Feasibility and safety of radiofrequency ablation for locally advanced pancreatic cancer.

BACKGROUND: : Radiofrequency ablation (RFA) may be a valuable treatment option for locally advanced pancreatic cancer. The present study examined its feasibility and safety. METHODS: : Fifty patients with locally advanced pancreatic cancer were studied prospectively. Ultrasound-guided RFA was performed during laparotomy. The main outcome measures were short-term morbidity and mortality. RESULTS: : The tumour was located in the pancreatic head or uncinate process in 34 patients and in the body or tail in 16; median diameter was 40 (interquartile range 30-50) mm. RFA was the only treatment in 19 patients. RFA was combined with biliary and gastric bypass in 19 patients, gastric bypass alone in eight, biliary bypass alone in three and pancreaticojejunostomy in one. The 30-day mortality rate was 2 per cent. Abdominal complications occurred in 24 per cent of patients; in half they were directly associated with RFA and treated conservatively. Three patients with surgery-related complications needed reoperation. Reduction of RFA temperature from 105 degrees C to 90 degrees C resulted in a significant reduction in complications (ten versus two of 25 patients; P = 0.028). Median postoperative hospital stay was 10 (range 7-31) days. CONCLUSION: : RFA of locally advanced pancreatic cancer is feasible and relatively well tolerated, with a 24 per cent complication rate.

[Echographic assessment of cutaneous neoplasms]. / Valutazione ecografica delle neoplasie cutanee.

A hundred and fifteen skin tumors were evaluated by means of US. Three variables were considered for each lesion--i.e., borders, echostructure and thickness--and the results compared with histology. High agreement was observed in melanomas: in these tumors, indeed, thickness is well known to be relevant for both surgical planning and prognosis. US scans with a 10 MHz transducer allowed the accurate assessment of borders and structure only in certain, mainly benign, kinds of skin tumors--e.g., angiomas, pilomatrixomas, sebaceous cysts and lipomas--, but also in lymphomas. On the contrary, most malignant neoplasms exhibit hypoechoic structure and borders from clear-cut to blurred. Finally, US proved to be highly reliable in demonstrating lesion thickness before surgery. High agreement was once again observed with histology relative to this variable: thickness (in mm) was the same in 30% of cases, overestimated by US (mean: 0.3 mm) in 44% of cases and underestimated by US (mean: 0.15 mm) in 26% of cases. Particularly, in 41 melanomas, histology-US agreement rate was 44% for the Breslow index, with r = 0.95 and 88% for the Clark index.