The Experts below are selected from a list of 327 Experts worldwide ranked by ideXlab platform
Ho Kyoung Hwang - One of the best experts on this subject based on the ideXlab platform.
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two cases of portal annular Pancreas
The Korean Journal of Gastroenterology, 2012Co-Authors: Ji Young Jang, Young Eun Chung, Chang Moo Kang, Sung Hoon Choi, Ho Kyoung HwangAbstract:Portal annular Pancreas is one of the pancreatic fusion anomalies in which the uncinate process of the Pancreas extends to fuse with the dorsal Pancreas by encircling the portal vein or superior mesenteric vein. We report two consecutive patients with portal annular Pancreas. The first case is a 71-year-old male patient who underwent a pancreaticoduodenectomy for intraductal papillary mucinous neoplasm in the Head of Pancreas. His preoperative computed tomography scan showed the suprasplenic type portal annular Pancreas. The second case is a 74-year-old female patient who underwent a laparoscopic anterior radical antegrade modular pancreatosplenectomy (RAMPS) for pancreatic body cancer. In operative finding, portal confluence (superior mesenteric vein-splenic vein-portal vein) was encased with the uncinate process of Pancreas in both cases. Therefore, they required pancreatic division at the pancreatic neck portion twice. During the postoperative period, grade B and A, respectively, postoperative pancreatic fistulas occurred and were controlled by conservative management. Surgeons need to know about this rare pancreatic condition prior to surgical intervention to avoid complications, and to provide patients with well-designed, case-specific pancreatic surgery. (Korean J Gastroenterol 2012;60:52-55)
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comparison of efficacy of enucleation and pancreaticoduodenectomy for small 3 cm branch duct type intraductal papillary mucinous neoplasm located at the Head of Pancreas and the uncinate process
Yonsei Medical Journal, 2012Co-Authors: Ho Kyoung Hwang, Joon Seong Park, Changmin Park, Dong Sup YoonAbstract:PURPOSE: Accurate indications and the extent of surgery for branch duct intraductal papillary mucinous neoplasm (IPMN) of the Pancreas are still debatable. In particular, small tumor is located at the Head portion of Pancreas presents a dilemma. The purpose of this study is to compare the efficacy of enucleation (EN) with that of pancreaticoduodenectomy (PD) in patients with small (2 cm
David P Berry - One of the best experts on this subject based on the ideXlab platform.
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tumour characteristics predictive of survival following resection for ductal adenocarcinoma of the Head of Pancreas
Ejso, 2007Co-Authors: G Garcea, A R Dennison, C J Pattenden, C P Neal, C D Sutton, C D Mann, David P BerryAbstract:Abstract Aims We have maintained a highly conservative policy in selecting patients with carcinoma of the Head of Pancreas for resection. This has been based on tumour size, evidence of lymph node involvement or local invasion outside of the gland at laparotomy, laparoscopy or CT imaging. This study investigated our survival rates following pancreatic resection and examined clinicopathological predictors of survival. Methods Sixty-two consecutive patients undergoing pancreatic resections for malignancy were identified from 1999 onwards. Thirty-three underwent resection for pancreatic ductal adenocarcinoma and were included in our analysis, the remainder included resections for ampullary adenocarcinoma ( n = 20) or other malignancies ( n = 9). Patient, tumour and operative characteristics were analysed to assess predictors of survival following resection (Kaplan–Meier survival curves). Results Median survival following resection for ductal pancreatic adenocarcinoma was 54 months (ampullary adenocarcinomas achieved a median survival of 62 months) and thirty-day mortality was 2.7% ( n = 1). Survival was not associated with any demographic or intraoperative factors, such as blood loss, operative duration or anaesthetic technique. Survival curves were significantly worse when perineural or vascular invasion was evident histologically ( p = 0.023 and 0.0023 respectively). Patients with positive lymph nodes had a significantly shorter survival ( p = 0.0030) especially when lymph node status was expressed as a percentage of total lymph node yield. If more than 20% of retrieved lymph nodes were positive for tumour, this was a clear predictor of survival ( p p = 0.0291). Conclusion Despite the advances made in the management of pancreatic cancer, tumour biology still dictates long-term survival. A highly selective surgical approach to the management of these patients results in good long-term survival.
Philippe Ruszniewski - One of the best experts on this subject based on the ideXlab platform.
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long term outcome of biliary and duodenal stents in palliative treatment of patients with unresectable adenocarcinoma of the Head of Pancreas
The American Journal of Gastroenterology, 2006Co-Authors: Frederique Maire, Pascal Hammel, P Ponsot, Alain Aubert, Dermot Otoole, Olivia Hentic, Philippe Levy, Philippe RuszniewskiAbstract:Long-term Outcome of Biliary and Duodenal Stents in Palliative Treatment of Patients with Unresectable Adenocarcinoma of the Head of Pancreas
G Garcea - One of the best experts on this subject based on the ideXlab platform.
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tumour characteristics predictive of survival following resection for ductal adenocarcinoma of the Head of Pancreas
Ejso, 2007Co-Authors: G Garcea, A R Dennison, C J Pattenden, C P Neal, C D Sutton, C D Mann, David P BerryAbstract:Abstract Aims We have maintained a highly conservative policy in selecting patients with carcinoma of the Head of Pancreas for resection. This has been based on tumour size, evidence of lymph node involvement or local invasion outside of the gland at laparotomy, laparoscopy or CT imaging. This study investigated our survival rates following pancreatic resection and examined clinicopathological predictors of survival. Methods Sixty-two consecutive patients undergoing pancreatic resections for malignancy were identified from 1999 onwards. Thirty-three underwent resection for pancreatic ductal adenocarcinoma and were included in our analysis, the remainder included resections for ampullary adenocarcinoma ( n = 20) or other malignancies ( n = 9). Patient, tumour and operative characteristics were analysed to assess predictors of survival following resection (Kaplan–Meier survival curves). Results Median survival following resection for ductal pancreatic adenocarcinoma was 54 months (ampullary adenocarcinomas achieved a median survival of 62 months) and thirty-day mortality was 2.7% ( n = 1). Survival was not associated with any demographic or intraoperative factors, such as blood loss, operative duration or anaesthetic technique. Survival curves were significantly worse when perineural or vascular invasion was evident histologically ( p = 0.023 and 0.0023 respectively). Patients with positive lymph nodes had a significantly shorter survival ( p = 0.0030) especially when lymph node status was expressed as a percentage of total lymph node yield. If more than 20% of retrieved lymph nodes were positive for tumour, this was a clear predictor of survival ( p p = 0.0291). Conclusion Despite the advances made in the management of pancreatic cancer, tumour biology still dictates long-term survival. A highly selective surgical approach to the management of these patients results in good long-term survival.
Edgar Benjosef - One of the best experts on this subject based on the ideXlab platform.
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a dosimetric comparison of proton and photon therapy in unresectable cancers of the Head of Pancreas
Medical Physics, 2014Co-Authors: Reid F Thompson, Sonal U Mayekar, H Zhai, S Both, Smith Apisarnthanarax, James M Metz, John P Plastaras, Edgar BenjosefAbstract:Purpose: Uncontrolled local growth is the cause of death in ∼30% of patients with unresectable pancreatic cancers. The addition of standard-dose radiotherapy to gemcitabine has been shown to confer a modest survival benefit in this population. Radiation dose escalation with three-dimensional planning is not feasible, but high-dose intensity-modulated radiation therapy (IMRT) has been shown to improve local control. Still, dose-escalation remains limited by gastrointestinal toxicity. In this study, the authors investigate the potential use of double scattering (DS) and pencil beam scanning (PBS) proton therapy in limiting dose to critical organs at risk. Methods: The authors compared DS, PBS, and IMRT plans in 13 patients with unresectable cancer of the pancreatic Head, paying particular attention to duodenum, small intestine, stomach, liver, kidney, and cord constraints in addition to target volume coverage. All plans were calculated to 5500 cGy in 25 fractions with equivalent constraints and normalized to prescription dose. All statistics were by two-tailed paired t-test. Results: Both DS and PBS decreased stomach, duodenum, and small bowel dose in low-dose regions compared to IMRT (p < 0.01). However, protons yielded increased doses in the mid to high dose regions (e.g., 23.6–53.8 and 34.9–52.4 Gy for duodenum using DS and PBS, respectively; p < 0.05). Protons also increased generalized equivalent uniform dose to duodenum and stomach, however these differences were small (<5% and 10%, respectively; p < 0.01). Doses to other organs-at-risk were within institutional constraints and placed no obvious limitations on treatment planning. Conclusions: Proton therapy does not appear to reduce OAR volumes receiving high dose. Protons are able to reduce the treated volume receiving low-intermediate doses, however the clinical significance of this remains to be determined in future investigations.
