The results of pancreatic surgery in Inuit patients from Greenland 1999-2022.

The study evaluates the outcome after surgery for pancreatic and periampullary tumors in Greenlandic Inuit with overall survival (OS) of pancreatic ductal adenocarcinoma (PDAC) as secondary outcome. Results were compared with Danish patients with an identical tumor stage and age operated at the same hospital during the same period from 31. January 1999 to 31. January 2021. Follow up was minimum one year. Preoperative health data shoved a higher rate of smoking among Greenlandic patients, but a lower preoperative comorbidity than in Danish patients. Patients from Greenland had a lower resection rate and a higher rate of palliative operations. Postoperative complications and in-hospital mortality were not significantly different. Adjuvant oncologic treatment was well accepted by Greenlandic patients but less common in a palliative setting than in Danish patients. The one, two, and five-year survival in Greenlandic and Danish patients after radical operation for PDAC was 54.4% vs. 74.6%, 23.4% vs. 48.6%, and 0.0% vs. 23.4%, respectively. The overall survival with non-resectable PDAC was 5.9 and 8.8 months, respectively. It is concluded that although patients from Greenland have the same access to specialized treatment, the outcome after treatment for pancreatic and periampullary cancer is less favorable than in Danish patients.

Posttransplant Diabetes Mellitus (PTDM) Following Solid Organ Transplantation - Systematic Analysis of Prevalence and Total Mortality and Meta-Analysis of Randomized Interventional Studies Aimed at Lowering Blood Glucose.

OBJECTIVE: A systematic review of the prevalence and prognosis of posttransplant diabetes mellitus (PTDM) following the transplantation of heart, lung, liver and kidney and a metaanalysis of randomised studies of glucose-lowering treatment is reported. METHODS: We searched for publications on solid organ transplants and PTDM in relation to the risk and total mortality of PTDM and randomized controlled trials aiming at reducing glucose levels. RESULTS: PTDM prevalence one year after transplantation was reported to be 9-40%. Ten years after transplantation, 60-85% of people without PTDM and 30-76% of people with PTDM were alive. Following kidney transplantation, we identified six randomized controlled trials on the treatment of PTDM. Intervention ranged from 3 to 12 months. Four studies used intervention with oral glucose-lowering drugs, one used dietician appointments and exercise, and one used insulin treatment. Among the intermediate results reported, a reduction in HbA1c of 2.7 mmol/mol, and an increase in the odds ratio of serious adverse events of 3.0 was significant. CONCLUSION: In conclusion, information on the prevalence and effect on survival of PTDM is heterogeneous, and the randomized studies on the effect of treatment available are short and lack information on clinically important endpoints, such as mortality or morbidity.

Primo non nocere or maximum survival in grade 2 gliomas? A medical ethical question.

BACKGROUND: Maximum safe resection is the "gold standard" in surgical treatment of grade 2 gliomas (G2Gs), aiming to achieve maximal survival benefit with minimal risk of functional deficit. OBJECTIVE: To investigate the attitude of patients and experts towards more extensive surgery with a trade-off between neurological function and survival time. METHODS: Eight patients and seven experts participated in semi-structured focus group interviews. RESULTS: Both patients and experts accepted the premise of balancing neurological function versus longevity. Some patients would accept an increased risk of permanent neurological deficits in order to obtain a chance of increased survival. There was a significant variance in what constituted "quality of life" both between patients and for the individual patient over time. CONCLUSIONS: In important life-changing decisions there is no "one size fits all". We find that it is ethically acceptable to offer more extensive surgery than is possible within the concept of maximal safe surgery as a treatment option, when balancing the principles of beneficence, non-maleficience, autonomy and justice supports the decision. At the same time it must be remembered that even when the patients have made a well-informed decision, some will regret it. In that situation it will be our job as healthcare professionals to support them and help carry some of this burden.