Current Approaches for the Curative-Intent Surgical Treatment of Pancreatic Ductal Adenocarcinoma.

Radical resection is the only curative treatment for pancreatic cancer. However, only up to 20% of patients are considered eligible for surgical resection at the time of diagnosis. Although upfront surgery followed by adjuvant chemotherapy has become the gold standard of treatment for resectable pancreatic cancer there are numerous ongoing trials aiming to compare the clinical outcomes of various surgical strategies (e.g., upfront surgery or neoadjuvant treatment with subsequent resection). Neoadjuvant treatment followed by surgery is considered the best approach in borderline resectable pancreatic tumors. Individuals with locally advanced disease are now candidates for palliative chemo- or chemoradiotherapy; however, some patients may become eligible for resection during the course of such treatment. When metastases are found, the cancer is qualified as unresectable. It is possible to perform radical pancreatic resection with metastasectomy in selected cases of oligometastatic disease. The role of multi-visceral resection, which involves reconstruction of major mesenteric veins, is well known. Nonetheless, there are some controversies in terms of arterial resection and reconstruction. Researchers are also trying to introduce personalized treatments. The careful, preliminary selection of patients eligible for surgery and other therapies should be based on tumor biology, among other factors. Such selection may play a key role in improving survival rates in patients with pancreatic cancer.

Simultaneous surgical treatment of hepatocellular carcinoma with tumor thrombus in the inferior vena cava and ischemic heart disease own research and literature review.

<b> Introduction:</b> Hepatocellular carcinoma (HCC) is the third leading cause of cancer-related death worldwide. Tumor penetration into the inferior vena cava/right atrium is rare, as it occurs only in 34% of HCC patients. There are no clear guidelines for the management of this stage of disease. </br></br> <b>Aim:</b> This is a case report of a patient with HCC and tumor thrombus in the inferior vena cava and with advanced coronary artery disease. </br></br> <b> Materials and methods:</b> The patient was qualified for a simultaneous cardiac surgery and liver resection with removal of the tumor thrombus from the inferior vena cava due to a high risk of sudden cardiac death. The first stage involved aortocoronary bypass followed by a right-sided hemihepatectomy with removal of the tumor thrombus from the inferior vena cava (this part of the operation was performed by extracorporeal circulation). The postoperative period was uneventful. Surgical treatment is one of the therapeutic options that offers a chance to radically remove the tumor and extend the patient's life. From a standpoint, these operations are extremely difficult and carry a high risk of perioperative complications (up to 40%). At the same time, the patient is at risk of complications due to cancer, such as pulmonary embolism, tricuspid stenosis, and congestive heart failure, which should be considered when choosing a treatment method. A significant number of patients also suffer from chronic conditions that worsen the prognosis. Cardiac diseases combined with tumor thrombus in the inferior vena cava may cause sudden cardiac death. </br></br> <b>Conclusions:</b> Surgical treatment should be considered in patients with HCC and tumor thrombus in the inferior vena cava, especially in patients with cardiovascular disease burden, as it is not only a chance to prolong life, but also to protect them against life-threatening cardiac complications.

Retrospective Analysis of Pancreas Transplants in Poland in Years 1998-2015.

Transplantation of the pancreas is an established method for the treatment of complicated diabetes mellitus. As the numbers of diabetic patients increase so does the need for efficient treatment methods. Despite significant perioperative risk and complications related to immunosuppression, pancreas transplant remains the best therapeutic option for selected patients. METHODS: The analysis was based on the comparison of characteristics of all organ donors and recipients in years 1998 to 2015. The collected data were divided into 2 periods to facilitate identification of populational changes. RESULTS: The total number of pancreas transplants in Poland was 139 in years 1998 to 2006 and 268 in years 2007 to 2015. The largest differences revealed by the comparison of donor-related variables in both periods were those related to the doses of pressor amines, duration of circulatory arrest, and duration of stay at the intensive care unit. The critical finding consisted in the improvement of short-term survival of recipients and organs being observed in contrast to the surprising lack of improvement in long-term survival. Reduced likelihood of transplantation success was observed already in overweight patients (body mass index 25-29.99 kg/m2). CONCLUSIONS: No significant changes were observed with regard to pancreas transplant outcomes over the period of many years. Transplantation success is determined by 1-year survival of the organ, and the therapeutic success is measured by long-term disease-free survival of the patient. In the era of rapid advances in numerous areas of medicine, the lack of significant extension of patient survival times warrants a closer look of our knowledge on pancreas transplants.

Usefulness of Pancreas Donor Risk Index and Pre-Procurement Pancreas Allocation Suitability Score: Results of the Polish National Study.

BACKGROUND Pre-procurement pancreas suitability score (P-PASS) and pancreas donor risk (PDRI) index are scoring systems believed to predict suitability of pancreatic grafts. Most European countries and the United States apply PDRI, while Poltransplant keeps using P-PASS: more than 16 points raises a red flag for graft use. Recent data discourage use of PDRI to predict pancreas graft survival. The aim of the present study was to assess PDRI and P-PASS as predictors of transplanted pancreas survival in a Polish population. MATERIAL AND METHODS From February 1998 to September 2015, 407 pancreas transplantations were performed in Poland: 370 (90.9%) simultaneous pancreas-kidney transplantation and 37 (9.1%) pancreas transplantation alone or pancreas after kidney. The endpoint was death-uncensored 12-month graft survival with satisfactory glycemic control without insulin. RESULTS Average P-PASS was 15.9±2.66 and PDRI was 0.96±0.37. Recipients who survived 12 months with good graft function had an average P-PASS score of 15.7 and PDRI of 0.95. Recipients with death-uncensored graft loss had a mean P-PASS of 16.4 and PDRI of 0.99. Univariate analysis revealed donor age, body mass index (BMI), and P-PASS to be significant risk factors for 1-year pancreas graft survival. CONCLUSIONS P-PASS, but not PDRI, is a reliable tool to predict pancreas graft survival in the Polish population.

Factors affecting one-year survival after radical cystectomy: A prospective study.

INTRODUCTION: Survival after radical cystectomy (RC) is affected by various factors. Significance of preoperative health status and its influence on treatment outcome is uncertain. The aim of the study was to prospectively evaluate overall survival, cause of death and the role of comorbidities in mortality during the first 12 months following RC. MATERIAL AND METHODS: All patients who underwent RC between January 2014 and May 2016 for T1-T4 bladder cancer in a single center were prospectively followed. Stage and comorbidities were explored as predictors of overall survival (OS). Patient status was assessed for at least 12 months. RESULTS: Follow-up was available for 25 men and 19 women at the mean age 67. Median time of follow-up for survivors was 16 months. Six-month and 1-year OS was 84% and 77%. Out of 11 deaths, 8 were related to cancer progression and 3 patients died for other causes. All deaths apart from one occurred in the first year after surgery. One-year OS was affected mostly by tumor stage: 95% for pT1-2 vs. 62.5% for pT3-4; p = 0.01. Worse outcome was found in patients ≥72 years old, (44% vs. 86%; p = 0.02) and among women (63% vs. 88%; p = 0.07). When patients who died were compared to survivors the following distribution of comorbidities was found: diabetes mellitus - 30.0% vs. 11.8%, p = 0.3; history of stroke - 30.0% vs. 2.9%, p = 0.1; thyroid disease - 30.0% vs. 11.8%, p = 0.3. CONCLUSIONS: Majority of patients died because cystectomy was performed too late. History of stroke, diabetes mellitus, and thyroid diseases should be assessed as possible risk factors in larger studies.