 min; Pringle maneuver 35 vs. 25 min; blood losses 1300 vs. 650 mL; postoperative stay 12.6 vs. 11.5 days. Mean total survival from time of colon resection was 50 months. As an interesting secondary finding, we observed prolonged inhibition of liver regeneration following treatment with Methotrexate. CONCLUSIONS: Repeated hepatic resection is a safe procedure for selected patients. Surgical risk is slightly increased, but the risk/benefit ratio is definitely in favor of as many repeated resections as needed, whenever there is a chance of curative surgery.