Adverse tumor biology associated with mesenterico-portal vein resection influences survival in patients with pancreatic ductal adenocarcinoma.

BACKGROUND: Although pancreatoduodenectomy (PD) with mesenterico-portal vein resection (VR) can be performed safely in patients with resectable pancreatic ductal adenocarcinoma (PDAC), the impact of this approach on long-term survival is controversial. PATIENTS AND METHODS: Analyses of a prospectively collected database revealed 122 consecutive patients with PDAC who underwent PD with (PD+VR) or without (PD-VR) VR between January 2004 and May 2012. Clinical data, operative results, and survival outcomes were analysed. RESULTS: Sixty-four (53 %) patients underwent PD+VR. The majority (84 %) of the venous reconstructions were performed with a primary end-to-end anastomosis. Demographic and postoperative outcomes were similar between the two groups. American Society of Anesthesiologists (ASA) score, duration of operation, intraoperative blood loss, and blood transfusion requirement were significantly greater in the PD+VR group compared with the PD-VR group. Furthermore, the tumor size was larger, and the rates of periuncinate neural invasion and positive resection margin were higher in the PD+VR group compared with the PD-VR group. Histological venous involvement occurred in 47 of 62 (76 %) patients in the PD+VR group. At a median follow-up of 29 months, the median overall survival (OS) was 18 months for the PD+VR group, and 31 months for the PD-VR group (p = 0.016). ASA score, lymph node metastasis, neurovascular invasion, and tumor differentiation were predictive of survival. The need for VR in itself was not prognostic of survival. CONCLUSIONS: PD with VR has similar morbidity but worse OS compared with a PD-VR. Although VR is not predictive of survival, tumors requiring a PD+VR have more adverse biological features.

Eversion carotid endarterectomy.

BACKGROUND: Eversion carotid endarterectomy (ECEA) is a technique that obviates the need for traditional longitudinal arteriotomy and patch closure, with low stroke and restenosis rates. The aim of the present study was to report an Australian experience and technique of ECEA. METHODS: All patients who underwent ECEA by the investigating surgeons between October 1997 and July 2000 were followed up clinically and with duplex ultrasound. The technique of ECEA is described. RESULTS: One hundred and fifty-two ECEA were performed, 13 combined with coronary artery bypass grafting (CABG). The combined perioperative stroke and death rate was 2%; 0.65% excluding CABG combined cases. This compares with 2.9% for standard carotid endarterectomy throughout Victoria. Significant restenosis occurred in 2.6% after a mean follow up of 21.7 months. CONCLUSION: ECEA is a simple and safe alternative to standard carotid endarterectomy.

Hyperbaric oxygenation treatment of acute paraplegia after resection of a thoracoabdominal aortic aneurysm.

Acute spinal cord ischemic injury after resection of thoracoabdominal aneurysm remains a relatively common and potentially devastating complication. The complete resolution of postoperative paraplegia after resection of a type II thoracoabdominal aneurysm, after treatment with hyperbaric oxygenation, is reported.