Abstract:
OBJECTIVE:The study was conducted to determine whether the performance of an extended lymphadenectomy and retroperitoneal soft-tissue clearance in association with a pancreatoduodenal resection improves the long-term survival of patients with a potentially curable adenocarcinoma of the head of the pancreas. SUMMARY BACKGROUND DATA:The usefulness of performing an extended lymphadenectomy and retroperitoneal soft-tissue clearance in conjunction with a pancreatoduodenal resection in the treatment of ductal adenocarcinoma of the head of the pancreas is still unknown. Published studies suggest a benefit for the procedure in terms of better long-term survival rates; however, these studies were retrospective or did not prospectively evaluate large series of patients. MATERIALS AND METHODS:Eighty-one patients undergoing a pancreatoduodenal resection for a potentially curable ductal adenocarcinoma of the head of the pancreas were randomized to a standard (n = 40) or extended (n = 41) lymphadenectomy and retroperitoneal soft-tissue clearance in a prospective, multicentric study. The standard lymphadenectomy included removal of the anterior and posterior pancreatoduodenal, pyloric, and biliary duct, superior and inferior pancreatic head, and body lymph node stations. In addition to the above, the extended lymphadenectomy included removal of lymph nodes from the hepatic hilum and along the aorta from the diaphragmatic hiatus to the inferior mesenteric artery and laterally to both renal hila, with circumferential clearance of the origin of the celiac trunk and superior mesenteric artery. Patients did not receive any postoperative adjuvant therapy. RESULTS:Demographic (age, gender) and histopathologic (tumor size, stage, differentiation, oncologic clearance) characteristics were similar in the two patient groups. Performance of the extended lymphadenectomy added time to the procedure, although the difference did not reach statistical significance (397 +/- 50 minutes vs. 372 +/- 50 minutes, p > 0.05). Transfusion requirements, postoperative morbidity and mortality rates, and overall survival did not differ between the two groups. When subgroups of patients were analyzed, using an a posteriori analysis that was not planned at the time of study design, there was a significantly (p < 0.05) longer survival rate in node positive patients after an extended rather than a standard lymphadenectomy. The survival curve of node positive patients after an extended lymphadenectomy could be superimposed onto the curves of node negative patients. Survival curves in node negative patients did not differ according to the magnitude of the lymphadenectomy. Multivariate analysis of all patients showed that long-term survival was affected by tumor differentiation (well vs. moderately vs. poorly differentiated, p > 0.001), diameter (< or = 2.0 cm. vs. > 2.0 cm., p < 0.01), lymph node metastasis (absent vs. present, p < 0.01) and need for 4 or more units of transfused blood (< 4 vs. > or = 4, p <0.01). CONCLUSIONS:The addition of an extended lymphadenectomy and retroperitoneal soft-tissue clearance to a pancreatoduodenal resection does not significantly increase morbidity and mortality rates. Although the overall survival rate does not differ in the two groups, there appears to be a trend toward longer survival in node positive patients treated with an extended rather than a standard lymphadenectomy.
journal_name
Ann Surgjournal_title
Annals of surgeryauthors
Pedrazzoli S,DiCarlo V,Dionigi R,Mosca F,Pederzoli P,Pasquali C,Klöppel G,Dhaene K,Michelassi Fdoi
10.1097/00000658-199810000-00007subject
Has Abstractpub_date
1998-10-01 00:00:00pages
508-17issue
4eissn
0003-4932issn
1528-1140journal_volume
228pub_type
临床试验,杂志文章,多中心研究,随机对照试验abstract:OBJECTIVE:The aim of this study was to obtain feedback from key stakeholders and end users to identify program strengths and weaknesses to plan for wider dissemination and implementation of the Virtual Acute Care for Elders (Virtual ACE) program, a novel intervention that improves outcomes for older surgical patients. ...
journal_title:Annals of surgery
pub_type: 杂志文章
doi:10.1097/SLA.0000000000004433
更新日期:2020-11-16 00:00:00
abstract:OBJECTIVE:To compare clinical outcomes after laparoscopic lavage (LL) or colonic resection (CR) for purulent diverticulitis. BACKGROUND:Laparoscopic lavage has been suggested as an alternative treatment for traditional CR. Comparative studies to date have shown conflicting results. METHODS:Electronic searches of Emba...
journal_title:Annals of surgery
pub_type: 杂志文章,meta分析,评审
doi:10.1097/SLA.0000000000002236
更新日期:2018-02-01 00:00:00
abstract:BACKGROUND:Although a randomized trial demonstrated a survival benefit of cytoreductive surgery (CRS) and intraperitoneal chemotherapy (IPC) over systemic chemotherapy alone, the treatment of peritoneal carcinomatosis from colorectal cancer (CRPC) is still a matter of debate. The aims of this study were to evaluate lon...
journal_title:Annals of surgery
pub_type: 杂志文章
doi:10.1097/SLA.0b013e31827e9289
更新日期:2013-06-01 00:00:00
abstract:OBJECTIVE:To assess surgical aspects in the treatment of children with unilateral Wilms tumor based on data from the Cooperative Tumor Study SIOP 93-01 of the German Society of Pediatric Hematology and Oncology. SUMMARY BACKGROUND DATA:Although multiple international study trials exist for the treatment of nephroblast...
journal_title:Annals of surgery
pub_type: 杂志文章
doi:10.1097/SLA.0b013e31819ed92b
更新日期:2009-04-01 00:00:00
abstract:OBJECTIVE:This study provided an objective survey by an outside auditing group of a large, complete patient population undergoing laparoscopic cholecystectomies, determined the frequency of complications, especially bile duct injuries, and presented a system for classifying and comparing the severity of bile duct injur...
journal_title:Annals of surgery
pub_type: 杂志文章
doi:10.1097/00000658-199411000-00005
更新日期:1994-11-01 00:00:00
abstract:OBJECTIVE:To review standardized Nuss correction of pectus excavatum and vacuum bell treatment over the last 10 years. SUMMARY OF BACKGROUND DATA:In 2010, we reported 21 years of the Nuss procedure in 1215 patients. METHODS:Over the last 10 years, 2008-2018, we evaluated 1885 pectus excavatum patients. Surgery was in...
journal_title:Annals of surgery
pub_type: 杂志文章
doi:10.1097/SLA.0000000000003877
更新日期:2020-03-27 00:00:00
abstract::Repair of the pharynx after extirpation of malignancy may require the introduction of independently vascularized tissue either at the time of resection (primary reconstruction) or later for undesirable sequelae, such as fistula or stenosis. A ten-year retrospective study compares two methods of pharyngeal reconstructi...
journal_title:Annals of surgery
pub_type: 杂志文章
doi:10.1097/00000658-198905000-00007
更新日期:1989-05-01 00:00:00
abstract:OBJECTIVE:To evaluate the efficacy of remote ischemic conditioning (RIC) on organ protection after hemorrhagic shock/resuscitation (S/R) in a murine model. BACKGROUND:Ischemia/reperfusion resulting from S/R contributes to multiple organ dysfunction in trauma patients. We hypothesized that RIC before shock (remote isch...
journal_title:Annals of surgery
pub_type: 杂志文章
doi:10.1097/SLA.0000000000000877
更新日期:2015-06-01 00:00:00
abstract::Three patients with Menetrier's disease and protein-losing gastropathy who were studied during a 12 year period have been presented. The characteristic findings which differentiate them from patients with hypertrophic hypersecretory gastropathy, including the Zollinger-Ellison syndrome, are: 1) hypertrophy of gastric ...
journal_title:Annals of surgery
pub_type: 杂志文章
doi:10.1097/00000658-197505000-00036
更新日期:1975-05-01 00:00:00
abstract:OBJECTIVE:To understand whether racial disparities in surgery for lower-extremity arterial disease are minimized by high-quality providers, or instead, differential treatment of otherwise similar patients pervades all settings. SUMMARY BACKGROUND DATA:Black patients are substantially more likely than whites to undergo...
journal_title:Annals of surgery
pub_type: 杂志文章
doi:10.1097/SLA.0b013e3181b41d53
更新日期:2009-09-01 00:00:00
abstract::Low mortality rates for elective surgical treatment of abdominal aortic aneurysms justify an aggressive approach in most patients. However, in high-risk patients with small aneurysms and no symptoms, the decision to operate remains a delicate balance of risk and benefit. Our observations include 99 high-risk patients ...
journal_title:Annals of surgery
pub_type: 杂志文章
doi:10.1097/00000658-198409000-00003
更新日期:1984-09-01 00:00:00
abstract:OBJECTIVE:"Rediscovered" in 1976, transhiatal esophagectomy (THE) has been applicable in most situations requiring esophageal resection and reconstruction. The objective of this study was to review the authors' 30-year experience with THE and changing trends in its use. METHODS:Using the authors' prospective Esophagec...
journal_title:Annals of surgery
pub_type: 杂志文章
doi:10.1097/SLA.0b013e31814697f2
更新日期:2007-09-01 00:00:00
abstract:OBJECTIVE:To determine the cost-effectiveness of enhanced recovery pathways (ERPs) versus conventional care for patients undergoing elective colorectal surgery. BACKGROUND:ERPs for colorectal surgery are clinically effective, but their cost-effectiveness is unknown. METHODS:A multi-institutional prospective cohort co...
journal_title:Annals of surgery
pub_type: 临床试验,杂志文章,多中心研究
doi:10.1097/SLA.0000000000001019
更新日期:2015-12-01 00:00:00
abstract::Cadaver kidneys remain a scarce resource, yet single pediatric donor kidneys are underutilized at some centers. Between 1967 and 1984, 133 single pediatric and 318 adult donor cadaver transplants were performed. Patient and graft survival, renal function, and complications in adult recipients grouped by donor age were...
journal_title:Annals of surgery
pub_type: 杂志文章
doi:10.1097/00000658-198608000-00011
更新日期:1986-08-01 00:00:00
abstract::Hemodynamic and metabolic consequences of a 90-minute period of liver ischemia followed by 120 minutes of reperfusion were studied in rats that were awake during most of the experiment and in rats anesthetized with either pentobarbital (40 mg/kg body weight) or chloralose (30 mg/kg X hour) during the complete length o...
journal_title:Annals of surgery
pub_type: 杂志文章
doi:10.1097/00000658-199007000-00004
更新日期:1990-07-01 00:00:00
abstract::Chronic idiopathic intestinal pseudo-obstruction is an increasingly recognized syndrome in which patients usually present with an acute or chronic history suggestive of intestinal obstruction, although no obstructing lesion is found at surgery. The diagnosis can be suspected in most cases from the clinical presentatio...
journal_title:Annals of surgery
pub_type: 杂志文章
doi:10.1097/00000658-198012000-00011
更新日期:1980-12-01 00:00:00
abstract:OBJECTIVE:Results of the first prospective randomized clinical trial comparing partial and total portacaval shunt for variceal hemorrhage are reported. SUMMARY BACKGROUND DATA:Total portacaval shunts produce subnormal portal pressures, completely diverting hepatic portal flow. Partial shunts maintain higher pressures ...
journal_title:Annals of surgery
pub_type: 临床试验,杂志文章,随机对照试验
doi:10.1097/00000658-199404000-00005
更新日期:1994-04-01 00:00:00
abstract::A prospective, randomized, blinded study was performed to determine whether prophylactic antibiotics would reduce the incidence of infection in peripheral vascular surgery and whether the route of antibiotic administration was important. Patients undergoing a vascular procedure with a groin incision were allocated to ...
journal_title:Annals of surgery
pub_type: 临床试验,杂志文章,随机对照试验
doi:10.1097/00000658-198009000-00011
更新日期:1980-09-01 00:00:00
abstract:OBJECTIVE:To develop a model of established respiratory immunity against Pseudomonas aeruginosa pneumonia and to investigate the effects of route and type of nutrition on this immunity. SUMMARY BACKGROUND DATA:Diet influences the ability of gut-associated lymphoid tissue (GALT) to maintain mucosal immunity. Complex en...
journal_title:Annals of surgery
pub_type: 杂志文章
doi:10.1097/00000658-199902000-00016
更新日期:1999-02-01 00:00:00
abstract::Thirteen patients with lymphoma of the breast are presented. In addition, 163 previously reported cases of lymphoma of the breast are reviewed. Complete staging was performed on all patients. No patient had a diagnosis of lymphoma prior to breast biopsy. The histologic findings were diffuse histiocytic lymphoma (DHL) ...
journal_title:Annals of surgery
pub_type: 杂志文章
doi:10.1097/00000658-198112000-00015
更新日期:1981-12-01 00:00:00
abstract:OBJECTIVE:To follow up in prospective fashion patients with coronary artery anastomoses completed endoscopically with robotic assistance. The robotic system was evaluated for safety and its effectiveness in completing microsurgical coronary anastomoses. SUMMARY BACKGROUND DATA:Recently there has been an interest in us...
journal_title:Annals of surgery
pub_type: 临床试验,杂志文章
doi:10.1097/00000658-200106000-00001
更新日期:2001-06-01 00:00:00
abstract:OBJECTIVE:Metabolic activity of transformed human liver (Hep G2) cells and primary rat hepatocytes were compared during in vitro application of a gel entrapment bioartificial liver. BACKGROUND:Clinical trials of bioartificial liver devices containing either transformed liver cells or primary hepatocytes have been init...
journal_title:Annals of surgery
pub_type: 杂志文章
doi:
更新日期:1994-07-01 00:00:00
abstract:OBJECTIVE:To assess the immediate and long-term clinical results of 2 different surgical procedures for the treatment of asymmetrical multinodular goiter (AMG). BACKGROUND:Half of the patients presenting with a single benign thyroid nodule have contralateral subclinical disease. There is a controversy whether these pa...
journal_title:Annals of surgery
pub_type: 杂志文章,多中心研究,随机对照试验
doi:10.1097/SLA.0b013e318272df62
更新日期:2012-11-01 00:00:00
abstract:OBJECTIVE:We have previously demonstrated that P. aeruginosa can have profound effects on the intestinal epithelial barrier via one of its virulence factors, the PA-I lectin/adhesin. The aims of the present study were to further characterize the interaction of P. aeruginosa and the intestinal epithelium using both in v...
journal_title:Annals of surgery
pub_type: 杂志文章
doi:10.1097/01.sla.0000094551.88143.f8
更新日期:2003-11-01 00:00:00
abstract:OBJECTIVE:To analyze the impact of a conservative strategy of management in patients with necrotizing pancreatitis, reserving intervention for patients with documented infection or the late complications of organized necrosis. SUMMARY BACKGROUND DATA:The role of surgery in patients with sterile pancreatic necrosis rem...
journal_title:Annals of surgery
pub_type: 杂志文章
doi:10.1097/00000658-200110000-00016
更新日期:2001-10-01 00:00:00
abstract:OBJECTIVE:The goal of this scoping review was to summarize the literature on facilitators and barriers to surgical practice change. This information can inform research to implement best practices and evaluate new surgical innovations. BACKGROUND:In an era of accelerated innovations, surgeons face the difficult decisi...
journal_title:Annals of surgery
pub_type: 杂志文章
doi:10.1097/SLA.0000000000004355
更新日期:2020-08-26 00:00:00
abstract::Twenty-seven patients with postoperative enterocutaneous fistulas were treated with parenteral nutrition and SMS 201-995 (100 micrograms/8 hours, subcutaneously), a long half-life somatostatin analogue. At the time SMS 201-995 was started, 11 patients had low output fistulas (less than 1000 ml/48 hours), 11 patients h...
journal_title:Annals of surgery
pub_type: 杂志文章
doi:10.1097/00000658-198907000-00009
更新日期:1989-07-01 00:00:00
abstract:OBJECTIVE:The aims of this study were to use a comprehensive whole-mount pathologic analysis to characterize microscopic patterns of residual disease, as well as circumferential and distal resection margins, in rectal cancer treated with preoperative CMT; and to identify clinicopathologic factors associated with residu...
journal_title:Annals of surgery
pub_type: 杂志文章
doi:10.1097/01.sla.0000232540.82364.43
更新日期:2007-01-01 00:00:00
abstract::The effects of pH on the tensile properties of eight commonly used 2-0 suture materials--plain catgut, Dexon, Vicryl, silk, Nurolon, Ethilon, Mersilene, and Prolene--were examined. The pH level ranged from 3.0 to 10.0. In general, absorbable suture materials were more sensitive to pH than non-absorbable suture materia...
journal_title:Annals of surgery
pub_type: 杂志文章
doi:10.1097/00000658-198308000-00019
更新日期:1983-08-01 00:00:00
abstract:OBJECTIVE:To determine whether insulinlike growth factor-I (IGF-I) and hepatocyte growth factor (HGF) cooperate to induce migration and invasion of human colorectal carcinoma (CRC) cells and whether the effects of IGF-I and/or HGF are mediated through activation of the urokinase plasminogen activator (uPA)/uPA receptor...
journal_title:Annals of surgery
pub_type: 杂志文章
doi:10.1097/01.sla.0000160699.59061.92
更新日期:2005-05-01 00:00:00