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Surgical management of adenocarcinoma of the pancreatic uncinate process in a cancer hospital in egypt.

Roshdy S, Hussein O, Abdallah A, Abdel-Wahab K, Senbel A - Clin Med Insights Gastroenterol (2015)

Bottom Line: Median DFS was 19.2 months.Survival was superior in the Whipple procedure group than in the total pancreatectomy group (median survival 19 months vs 4 months, respectively).Vascular resection and retroperitoneal safety margin status did not affect disease relapse.

View Article: PubMed Central - PubMed

Affiliation: Surgical Oncology Department, Mansoura University Cancer Center, Mansoura, Egypt.

ABSTRACT

Introduction: Pancreatic carcinoma affecting the uncinate process is a challenging surgical condition. Several considerations affect the management plan, including the need for vascular resection and the ability to achieve a clear margin.

Methods: The data of 19 patients who had curative resection for pancreatic adenocarcinoma of the uncinate process were reviewed. Operative mortality and morbidity, and disease-free survival (DFS) were calculated.

Results: The study population included 13 male and 6 female patients with a mean age of 55 years. Nine patients (47.4%) had stage I disease, seven patients (36.8%) had stage II disease, and three patients (15.8%) had stage III disease. A total of 12 patients had Whipple procedure and 7 patients had total pancreatectomy. In total, there were 9 R0 and 10 R1 resections. Operative mortality rate was 10.5% (2/19), postoperative leakage rate was 21.1% (4/19), and wound sepsis rate was 21.1%. Median DFS was 19.2 months. Survival was superior in the Whipple procedure group than in the total pancreatectomy group (median survival 19 months vs 4 months, respectively). Vascular resection and retroperitoneal safety margin status did not affect disease relapse.

Conclusion: Non-metastatic pancreatic adenocarcinoma of the uncinate process should be offered R0 or R1 resection whenever technically feasible.

No MeSH data available.


Related in: MedlinePlus

DFS according to tumor stage.
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f1-cgast-8-2015-001: DFS according to tumor stage.

Mentions: All patients were followed for the occurrence of relapse. Median DFS for the whole group was 19.2 months (95% CI = 11.2–27.3 months). On univariate analysis, the type of resection (Whipple vs. total pancreatectomy), infiltration of the retroperitoneal safety margin, and the presence of vascular resection did not affect the relapse rate (all P-values = NS; chi-square test). Patients who received total pancreaticoduodenectomy had shorter DFS than patients who underwent Whipple resection. The presence of vascular resection did not affect DFS in this cohort (Figs. 1 and 2). Similarly, 12 patients with free retroperitoneal margin and 7 patients with infiltrated margin had no significant difference in median DFS (19.22 vs. 17.87 months; P = NS; log-rank, Mantel–Cox tests). Only three patients had an infiltrated pancreatic transaction margin and one patient had a narrow transaction margin. Three other patients were offered vascular resection, and their data are summarized below.


Surgical management of adenocarcinoma of the pancreatic uncinate process in a cancer hospital in egypt.

Roshdy S, Hussein O, Abdallah A, Abdel-Wahab K, Senbel A - Clin Med Insights Gastroenterol (2015)

DFS according to tumor stage.
© Copyright Policy - open-access
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC4295910&req=5

f1-cgast-8-2015-001: DFS according to tumor stage.
Mentions: All patients were followed for the occurrence of relapse. Median DFS for the whole group was 19.2 months (95% CI = 11.2–27.3 months). On univariate analysis, the type of resection (Whipple vs. total pancreatectomy), infiltration of the retroperitoneal safety margin, and the presence of vascular resection did not affect the relapse rate (all P-values = NS; chi-square test). Patients who received total pancreaticoduodenectomy had shorter DFS than patients who underwent Whipple resection. The presence of vascular resection did not affect DFS in this cohort (Figs. 1 and 2). Similarly, 12 patients with free retroperitoneal margin and 7 patients with infiltrated margin had no significant difference in median DFS (19.22 vs. 17.87 months; P = NS; log-rank, Mantel–Cox tests). Only three patients had an infiltrated pancreatic transaction margin and one patient had a narrow transaction margin. Three other patients were offered vascular resection, and their data are summarized below.

Bottom Line: Median DFS was 19.2 months.Survival was superior in the Whipple procedure group than in the total pancreatectomy group (median survival 19 months vs 4 months, respectively).Vascular resection and retroperitoneal safety margin status did not affect disease relapse.

View Article: PubMed Central - PubMed

Affiliation: Surgical Oncology Department, Mansoura University Cancer Center, Mansoura, Egypt.

ABSTRACT

Introduction: Pancreatic carcinoma affecting the uncinate process is a challenging surgical condition. Several considerations affect the management plan, including the need for vascular resection and the ability to achieve a clear margin.

Methods: The data of 19 patients who had curative resection for pancreatic adenocarcinoma of the uncinate process were reviewed. Operative mortality and morbidity, and disease-free survival (DFS) were calculated.

Results: The study population included 13 male and 6 female patients with a mean age of 55 years. Nine patients (47.4%) had stage I disease, seven patients (36.8%) had stage II disease, and three patients (15.8%) had stage III disease. A total of 12 patients had Whipple procedure and 7 patients had total pancreatectomy. In total, there were 9 R0 and 10 R1 resections. Operative mortality rate was 10.5% (2/19), postoperative leakage rate was 21.1% (4/19), and wound sepsis rate was 21.1%. Median DFS was 19.2 months. Survival was superior in the Whipple procedure group than in the total pancreatectomy group (median survival 19 months vs 4 months, respectively). Vascular resection and retroperitoneal safety margin status did not affect disease relapse.

Conclusion: Non-metastatic pancreatic adenocarcinoma of the uncinate process should be offered R0 or R1 resection whenever technically feasible.

No MeSH data available.


Related in: MedlinePlus