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Radiolabeled microsphere method was evaluated for its accuracy in making pancreatic blood flow computations. A canine model was employed with an isolated pancreatic circulation to evaluate the movement of 11 and 15 micrometer microspheres within the pancreas. The study evaluated two microspheres of different sizes, commonly used in physiological experiments, to define the results of a heavy microspheric load on the pancreases.

Pancreatic cancer occurred in nine out of every 100,000 people in the United States in 1988, and it has one of the lowest five-year survival rates. People who have an increased risk of developing pancreatic cancer are those who smoke cigarettes, have a high fat and/or meat diet, have had peptic-ulcer surgery or work with certain industrial chemicals. Oncogenes, genes that can change normal cells to cancer cells, may be involved in pancreatic cancer. Patients with pancreatic cancer are most often identified by their symptoms, and their diagnoses are usually confirmed using ultrasound and CT. Staging of, or evaluating, pancreatic tumors is done surgically or by using X-ray imaging techniques. Many patients with pancreatic cancer are treated surgically. Radiation therapy is the most effective treatment for patients with inoperable pancreatic cancer that has not spread. Other less effective treatments are chemotherapy and endocrine therapy, and scientists are testing new treatments on animals.

Heart-related deaths following heart surgery have decreased, and any further declines will probably result from the prevention of other types of complications. Pancreatitis (inflammation of the pancreas, a gland in the abdomen) occurs in as many as 5 percent of patients after any type of cardiac surgery, evidently caused by decreased blood flow or as a side effect of some drugs. Mortality is high. In order to determine the cause of pancreatitis, 300 patients about to undergo heart surgery with cardiopulmonary bypass (in which the circulation is routed outside the body while the heart is being operated on) were examined. Hyperamylasemia (increased concentrations of the enzyme amylase in the blood) indicates pancreatic injury, and was found in 27 percent of the patients. Because pancreatic involvement ranged from acute pancreatitis to a level of disease that could only be determined by biochemical analysis, the entire cluster was referred to as 'pancreatic cellular injury.' One factor that was closely associated with pancreatic complications was administration of calcium chloride at the time of the operation. The higher the dose of calcium chloride, the higher the risk of injury, with the risk rising very rapidly when the dose exceeded 800 mg. per square meter of body surface area. The use of calcium chloride is controversial, but it is routinely used at many medical centers because it is thought to improve heart function. However, if vasoconstriction (constriction of the blood vessels) is required, other drugs can be used. The other risk factor for pancreatic injury was ischemia (decreased blood flow) from low blood pressure (hypotension), low cardiac output, and a longer time spent in surgery. Heart valve surgery and previous kidney insufficiency also raised the risk of pancreatic cellular injury. (Consumer Summary produced by Reliance Medical Information, Inc.)

Objective: This study simulates the regionalization of pancreatectomies to assess its impact on spatial access in terms of patient driving times. Background: Although policies to regionalize complex procedures to high-volume centers may improve outcomes, the impact on patient access is unknown. Methods: Patients who underwent pancreatectomies from 2005 to 2014 were identified from California's statewide database. Round-trip driving times between patients' home ZIP code and hospital addresses were calculated via Google Maps. Regionalization was simulated by eliminating hospitals performing <20 pancreatectomies/yr, and reassigning patients to the next closest hospital that satisfied the volume threshold. Sensitivity analyses were performed for New York and Medicare patients to assess for influence of geography and insurance coverage, respectively. Results: Of 13,317 pancreatectomies, 6335 (47.6%) were performed by hospitals with <20 cases/yr. Patients traveled a median of 49.8 minutes [interquartile range (IQR) 30.8-96.2] per round-trip. A volume-restriction policy would increase median round-trip driving time by 24.1 minutes (IQR 4.5-53.5). Population in-hospital mortality rates were estimated to decrease from 6.7% to 2.8% (P < 0.001). Affected patients were more likely to be racial minorities (44.6% vs 36.5% of unaffected group, P < 0.001) and covered by Medicaid or uninsured (16.3% vs 9.8% of unaffected group, P < 0.001). Sensitivity analyses revealed a 17.8 minutes increment for patients in NY (IQR 0.8-47.4), and 27.0 minutes increment for Medicare patients (IQR 6.2-57.1). Conclusions: A policy that limits access to low-volume pancreatectomy hospitals will increase round-trip driving time by 24 minutes, but up to 54 minutes for 25% of patients. Population mortality rates may improve by 1.5%. [ABSTRACT FROM AUTHOR]

Objective: To test the hypothesis that complete, tumor-free resection at the pancreatic neck, achieved either en-bloc or non-en-bloc (ie, revision based on intraoperative frozen section [FS] analysis), is associated with improved survival as compared with incomplete resection (IR) in pancreatic ductal adenocarcinoma. Summary background data: Given the likely systemic nature of pancreatic ductal adenocarcinoma, the oncologic benefit of achieving a histologically complete local resection, particularly through revision of a positive intraoperative FS at the pancreatic neck, remains controversial. Methods: Clinicopathologic and treatment data were reviewed for 986 consecutive patients with ductal adenocarcinoma at the head, neck, or uncinate process of the pancreas who underwent open pancreatectomy as well as intraoperative FS analysis between 1998 and 2012 at Massachusetts General Hospital and between 1998 and 2013 at the University of Verona. Overall survival (OS) and perioperative morbidity and mortality were compared across 3 groups: complete resection achieved en-bloc (CR-EB), complete resection achieved non-en-bloc (CR-NEB), and IR. Results: The CR-EB cohort comprised 749 (76%) patients, CR-NEB 159 patients (16%), and IR 78 patients (8%). Other than a higher incidence of vascular resection among CR-NEB and IR patients, no demographic, pathologic (eg, tumor grade, lymph node positivity, superior mesenteric artery involvement), or treatment factors (eg, neoadjuvant and adjuvant therapy use) differed between the groups. Median OS was significantly higher in patients with CR-EB (28 mo, P = 0.01) and CR-NEB resections (24 mo, P = 0.02) as compared with patients with IR resections (19 mo). After adjusting for clinicopathologic and treatment characteristics, CR-EB and CR-NEB margin status were found to be independent predictors of improved OS (relative to IR, CR-EB hazard ratio [HR] 0.65, 95% confidence interval [CI] 0.49-0.86; CR-NEB HR 0.69, 95% CI 0.50-0.96). There were no intergroup differences in perioperative morbidity and mortality, including rates of pancreatic fistula. Conclusions: For patients with ductal adenocarcinoma at the head, neck, or uncinate process of the pancreas undergoing pancreatectomy, complete tumor extirpation via either en-bloc or non-en-bloc complete resection based on FS analysis is associated with improved OS, without an associated increased perioperative morbidity or mortality. [ABSTRACT FROM AUTHOR]