Resectable adenocarcinomas in the pancreatic head: the retroperitoneal resection margin is an independent prognostic factor

Pancreatic cancer is a lethal disease, and even after assumed margin-free pancreatoduodenectomy, most patients die within few years. The aims were to evaluate the importance of standardised histopathologic assessment for adequacy of reporting and survival estimates, and to report on prognostic factors in a setting of standardised histopathologic assessment. We performed immunohistochemical evaluation, slide review, and review of histopathologic reports from all pancreatoduodenectomies at Rikshospitalet University Hospital in 1980–2004. Reports from 1998-2004 at this institution were compared with reports from all other Norwegian institutions in the same period. Standardised histopathologic assessment and reporting was found necessary to avoid underestimation of poor prognostic factors, and to avoid misdiagnosis of tumours originating from non-pancreatic tissue (ampulla, distal bile duct, duodenum). Standardised histopathology was more important than surgical volume for completeness of reporting and for reliability of survival estimates, particularly with respect to lymph node evaluation. Immunostaining for MUC1 and MUC4 identified a subgroup of patients with particularly poor prognosis. Standardised histopathologic evaluation should be a first prerequisite to assure adequate histopathology after pancreatoduodenectomy. Immunostaining may identify tumour markers potentially targetable in future adjuvant treatments for pancreatic cancer

Pattern of lateral neck metastases in N0 papillary thyroid carcinoma

<p>Abstract</p> <p>Background</p> <p>Indication and extent of lateral prophylactic neck dissection (PLND) in papillary thyroid carcinoma (PTC) is very controversial.</p> <p>Methods</p> <p>We retrospectively analysed 131 patients who underwent thyroidectomy and prophylactic lateral neck dissection from level II to V for PTC.</p> <p>Results</p> <p>140 PLND were performed. The occult lymph node metastases (OLNM) overall rate was 18.6%. The incidence of node involvement was 10% at level III and 6.4% at level IIa. Level IV and level Vb were both concerned by 5.7% OLNM. Only 2.9% of level IIb contained OLNM. None of the level Va ND revealed OLNM.</p> <p>Conclusions</p> <p>OLNM from PTC occurs commonly in level IIa, III, IV and Vb. Incidence in other levels is low. For surgeons that usually perform PLND, we believe that a selective neck dissection of levels IIa, III, IV and Vb in N0 neck PTC is sufficient for the clearance of occult metastases.</p