[Prediction of resectability and of surgical risk in pancreatic carcinoma; conditioning factors of survival after resective intervention]

Pancreatic cancer has been extensively researched in recent years, but overall survival after diagnosis is almost unchanged since the time of Whipple. In the meantime, we have tried to determine the factors influencing surgical risk, resectability and survival. Between 1968 and 1992, 516 patients with pancreatic cancer were monitored; 160 patients with cancer of the body-tail were excluded. Eighty-five of the remaining 356 patients with pancreatic head cancer were resected, while the remainder underwent only palliative procedures. Surgical outcome, in terms of operative mortality or complications, was correctly predicted preoperatively in > 80% of patients. The preoperative evaluation of the resectability of pancreatic cancer has been investigated with different, mainly invasive, procedures. CT scan, associated with angiography and laparoscopy is reported to give better results, with a resectability rate up to 78%. 67% of our patients who were diagnosed as resectable according to CT-scan features and serum CA 19-9 < 200 U/ml, were actually resected; furthermore 40% had a potentially curative resection. Most of our 'curative' resections (80%) were within this group of patients. Multivariate analysis showed only 4 factors influencing long-term survival: TNM stage, diabetes, age > 70 years, tumour grading.

Duodenal leiomyosarcoma and its multiple recurrences: good surgical result after three years of follow-up

Duodenal leiomyosarcoma is a rare tumor and its current prognosis is poor. A case of duodenal leiomyosarcoma is described which recurred five years after the first intestinal resection, and was treated successfully with pancreaticoduodenectomy (PCD), extensive small bowel resection, and transverse, descending and sigmoid colon removal. The patient is still alive three years after this operation. Preservation of the stomach and the first duodenal portion after PCD most likely reduced the malabsorption, which is expected following such radical intestinal resection. This experience suggests an aggressive surgical approach to duodenal leiomyosarcomas, even when metastases are present.

Cystic neoplasms of the pancreas

Seven cases of cystic neoplasms of the pancreas (5 cystadenomata and 2 cystadenocarcinomata) are reported. While cystadenomata were localized in the tail of pancreas, cystadenocarcinomata were localized in the head. Only one case was asymptomatic and evidenced in the course of other type of surgery. Preoperative diagnosis of cystadenoma was assessed only in one case. All benign forms were treated with radical resection. Only palliation was possible for malignant forms. The moderate malignancy of cystic tumors as compared to the more common pancreatic adenocarcinoma is underlined. A more careful intraoperative diagnosis and surgical resection are therefore advocated, whenever possible.