Biomedical subjects

W F Sindelar

Publications and source records attributed to W F Sindelar.

At least 19 recordsLinked to original sources

PubMed1995

Clinical toxicity of peripheral nerve to intraoperative radiotherapy in a canine model.

PURPOSE: The clinical late effects of intraoperative radiotherapy (IORT) on peripheral nerve were investigated in a foxhound model. METHODS AND MATERIALS: Between 1982 and 1987, 40 animals underwent laparotomy with intraoperative radiotherapy of doses from 0-75 Gy administered to the right lumbosacral plexus. Subsequently, all animals were monitored closely and sacrificed to assess clinical effects to peripheral nerve. This analysis reports final clinical results of all animals, with follow-up to 5 years. RESULTS: All animals treated with > or = 25 Gy developed ipsilateral neuropathy. An inverse relationship was noted between intraoperative radiotherapy dose and time to neuropathy, with an effective dose for 50% paralysis (ED50) of 17.2 Gy. One of the animals treated with 15 Gy IORT developed paralysis, after a much longer latency than the other animals. CONCLUSIONS: Doses of 15 Gy delivered intraoperatively may be accompanied by peripheral neuropathy with long-term follow-up. This threshold is less than that reported with shorter follow-up. The value of ED50 determined here is in keeping with data from other animal trials, and from clinical trials in humans.

Animals↗

PubMed1995

Iatrogenic transplantation of osteosarcoma.

We report a case in which a patient having curettage and resection of a presumed benign lesion of the tibia (later recognized as osteosarcoma) had probable iatrogenic transplantation of tumor to the contralateral iliac crest, which had served as a donor site for bone chips used to pack the tibial lesion. The patient later had above-knee amputation for the primary tumor and eventually required contralateral hemipelvectomy when tumor developed in the iliac crest donor site. We discuss the literature of tumor transplantation and seeding in operative settings and stress the clinical importance of avoiding possible tumor contamination of operative fields by meticulous instrument changes and by isolation of multiple surgical fields.

Amputation, Surgical↗

PubMed1995

Evolving strategies for the treatment of adenocarcinoma of the pancreas. A review.

Adenocarcinoma of the pancreas has an incidence of only 0.01%, yet is the fourth leading cause of cancer death for American men and women. Despite this dismal outlook, new strategies for staging and therapy for pancreatic cancer have emerged over the last few years. Laparoscopy with cytologic evaluation of peritoneal washings, and more recently, although still investigational, endoscopic and intracorporeal ultrasonography have provided more detailed staging information. The result of improved staging is earlier, more accurate selection of treatment most appropriate for stage of disease. For those patients with clinically localized disease, laparotomy with an attempt at resection is indicated, particularly with the recent trend in declining morbidity and operative mortality the recent trend in declining morbidity and operative mortality associated with pancreatectomy. With clinically unresectable disease, patients may potentially be spared the morbidity of laparotomy. Advances in therapeutic endoscopic and percutaneous manipulation of the obstructed biliary tree have provided an alternative to surgery and improved quality of life for patients with abbreviated life spans. Gastroduodenal obstruction has traditionally been managed by laparotomy, although with improved technology and surgical skill, a laparoscopic approach may become standard. Because even at presentation pancreatic cancer is rarely a localized process but is a disseminated disease, surgery alone is unlikely to increase survival rates in the absence of adjuvant therapies. Present and future strategies for treatment include the addition of neoadjuvant regimens and adjuvant modalities including intraoperative radiation, photodynamic therapy, intraperitoneal therapies, and pancreatic and splanchnic perfusion. Clearly, the greatest strides in treatment of pancreatic cancer will come with development of new agents with significantly greater antitumor efficacy.

Adenocarcinoma↗

PubMed1994

Tolerance of the bladder to intraoperative radiation in a canine model: a five-year follow-up.

PURPOSE: Late effects of intraoperative radiation therapy (IORT) on bladder were investigated in a canine model. METHODS AND MATERIALS: After laporatomy and cystotomy in adult female foxhounds weighing 25-35 kg, 12 MeV electrons were delivered intraoperatively to a 5 cm circular bladder field which included the trigone and both uretero-vesicle junctions. Each animal received doses of 0, 20, 25, 30, 35, or 40 Gy. All the dogs were followed 5 years postoperatively. An unoperated dog receiving no surgery or radiation treatment was followed as a control. Close clinical monitoring was performed with regular cystometrics and intravenous pyelography. Animals were killed as scheduled with complete necropsies, including histopathology, with special attention to genitourinary structures. RESULTS: There were no acute or late bladder complications detected clinically in any animal. The dog receiving 30 Gy IORT developed rhabdomyosarcoma in the treatment field at 58 months. On follow-up testing over 5 years, there was no loss of bladder contractility on cystometry, and mild changes in the ureters on intravenous pyleography when animals receiving IORT were compared with baseline pretreatment values or with control animals. Histologically, a difference was evident between irradiated and unirradiated animals, but the changes were not clearly dose-related. CONCLUSION: Intraoperative radiation therapy may by safely delivered to the canine bladder with few acute or chronic complications. It is an approach which has potential for clinical use and should continue to be explored in human clinical trials.

Animals↗

PubMed1994

Effects of intraoperative radiotherapy on vascular grafts in a canine model.

PURPOSE: The effects of intraoperative radiotherapy +/- external beam radiotherapy on prosthetic vascular grafts were investigated in a canine model. METHODS AND MATERIALS: In 1986 and 1987, 30 adult beagles underwent laparotomy with transection and segmental resection of the infrarenal aorta followed by immediate reconstruction with a prosthetic graft. Intraoperative radiotherapy at varying doses from 0-30 Gy was then administered to all animals. Half of the dogs received 36 Gy external beam radiotherapy in 10 fractions postoperatively. Animals were sacrificed and necropsied at predetermined intervals and as clinically indicated to assess early (< or = 6 months) and late (> 6 months) effects to the vascular graft and surrounding normal tissue. RESULTS: Histopathologic analyses of irradiated vascular structures were performed and correlations were made with the clinical outcome. The most frequent early clinical toxicity was graft thrombosis, occurring in 7 of 10 animals followed for < or = 6 months. Early graft thrombus formation appeared unrelated to radiotherapy dose and probably represented a technical surgical complication. Anastomotic stenosis of varying severity occurred in most animals followed > 6 months. Late (> 6 months) graft stenosis was correlated with intraoperative radiotherapy dose. At < or = 20 Gy of intraoperative irradiation, 3 of 14 animals developed late graft occlusion; at > 25 Gy, five of six animals developed late occlusion. On histopathologic review, increasing intraoperative dose and increasing total radiotherapy dose (intraoperative+external beam) appeared to correspond with increasing severity of graft changes seen after 6 months of follow-up. CONCLUSIONS: Thrombus formation is a frequent early complication of vascular graft placement of the infrarenal aorta in our beagle dog model. Intraoperative doses up to 20 Gy appear to contribute minimally to late graft occlusion, while doses > or = 25 Gy contribute to late occlusion with high likelihood. Both intraoperative dose and total radiotherapy dose correlated with late graft occlusion, and with histopathologic changes in the graft and anastomoses.

Animals↗

PubMed1994

Late effects of intraoperative radiation therapy on retroperitoneal tissues, intestine, and bile duct in a large animal model.

PURPOSE: The late histopathological effects of intraoperative radiotherapy (IORT) on retroperitoneal tissues, intestine, and bile duct were investigated in dogs. METHODS AND MATERIALS: Fourteen adult foxhounds were subjected to laparotomy and varying doses (0-45 Gy) of IORT (11 MeV electrons) delivered to retroperitoneal tissues including the great vessels and ureters, to a loop of defunctionalized small bowel, or to the extrahepatic bile duct. One control animal received an aortic transection and reanastomosis at the time of laparotomy; another control received laparotomy alone. This paper describes the late effects of single-fraction IORT occurring 3-5 years following treatment. RESULTS AND CONCLUSION: Dogs receiving IORT to the retroperitoneum through a 4 x 15 cm portal showed few gross or histologic abnormalities at 20 Gy. At doses ranging from 30-45 Gy, radiation changes in normal tissues were consistently observed. Retroperitoneal fibrosis with encasement of the ureters and great vessels developed at doses > or = 30 Gy. Radiation changes were present in the aorta and vena cava at doses > or = 40 Gy. A 30 Gy dog developed an in-field malignant osteosarcoma at 3 years which invaded the vertebral column and compressed the spinal cord. A 40 Gy animal developed obstruction of the right ureter with fatal septic hydronephrosis at 4 years. Animals receiving IORT through a 5 cm IORT portal to an upper abdominal field which included a defunctionalized loop of small bowel, showed a few gross or histologic abnormalities at a dose of 20 Gy. At 30 Gy, hyaline degeneration of the intestinal muscularis layer of the bowel occurred. At a dose of 45 Gy, internal intestinal fistulae developed. One 30 Gy animal developed right ureteral obstruction and hydronephrosis at 5 years. A dog receiving 30 Gy IORT through a 5 cm portal to the extrahepatic bile duct showed diffuse fibrosis through the gastroduodenal ligament. These canine studies contribute to the area of late tissue tolerance to IORT.

Anastomosis, Surgical↗

PubMed1994

Postoperative complications in patients receiving suramin therapy.

BACKGROUND: Suramin is an antiparasitic agent that is currently being evaluated for antineoplastic activity. Documented toxicities of suramin include adrenal and renal insufficiency, coagulation factor abnormalities, immunosuppression, and polyneuropathy. These adverse effects have potential for contributing to postoperative morbidity in surgical patients. Because no experience with suramin has been reported in the surgical literature, this 5-year retrospective review of postoperative complications in patients receiving suramin was performed. METHODS: From a review of 171 charts, 14 patients were identified who had undergone a major surgical procedure either while receiving intravenous suramin or within 1 year after its administration. Primary diagnoses included prostate cancer (six), lymphoma (four), ovarian cancer (two), colon cancer (one), and glioblastoma (one). All patients received replacement dose hydrocortisone at the initiation of suramin therapy and thereafter. RESULTS: Eighteen major surgical procedures were performed with 18 complications occurring in five patients. The predominant complications encountered were hemorrhage (five), impaired wound healing (three), and bowel dysmotility (two). A highly significant relationship existed between the incidence of complications and interval from completion of suramin therapy to the time of operation (p < 0.0005), with 17 of the 18 morbidities occurring within the first month. The length of operation (p < 0.05) and amount of blood transfused during the procedure were related to postoperative morbidity (p < 0.05). No other factors evaluated were correlated to complications. CONCLUSIONS: This experience suggests the avoidance of elective procedures during the first month after suramin therapy and a heightened awareness of the potential for bleeding and wound healing problems in patients receiving suramin who do require an emergent procedure.

Adult↗

PubMed1993

Patterns of disease recurrence following definitive therapy of adenocarcinoma of the pancreas using surgery and adjuvant radiotherapy:correlations of a clinical trial.

PURPOSE: Between 1980 and 1984, 26 patients with resectable adenocarcinoma of the pancreatic head were enrolled in a National Cancer Institute protocol evaluating intraoperative radiotherapy vs. standard therapy. METHODS AND MATERIALS: After complete excision of their lesions, patients were observed (Stage I), or randomized to intraoperative radiotherapy vs. external beam radiotherapy (Stages II-IV). The intraoperative dose was 20 Gy in a single fraction using 9-20 MeV electrons. The external beam radiotherapy schema involved daily 150-180 cGy fractions to 45-55 Gy in 5-6 weeks. Chemotherapy was not used for primary disease but was administered off protocol for recurrent disease. Median potential followup for the trial was > 9 years, with a median patient survival of 18 months. Perioperative mortality was 27% (7 patients). Of the remaining 19 patients, one remains alive and without evidence of disease 9 years post-therapy. Twelve patients underwent autopsy and 2 required antemortem laparotomy; histopathologic evidence of disease recurrence was analyzed. RESULTS: Of 15 patients evaluable for intra-abdominal control, 7 (47%) suffered local recurrences and 7 (47%) failed regionally, with 5 patients (35%) failing in both areas. Five patients (35%) developed peritoneal seeding. Of 13 patients evaluable for systemic disease, 8 (62%) suffered distant failure. There were no differences in outcome between intraoperative or external beam radiotherapy or observation in this subset of patients. CONCLUSION: This report is among the most rigorous descriptions of patterns of failure after resection of pancreatic cancer. It appears clear that advances in local control of this disease are unlikely to translate into increased survival in the absence of improved systemic therapy.

Adenocarcinoma↗

PubMed1993

Phase I study of debulking surgery and photodynamic therapy for disseminated intraperitoneal tumors.

PURPOSE: Phase I study designed to determine the maximum tolerated dose of intraoperative photodynamic therapy (PDT) at laparotomy/debulking surgery in patients with refractory or recurrent, disseminated intraperitoneal tumors. METHODS AND MATERIALS: Patients received dihematoporphyrin ethers (DHE) 1.5-2.5 mg/kg by i.v. injection prior to surgery. Patients resected to < or = 5 mm of residual disease underwent laser light delivery to all peritoneal surfaces. RESULTS: Fifty-four patients entered the study. Thirty-nine underwent resection and light delivery/PDT. PDT dose was escalated by increasing DHE from 1.5 to 2.5 mg/kg, shortening the interval between DHE injection and surgery from 72 to 48 hr, and increasing the light dose. Initially, 630 nm red light alone was used. In this group, PDT of 2.8-3.0 J/cm2 induced small bowel edema and resulted in 3 small bowel perforations after bowel resection or enterotomy. Further light dose escalation, however, was achieved by switching to less penetrating 514 nm green light to the bowel/mesentery. In later patients, whole peritoneal PDT was supplemented with boost doses of 10-15 J/cm2 red light or 5-7.5 J/cm2 green light to high risk areas. Small bowel complications were not seen after switching to less penetrating green light. Dose limiting toxicities occurred in 2 of 3 patients at the highest light dose of 5.0 J/cm2 green light with boost. These patients had pleural effusions that required thoracentesis and postoperative respiratory support for 7-9 days, while one had a gastric perforation. At potential follow-up times of 3.8-43.1 months (median 22.1 months), 30/39 patients are alive and 9/39 are free of disease. CONCLUSION: The maximum tolerated dose of intraoperative PDT following debulking surgery performed 48 hr after intravenous administration 2.5 mg/kg DHE is 3.75 J/cm2 of 514 nm green light to the entire peritoneal surface with boosts to 5.0-7.5 J/cm2 of 514 nm green light or 10-15 J/cm2 of 630 nm red light to sites of gross disease encountered at surgery.

Adult↗

PubMed1993

Intraoperative radiotherapy in retroperitoneal sarcomas. Final results of a prospective, randomized, clinical trial.

Thirty-five patients with surgically resected sarcomas of the retroperitoneum were enrolled in a prospective, randomized, clinical trial comparing 20-Gy intraoperative radiotherapy in combination with postoperative low-dose (35- to 40-Gy) external-beam radiotherapy with postoperative high-dose (50- to 55-Gy) external-beam radiotherapy alone. Chemotherapy with doxorubicin hydrochloride, cyclophosphamide (anhydrous), and methotrexate sodium was used for a portion of the trial. Fifteen patients who received intraoperative radiotherapy and 20 control patients were followed up for a minimum of 5 years (median follow-up, 8 years). Median survival times were similar for the group that received intraoperative radiotherapy (45 months) and the control group (52 months). There were no indications of benefit from adjunctive chemotherapy. The number of locoregional recurrences was significantly lower among those who received intraoperative radiotherapy (six of 15) than control patients (16 of 20). Patients who received intraoperative radiotherapy had fewer complications of disabling radiation-related enteritis (two of 15) than control patients (10 of 20), but radiation-related peripheral neuropathy was more frequent among those who received intraoperative radiotherapy (nine of 15) than among control patients (one of 20).

Adult↗

PubMed1993

Tolerance of small bowel anastomoses in rabbits to photodynamic therapy with dihematoporphyrin ethers and 630 nm red light.

Photodynamic therapy (PDT) is being evaluated in experimental clinical trials in patients with peritoneal malignancies. Some patients require partial small bowel resection with re-anastomosis prior to PDT because of bulky tumor or focal involvement of the small bowel by tumor. To assess the safety of PDT in this setting, the tolerance of small bowel anastomoses in New Zealand white rabbits to PDT with dihematoporphyrin ethers (DHE) and 630 nm light was studied. With conventional DHE doses of 1.5-2.5 mg/kg given 24 hours prior to surgery and light doses of 0-20 J/cm2 of 630 nm light, no adverse effects were seen on the healing of small bowel anastomoses. Higher photosensitizer doses of 10 mg/kg and 20 mg/kg in conjunction with 20 J/cm2, however, induced failure and breakdown of fresh anastomoses in 2/3 and 4/4 animals, respectively.

Anastomosis, Surgical↗

PubMed1993

Randomized trial of intraoperative radiotherapy in carcinoma of the stomach.

A prospectively randomized controlled clinical trial was performed comparing surgical resection and intraoperative radiotherapy (IORT) with conventional therapy in adenocarcinoma of the stomach. Patients in the experimental group underwent gastrectomy, and IORT was administered to their gastric bed (20 Gy using 11 to 15 MeV electrons). Patients in the control group underwent gastrectomy alone for early-stage lesions confined to the stomach (stages I to II) or resection and postoperative external beam radiotherapy to the upper abdomen (50 Gy using 6 to 10 mV photons) for advanced-stage lesions extending beyond the gastric wall (stages III to IV). One hundred patients were screened for the study, of whom 60 were randomized and underwent exploratory surgery. Nineteen patients were excluded intraoperatively because of unresectability or metastatic disease, leaving 41 patients in the study. Seven patients (17%) died of complications. The median survival for patients with tumors of all stages was 25 months for the IORT group and 21 months for the control group (p = 0.99). Locoregional disease failures occurred in 7 of 16 (44%) IORT patients and in 23 of 25 (92%) control patients (p < 0.001). Complication rates were similar between IORT and control patients. Although IORT failed to afford a significant advantage over conventional therapy in overall survival, IORT did significantly improve control of locoregional disease.

Actuarial Analysis↗

PubMed1993

Lymph node involvement and pancreatic resection: correlation with prognosis and local disease control in a clinical trial.

In a prospectively randomized trial evaluating pancreatic resection with adjuvant radiotherapy (intraoperative radiotherapy [IORT] vs. external beam radiotherapy [EBRT]), lymph nodal involvement was examined and correlated with outcome. Twenty-six patients underwent pancreatic resection and received either IORT or EBRT (Stages II-IV). Patients who were stage I received surgery alone. Regional nodal metastases were present in 15 of 26 (57%) patients. Seven patients suffered treatment-related mortality. Survival, mortality, and morbidity were unaffected by the type of radiotherapy. The survival of patients with negative nodes (median survival 24 months, range 10 to > 109) appeared superior to the survival of patients with nodal involvement (median survival 11.5 months; range 4-39). Even in patients with locally advanced disease extending into extrapancreatic tissues, two node-negative patients appeared to survive longer (12 and 53 months) than 10 node-positive patients with similarly extensive local disease (median survival 11.5 months; range 4-39). Local disease control, however, appeared to be independent of nodal involvement, with eventual local recurrences in 6 of 8 node-negative patients and in 4 of 7 node-positive patients who were evaluable for local disease control by autopsy or by antemortem laparotomy.

Combined Modality Therapy↗

PubMed1992

Long term tolerance of thoracic organs to intraoperative radiotherapy.

The tolerance of mediastinal structures to intraoperative radiotherapy (IORT) was investigated in 3 separate animals trials using 49 adult foxhounds and one limited Phase I trial in 4 patients with Stage II or III non-small cell lung cancer (NSCLC). The 1- to 2-year results of these trials have been previously reported with significant toxicity found at dose levels over 20 Gy. We now report the results of five dogs reserved for long term studies and one Stage II NSCLC patient alive at 5 years. Two dogs received 20 Gy IORT and one received 30 Gy IORT to the esophagus, all three to a single 6 cm field with 9 MeV electrons. One control dog underwent surgery without irradiation. One dog received 20 Gy IORT to a single 5 cm mediastinal field with 13 MeV electrons following left pneumonectomy. At 5 years, all five dogs reserved for a long term evaluation were alive and evaluable with minimal endoscopic and radiographic abnormalities. The one patient alive at 5 years for evaluation received 25 Gy IORT to two matched 6 cm fields with 13 MeV electrons. She has stable dyspnea on exertion and there is no evidence of cancer by endoscopy. We conclude, based on these limited data, that IORT in the mediastinum may be safe at dose levels that do not exceed 20 Gy, and further careful evaluation at these lower treatment doses is warranted to determine efficacy.

Animals↗

PubMed1991

Technique of photodynamic therapy for disseminated intraperitoneal malignant neoplasms. Phase I study.

Patients with disseminated intraperitoneal malignant neoplasms were given intra-abdominal photodynamic therapy. Patients received dihematoporphyrin ethers intravenously 48 to 72 hours before laparotomy at doses of 1.5 to 3.0 mg/kg. At operation, as much tumor as possible was resected. Red light (630 nm) was delivered to all peritoneal surfaces from an argon-pumped dye laser at doses ranging from 0.2 to 3.0 J/cm2 in an escalating fashion. Viscera and peritoneal surfaces were anatomically isolated and exposed to light for intervals calculated to deliver the prescribed energy. Light was delivered to mesentery and bowel by a flat-cut optical fiber, while other areas, including diaphragm, viscera, omental bursa, gutters, and pelvis, were delivered light through a diffusing wand. Twenty-three patients (13 with ovarian cancer, eight with sarcoma, and two with pseudomyxoma peritoneii) underwent photodynamic therapy. Five of eight patients cleared positive peritoneal cytologies after treatment. Six patients remained clinically free of disease for up to 18 months, and five patients had treatment-related complications. Intraperitoneal phototherapy is technically feasible and deserving of clinical evaluation.

Adrenal Gland Neoplasms↗

PubMed1991

Recurrent or metastatic disease in select patients with adrenocortical carcinoma. Aggressive resection vs chemotherapy.

In a retrospective, nonrandomized comparison of patients with first recurrence of adrenocortical cancer, 18 patients were treated with chemotherapy (primarily mitotane) and 15 patients were treated with surgical resection plus similar chemotherapy. Surgical resection of recurrent adrenocortical cancer was often extensive, with morbidity in 20% of patients and no mortality. Mitotane therapy was ineffective at controlling tumor growth. Median survival from the time of diagnosis for all patients was only 23 months and no patient was cured. Disease-free interval greater than 12 months was associated with prolonged survival, but it only occurred in six patients (18%), with a similar frequency in both treatment groups. Surgical resection of recurrent disease was associated with prolonged survival from the time of first recurrence. The potential benefit of this resection was evident in the 5 patients (33%) who were able to live greater than 5 years from the time of first recurrence with improvement in symptoms and signs of hypercortisolism. Although no patient with recurrent adrenal cancer could be cured, resection of recurrent disease was associated with a slight prolongation of survival and good palliation of Cushing's syndrome.

Adolescent↗

PubMed1991

Threshold dose for peripheral neuropathy following intraoperative radiotherapy (IORT) in a large animal model.

Radiation injury to peripheral nerve is a dose-limiting toxicity in the clinical application of intraoperative radiotherapy, particularly for pelvic and retroperitoneal tumors. Intraoperative radiotherapy-related peripheral neuropathy in humans receiving doses of 20-25 Gy is manifested as a mixed motor-sensory deficit beginning 6-9 months following treatment. In a previous experimental study of intraoperative radiotherapy-related neuropathy of the lumbro-sacral plexus, an approximate inverse linear relationship was reported between the intraoperative dose (20-75 Gy range) and the time to onset of hind limb paresis (1-12 mos following intraoperative radiotherapy). The principal histological lesion in irradiated nerve was loss of large nerve fibers and perineural fibrosis without significant vascular injury. Similar histological changes in irradiated nerves were found in humans. To assess peripheral nerve injury to lower doses of intraoperative radiotherapy in this same large animal model, groups of four adult American Foxhounds (wt 20-25 kg) received doses of 10, 15, or 20 Gy to the right lumbro-sacral plexus and sciatic nerve using 9 MeV electrons. The left lumbro-sacral plexus and sciatic nerve were excluded from the intraoperative field to allow each animal to serve as its own control. Following treatment, a complete neurological exam, electromyogram, and nerve conduction studies were performed monthly for 1 year. Monthly neurological exams were performed in years 2 and 3 whereas electromyogram and nerve conduction studies were performed every 3 months during this follow-up period. With follow-up of greater than or equal to 42 months, no dog receiving 10 or 15 Gy IORT shows any clinical or laboratory evidence of peripheral nerve injury. However, all four dogs receiving 20 Gy developed right hind limb paresis at 8, 9, 9, and 12 mos following intraoperative radiotherapy. These experimental data suggest that intraoperative doses of less than 20 Gy may not result in clinically significant peripheral nerve injury with follow-up of 3.5 years. Longer (5 yrs) follow-up with planned sacrifice of the remaining dogs is scheduled to assess any late peripheral nerve damage.

Animals↗

PubMed1989

Clinical experience with regional pancreatectomy for adenocarcinoma of the pancreas.

Twenty patients with adenocarcinoma of the pancreas underwent a regional pancreatectomy, including resection of the pancreas, regional lymphadenectomy, duodenectomy, antrectomy, and sleeve resection of the portal vein. Three patients required mesenteric arterial reconstruction. Adjunctive radiotherapy was administered to 17 patients, with 11 patients receiving intraoperative radiation and six patients receiving postoperative external-beam-radiation. Complications developed in 11 patients (55%), including infectious and septic events (five patients), biliary or enteric fistulas (two patients), mesenteric vascular thrombosis (two patients), and other complications (two patients). Four patients (20%) suffered treatment-related deaths. The overall median survival was 12.0 months. Survival at one year was 50% and, at three years, 10%. Two patients died of causes unrelated to cancer at 18 and 39 months, and one patient remains alive and free of disease 50 months following therapy. Morbidity and survival did not differ among patients who received intraoperative, conventional postoperative, or no radiation therapy. Although occasional patients may benefit with survivals of longer than three years, regional pancreatectomy carries major morbidity and produces little survival benefit for most patients with pancreatic cancer.

Adenocarcinoma↗