- Email: [email protected]
Analysis of resectability and survival in pancreatic cancer patients with vascular invasion on spiral CT
April 2000
AGAA463
2524
2526
PREVENTION OF INTRA-ABDOMINAL COMPLICATIONS AFTER PANCREATIC RESECTION BY OCTREOTIDE. A PROSPECTIVE, MULTICENTER, RANDOMIZED TRIAL. Philippe Oberlin, Bertrand Sue, Denis Pezet, Pierre-Louis Fagniez, JeanMarie Hay, French Associations for Surg Research, Colombes, France.
ANALYSIS OF RESECTABILITY AND SURVIVAL IN PANCREATIC CANCER PATIENTS WITH VASCULAR INVASION ON SPIRAL CT. Dong II Park, Jong Kyun Lee, Kyu Taek Lee, Poong-Lyul Rhee, Jae Jun Kim, Kwang Cheol Koh, Seung Woon Paik, Jong Chul Rhee, Kyoo Wan Choi, Jae Hoon Eim, Jee-Eun Kim, Jae Geun Hyun, Samsung Med Ctr, Seoul, South Korea. Background: One of the major limitations for curative resection in patients with pancreatic cancer is local tumor extension to the mesenteric vessels. There was no standard guideline for deciding to perform curative resection in these patients. The purposes of our study were (1) to assess the clinical usefulness of contrast enhanced spiral CT for predicting the resectability and survival of pancreatic cancer patients with suspicious vascular invasion and (2) to assess the influence on survival after curative resection of these patients. Methods : Forty cases of the pancreatic cancer patients who were suspected of having involvement of adjacent large vessels and subsequently underwent operation with curative intent were enrolled in this study. Resectability and survival were correlated with CT findings such as length of vessel involvement, degree of encasement, type and number of vessel involved. Patient survival was compared between curative and palliative resection group, and between resected and non-resected group. Results: Of the 40 patients with adenocarcinoma of the pancreas, 14 patients underwent curative resection, and 26 palliative resection. The probability of curative resection was higher in patients with vessel involvement less than 2cm length, compared to those with more than 2cm. However, there was no difference in survival between curative and palliative resection groups. There was no differences in resectability and survival according to the degree of encasement, type and number of vessel involved. There was no difference in survival between curative and palliative resection group, and between resected and non-resected group. Conclusions : A survival benefit was not achieved by curative resection in pancreatic cancer patients with vascular invasion. Threrfore, other palliative non-surgical treatments should be considered as effective tools prior to resection in these patients.
From 1992 to 1997, 230 patients(pts)undergoing pancreatic resection were included in a prospective, randomized trial to determine whether octreotide decreased the rate or the severity of intra-abdominal complications. Sex ratio was 1.3, mean age 56.3(16-81). 177 Pancreatoduodenectomy (PD) and 53 Distal Pancreatectomy (DP) were made for 154 malignant tumors, 36 benign tumors, 30 chronic pancreatitis and 10 other causes. After PD, pancreato-digestive anastomosis was mandatory; after DP, pancreas remnant could either be sutured closed, or anastomosed with a Roux-en-Y loop. Fibrin glue could be used to seal the pancreatic duct or the digestive tract anastomoses. Randomization was done after resection, according to the type of resection, the pathology and the texture of pancreatic parenchyma. In the treatment group (OCT), 100/Lg of octreotide were given subcutaneously immediately after randomization and every 8 hours for 10 days. The control group (CTL)had no placebo. The main endpoint was the number of pts with one or more of the following complications: pancreatic, biliary or digestive fistula, collection, acute pancreatitis, intra-abdominal or digestive tract hemorrhage. Severity of the complications was evaluated by the rate of re-operation or percutaneous drainage for collections, mortality rate, length of hospital stay. 122 pts were allotted to OCT group and 108 to CTL group. Both groups were comparable regarding pts demographics, except for more frequent use of fibrin glue in OCT group (p
2525 ARGON PLASMA COAGULATION (APC) : AN EFFECTIVE ENDOSCOPIC TREATMENT OF BLEEDING GASTRIC ANTRAL VASCULAR ECTASIA (GAVE). Frederic Oberti, Vincent Croquet, Mehdi Kaassis, Eric Vuillemin, Mene Zua, Paul Cales, Jean Boyer, Hosp, Angers, France; Univ Hosp, Angers, France. INTRODUCTION: Gastric antral vascular ectasia (GAVE) are frequently responsable for iron deficiency anemia secondary to chronic occult gastrointestinal blood loss, particurlaly in cirrhotic patients. Several endoscopic treatments has been reported (laser Nd YAG, heater probe..) but with unproven efficacy and sometimes severe complications, mainly in case of diffuse endoscopic GAVE. APC treatment could be useful for bleeding GAVE treatment. AIM: we report the efficacy and tolerance of APC for treatment in patients with hemorrhagic GAVE METHODS: From 01/97 to 07/99, all the referred patients with severe iron deficiency anemia in our unit were investigated. GAVE was thought to be causative factor in patients with negative laboratory investigations. GAVE was affirmed on the basis of clinical history, endoscopic appearance and histology. Endoscopic treatment was performed using APC (ERBE probe, argon gaz flow llImin, power: 40 watts). Endoscopic treatment sessions were repeated based on hemoglobin level and blood transfusions requirements. RESULTS: 13 patients (7 men, 6 women), with average age to 68 ± 14 years, underwent APe treatment. Eight patients had cirrhosis. All patients had chronic deficiency anemia (mean level of Hb = 6.9± 1.6 g/dl) and 11/13 patients had blood transfusions (mean = 1.3 unit/month, range: 0.2-21). 6 patients received iron replacement before endoscopic treatment. Diffuse endoscopic appearance of GAVE was noted in 9 patients, and water-melon stomach in 4 patients. Twenty five endoscopic sessions were performed (mean/patient: 2±0.9). There was no severe complication. The mean follow-up period post APC therapy was 17±9.5 month. Mean hemoglobin level post APe therapy (l0.3±2.2 g/dl) was significantly higher than mean initial hemoglobin level (p=0.OO4). The frequency of anemia reccurence was higher in water-melon patterns than in endoscopic diffus patterns (respectively 50% vs 22%, p=0.OO7). Total units requirements were significantly decreased after APC therapy (157 vs 21 units, p=O.OO4). In 7 of 11 initially transfused patients, bleeding stopped definitively and no further transfusions were required in follow-up period. Post-treatment rebleeding occured in 4 patients but blood transfusions requirements partially decreased in at least 75% in 3 patients. Only one death occured due to uncontrolled diffuse bleeding. CONCLUSIONS : This study shows that endoscopic APe is an easy, well tolerated, safe and effective treatment for bleeding GAVE.
2527 THE VIRTUAL ESOPHAGUS - PHASE II. James Neville Pasley, James A. Sumpter, Cesar M. Compadre, Phillip R. Breen, Muriel D. Ross, Univ of Arkansas for Med Sci, Little Rock, AR; Uams, Little Rock, AR; NASA Ames Ctr for Bioinformatics, Moffett Field, CA. INTRODUCTION: Swallowing disorders affect an estimated 12 to 15 million Americans and may lead to nutritional problems, depression and an impaired quality of life. Phase I of our study produced a virtual reality simulation of esophageal motility based on a 3-D reconstuction of the Visible Male dataset. In this study (phase II) we continued development of the esophageal simulation. The virtual reality simulation now incorporates a reconstruction utilizing patient CT data and the passage of a bolus under various pathophysiological conditions. METHODS: A 3-D reconstruction of an esophagus from high resolution patient CT data was performed with the NASA Ames Bioinformatics Center Mesher software. Computer-aided engineering techniques were used to define the relaxation/contraction characteristics of the esophagus in response to ingested homogeneous boluses. RESULTS: An enhanced computer simulation of an anatomically accurate model of esophageal motility that allows for more complete visualization of biomechanical function will be presented. Application of realistic forces, such as the acceleration due to gravity and peristaltic contractions, to both the bolus and the esophagus allow simulation of swallowing in the upright vs. supine positions. The simulation provides for the study of normal swallowing and dysphagic conditions. CONCLUSIONS: The interactive 3-D simulation can serve as a research tool in the study of various pathophysiologic states of esophageal function and bolus transit. In addition, "the virtual esophagus" can be used as an educational tool for the training of students, residents and for the enhancement of patient education regarding specific types of esophageal dysphagia. This research was supported by NASA and the Arkansas Space Grant Consortium.
AGAA463
2524
2526
PREVENTION OF INTRA-ABDOMINAL COMPLICATIONS AFTER PANCREATIC RESECTION BY OCTREOTIDE. A PROSPECTIVE, MULTICENTER, RANDOMIZED TRIAL. Philippe Oberlin, Bertrand Sue, Denis Pezet, Pierre-Louis Fagniez, JeanMarie Hay, French Associations for Surg Research, Colombes, France.
ANALYSIS OF RESECTABILITY AND SURVIVAL IN PANCREATIC CANCER PATIENTS WITH VASCULAR INVASION ON SPIRAL CT. Dong II Park, Jong Kyun Lee, Kyu Taek Lee, Poong-Lyul Rhee, Jae Jun Kim, Kwang Cheol Koh, Seung Woon Paik, Jong Chul Rhee, Kyoo Wan Choi, Jae Hoon Eim, Jee-Eun Kim, Jae Geun Hyun, Samsung Med Ctr, Seoul, South Korea. Background: One of the major limitations for curative resection in patients with pancreatic cancer is local tumor extension to the mesenteric vessels. There was no standard guideline for deciding to perform curative resection in these patients. The purposes of our study were (1) to assess the clinical usefulness of contrast enhanced spiral CT for predicting the resectability and survival of pancreatic cancer patients with suspicious vascular invasion and (2) to assess the influence on survival after curative resection of these patients. Methods : Forty cases of the pancreatic cancer patients who were suspected of having involvement of adjacent large vessels and subsequently underwent operation with curative intent were enrolled in this study. Resectability and survival were correlated with CT findings such as length of vessel involvement, degree of encasement, type and number of vessel involved. Patient survival was compared between curative and palliative resection group, and between resected and non-resected group. Results: Of the 40 patients with adenocarcinoma of the pancreas, 14 patients underwent curative resection, and 26 palliative resection. The probability of curative resection was higher in patients with vessel involvement less than 2cm length, compared to those with more than 2cm. However, there was no difference in survival between curative and palliative resection groups. There was no differences in resectability and survival according to the degree of encasement, type and number of vessel involved. There was no difference in survival between curative and palliative resection group, and between resected and non-resected group. Conclusions : A survival benefit was not achieved by curative resection in pancreatic cancer patients with vascular invasion. Threrfore, other palliative non-surgical treatments should be considered as effective tools prior to resection in these patients.
From 1992 to 1997, 230 patients(pts)undergoing pancreatic resection were included in a prospective, randomized trial to determine whether octreotide decreased the rate or the severity of intra-abdominal complications. Sex ratio was 1.3, mean age 56.3(16-81). 177 Pancreatoduodenectomy (PD) and 53 Distal Pancreatectomy (DP) were made for 154 malignant tumors, 36 benign tumors, 30 chronic pancreatitis and 10 other causes. After PD, pancreato-digestive anastomosis was mandatory; after DP, pancreas remnant could either be sutured closed, or anastomosed with a Roux-en-Y loop. Fibrin glue could be used to seal the pancreatic duct or the digestive tract anastomoses. Randomization was done after resection, according to the type of resection, the pathology and the texture of pancreatic parenchyma. In the treatment group (OCT), 100/Lg of octreotide were given subcutaneously immediately after randomization and every 8 hours for 10 days. The control group (CTL)had no placebo. The main endpoint was the number of pts with one or more of the following complications: pancreatic, biliary or digestive fistula, collection, acute pancreatitis, intra-abdominal or digestive tract hemorrhage. Severity of the complications was evaluated by the rate of re-operation or percutaneous drainage for collections, mortality rate, length of hospital stay. 122 pts were allotted to OCT group and 108 to CTL group. Both groups were comparable regarding pts demographics, except for more frequent use of fibrin glue in OCT group (p
2525 ARGON PLASMA COAGULATION (APC) : AN EFFECTIVE ENDOSCOPIC TREATMENT OF BLEEDING GASTRIC ANTRAL VASCULAR ECTASIA (GAVE). Frederic Oberti, Vincent Croquet, Mehdi Kaassis, Eric Vuillemin, Mene Zua, Paul Cales, Jean Boyer, Hosp, Angers, France; Univ Hosp, Angers, France. INTRODUCTION: Gastric antral vascular ectasia (GAVE) are frequently responsable for iron deficiency anemia secondary to chronic occult gastrointestinal blood loss, particurlaly in cirrhotic patients. Several endoscopic treatments has been reported (laser Nd YAG, heater probe..) but with unproven efficacy and sometimes severe complications, mainly in case of diffuse endoscopic GAVE. APC treatment could be useful for bleeding GAVE treatment. AIM: we report the efficacy and tolerance of APC for treatment in patients with hemorrhagic GAVE METHODS: From 01/97 to 07/99, all the referred patients with severe iron deficiency anemia in our unit were investigated. GAVE was thought to be causative factor in patients with negative laboratory investigations. GAVE was affirmed on the basis of clinical history, endoscopic appearance and histology. Endoscopic treatment was performed using APC (ERBE probe, argon gaz flow llImin, power: 40 watts). Endoscopic treatment sessions were repeated based on hemoglobin level and blood transfusions requirements. RESULTS: 13 patients (7 men, 6 women), with average age to 68 ± 14 years, underwent APe treatment. Eight patients had cirrhosis. All patients had chronic deficiency anemia (mean level of Hb = 6.9± 1.6 g/dl) and 11/13 patients had blood transfusions (mean = 1.3 unit/month, range: 0.2-21). 6 patients received iron replacement before endoscopic treatment. Diffuse endoscopic appearance of GAVE was noted in 9 patients, and water-melon stomach in 4 patients. Twenty five endoscopic sessions were performed (mean/patient: 2±0.9). There was no severe complication. The mean follow-up period post APC therapy was 17±9.5 month. Mean hemoglobin level post APe therapy (l0.3±2.2 g/dl) was significantly higher than mean initial hemoglobin level (p=0.OO4). The frequency of anemia reccurence was higher in water-melon patterns than in endoscopic diffus patterns (respectively 50% vs 22%, p=0.OO7). Total units requirements were significantly decreased after APC therapy (157 vs 21 units, p=O.OO4). In 7 of 11 initially transfused patients, bleeding stopped definitively and no further transfusions were required in follow-up period. Post-treatment rebleeding occured in 4 patients but blood transfusions requirements partially decreased in at least 75% in 3 patients. Only one death occured due to uncontrolled diffuse bleeding. CONCLUSIONS : This study shows that endoscopic APe is an easy, well tolerated, safe and effective treatment for bleeding GAVE.
2527 THE VIRTUAL ESOPHAGUS - PHASE II. James Neville Pasley, James A. Sumpter, Cesar M. Compadre, Phillip R. Breen, Muriel D. Ross, Univ of Arkansas for Med Sci, Little Rock, AR; Uams, Little Rock, AR; NASA Ames Ctr for Bioinformatics, Moffett Field, CA. INTRODUCTION: Swallowing disorders affect an estimated 12 to 15 million Americans and may lead to nutritional problems, depression and an impaired quality of life. Phase I of our study produced a virtual reality simulation of esophageal motility based on a 3-D reconstuction of the Visible Male dataset. In this study (phase II) we continued development of the esophageal simulation. The virtual reality simulation now incorporates a reconstruction utilizing patient CT data and the passage of a bolus under various pathophysiological conditions. METHODS: A 3-D reconstruction of an esophagus from high resolution patient CT data was performed with the NASA Ames Bioinformatics Center Mesher software. Computer-aided engineering techniques were used to define the relaxation/contraction characteristics of the esophagus in response to ingested homogeneous boluses. RESULTS: An enhanced computer simulation of an anatomically accurate model of esophageal motility that allows for more complete visualization of biomechanical function will be presented. Application of realistic forces, such as the acceleration due to gravity and peristaltic contractions, to both the bolus and the esophagus allow simulation of swallowing in the upright vs. supine positions. The simulation provides for the study of normal swallowing and dysphagic conditions. CONCLUSIONS: The interactive 3-D simulation can serve as a research tool in the study of various pathophysiologic states of esophageal function and bolus transit. In addition, "the virtual esophagus" can be used as an educational tool for the training of students, residents and for the enhancement of patient education regarding specific types of esophageal dysphagia. This research was supported by NASA and the Arkansas Space Grant Consortium.