Months

Halki Diabetes Remedy

Most Effective Diabetes Treatment

Get Instant Access

Figure 5-21 The retroperitoneal dissection component of the extended lymphadenectomy. The retroperitoneum is dissected from the hilum of the right kidney (K) to the left lateral border of the aorta (Ao) in the horizontal axis, to expose the left renal vein. In the vertical axis, the dissection extends from the level of the portal vein to below the level of the third portion of the duodenum (level of the inferior mesenteric artery [IMA] origin). Here the gastric staple line and pancreatic remnant (P) are being retracted toward the upper right. The inferior vena cava (IVC) and aorta are fully exposed, and the right gonadal vein has been preserved. A curved vascular clamp gently occludes the inferior aspect of the bile duct. The retroperitoneal fat and lymph nodes are being resected en bloc (bottomright). (From Yeo, C.J., Cameron J.L., Sohn, T.A., etal: Pancreaticoduodenectomy with or without extended retroperitoneal lymphadenectomy for periampullary adenocarcinoma: Comparison of morbidity, mortality and short-term outcome. Ann. Surg., 229:613, 1999, with permission.)

Portal v.

resected en bloc

Figure 5-22 The actuarial survival curves for all patients who survived the immediate postoperative period, comparing the standard resection (n = 53) and the radical resection (n = 56) groups. The 1- and 2-year survival rates were 77 and 47% for the standard group, respectively, compared with 83 and 56% for the radical group (P = .6, NS). (From Yeo, C.J., Cameron, J.L., Sohn, T.A., etal.: Pancreaticoduodenectomy with or without extended retroperitoneal lymphadenectomy for periampullary adenocarcinoma: Comparison of morbidity, mortality and short-term outcome. Ann. Surg., 229:613, 1999, with permission.)

Figure 5-23 Actuarial survival curves comparing patients 80 years of age or older undergoing pancreaticoduodenectomy for periampullary adenocarcinoma (n = 41; median survival, 32 months; 5-year survival, 19%) to those younger than 80 years (n = 454; median survival, 20 months; 5-year survival 27% P = 0.77). (From Sohn, T.A., Yeo, C.J., Cameron, J.L., et al.: Should pancreaticoduodenectomy be performed in octogenarians? J. Gastrointest. Surg., 2:207, 1998, with permission.)

Figure 5-24 Near the completion of a distal pancreatectomy and splenectomy for a tumor in the body of the pancreas. The spleen and tail of the pancreas have been mobilized out of the retro peritoneum. The pancreatic parenchyma is being divided with the electrocautery. (From Cameron, J.L.: Atlas of Surgery, vol. 1. Toronto, B.C. Decker, 1990, p. 27, with permission.)

Figure 5-25 The actuarial survival curves for patients undergoing pancreaticoduodenectomy comparing patients receiving adjuvant therapy (n = 120) to those declining adjuvant therapy (n = 53; P = .003). (From Yeo, C.J., Abrams, R.A., Grochow, L.B., et al.: Pancreaticoduodenectomy for pancreatic adenocarcinoma: Postoperative adjuvant chemoradiation improves survival. A prospective, single institution experience. Ann. Surg., 225:621, 1997, with permission).

References

1. Landis, S.H., Murray, T., Bolden, S., et al.: Cancer statistics, 1999. CA Cancer J. Clin., 49:8, 1999.

2. Gold, E.B., and Goldin, S.B.: Epidemiology of and risk factors for pancreatic cancer. Surg. Oncol. Clin. North Am., 7:67, 1998.

3. Miller, B.A., Silverman, D.T., and Kaplan, R.: Pancreas. In Miller, B.A., Ries, L.A.G., and Hankey, B.F., et al. (eds.): SEER Cancer Statistics Review: 1973-1990. Bethesda, National Cancer Institute, 1993, p. XX1.1.

4. Lowenfels, A.B., Maissoneuve, P., and Boyle, P.: Epidemiology of pancreatic cancer. In Howard, J.M., Idezuki, Y., Ihse, I., and Prinz, R.A. (eds.): Surgical Diseases of the Pancreas, 3rd ed. Baltimore, Williams & Wilkins, 1998, p. 433.

5. Parkin, D.M., Muir, C.S., Whelan, S.L., et al. (eds.): Cancer Incidence in Five Continents. Lyons, France, International Agency for Research on Cancer, 1992, p. 1.

6. Hruban, R.H., Peterson, G.M., Ha, P.K., and Kern, S.E.: Genetics of pancreatic cancer: From genes to families. Surg. Oncol. Clin. North Am., 7:1, 1998.

7. Lowenfels, A.B., Maisonneuve, P., Cavallini, G., et al.: Pancreatitis and the risk of pancreatic cancer: International Pancreatitis Study Group. N. Engl. J. Med., 328:1433, 1993.

8. Bansal, P., and Sonnenberg, A.: Pancreatitis is a risk factor for pancreatic cancer. Gastroenterology, 109:247, 1995.

9. Fernandez, E., LaVecchia, C., Porta, M., et al.: Pancreatitis and the risk of pancreatic cancer. Pancreas, 11:185, 1995.

10. Karlson, B.M., Ekbom, A., Josefsson, S., et al.: The risk of pancreatic cancer following pancreatitis: An association due to confounding? Gastroenterology, 113:587, 1997.

11. Chow, H-W., Gridley, G., Nyren, O., et al.: Risk of pancreatic cancer following diabetes mellitus: A nationwide cohort study in Sweden. J. Natl. Cancer Inst., 87:930, 1995.

12. LaVecchia, C., Negri, E., D'Avanzo, B., et al.: Medical history, diet and pancreatic cancer. Oncology, 47:463, 1990.

13. Everhart, J., and Wright, D.: Diabetes mellitus as a risk factor for pancreatic cancer: A meta-analysis. JAMA, 273:1605, 1995.

14. Whittemore, A.S., Paffenbarger, R.S., Jr., Anderson, K., et al.: Early precursors of pancreatic cancer in college men. J. Chronic Dis., 36:251, 1983.

15. Neglia, J.P., Fitzsimmons, S.C., Maisonneuve, P., et al.: The risk of cancer among patients with cystic fibrosis. N. Engl. J. Med., 332:494, 1995.

16. Ji, B-T., Hatch, MC., Chow, H-W., et al.: Anthropometric and reproductive factors and the risk of pancreatic cancer: A case-control study in Shanghai, China. Int. J. Cancer., 66:432, 1996.

17. Mills, P.K., Beeson, W.L., Abbey, D.E., et al.: Dietary habits and past medical history as related to fatal pancreas cancer risk among Adventists. Cancer, 61:2578, 1988.

18. Gold, EB: Epidemiology of and risk factors for pancreatic cancer. Surg. Clin. North Am., 75:819, 1995.

19. Howe, G.R., and Burch, J.D.: Nutrition and pancreatic cancer. Cancer Causes Control, 7:69, 1996.

20. MacMahon, B., Yen, S., Trichopoulos, D., et al.: Coffee and cancer of the pancreas. N. Engl. J. Med., 304:630, 1981.

21. Hseih, C-C., MacMahon, B., Yen, S., et al.: Coffee and pancreatic cancer (chapter 2). N. Engl. J. Med., 315:587, 1986.

22. Angevine, D.M., and Jablon, S.: Late radiation effects of neoplasia and other diseases in Japan. Ann. N. Y. Acad. Sci., 114:823, 1964.

23. Thompson, D.E., Mabuchi, K., Ron, E., et al.: Cancer incidence in atomic bomb survivors. Part II: Solid tumors, 1958-1987. Radiat. Res., 137:S17, 1994.

24. Cubilla, A.L., and Fitzgerald, P.J.: Cancer of the pancreas (nonendocrine): A suggested morphological classification. Semin. Oncol., 6:285, 1979.

Was this article helpful?

0 0
Supplements For Diabetics

Supplements For Diabetics

All you need is a proper diet of fresh fruits and vegetables and get plenty of exercise and you'll be fine. Ever heard those words from your doctor? If that's all heshe recommends then you're missing out an important ingredient for health that he's not telling you. Fact is that you can adhere to the strictest diet, watch everything you eat and get the exercise of amarathon runner and still come down with diabetic complications. Diet, exercise and standard drug treatments simply aren't enough to help keep your diabetes under control.

Get My Free Ebook


Post a comment