[Extended partial Kausch-Whipple duodenopancreatectomy by resection of tumor infiltrated vascular segments]. / Erweiterte partielle Duodenopankreatektomie nach Kausch-Whipple durch Resektion tumorinfiltrierter Gefässabschnitte.

The experience with standard Kausch-Whipple procedure is reviewed and compared with partial duodenopancreatectomies extended by partial resection of the portal vein. Perioperative morbidity has decreased to below 5% and survival rates with and without vessel resection are not significantly different. Therefore, infiltration of mesentericoportal vessels is not a contraindication for Kausch-Whipple procedure.

Surgical concepts for therapy of pancreatic neoplasms.

Surgical treatment of pancreatic malignomas has improved dramatically over the past decades, which is illustrated by the decrease in perioperative mortality to 1%-2%. This has made it possible to widen the indication for pancreatic resection and the extent of the surgical intervention. Experience with pancreatic resection for neoplasms at our center using standard surgical techniques during the last decade is reviewed, with special focus on the cases with partial resection of the portal vein. Perioperative morbidity has decreased below 5% and 5-year survival rates reach 60% for stage I tumors and 15%-25% for stage II and III tumors. The authors conclude that surgical therapy for pancreatic neoplasms is safe and yields a considerably higher quality of life for the patient and therefore should be considered in all patients with this disease entity.

[Extended partial Kausch-Whipple duodenopancreatectomy by resection of tumor infiltrated vascular segments]. / Erweiterte partielle Duodenopankreatektomie nach Kausch-Whipple durch Resektion tumorinfiltrierter Gefässabschnitte.

AIM: Vessel infiltration of the portal vein is often considered as contraindication for pancreas resection for carcinoma. In this retrospective analysis we investigated if an extended Whipple's procedure including vessel resection submits the patient to a significantly higher risk. PATIENTS AND METHODS: From August 1985 until February 1994 179 Whipple's procedures were carried out, in 74 cases for carcinoma of the pancreatic head. In this group 26 patients were classified as stage I (35.2%), 5 as stage II (6.7%), 38 as stage III (51.4%) and one patient as stage IV. In 18 cases a segment of the portal vein was resected, in 16 cases reconstructed by end-to-end anastomosis and in two cases by implantation of a GoreTex prosthesis. No special anticoagulation was applied. RESULTS: There were no anastomosis-related complications such as hemorrhage, thrombosis or stenosis. The lethality rate was 1.4% (1/74), insufficiencies at the pancreas and bile duct anastomosis occurred in 0% and 1.4% (1/74), resp. Patients with segmental vessel resection in stage III had a mean survival of 9 months and by 3 years there was no survivor compared to 11.7 months and 17% survival after 4 years in stage III without vessel resection. CONCLUSION: By performing vessel resection more pancreas tumors than earlier are resectable without increased risk. Since the results of oncologic alternative treatment modalities are still poor pancreas resection represents at present the best option for the patient.

[Measuring model for intraoperative determination of vascular resistance in crural vascular surgery]. / Mess-Modell zur intraoperativen Bestimmung des Abflusswiderstandes in der kruralen Gefässchirurgie.

The measurement of the vascular outflow resistance during reconstructive vascular operations was applied since 1989 on 45 subjects with reliable results. This measurement is an aid for decision of additional treatment increasing the outflow, like a jump- or sequential bypass or a pharmacological therapy. The principle of measurement is based on the injection of a known volume of saline in the vessel and the integration of the intravascular pressure during this injection. In the prototype used, the pressure integration was performed by means of a modified analog/digital conversion method, hereby the results could be achieved directly as numerical values. Further an automatic, microcomputer based implementation of the outflow resistance measurement, showed remarkable improvements of accuracy in laboratory tests.

[Effect of vascular resistance on results in crural artery surgery]. / Einfluss des Abflusswiderstandes auf die Ergebnisse in der kruralen Arterienchirurgie.

Between February 1989 and June 1991 the peripheral outflow resistance was measured at 45 patients during infragenual bypass surgery. In order to find out whether there is a correlation between successful bypass grafting and measured outflow resistance, all patients were controlled regularly. There was a significant difference in mean resistance between those grafts remaining patent and those that failed. 8 out of 11 bypasses, that failed up to one month after operation, had measured peripheral resistance higher than 1.1 mmHg x min/ml. 12 out of 15 bypass grafts remained patent for more than one month and had an outflow resistance less than 0.55 mmHg x min/ml. There is no definite correlation between a measured outflow resistance from 0.55 to 1.1 mmHg x min/ml because of the low number of patients in this group. The purpose of resistance measurement during peripheral vascular surgery was to determine a final value for a decision, if additional surgical or non surgical treatment for a better runoff is necessary. In our study this value is 1.1 mmHg x min/ml. Additional treatments are the peripheral AV-fistula and a jump- or sequential-graft. Another possibility is the intra- and postoperative application of Prostaglandin, which is in an experimental study in our clinic.