0
We're unable to sign you in at this time. Please try again in a few minutes.
Retry
We were able to sign you in, but your subscription(s) could not be found. Please try again in a few minutes.
Retry
There may be a problem with your account. Please contact the AMA Service Center to resolve this issue.
Contact the AMA Service Center:
Telephone: 1 (800) 262-2350 or 1 (312) 670-7827  *   Email: subscriptions@jamanetwork.com
Error Message ......
Invited Critique |

Especially Dangerous and Therefore Anxious Operations Comment on “Pancreatic Endocrine Tumors With Major Vascular Abutment, Involvement, or Encasement and Indication for Resection”

David B. Adams, MD
Arch Surg. 2011;146(6):732-733. doi:10.1001/archsurg.2011.110.
Text Size: A A A
Published online

Extract

In the summer of 1904, Sir Frederick Treves, the most famous surgeon of his time, wrote to King Edward seeking approval of the decision to retire from surgical practice. “I am anxious to retire from active practice,” Treves wrote, “and I trust Your Royal Highness will approve of my doing so. I have had 25 years of incessant and exacting work, and of late years I have been almost exclusively concerned with specially dangerous–and therefore anxious–operations.”1 Norton and his colleagues at the National Institutes of Health and Stanford University hospitals report their quarter of a century of incessant and exacting work with the dangerous and anxious operative treatment of PETs with major vascular involvement. The operations are dangerous because these tumors may be large and associated with pancreatic and peripancreatic fibrosis. Despite well-formulated and safe surgical techniques of vascular resection and reconstruction, these operations carry extra physical and emotional work, and the postoperative morbidity is worse than that of operations without vascular involvement. Anxious debate rattles the surgeon because the clinical course of PETs is capricious. Many advanced tumors pursue an indolent course, and long-term survival with advanced disease is possible. Other ostensibly early and small tumors seem to spread quickly and widely to the liver. The pancreatic surgeon worries whether the risk of resecting advanced PETs outweighs the benefits. The experience of Norton et al indicates that surgical resection of PETs with major vascular involvement and nodal or distal metastatic spread is safe and may be effective. Although carrying the imperfections of a retrospective cohort study at bicoastal centers during several decades, the ineluctable conclusion from this experience is that surgical resection of PETs with vascular involvement is analogous to that of adenocarcinoma of the pancreas, and involvement of the splanchnic vasculature is not a contraindication to operation. This hard-earned experience is encouraging because their findings suggest that patients with concomitant liver metastatic disease may also benefit from operative resection. Treves retired from the practice of surgery at age 50. The advice by Norton et al to refer patients with advanced PETs to multidisciplinary centers is good advice, and one hopes that it will keep them and their kind working on this problem in the operating room for decades to come.

Sign in

Purchase Options

• Buy this article
• Subscribe to the journal
• Rent this article ?

First Page Preview

View Large
First page PDF preview

Figures

Tables

References

Correspondence

CME
Also Meets CME requirements for:
Browse CME for all U.S. States
Accreditation Information
The American Medical Association is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians. The AMA designates this journal-based CME activity for a maximum of 1 AMA PRA Category 1 CreditTM per course. Physicians should claim only the credit commensurate with the extent of their participation in the activity. Physicians who complete the CME course and score at least 80% correct on the quiz are eligible for AMA PRA Category 1 CreditTM.
Note: You must get at least of the answers correct to pass this quiz.
Please click the checkbox indicating that you have read the full article in order to submit your answers.
Your answers have been saved for later.
You have not filled in all the answers to complete this quiz
The following questions were not answered:
Sorry, you have unsuccessfully completed this CME quiz with a score of
The following questions were not answered correctly:
Commitment to Change (optional):
Indicate what change(s) you will implement in your practice, if any, based on this CME course.
Your quiz results:
The filled radio buttons indicate your responses. The preferred responses are highlighted
For CME Course: A Proposed Model for Initial Assessment and Management of Acute Heart Failure Syndromes
Indicate what changes(s) you will implement in your practice, if any, based on this CME course.

Multimedia

Some tools below are only available to our subscribers or users with an online account.

36 Views
0 Citations
×

Sign in

Purchase Options

• Buy this article
• Subscribe to the journal
• Rent this article ?

Related Content

Customize your page view by dragging & repositioning the boxes below.

See Also...
Articles Related By Topic
Related Collections
PubMed Articles
Jobs
JAMAevidence.com

Care at the Close of Life: Evidence and Experience
Anxiety

brightcove.createExperiences();