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De Rai P.,Fondazione Istit. di Ricovero e Cura a Carattere Scienti. Ca Granda Ospedale Maggiore Policlinico | Zerbi A.,IRCCS Instituto Clinico Humanitas Humanitas Clinical Institute | Castoldi L.,Fondazione Istit. di Ricovero e Cura a Carattere Scienti. Ca Granda Ospedale Maggiore Policlinico | Bassi C.,University of Verona | And 126 more authors.
HPB | Year: 2010

Objective: This study aimed to evaluate the surgical treatment of acute pancreatitis in Italy and to assess compliance with international guidelines. Methods: A series of 1173 patients in 56 hospitals were prospectively enrolled and their data analysed. Results: Twenty-nine patients with severe pancreatitis underwent surgical intervention. Necrosectomy was performed in 26 patients, associated with postoperative lavage in 70% of cases. A feeding jejunostomy was added in 37% of cases. Mortality was 21%. Of the patients with mild pancreatitis, 714 patients with a biliary aetiology were evaluated. Prophylactic treatment of relapses was carried out in 212 patients (36%) by cholecystectomy and in 161 using a laparoscopic approach. Preoperative endoscopic retrograde cholangiopancreatography was associated with cholecystectomy in 83 patients (39%). Forty-seven patients (22%) were treated at a second admission, with a median delay of 31 days from the onset of pancreatitis. Eighteen patients with severe pancreatitis underwent cholecystectomy 37.9 days after the first admission. There were no deaths. Discussion: The results indicate poor compliance with published guidelines. In severe pancreatitis, early surgical intervention is frequently performed and enteral feeding is seldom used. Only a small number of patients with mild biliary pancreatitis undergo definitive treatment (i.e. cholecystectomy) within 4 weeks of the onset of pancreatitis. © 2010 International Hepato-Pancreato-Biliary Association.

Ray-Coquard I.,Leon Berard | Ray-Coquard I.,Center Leon Berard | Rizzo E.,European Organisation for Research and Treatment of Cancer Headquarters | Blay J.Y.,Leon Berard | And 12 more authors.
Gynecologic Oncology | Year: 2016

Objective UtS are a group of uncommon tumors representing 1% of malignant neoplasms of the female genital tract, and 7% of sarcomas. The objective of this study was to evaluate the factors associated with the clinical behavior UtS. Methods Information on 269 patients with advanced or metastatic first line UtS treated by chemotherapy was available in a database containing information on 3270 patients with advanced soft tissue sarcomas (STS) entered in EORTC-STBSG clinical trials between 1977 and 2010. The chemotherapy was aggregated in 4 categories: anthracyclines alone, ifosfamide alone, the combination of doxorubicin and ifosfamide, and CYVADIC. Results Among the 269 UtS pts, there were 231 deaths (median OS 10.4 months, 95% CI: 9.1-11.9) and 257 progressions and/or deaths (median PFS 4.1 months, 95% CI: 3.5-4.9). Multivariate analyses reported PS (p < 0.001) only to be a statistically significant prognostic factor for OS in UtS; for PFS, LMS histology (p = 0.025) is associated with a better outcome. There was no relationship between the 4 groups of chemotherapy regimens and impact on clinical outcomes. Histological subtype was significantly correlated with response to chemotherapy (RR: LMS 19% vs other 33%, p = 0.026). Ifosfamide single agent yielded only 5% of RR. Conclusions Clearly, UtS are very aggressive neoplasms with poor outcome when treated with chemotherapy consisting of anthracyclines with or without ifosfamide or cyclophosphamide. New strategies are urgently needed. © 2016 Elsevier Inc.

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