Staging chest computed tomography and positron emission tomography in patients with pancreatic adenocarcinoma: utility or futility?

Objectives: This study was conducted to determine if routine staging chest computed tomography (CT) or positron emission tomography (PET) scanning alters the clinical management of patients with newly diagnosed pancreatic adenocarcinoma.

Methods: All new pancreas cancers seen in medical oncology, radiation oncology and surgery from 1 June 2008 to 20 June 2010 were retrospectively reviewed. Patients with metastatic disease on chest CT or PET, that had been unsuspected on initial imaging, were identified.

Venous thromboembolism prophylaxis in surgical patients: identifying a patient group to maximize performance improvement.

Background: Venous thromboembolism (VTE) in surgical patients is a cause of increased morbidity, mortality, and cost of care. Deep vein thrombosis (DVT) prophylaxis reduces the risk of DVT or pulmonary embolism (PE), but not to zero, which is concerning because DVT/PE is being considered a serious reportable event. A study was conducted in January-June 2009 to test the hypothesis that most surgical VTEs occur despite the patient's receiving appropriate prophylaxis.

Hereditary pancreatitis.

Hereditary chronic pancreatitis (HCP) is a rare disease in which chronic pancreatitis develops in childhood. HCP has autosomal dominant inheritance with approximately 80% penetrance. Diagnostic criteria are not universally agreed upon but the EUROPAC trial defined it as two first-degree relatives or at least 3 second-degree relatives in two or more generations, with chronic pancreatitis for which there is no other etiology.

Portal vein resection.

The American Hepato-Pancreatico-Biliary Association and Society of Surgical Oncology published a consensus statement in 2009 on the subject of vein resection and reconstruction during pancreaticoduodenectomy (PD), and concluded that PD with vein resection and reconstruction is a viable option for treatment of some pancreatic adenocarcinomas. This article describes the current approaches and recent advances in the management, staging, and surgical techniques regarding portal vein resection. With proper patient selection, a detailed understanding of the anatomy of the root of mesentery, and adequate surgeon experience, vascular resection and reconstruction can be performed safely and does not impact survival duration.

Management of borderline resectable pancreatic cancer.

Borderline resectable pancreatic cancer is an emerging stage of disease defined by computed tomogrpahy criteria, patient (Katz type B), or disease characteristics (Katz type C). These patients are particularly well suited to a surgery-last strategy with induction therapy consisting of chemotherapy (gemcitabine alone or in combination) followed by chemoradiation. With appropriate selection and preoperative planning, many patients with borderline resectable disease derive clinical benefit from multimodality therapy.

The negative sestamibi scan: is a minimally invasive parathyroidectomy still possible?

Background: Tc-99-sestamibi scanning is utilized to determine whether patients with primary hyperparathyroidism (HPT) are candidates for minimally invasive parathyroidectomy (MIP). However, if the result of this scan is negative, many surgeons recommend bilateral parathyroid exploration because of possible multi-gland disease. The objectives of this study were to determine whether patients with primary HPT and negative sestamibi scans can benefit from additional imaging studies and are still potential candidates for MIP.

Radioguided parathyroidectomy in patients with familial hyperparathyroidism.

Background: In patients with sporadic hyperparathyroidism (HPT), radioguided parathyroidectomy (RGP) has been shown to facilitate intraoperative localization of parathyroid glands, reduced operative time, and improve patient outcomes. No studies have focused on the role of RGP in patients with familial HPT.

Methods: Between 3/01 and 6/05, 419 patients underwent RGP.

Treatment of advanced carcinoid tumors.

Purpose Of Review: Carcinoid tumors often present with metastatic disease. Generally, these tumors can be treated conservatively. New evidence exists, however, that stage IV disease may be better managed with more aggressive medical and surgical treatment.