Teres Ligament Patch Reduces Relevant Morbidity After Distal Pancreatectomy (the DISCOVER Randomized Controlled Trial)

Objective:The aim of this study was to analyze the impact of teres ligament covering on pancreatic fistula rate after distal pancreatectomy (DP).Background:Postoperative pancreatic fistula (POPF) represents the most significant complication after DP. Retrospective studies suggested a benefit of covering the resection margin by a teres ligament patch.Methods:This prospective randomized controlled study (DISCOVER trial) included 152 patients undergoing DP, between October 2010 and July 2014. Patients were randomized to undergo closure of the pancreatic cut margin without (control, n = 76) or with teres ligament coverage (teres, n = 76). The primary endpoint was the rate of POPF, and the secondary endpoints included postoperative morbidity and mortality, length of hospital stay, and readmission rate.Results:Both groups were comparable regarding epidemiology (age, sex, body mass index), operative parameters (operation time [OP] time, blood loss, method of pancreas transection, additional operative procedures), and histopathological findings. Overall inhospital mortality was 0.6% (1/152 patients). In the group of patients with teres ligament patch, the rate of reoperations (1.3% vs 13.0%;P = 0.009), and also the rate of readmission (13.1 vs 31.5%;P = 0.011) were significantly lower. Clinically relevant POPF rate (grade B/C) was 32.9% (control) versus 22.4% (teres, P = 0.20). Multivariable analysis showed teres ligament coverage to be a protective factor for clinically relevant POPF (P = 0.0146).Conclusions:Coverage of the pancreatic remnant after DP is associated with less reinterventions, reoperations, and need for readmission. Although the overall fistula rate is not reduced by the coverage procedure, it should be considered as a valid measure for complication prevention due to its clinical benefit

Fluid collection after distal pancreatectomy: a frequent finding

AbstractBackgroundFluid collections (FC) at the resection margin of the pancreatic stump after distal pancreatectomy (DP) are common radiological findings in follow-up scans. No recommendations exist regarding the management of such findings. The aim was to characterise incidence, risk factors, clinical impact and therapy of FC.MethodData of 209 patients who underwent DP between 07/2009 and 06/2011 were prospectively collected and analysed, regarding follow-up CT or MRI scan findings of FC at the resection margin. FC was defined as a cyst-like lesion >1 cm in diameter.ResultsA follow-up with at least two cross-sectional images was available in 159/209 patients. In the first postoperative control, 68 patients showed an FC (43%). FC size was classified as <5 cm (n = 38 pat.), 5–10 cm (n = 24 pat.) and >10 cm (n = 6 pat.). 20 patients (30%) showed clinical symptoms. Six patients (9%) required specific treatment, all other FC showed spontaneous regression. No correlation with stump closure techniques or preceding postoperative pancreatic fistula was found (4/68 patients, 6%). Multivariate analysis revealed standard resections as the only significant factor for FC.ConclusionsFCs at the resection margin after DP are frequent and harmless findings. Therapeutic interventions are required in only 9% of all FC patients

За кадры. 1986. № 70 (2240)

Ученые ТПИ - народному хозяйствуКирову посвящяется / Р. ГалановаИтоги первого тура / Л. ИванкинаТЭФ: день за днем / А. КузьминПроблемы и поиски / Г. КривцоваТрудная задача / Г. КозловаВремя требует инициатив / Г. ЯловскаяБез всяких скидок / М. НикитинВ центре внимания / Н. ПавловаКруговорот вокруг внедрения. Ученые и НТП / Ю. АлексеевДвижение без активности / А. ТаенковЗавершился конкурс / Н. ПлещенкоДень последний / Е. КожемяченкоБиблиотекари учатся управлению / М. Тарасов

Recurrence of Ewing sarcoma: Is detection by imaging follow-up protocol associated with survival advantage?

BackgroundThe Cooperative Ewing Sarcoma Study and the Late Effects Surveillance System of the Society for Paediatric Oncology and Haematology recommend a structured follow-up imaging protocol (FUIP) for patients with Ewing sarcoma (EwS) with decreasing frequency of imaging over the first 5 years. The present study aims to assess the effectiveness of the FUIP for EwS patients regarding survival after relapse. Patients and methodsA retrospective multicenter analysis on 160 eligible patients with EwS recurrence was performed. Potential survival differences following recurrence diagnosis between patients with protocol-detected and symptomatic relapse were investigated using the Kaplan-Meier method. Additional subgroup analyses were performed on the relapse type. Overall survival (OS) was calculated from diagnosis of relapse to last follow-up or death. ResultsIn the multicenter analysis, recurrence was detected by FUIP in 77 of 160 patients (48%) and due to symptoms in 83 patients (52%). Regarding the entire study population, OS was significantly superior in patients with protocol-detected relapse compared to patients with symptomatic relapse (median, 2.4 vs. 1.2 years; P<0.001). In the subgroup analyses, patients whose lung recurrences were detected by the FUIP experienced longer survival after recurrence than those whose recurrences were detected symptomatically (P=0.023). In the 83 symptomatic patients, pain was the most prevalent symptom of relapse (72%). ConclusionFUIP may benefit survival in EwS relapse, especially in lung recurrence. Pain was the leading symptom of relapse

VLM-1 - Vehicle Design and Analysis (XTRAS-TN-VLM-20150302)

This report is a summary of the activities performed by the X-TRAS (Expertise Raumtransportsysteme) group within the German Aerospace Center (DLR) in 2014, based on the data and design created by the VLM-1 development team of DLR and the Brazilian Aerospace Technology and Science Department (DCTA/IAE). The analyses were conducted with the present configuration of the VLM-1 Carrier, which is close to the Preliminary Design Review (PDR) of the Vehicle. VLM-1 is a three-staged solid propellant rocket, capable of scientific suborbital and microsatellite launches. The first two stages feature identical S50 solid rocket motors with thrust vector control and a fixed-nozzle, spin stabilized S44 solid rocket motor in third stage on top. Its maiden flight will take place at Alcantara launch site (Centro de Lançamento de Alcântara) in Brazil. VLM-1 unites flightproven, robust sounding rocket heritage technology and hardware, newly developed motors and structures, and advanced control systems in order to provide efficient launch services. Investigations in this report include, but are not limited to: aerodynamics, trajectory and performance, load analysis, control systems and flight stability, guidance and navigation, mechanical design, separation processes, trust vector control, solid rocket motors, electrical and RF systems, ground infrastructure, fairing separation, launcher testing and qualification, costs, mission cases, and future upgrades; The VLM-1 launcher’s capabilities and system design are described and analyzed in this case study

Minimally Invasive versus Open Distal Pancreatectomy for Ductal Adenocarcinoma (DIPLOMA): A Pan-European Propensity Score Matched Study

OBJECTIVE: The aim of this study was to compare oncological outcomes after minimally invasive distal pancreatectomy (MIDP) with open distal pancreatectomy (ODP) in patients with pancreatic ductal adenocarcinoma (PDAC). BACKGROUND: Cohort studies have suggested superior short-term outcomes of MIDP vs. ODP. Recent international surveys, however, revealed that surgeons have concerns about the oncological outcomes of MIDP for PDAC. METHODS: This is a pan-European propensity score matched study including patients who underwent MIDP (laparoscopic or robot-assisted) or ODP for PDAC between January 1, 2007 and July 1, 2015. MIDP patients were matched to ODP patients in a 1:1 ratio. Main outcomes were radical (R0) resection, lymph node retrieval, and survival. RESULTS: In total, 1212 patients were included from 34 centers in 11 countries. Of 356 (29%) MIDP patients, 340 could be matched. After matching, the MIDP conversion rate was 19% (n = 62). Median blood loss [200 mL (60-400) vs 300 mL (150-500), P = 0.001] and hospital stay [8 (6-12) vs 9 (7-14) days, P 0.99) were comparable for MIDP and ODP, respectively. R0 resection rate was higher (67% vs 58%, P = 0.019), whereas Gerota's fascia resection (31% vs 60%, P < 0.001) and lymph node retrieval [14 (8-22) vs 22 (14-31), P < 0.001] were lower after MIDP. Median overall survival was 28 [95% confidence interval (CI), 22-34] versus 31 (95% CI, 26-36) months (P = 0.929). CONCLUSIONS: Comparable survival was seen after MIDP and ODP for PDAC, but the opposing differences in R0 resection rate, resection of Gerota's fascia, and lymph node retrieval strengthen the need for a randomized trial to confirm the oncological safety of MIDP