GERALD W.PESKINMDGERALD W.PESKINMD
An argument continues to rage regarding the use of octreotide for the prevention of fistulae following pancreatic resection; the Europeans claim that there is value to this therapeutic regimen, whereas in the United States, the studies conducted have shown disappointing results. Dr Suc and colleagues have organized a prospective, multicenter randomized study of this problem, suggesting that octreotide is useful when the main duct is less than 3 mm in diameter and when pancreatoduodenectomy is completed by pancreatojejunostomy. Please see the invited critique by Dr John Windsor of New Zealand.
Dr Spitzer and colleagues, from the Kaiser Permanente Medical Center, Oakland, Calif, have attempted to classify paraspinal tumors according to sacral levels. They have devised a 6-level anatomical classification system based on tumor location, which they feel allows surgeons to anticipate specific problems and evaluate risks of resection and complications.
Drs Webber and Fromm of Wayne State University, Detroit, Mich, have come up with a treatment for anal carcinoma in situ in a group of patients who are at high risk for recurrence irrespective of their initial treatment. All were seropositive for the human immunodeficiency virus and were kept free of advancing disease for at least 5 months by the use of photodynamic therapy.
In this retrospective clinical trial, 250 patients underwent pancreaticoduodenectomy with 83 undergoing pancreaticojejunostomy and 167, pancreaticogastrostomy. Oussoultzoglou et al found that pancreaticogastrostomy is a safe method of reconstruction after pancreaticoduodenectomy, with a significantly lower rate of pancreatic fistula and relaparotomy.
Dr Eachempati and associates point out that opening an intermediate care unit resulted in an increased overall acuity of the surgical intensive care unit population, optimized the use of hospital resources, permitted expansion of emergency or tertiary care services, and improved outcomes for critically ill surgical patients.
The controversy over the appropriate treatment for a small lesion or lesions in patients with noncirrhotic livers harboring hepatocellular carcinoma is resolvable only after appropriate numbers of livers are available for transplantation. Meanwhile, Dr Chang and colleagues suggest that in early disease, patients with noncirrhotic livers had a significantly better survival rate than patients with cirrhotic livers and that hepatic resection is a reasonable first-line treatment, with transplantation reserved as salvage treatment for patients with recurrent disease after resection.
This Month in Archives of Surgery. Arch Surg. 2004;139(3):239. doi:10.1001/archsurg.139.3.239