Prevalence of Orthorexia Nervosa in a sample of italian young adults.

Abstract: There is only limited epidemiological information on Orthorexia Nervosa; the aim of the present study is, therefore, to assess the prevalence of ON in a population of young adults and to identify possible specific features and eventual psychopatological dimensions. 1317 participants (732 females and 585 males; mean age 22.36 yrs) completed a battery containing the orthorexia measure (ORTHO-15), statements about demographic characteristics as well as physiological parameters. The mean ORTO-15 score was 31.89; considering the cut-off of 40 in the reference test, our results showed a 11.9% prevalence of ON. Analyzing the characteristics of the orthorexic group, the prevalence in females compared to males appears to be statistically very significant (115 vs 43; 72.8% vs 27.2%); moreover shows higher and statistically significant scores in each of the 15 items of the reference test compared to the non-orthorexic group. Our data confirming that ON might be a relevant and potentially underestimate phenomenon in the community. Further studies are warranted in order to explore the diagnostic boundaries of this syndrome, its course and outcome, and the possible therapeutic strategies.

Paediatric ulcerative colitis surgery: Italian survey.

BACKGROUND AND AIMS: Recent epidemiological studies showed an increase in ulcerative colitis among children, especially in its aggressive form, requiring surgical treatment. Although medical therapeutic strategies are standardized, there is still no consensus regarding indications, timing and kind of surgery. This study aimed to define the surgical management of paediatric ulcerative colitis and describe attitudes to it among paediatric surgeons. METHODS: This was a retrospective cohort study. All national gastroenterology units were invited to participate. From January 2009 to December 2013, data on paediatric patients diagnosed with ulcerative colitis that required surgery were collected. RESULTS: Seven units participated in the study. Seventy-one colectomies were performed (77.3% laparoscopically). Main surgical indications were a severe ulcerative colitis attack (33.8%) and no response to medical therapies (56.3%). A three-stage strategy was chosen in 71% of cases. Straight anastomosis was performed in 14% and J-pouch anastomosis in 86% of cases. A reconstructive laparoscopic approach was used in 58% of patients. Ileo-anal anastomosis was performed by the Knight-Griffen technique in 85.4% and by the pull-through technique in 9.1% of patients. Complications after colectomy, after reconstruction and after stoma closure were reported in 12.7, 19.3 and 35% of cases, respectively. CONCLUSIONS: This study shows that there is general consensus regarding indications for surgery. The ideal surgical technique remains under debate. Laparoscopy is a procedure widely adopted for colectomy but its use in reconstructive surgery remains limited. Longer follow-up must be planned to define the quality of life of these patients.

A cross-sectional nationwide survey on esophageal atresia and tracheoesophageal fistula.

BACKGROUND: Our study aims at disclosing epidemiology and most relevant clinical features of esophageal atresia (EA) pointing to a model of multicentre collaboration. METHODS: A detailed questionnaire was sent to all Italian Units of pediatric surgery in order to collect data of patients born with EA between January and December 2012. The results were crosschecked by matching date and place of birth of the patients with those of diagnosis-related group provided by the Italian Ministry of Health (MOH). RESULTS: A total of 146 questionnaires were returned plus a further 32 patients reported in the MOH database. Basing on a total of 178 patients with EA born in Italy in 2012, the incidence of EA was calculated in 3.33 per 10,000 live births. Antenatal diagnosis was suspected in 29.5% patients. 55.5% showed associated anomalies. The most common type of EA was Gross type C (89%). Postoperative complications occurred in 37% of type C EA and 100% of type A EA. A 9.5% mortality rate was reported. CONCLUSIONS: This is the first Italian cross-sectional nationwide survey on EA. We can now develop shared guidelines and provide more reliable prognostic expectations for our patients.

Altered expression of cytokines in mice infected intranasally with two syncytial variants of Herpes simplex virus type 1.

Immune evasion strategies are important for the onset and the maintenance of viral infections. Many viruses have evolved mechanisms to counteract or suppress the host immune response. We have previously characterized two syncytial (syn) variants of Herpes simplex 1 (HSV-1) strain F, syn14-1 and syn17-2, obtained by selective pressure with a natural carrageenan. These variants showed a differential pathology in vaginal and respiratory mucosa infection in comparison with parental strain. In this paper, we evaluated the modulation of immune response in respiratory mucosa by these HSV-1 variants. We observed altered levels of Tumor Necrosis Factor-α and Interleukin-6 in lungs of animals infected with the syn14-1 and syn17-2 variants compared with the parental strain. Also, we detected differences in the recruitment of immune cells to the lung in syn variants infected mice. Both variants exhibit one point mutation in the sequence of the gene of glycoprotein D detected in the ectodomain of syn14-1 and the cytoplasmic tail of syn17-2. Results obtained in the present study contribute to the characterization of HSV-1 syn variants and the participation of the cellular inflammatory response in viral pathogenesis.

Abdominal wall defects: a 33-year unicentric experience.

AIM: The aim of this paper was to provide the main clinical features, surgical details, and long term outcome of patients with gastroschisis and omphalocele operated on at Giannina Gaslini Institute between 1976 and 2009. METHODS: All patients who were operated on between 1976 and 2009 for omphalocele or gastroschisis were included. Detailed informations regarding demographics, maternal history, type of delivery, associated anomalies, surgical details, complications, morbidity and mortality were collected. RESULTS: Sixty-one patients were included. Type of delivery did not interfere with outcome. Although patients with omphalocele had higher incidence of associated anomalies with their obvious impact on survival and quality of life, they showed a quicker recovery from surgery. Mortality rate was around 5%. Long-term outcome was available in 18 of them and proved to be satisfactory in all although almost 70% of them complained some gastrointestinal issues. CONCLUSION: Gastroschisis and Omphalocele showed improving survival and outcome during the last decades. Caesarean section proved not to confer advantages over vaginal delivery. Associated anomalies have the highest impact on survival being cardiac malformation the most significant risk factors. Although overall outcome is good in the majority of the patients, gastrointestinal and cosmetic issues seem to have a significant impact on quality of life and overall patients' perspectives.

Diagnostic laparoscopy for early detection of acute mesenteric ischaemia in patients with aortic dissection.

INTRODUCTION: Recognition of acute mesenteric ischaemia (AMesI) in patients with aortic dissection (AoD) may be a challenge and exploratory laparotomy is often performed. METHODS: We retrospectively analysed our experience with the use of diagnostic laparoscopy (DL) for the early detection of AMesI in patients with AoD, either undergoing medical treatment or after open/endovascular interventions. RESULTS: Between 2004 and 2011, 202 consecutive AoDs were treated in our centre (71 acute type A AoD; 131 acute and chronic type B AoD). Among the 17 (8.4%) patients in which AMesI was suspected, nine (52.9%) were selected for DL. Three DLs were performed during medical treatment of patients with acute type B AoD, six after treatment of AoD (both surgical and endovascular). Three second-look DLs were also performed. Eight DLs were negative, three showed AMesI and the patients underwent successful emergent revascularisation. One DL was not conclusive and laparotomy was required. Among the eight patients not submitted to DL, one case of bowel infarction was recorded. CONCLUSIONS: In our series DL was feasible and safe. The low invasiveness and repeatability were the main advantages. Although additional experience is mandatory, DL seems a promising technique for the detection of AMesI in patients with AoD.

Development of inducible EIAV-based lentiviral vector packaging and producer cell lines.

Large-scale production of gene therapeutics comprising equine infectious anaemia virus (EIAV) -based lentiviral vectors (LVs) would benefit from the development of producer cell lines enabling the generation of larger quantities of vector than achievable by transient systems. Such cell lines would contain three vector components (Gag/Pol, VSV-G envelope and genome expression constructs). As the vesicular stomatitis virus (VSV-G) envelope protein is cytotoxic, its expression must be regulated. It is also desirable to regulate Gag/Pol expression to minimise metabolic burden on the cell. The Tet repressor (TetR) system was selected to regulate expression of VSV-G and Gag/Pol, necessitating the introduction of a fourth construct, encoding TetR, into the cell line. We have generated an inducible packaging cell line that shows tight control of the packaging components, and high-titre vector production on transient transfection of the EIAV genome. The cell line is stable for at least 7 weeks in the absence of selective pressure. To verify that this packaging cell line can support the generation of producer cell lines it was transfected stably with an EIAV genome cassette encoding ProSavin; a gene therapeutic for Parkinson's disease. Producer cell lines were generated, which on induction, yielded ProSavin with titres comparable to the transient system.

[Prognostic factors of gastric neoplasms: experience with 1,074 cases undergoing surgical treatment at a single center]. / Fattori prognostici delle neoplasie gastriche: esperienza su 1074 casi sottoposti a trattamento chirurgico presso un singolo centro.

AIM: The aim of our study was to identify clinicopathological predictors of survival among patients undergoing potentially curative resections for gastric carcinoma. PATIENTS AND METHODS: From January 1987-March 2004, 1074 patients have been submitted to curative gastric resection for gastric cancer (647 males and 427 females, mean age, 65 +/- 12, min 22, max 92). The surgical procedure consisted of 289 (27%) total and 785 (63%) subtotal gastrectomies. The extent of lymph node dissection was limited D1 (n = 376, 35%) or extended D2 (n = 578, 54%) and D3 (n = 12, 1%); no lymphadenectomy was performed in 108 (10%) cases. The pathological nodal status has been defined based on the number of involved lymph nodes (N1: 1 to 6 positive nodes; N2: 7 to 15 positive nodes; N3: more than 15 positive nodes). The distribution of N stage was: N0 = 278 (26%), N1 = 344 (32%); N2 = 215 (20%); N3 = 129 (12%). Univariate analyses were performed for gender, age, pT stage, pN stage, tumor site, tumor size, and extent of lymphadenectomy. Significant factors were then entered into a Cox regression analysis. RESULTS: The median number of examined lymph nodes was 17 (mean, 18). Overall, 688 (64%) of patients had lymph node metastases. Of these patients, the median number of involved nodes was 2 (mean, 6). In the univariate analysis age, pT stage, pN stage, tumor size, and extent of lymphadenectomy were found to be significant factors. In the multivariate analysis T stage, N stage, and extent of lymphadenectomy were all independent predictors of survival. The median and mean survival time were 69 and 87 months, respectively. Overall survival was 80%, 51% and 40% at 1, 5, and 10 years, respectively. CONCLUSIONS: T stage, N stage, and extent of lymphadenectomy were all independent predictors of survival in patients submitted to curative gastric resections.

[Minimally invasive esophagectomy for adenocarcinoma of the lower esophagus and the gastroesophageal junction]. / Esofagectomia mininvasiva per adenocarcinoma siewert i della giunzione gastroesofagea.

BACKGROUND: Adenocarcinoma of lower esophagus and GEJ shows worldwide an increasing incidence. The optimal approach to resection is still controversial. One of the major disadvantages of radical esophagectomy with extensive lymphadenectomy with open technique is its high rate of morbidity and mortality. Recent advances in minimally invasive surgical technology have allowed surgeons to apply laparoscopy and thoracoscopy to perform esophagectomy. PATIENT AND METHODS: In the video we report the case of a 79 years old man with Siewert I adenocarcinoma of GEJ, who was submitted to a 3-stage minimally invasive esophagectomy by laparoscopy, right thoracoscopy and cervicotomy. Preoperative endoscopic ultrasound and CT scan showed a marked thickening of the wall of the distal esophagus, with extension proximal to the mediastinal pleura and the anterior surface of the aorta, but still showing features of resectability. Four ports were used for the abdominal approach. A complete mobilization of the stomach preserving the right gastroepiploic arcade was achieved. The patient was then turned to the left lateral decubitus position proned to 30 degrees. Three ports were needed for right thoracoscopy. Mobilization of the thoracic esophagus was carried out from the diaphragm to the thoracic inlet. After extraction of the specimen through a small abdominal incision, the stomach was pulled up to the neck and esophagogastric anastomosis with the Orringer technique was constructed through a left cervicotomy. Pathology showed pT3 pN1 G3 adenocarcinoma. CONCLUSIONS: The minimally invasive approach to adenocarcinoma of the lower esophagus, in center with expertise in minimally invasive surgical technique, is feasible and safe.

[Gastrectomy and laparoscopic lymphadenectomy for carcinoma: preliminary experience with 59 cases]. / Gastrectomia e linfoadenectomia laparoscopica per carcinoma: esperienza preliminare su 59 casi.

BACKGROUND: Laparoscopic surgery has been used in the treatment of gastric cancer with low mortality and morbidity and improvement in patient's quality of life. AIM: To evaluate the results of laparoscopic gastric resection. METHODS: A retrospective review of 59 patients after laparoscopic surgery for gastric cancer was performed. The patients were 31 males and 28 females with a mean age of 67 (+/- 11) years (min 39, max 90). RESULTS: Tumor stage was IA in 15 patients, IB in 10, II in 9, IIIA in 6, IIIB in 9, and IV in 10. In 15 cases the tumor was an early gastric cancer. The mean number of dissected lymph nodes was 29 +/-10. Conversion rate was 16%. Morbidity rate was 37%. The median length of hospital stay was 10 days. Operative mortality was 3%. The mean time of follow-up was 23 months. Two-year survival was 75%. CONCLUSIONS: Laparoscopic radical total or subtotal gastrectomy with extended lymphadenectomy for gastric cancer is a feasible, safe, and oncologically effective procedure.

Novel DL-galactan hybrids from the red seaweed Gymnogongrus torulosus are potent inhibitors of herpes simplex virus and dengue virus.

A novel series of DL-galactan hybrids extracted from the red seaweed Gymnogongrus torulosus, was evaluated for its in vitro antiviral properties against herpes simplex virus type 2 (HSV-2) and dengue virus 2 (DEN-2). These compounds were very active against both viruses with inhibitory concentration 50% (IC50) values in the range 0.6-16 microg/ml for HSV-2 and 0.19-1.7 microg/ml for DEN-2, respectively, as determined in a virus plaque reduction assay in Vero cells. The DL-galactans lacked of cytotoxic effects, on stationary as well as on actively dividing cells, and anticoagulant properties. Some of the compounds showed a variable level of direct inactivating effect on both virions, with virucidal concentration 50% values exceeding the IC50s obtained by plaque reduction assay. Full inhibitory activity was achieved when the galactans were present during virus adsorption period, suggesting that the mode of action of these compounds is an interference in the binding of the surface envelope glycoprotein with the cell receptor.

Herpes simplex virus type 1 variants arising after selection with an antiviral carrageenan: lack of correlation between drug susceptibility and syn phenotype.

Natural carrageenans of diverse structural types isolated from the red seaweed Gigartina skottsbergii were recently identified as potent and selective inhibitors of herpes simplex virus types 1 and 2 (HSV-1 and -2). The mu/nu-carrageenan 1C3 was tested in vitro for its ability to select resistant variants. After serial passages of HSV-1 strain F in Vero cells in the presence of increasing concentrations of 1C3, viruses emerged that were approximately 2- to 10-fold more resistant to 1C3 inhibition than parental virus; these viruses formed large plaques with an altered syncytial phenotype (1C3-syn). Plaque-purified syncytial variants isolated from passages 13 and 14 have shown variable levels of resistance to 1C3, as well as to the other antiviral carrageenans isolated from G. skottsbergii and to other sulfated polysaccharides with known antiviral activity, such as heparin and dextran sulfate 8000, but all the clones were susceptible to acyclovir. The syn phenotype was not related to polysaccharide resistance. All the 1C3-syn variants formed large syncytia in Vero and CV-1 cells but did not induce fusion in other cell types. The growth efficiency in Vero cells, as well as the virulence for mice by intracerebral or intraperitoneal inoculation of 1C3-syn variants, showed no significant alterations in comparison with the parental virus. The syncytial properties were not affected by cyclosporine or melittin, suggesting that an alteration on glycoprotein gB could be responsible for the syn phenotype induced by 1C3.

[The Pap test in HIV-positive women]. / Il Pap test in donne HIV positive.

The aim of this work was to estimate the frequency of abnormal Papanicolau (Pap) smears in a group of HIV-infected women undergoing cervical screening. We re-examined 162 Pap smears from 118 patients infected with HIV. The patients were aged 23-55 years. A total of 108 smears (66.6%) from 80 patients were negative; 14 smears (8.6%) from 14 patients showed inflammation; 3 smears (1.8%) from 3 patients had atypical squamous cells of undetermined significance (ASCUS); 20 smears (13.5%) from 16 patients were abnormal for human papillomavirus (HPV); 13 smears (8.0%) from 9 patients revealed low-grade, squamous intraepithelial lesions; 10 smears (6.2%) from 7 patients were SIL-HG; the diagnosis of carcinoma was made in 3 cases (1.8%) and 2 smears from 2 patients were unsatisfactory. HIV-infected women have an increased rate of abnormal Pap smears for both HPV infections and cervical dysplasia. These results confirm the validity of cervical screening by Pap test.

[Laparoscopic versus conventional surgery in the treatment of colorectal diseases]. / Chirurgia laparoscopica versus chirurgia tradizionale nel trattamento della patologia colo-rettale.

The aim of the study was to compare the results obtained with laparoscopic (LPS) and laparotomic (LPT) colorectal resection after our initial experience with the laparoscopic technique. Fifty-six patients were submitted to colorectal resection, 26 with the LPS and 30 with the LPT technique. Eighteen patients out of 26 in the LPS group and 22/30 in the LPT group had malignancies. All resections were performed with a curative intent. The mean operating time was 220 min in the LPS group and 208 min in the LPT group. Mean blood loss was 287 ml and 312 ml, respectively (blood transfusions were needed in 1/26 and in 7/30 patients). The rates of major complications were 9.5% and 5.7%, respectively. There was no mortality. The conversion rate for the LPS group was 19.2%. In the cancer patients, no significant difference was observed between the two groups as regards postoperative staging. The mean length of specimens and the mean distance of the tumours from the resection margins were adequate. The mean number of lymph nodes harvested was 11.8 in the LPS group as against 18.5 in the LPT group. No early recurrences were observed. Resumption of gastrointestinal function was faster in the LPS patients who underwent the surgical procedure under general anaesthesia associated with epidural anaesthesia/postoperative analgesia. In conclusion, these preliminary results indicate that laparoscopic colorectal surgery is feasible and that the resections in cancer patients appear to be oncologically adequate. Long-term follow-up is needed for reliable assessment of oncological outcomes.

Carrageenans from chilean samples of Stenogramme interrupta (Phyllophoraceae): structural analysis and biological activity.

Carrageenans extracted from cystocarpic and tetrasporic Stenogramme interrupta were analysed by chemical and spectroscopic methods. The carrageenan from cystocarpic plants is composed predominantly of 0.5 M KCl-insoluble and 1 M KCl-soluble fractions. The insoluble fraction contained iota-carrageenan as the major component with alpha-carrageenan and pyruvated carrageenan as minor components. The soluble fraction is highly heterogeneous and did not contain the precursors mu- and nu-carrageenans. The polysaccharide from tetrasporic plants is composed of zeta- and lambda-carrageenans, and low sulfated galactans. It is soluble in KCl and partly cyclized by alkaline treatment. The antiviral and anticoagulant properties of the insoluble polysaccharide fraction from cystocarpic S. interrupta and the polysaccharide from tetrasporic S. interrupta are reported the results of which suggest promising antiherpetic activity.

[Intraoperative radiotherapy as adjuvant treatment for resection of carcinoma of the pancreas]. / La radioterapia intraopertoria come trattamento adiuvante alla resezione nel carcinoma del pancreas.

Local recurrence is the most frequent site of failure after resection for pancreatic cancer. We reported our experience in term of tolerance, local control and survival obtained by the association of resection and intraoperative radiation therapy (IORT). Between January 1985 and July 1996 152 resection for pancreatic cancer were performed at the authors' institution. For 77 patients, IORT was added to resection (group 1), whereas the other 75 patients underwent resection alone (group 2), because of either the unavailability of the linear accelerator or the patient's refusal. In group 1, radiation doses from 12.5 to 20 Gy, with electron beam energies between 6 and 12 MeV, were delivered. Extension of the disease, percentage of radical resection and postoperative chemotherapy were similar in the two groups of patients. Operative mortality and overall early postoperative complications were respectively 1.3% and 31.2% in group 1 and 4% and 32% in group 2. The median survival was 17 months in group 1 and 15 months in group 2 and the median disease free survival was 12 months in group 1 and 8 months in group 2. A local recurrence was detected in 31% of patients in group 1 and in 49.3% of patients in group 2 (p < 0.1). The results suggest a better local control in patients with pancreatic cancer undergoing adjuvant IORT.

Recurring intracranial meningiomas. Morphometrical evaluation of nuclear pleomorphism by S.A.M. (shape analytical morphometry) system.

Meningiomas are the most common neoplasms of the central nervous system and their biological behavior is not always predictable from the histologic appearance of the tumors. The nuclear pleomorphism seems to be one of the most important morphological features in the prediction of recurrence. By using analytical morphometric methods it is possible to quantify nuclear atypias and to obtain parameters describing nuclear contour irregularities and distortions of the figure. Moreover the amount of information obtained from analytical procedure allowed to discriminate, by multivariate discriminant analysis recurrent or no-recurrent meningiomas (5% of error).

Surgery in the very old patient: evaluation of factors linked to postoperative morbidity and mortality.

One hundred and sixty-seven patients over 79 years of age were studied prospectively in our Emergency Surgery Department in order to evaluate their outcome, and the possible existence of factors linked to morbidity and mortality. The most common indications for surgery were gallstones (22.1%), hernias (14.9%), colo-rectal cancer (13.7%), peptic ulcer (6.5%), gastric cancer (5.9%) and ischemic or hemorrhagic vascular diseases (13.1%). Emergency surgery was performed in 93 (55.6%) patients. Forty-nine patients (29.3%) developed 83 postoperative complications. The risk of morbidity was statistically higher in patients who had more than two associated diseases (p < 0.05) and received blood transfusions (p < 0.01). The mortality rate was 16.1%, and was significantly related to ASA scores > or = 4 (p < 0.001) and a high degree of intraoperative bacterial contamination (Classes III-IV) (p < 0.05). Compared to elective surgery emergency operations had a higher morbidity (33.3% vs 24.3%) and mortality (21.5% vs 9.4%), but the difference was not significant. Mortality/morbidity ratio was significantly higher in emergency, as compared to elective surgery (64.5% vs 38.8%, p < 0.001).

The role of intraoperative therapy by electron beam and combination of adjuvant chemotherapy and external radiotherapy in carcinoma of the pancreas.

AIMS AND BACKGROUND: In the treatment of pancreatic carcinomas, one modality is intraoperative radiotherapy (IORT). A study was carried out to assess the feasibility of IORT alone or in a multimodality approach with postoperative adjuvant chemotherapy and external radiotherapy and to compare local control and survival of patients. Another objective of this retrospective study was to verify prognostic factors in resected patients treated with IORT. METHODS: From January 1985 through September 1992, 54 adenocarcinomas of the pancreas (unresectable and resected patients) were treated with IORT by electron beam at the San Raffaele Hospital and then analyzed. Comparison was also carried out between IORT-treated resected patients and a non-randomized control group of resected patients treated without IORT in the same period. RESULTS: In unresectable patients treated by laparotomy bypass and IORT, overall median survival was 6 months and 8 months in non-metastatic patients. Relief of severe pain present in 14 patients was observed in 85% within 12 days of IORT. As regards resected patients, the most important finding was that significantly better local control resulted from IORT. In fact, overall, local relapses were 25% in the IORT group and 55.8% in the non-IORT group (control group); instead, survival of the IORT group was not significantly longer than that of the control group. From a statistical analysis of resected patients treated with IORT and performed on prognostic factors on the basis of available data, survival was significantly influenced by tumor pathologic grading and diameter; postoperative adjuvant therapy was not a significant prognosis factor. CONCLUSIONS: IORT has a role in local control of unresectable pancreatic carcinomas and in control of resultant severe pain. In resected patients, IORT is effective in decreasing local recurrences but has little impact on survival. To obtain more satisfactory results, new and more effective adjuvant therapies and better abdominal prophylaxis should be tested.

Intraoperative radiation therapy adjuvant to resection in the treatment of pancreatic cancer.

BACKGROUND: Local recurrence is the most frequent site of failure after resection for pancreatic cancer. Tolerance, local control, and survival obtained by the association of resection and intraoperative radiation therapy (IORT) were reported. METHODS: Between June 1985 and March 1993, 90 resections for pancreatic cancer were performed at the authors' institution. For 43 patients, IORT was added to resection (Group 1), whereas the other 47 patients underwent resection alone (Group 2), because of either the unavailability of linear accelerator or the patient's refusal. In Group 1, radiation doses from 12.5 to 20 Gy, with electron beam energies between 6 and 12 MeV, were delivered. Extension of the disease was similar in the two groups of patients: mean diameter of the tumor was 3.2 cm in Group 1 and 3.4 cm in Group 2; percentage of third degree stage disease (International Union Against Cancer classification) was 65.1% in Group 1 and 57.4% in Group 2; and tumor clearance was incomplete in 39.5% of patients in Group 1 and in 34.0% in Group 2. RESULTS: Operative mortality and overall early post-operative complications were respectively 2.3% and 23.2% in Group 1 and 2.1% and 23.4% in Group 2. One-year, 2-year, and 3-year survival rates were respectively 71%, 24%, and 7% in Group 1 and 49%, 16%, and 10% in Group 2 (P was not significant). Median disease free survival was 13 months in Group 1 and 8 months in Group 2 (P was not significant). A local recurrence was detected in 27.0% of patients in Group 1 and in 56.4% of patients in Group 2 (P < 0.01). CONCLUSIONS: The results suggest a better local control in patients with pancreatic cancer undergoing adjuvant IORT.