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Yi-Ming Shyr

Publications and source records attributed to Yi-Ming Shyr.

At least 19 recordsLinked to original sources
PubMed2006

Characterization of pancreatic stem cells derived from adult human pancreas ducts by fluorescence activated cell sorting.

AIM: To isolate putative pancreatic stem cells (PSCs) from human adult tissues of pancreas duct using serum-free, conditioned medium. The characterization of surface phenotype of these PSCs was analyzed by flow cytometry. The potential for pancreatic lineage and the capability of beta-cell differentiation in these PSCs were evaluated as well. METHODS: By using serum-free medium supplemented with essential growth factors, we attempted to isolate the putative PSCs which has been reported to express nestin and pdx-1. The Matrigel(TM) was employed to evaluate the differential capacity of isolated cells. Dithizone staining, insulin content/secretion measurement, and immunohistochemistry staining were used to monitor the differentiation. Fluorescence activated cell sorting (FACS) was used to detect the phenotypic markers of putative PSCs. RESULTS: A monolayer of spindle-like cells was cultivated. The putative PSCs expressed pdx-1 and nestin. They were also able to differentiate into insulin-, glucagon-, and somatostatin-positive cells. The spectrum of phenotypic markers in PSCs was investigated; a similarity was revealed when using human bone marrow-derived stem cells as the comparative experiment, such as CD29, CD44, CD49, CD50, CD51, CD62E, PDGFR-alpha, CD73 (SH2), CD81, CD105(SH3). CONCLUSION: In this study, we successfully isolated PSCs from adult human pancreatic duct by using serum-free medium. These PSCs not only expressed nestin and pdx-1 but also exhibited markers attributable to mesenchymal stem cells. Although work is needed to elucidate the role of these cells, the application of these PSCs might be therapeutic strategies for diabetes mellitus.

Bone Marrow Cells↗
PubMed2006

Gastric body partition for giant perforated peptic ulcer in critically ill elderly patients.

BACKGROUND: To prevent or minimize leakage after simple closure of giant perforated peptic ulcers in critically ill elderly patients, we conducted a clinical study using gastric body partition to prevent upstream gastric juice and food from passing through the sutured ulcer. METHODS: Ten critically ill elderly patients with giant (> 2.5 m) perforated peptic ulcer were included in the study of gastric body partition. RESULTS: The patients' mean age was 78.2 years and mean delay in treatment was 95.6 hours. None of the 10 patients had major complications after operation, although minor leakage of the sutured ulcer occurred in 4 patients. Only one patient presented with recurrent anastomotic ulcer and one patient died 28 days after surgery. CONCLUSIONS: Gastric body partition and gastrojejunostomy, in addition to simple closure of a giant perforated peptic ulcer, could be a quick, easy, and potentially effective alternative to avoid or at least to minimize leakage of the sutured ulcer. Moreover, gastric body partition, unlike antral partition, might not necessarily increase risks of hypergastrinemia and marginal ulcer.

Aged↗
PubMed2006

Surgical anatomy of the recurrent laryngeal nerves and its clinical applications in chinese adults.

PURPOSE: When removing the thyroid gland, great care must be taken to avoid damaging the recurrent laryngeal nerves (RLNs). The present study aims to present a clear picture of certain anatomical features of the RLNs in relation to the inferior thyroid artery (ITA), the tracheoesophageal groove (TE), Berry's ligament, and the inferior cornu of the thyroid cartilage in Chinese adults. METHODS: We removed a collective 120 RLNs from 60 Chinese adult cadavers (52 men and 8 women), and examined their anatomic course and relationship on both sides. RESULTS: The right and left RLNs were found in the tracheoesophageal groove in 78.3% and 91.3% of cases, respectively. Both RLNs were found posterior to and to the right of the ITA in 80% of cases, and one was found on the left side of the ITA in 91.7%. Most of the RLNs were within 3 mm of Berry's ligament, with a laryngeal entry point about 0.8 cm below and just anterior to the inferior horn of the thyroid cartilage. CONCLUSIONS: The inferior cornu of the thyroid cartilage is a reliable landmark in identifying the RLNs. Racial variations between Caucasians and Chinese may explain some anatomic differences.

Asian People↗
PubMed2006

Gastric body partition to avoid ulcerogenic risk and hypergastrinemia.

BACKGROUND: For treatment of giant perforated peptic ulcers, we hypothesized that partitioning of the gastric body instead of the antrum would prevent hypergastrinemia and minimize ulcerogenic risk. By maintaining part of the acid-secreting gastric body in continuity with the excluded distal stomach, gastrin-secreting cells in the antrum would still be inhibited by gastric acid secretion from the gastric body. METHODS: We studied (1) gastric body partition with gastrojejunostomy in 8 critically ill patients with giant perforated peptic ulcers and (2) the influence of gastric partition on serum gastrin in 18 dogs with gastric antral partition + gastrojejunostomy, or gastric body partition + gastrojejunostomy, or gastrotomy. RESULTS: No patient developed major postoperative complications. Serum gastrin levels were normal in 6 patients but showed an abnormal increase in 2 patients 1 month after gastric body partition. Serum gastrin levels had returned to the normal range at postoperative follow-up after 2 years. In the animal study, serum gastrin levels and the number of G-cells in the excluded antrum and acid-secreting parietal cells in the gastric body were increased when evaluated on day 60 postoperatively or after antral partition, compared with preoperative data in the same group. These changes did not occur in the group undergoing partition of the gastric body and the group undergoing gastrostomy. Postoperative serum gastrin levels, and the number of G-cells and parietal cells also was significantly greater in the antral partition group than in the other 2 groups. No ulcer was found in any dog in the gastric body partition and gastrostomy groups, but ulcers occurred in 4 dogs in the antral partition group, all of whom died of ulcer perforation. CONCLUSIONS: Gastric body partition + gastrojejunostomy is a simple, dependable procedure for patients with perforated giant peptic ulcers. This procedure does not require extreme expertise and can be performed in a very short time, even by a trainee general surgeon in emergency.

Adult↗
PubMed2006

Retroperitoneal bronchogenic cyst mimicking pancreatic cystic lesion.

Retroperitoneal bronchogenic cyst is detected extremely rarely and often masquerades as other diseases. Here, we report 2 cases of retroperitoneal bronchogenic cyst mimicking pancreatic mucinous tumor. Histologically, both cysts were composed of ciliated respiratory-like epithelium with abundant mucin content, smooth muscle bundles and mature cartilage, compatible with the diagnosis of retroperitoneal bronchogenic cyst. In addition to these 2 cases, another 42 retroperitoneal bronchogenic cysts reported in the English literature were collected for review and analysis. Twelve (28%) were located over the peripancreatic area. Just over half (51%) of them were asymptomatic. No accurate preoperative diagnosis could be made for any of the lesions. About a third (33.3%) of the peripancreatic retroperitoneal bronchogenic cysts masqueraded as pancreatic cystic lesions.

Aged↗
PubMed2005

A novel in vitro retinal differentiation model by co-culturing adult human bone marrow stem cells with retinal pigmented epithelium cells.

Human retinal pigment epithelium (HRPE) cells are important in maintaining the normal physiology within the neurosensory retina and photoreceptors. Recently, transplantation of HRPE has become a possible therapeutic approach for retinal degeneration. By negative immunoselection (CD45 and glycophorin A), in this study, we have isolated and cultivated adult human bone marrow stem cells (BMSCs) with multilineage differentiation potential. After a 2- to 4-week culture under chondrogenic, osteogenic, adipogenic, and hepatogenic induction medium, these BMSCs were found to differentiate into cartilage, bone, adipocyte, and hepatocyte-like cells, respectively. We also showed that these BMSCs could differentiate into neural precursor cells (nestin-positive) and mature neurons (MAP-2 and Tuj1-positive) following treatment of neural selection and induction medium for 1 month. Furthermore, the plasticity of BMSCs was confirmed by initiating their differentiation into retinal cells and photoreceptor lineages by co-culturing with HRPE cells. The latter system provides an ex vivo expansion model of culturing photoreceptors for the treatment of retinal degeneration diseases.

Bone Marrow Cells↗
PubMed2005

Comparison of resected and non-resected intraductal papillary mucinous neoplasms of the pancreas.

By comparing the clinicopathological features and survivals between the resected and non-resected intraductal papillary mucinous neoplasms (IPMNs) of the pancreas, this study tried to clarify the natural history of IPMNs, to provide a strategy for treatment, and to determine the justification of not performing resection for some patients. A total of 57 patients with IPMN, including 39 resected and 18 non-resected IPMNs, were recruited for study. Data on demographics, clinical presentations, diagnostic work-up, treatment modality, clinical course, and outcomes were evaluated and compared between the resected and non-resected IPMNs. The most common clinical presentation was abdominal pain (57% in total IPMNs, 67% in resected, 33% in non-resected), followed by body weight loss (32% in total IPMNs, 33% in resected, 28% in non-resected). The sensitivity in the diagnosis of IPMN was highest by magnetic resonance cholangiopancreatography (MRCP) (88%), followed by endoscopic retrograde cholangiopancreatography (ERCP) (68%), and computed tomography scan (CT scan) (42%) and sonography (10%). The median survival was 21.5 months for patients with resected IPMNs, ranging from 2 to 124 months, and 14 months in non-resected IPMN patients, ranging from 5.5 to 70 months. There is no significant survival difference between the resected and non-resected groups, with a 5-year survival of 69.8% in resected IPMNs and 59.8% in non-resected IPMNs, P = 0.347. The survival outcome of the unresectable non-resected IPMNs was much inferior to the resected IPMNs, P = 0.002 and resectable non-resected IPMNs, P = 0.001. Thus, the prime prognostic factor in predicting the survival outcome of IPMNs is resectability, instead of resection itself. Long-term survival could also be expected in resectable IPMNs without resection. No resection for the IPMN may be justified for patients with high surgical risks, especially for those who are asymptomatic and very aged.

Adenocarcinoma, Mucinous↗
PubMed2005

Acute appendicitis in patients with acquired immunodeficiency syndrome.

BACKGROUND: We report our experience with patients who had acquired immunodeficiency syndrome (AIDS) and who presented with signs and symptoms suggesting acute appendicitis. METHODS: Observational data are documented for 9 patients with AIDS who underwent surgery for acute appendicitis. RESULTS: Of the 9 patients, 6 (66.7%) had acute appendicitis without perforation, while the other 3 (33.3%) had perforated appendicitis. An elevated preoperative temperature was found in 4 patients without perforation (66.7%), and in 1 patient with perforation (33.3%). An elevated white blood cell count was found in all 6 patients without perforation (100%), but in none with perforation (0%). The mean interval from surgical referral to laparotomy was 61.1 hours, the mean hospital stay was 9.3 days, and the perioperative mortality rate was 22.2%. CONCLUSION: Our experience should alert emergency medical staff who care for AIDS patients to the need for early diagnosis and prompt surgical treatment of appendicitis.

Acquired Immunodeficiency Syndrome↗
PubMed2004

The anatomical variations of the palmar cutaneous branch of the median nerve in Chinese adults.

BACKGROUND: In a detailed analysis of the palmar cutaneous branch of median nerve (PCN) in the Chinese adults, we tried to evaluate its anatomic variation and clinical significance. METHODS: Observations were described in all the 60 specimens of the PCN at the wrist. RESULTS: The PCN was present in all 60 specimens and in most cases (88.3%) it originated from the radial side of the median nerve and the average length from the palmaris longus was 1.4 cm; ulnarward (11.7%); only 5 cases (4.1%) were located at ulnar side and extended beyond the palmaris longus, the average distance being 0.3 cm. Its mean point of origin was 3.2 cm proximal to the distal wrist crease and the variations of the PCN in Lanz classification were: group 0 (31.7%), group 1 (40%), group 2 (15%), group 3 (0%) and group 4 (13.3%). CONCLUSIONS: Longitudinal incision located 1 cm on the ulnar side from palmaris longus could avoid injury to the PCN during decompression for carpal tunnel syndrome.

Adult↗
PubMed2003

Does drainage fluid amylase reflect pancreatic leakage after pancreaticoduodenectomy?

This study tried to determine if drainage fluid amylase reflects pancreatic leakage after pancreaticoduodenectomy and to determine the factors affecting the drainage amylase level. Patients undergoing pancreaticoduodenectomy were recruited. The drainage amylase was measured from postoperative day (POD) 1 to POD 7. Direct evidence of pancreatic leakage was provided by upper gastrointestinal studies using a water-soluble contrast medium and methylene blue dye in the pancreaticogastrostomy group or by pancreaticography with injected contrast medium via an exteriorized pancreatic stent in the pancreaticojejunostomy group on POD 7. A total of 37 patients were recruited. The drainage amylase level was higher than the normal serum amylase (>or= 190 U/L) in more than half of the cases on the initial POD 2 specimen, with a median of 745 U/L on POD 1 and 663 U/L on POD 2. The drainage amylase level was more than three times the normal serum amylase level (>or= 190 x 3 U/L) in 56.8% on POD 1, in 51.4% on POD 2, and in nearly one-third on POD 7 (29.7%). However, no pancreatic leakage occurred in any of the patients with a drainage amylase of >or= 190 U/L. Only one case of pancreatic leakage with a small amount of drainage fluid (10 ml) and low amylase level (74 U/L), was noted. Soft pancreatic parenchyma and a nondilated pancreatic duct were significantly associated with higher drainage amylase levels. In conclusion, biochemical leakage defined by amylase-rich drainage fluid might have no clinical significance and was not necessarily clinical pancreatic leakage following pancreaticoduodenectomy.

Adolescent↗
PubMed2002

Non-stented pancreaticogastrostomy after pylorus-preserving pancreaticoduodenectomy.

BACKGROUND: We hypothesized that neutralization of the gastric acidity by alkaline pancreatic secretion via a non-stented pancreaticogastrostomy after pylorus-preserving pancreaticoduodenectomy (non-stented PPPD-PG) might provide protection against marginal or stress ulcer. Surgical risk of non-stented pancreaticogastrostomy was also assessed to clarify the importance of stenting in pancreatic anastomosis. METHODS: From January 1997 to December 2000, 54 patients with resectable periampullary lesions were included for non-stented PPPD-PG. Gastric pH and amylase levels were measured on the postoperative day 7. Surgical risks including pancreatic leakage, morbidity and mortality were also assessed. RESULTS: Patients undergoing the non-stented PPPD-PG presented significantly higher gastric levels of pH and amylase than healthy patients as controls (median pH 5.0 vs 2.8, p = 0.007; and median amylase 7,660 vs 21 IU/L, p = 0.031). Among the patients undergoing the non-stented PPPD-PG, low gastric pH and amylase levels were associated with high gastric drainage group > or = 600 c.c./day. However, only 1 of the 18 patients with low gastric amylase level (high gastric drainage group) developed significant steatorrhea and needed replacement of concentrated pancreatic enzymes. There were 18 (33.3%) complications and 1 (1.8%) mortality. The cause of death was cardiac arrythmia, not related to operation. Gastric atonia was the most common complication (18.5%), followed by wound infection, intraabdominal abscess, and intraabdominal bleeding in 2 patients (5.6%) individually. No pancreatic leakage or ulcer-related complication occurred after non-stented PPPD-PG. CONCLUSIONS: Experience of no pancreatic leakage in our 54 non-stented PPPD-PG implies that stenting of pancreaticogastrostomy might not be crucial in prevention of pancreatic leakage and ductal occlusion. Moreover, non-stented PPPD-PG can increase gastric pH and amylase levels, which might be beneficial in protection against marginal ulceration.

Adult↗
PubMed2002

Canine pancreas allotransplantation with enteric drainage.

BACKGROUND: Before embarking on a clinical human pancreas transplantation program we sought a canine animal model with enteric drainage to refine our technical skills, to evaluate the surgical risks and to study the rejection pictures under modern triple immunosuppression therapy. METHODS: Twenty donor-recipient pairs of unrelated mongrel dogs underwent pancreaticoduodenal allotransplantation with enteric drainage. All dogs were immunosuppressed by triple therapy with prednisolone, cyclosporine (Neoral) and mycophenolate mofetil (MMF). Rejection grade and surgical risk were evaluated. RESULTS: Group 1 included 10 (50%) dogs surviving at least 14 days. In group 2 surviving less than 14 days, the median survival was 5.5 days, ranging from 1 day to 13 days. The most common complications were duodenal stump leakage and wound infection. Duodenal stump leakage eventually led to mortality in 3 dogs of group 2. Two (in group 2) of the 3 wound infections became too severe to control and caused death. There were 2 dogs complicated with graft necrosis and 2 with graft vascular thrombosis individually, which all resulted in death. Other fatal complications included 1 chyle leakage, 1 intraabdominal abscess and 1 pneumonia individually. Ninety percent in each group developed rejection. Severe rejection developed in 5 (50%) dogs in group 2 (grade 4 and 5), p = 0.033, as compared with none in group 1. The rejection in most cases (90%) of group 1 was mild to moderate, with 4 grade 3, 3 grade 2 and 2 grade 1. CONCLUSIONS: Canine pancreas allotransplantation with enteric drainage is a feasible animal model to achieve survival longer than 14 days in 50% cases studied. Duodenal stump leakage was the most common fatal complication in this model. Severity of rejection was closely associated with posttransplant fatal complications and played a crucial role in determining the dog survival.

Animals↗
PubMed2002

Segmental pancreatectomy for benign tumor of the pancreas.

BACKGROUND: Enucleation of pancreatic tumor has the potential risk for damage of the main pancreatic duct. Benign tumors located in the neck or body of the pancreas are usually removed by left (spleno-) pancreatectomy or pancreatoduodenectomy. Standard pancreatic resection may result in serious loss of normal pancreatic parenchyme and impairment of pancreatic function. The aim of this study is to evaluate the results of segmental pancreatectomy, a limited resection of the midportion of the pancreas, in patients with benign tumor of the pancreas. METHODS: Four patients with benign tumor over pancreatic neck or body were treated with segmental pancreatectomy after pathological confirmation by frozen section. The proximal stump was closed and distal stump was anastomosed with a Roux-en-Y pancreaticojejunostomy. Clinical evaluation, routine blood sugar, stool fat examination and abdominal ultrasonography were performed for their follow up. RESULTS: Segmental pancreatectomy was satisfactory in these four patients. The pathologic examinations revealed serous cystadenoma. No mortality was noted. Minor pancreatic fistula was found in three of them and was treated conservatively. No obvious exocrine insufficiency was noticed. One patient had diabetes mellitus before operation, which was persisted postoperatively. CONCLUSIONS: Segmental pancreatectomy is a safe and effective alternative to major pancreatic resection in selected patients with benign tumor of the pancreas. This procedure has a surgical risk similar to that of the standard operation, but preserves more pancreatic tissues, which may prevent pancreatic function impairment.

Adult↗
PubMedDate not supplied

Clinical experience of pseudomyxoma peritonei in Taiwan with emphasis on the treatment and survival.

BACKGROUND/AIMS: Pseudomyxoma peritonei is a rare neoplasm with intra-abdominal gelatinous, jelly-like fluid accumulation. To assess the clinical characteristics, treatment modalities, and predictors of survival of pseudomyxoma peritonei in Chinese patients, we conducted this study. METHODOLOGY: Over a 27-year period, 15 patients with the diagnosis of pseudomyxoma peritonei were enrolled. Their demographic, clinical, treatment and survival data were collected. RESULTS: Seven patients were female and eight were male. The median age at diagnosis was 48 years old for 7 females and 66 years old for 8 males. Exploratory laparotomy and debulking surgery were performed for 11 patients (73%); 6 of these 11 patients received adjuvant chemotherapy. Among 4 patients without surgical treatment, 1 received chemotherapy and 3 had supportive treatment only. The 5-year survival for all patients and patients with surgical treatment were 39% and 62%, respectively. Patients with surgical intervention had longer survival (median, 125 months) than those without surgical treatment (median, 8 months) (P = 0.0106). However, adjuvant chemotherapy did not further prolong the survival time (P = 0.744). CONCLUSIONS: Surgical intervention rather than adjuvant chemotherapy appears to provide a longer survival for patients with pseudomyxoma peritonei.

Adult↗
PubMedDate not supplied

Gastric pH and amylase and safety for non-stented pancreaticogastrostomy.

BACKGROUND/AIMS: The main purpose of this study was to try to provide the indirect evidence of protection against marginal ulceration by neutralizing the gastric acidity with alkaline pancreatic secretions following non-stented pancreaticogastrostomy after pylorus-preserving pancreaticoduodenectomy (PPPD-PG). Safety of the non-stented PPPD-PG was also evaluated and reviewed. METHODOLOGY: Twenty-five patients with resectable periampullary lesions undergoing non-stented PPPD-PG were recruited for study. Gastric pH and amylase levels were measured on postoperative day 7. Morbidity, pancreatic leakage and mortality were also evaluated. RESULTS: The median values of gastric pH and amylase following non-stented PPPD-PG group were both statistically higher than those of healthy control group (pH, 6.3 vs. 2.8; amylase, 26,300 vs. 21 IU/L). The overall complication rate was 24.0%. Gastric atonia was the most common complication, occurring in 4 (16%) patients. No pancreatic leakage or ulcer-related complication such as upper gastrointestinal bleeding or perforation occurred in patients after non-stented PPPD-PG. There was 1 (4.0%) death, which was secondary to cardiac arrhythmia, but not related to operation. CONCLUSIONS: Non-stented PPPD-PG could increase gastric pH and amylase levels, which might provide protection against marginal ulceration. No pancreatic leakage, and low morbidity and mortality confirm that non-stented PPPD-PG could be a relatively safe and reliable alternative in the pancreatic reconstruction after pancreaticoduodenecomy.

Aged↗
PubMedDate not supplied

Is pancreaticoduodenectomy justified for chronic pancreatitis masquerading as periampullary tumor?

BACKGROUND/AIMS: Chronic pancreatitis associated with periampullary mass often presents diagnostic and therapeutic dilemmas. Incidence and justification of pancraticoduodenectomy for chronic pancreatitis masquerading as pancreatic head cancer and sensitivity of frozen-section biopsy in detecting the periampullary malignancy were investigated. METHODOLOGY: Nine patients with chronic pancreatitis masquerading as periampullary tumor were included to study the clinical features, clinical diagnostic rates, and surgical risk. Pathological data of 272 periampullary malignancies were analyzed to evaluate the diagnostic rate of preoperative endoscopic biopsy and the reliability of intraoperative frozen-section biopsy. RESULTS: The incidence of pancreaticoduodenectomy for chronic pancreatitis masquerading as periampullary tumor was 3.2%. The most common symptoms for these 9 chronic pancreatitis patients were epigastric pain (88.9%), jaundice (55.6%) and body weight loss (55.6%), with a median duration of symptom of 9 months. All of these chronic pancreatitis lesions in the periampullary region were considered to be pancreatic head or periampullary cancer by image studies except 1 to be chronic pancreatitis by ultrasound and endoscopic retrograde cholangiopancreatography. No surgical mortality and only 1 minor complication with wound infection occurred. Among the 272 periampullary malignancies, the positive diagnostic rate by preoperative endoscopic biopsy was 26.5%. The overall sensitivity of frozen-section biopsy in detecting the periampullary malignancy was 70.7%. CONCLUSIONS: Pancreaticoduodenectomy may be justified for chronic pancreatitis presenting as periampullary mass, in terms of nonspecific clinical features, unreliable preoperative imaging studies, undependable intraoperative frozen-section biopsy and low surgical risk.

Chronic Disease↗
PubMedDate not supplied

Is pancreaticoduodenectomy justified for septuagenarians and octogenarians?

BACKGROUND/AIMS: Almost all of the studies described elderly as beginning at the age 70 and very few focused on the group of patients over 80 years of age. This study was undertaken to compare the surgical risk and prognosis between septuagenarians and octogenarians undergoing pancreaticoduodenectomy and to clarify whether or not pancreaticoduodenectomy is justified in octogenarians. METHODOLOGY: Among 276 patients with periampullary lesions undergoing pancreaticoduodenectomy between 1982 and 2000, octogenarians and septuagenarians were identified. The study concentrated on the surgical risks and outcomes. RESULTS: There were 16 (6%) octogenarians and 82 (30%) septuagenarians among our 276 patients undergoing pancreaticoduodenectomy. Surgical mortality did not significantly increase in octogenarians (13%), as compared to septuagenarians (12%). Surgical morbidity was also similar in both groups (51% in octogenarians vs. 56% in septuagenarians). Octogenarians needed more frequent care in the intensive care unit (69%) postoperatively than septuagenarians (27%), p = 0.001. There was no significant difference in survival, (median survival = 16 months for septuagenarians and 17.6 months for octogenarians), p = 0.137. About half of each group (44.2% septuagenarians and 54.5% octogenarians) still died of the underlying periampullary lesions, p = 0.771. CONCLUSIONS: Surgical risk did not significantly increase and prognosis was similar in octogenarians after pancreaticoduodenectomy, as compared to septuagenarians. Therefore, pancreaticoduodenectomy is justified not only in septuagenarians but also in octogenarians if carefully selected.

Aged↗