Selective Surgical Approach Research Articles

Does a selective surgical approach to malignant bowel obstruction help in palliative care patients?

Malignant bowel obstruction (MBO) is a condition secondary to intra-abdominal metastatic spread of advanced-stage tumors. There is no consensus for the treatment approach of MBO. This study aims to present the results of medical treatment and palliative surgery in patients diagnosed with MBO. The patients who were treated for advanced-stage tumors between 2010 and 2017 and for whom consultation was requested from the surgical clinic for MBO symptoms were identified. A selective approach together with palliative care for the indication of surgery was instituted. The patients with surgical treatment and medical treatment were compared concerning survival, oral food intake and symptom relief. Seventy-six patients (30 female, 46 male) aged 60.5±12.8 years (range: 27-88) were included in this study. Forty-eight of the patients (64.9%) underwent surgical treatment, while 28 (35.1%) had medical treatment. Although the patients with surgery had longer duration of stay in the hospital (median 16 days vs. 4 days) (p<0.001) and higher complication rates (27.1% vs. 3.5%) compared to medically treated patients; the restoring oral food intake was better (97.9% vs. 78.6%) (p=0.005) and the survival was longer (105 days vs. 43 days). This study revealed that surgical treatment resulted in better outcomes for life quality parameters in highly selected patients with malignant bowel obstruction evaluated by multidisciplinary team, including palliative care.

High-Risk Features of Esophageal Adenocarcinoma Following Neoadjuvant Chemoradiation: Patients for Whom Surgery Should Not Be Delayed.

Clinical predictors of pathological complete response have not reliably identified patients for whom an organ-sparing approach following neoadjuvant chemoradiation be undertaken for esophageal cancer patients. We sought to identify high-risk predictors of residual carcinoma that may preclude patients from a selective surgical approach. Patients treated with neoadjuvant chemoradiation followed by esophagectomy for esophageal adenocarcinoma were identified. Correlation between clinical and pathologic complete responses were examined. Regression models and recursive partitioning were utilized to identify features associated with residual carcinoma. External validation of these high-risk factors was performed on a data set from an independent institution. A total of 326 patients were identified, in whom clinical complete response was noted in 104/326 (32%). Pathologic complete response was noted in only 33/104 (32%) of these clinical complete responders. Multivariable analysis identified that the presence of stricture ( P =0.011), positive biopsy ( P =0.010), and signet ring cell histology ( P =0.019) were associated with residual cancer. Recursive partitioning corroborated a 94% probability of residual disease, or greater, for each of these features. The positive predictive value was >90% for these characteristics. A SUV max >5.4 at the esophageal primary in the absence of esophagitis was also a high-risk factor for residual carcinoma. External validation confirmed these high-risk factors to be implicated in the finding of residual carcinoma. Clinical parameters of response are poor predictors of complete pathologic response leading to challenges in selecting candidates for active surveillance. However, we characterize several high-risk features for residual carcinoma which indicate that esophagectomy should not be delayed.

How I do it?: Selective surgical approach to the third axillary level

How I do it?: Selective surgical approach to the third axillary level

Surgical management of brain metastases following female reproductive system cancers: analysis of 37 cases

To demonstrate an appropriateness and role of neurosurgical care in the complex management of women with brain metastases following reproductive system cancers. There were 78 women with brain metastases following reproductive system cancer. All patients were treated at the Blokhin National Cancer Medical Research Center for the period 2004-2019. We have also reviewed the literature data for the last 30 years. Selective surgical approach should be essential in the treatment of patients with brain metastases following reproductive system cancer. A multidisciplinary approach ensures the best treatment outcomes.

Discussion

Discussion

Nonoperative management of solid abdominal organ injuries: From past to present.

Today, a significant proportion of solid abdominal organ injuries, whether caused by penetrating or blunt trauma, are managed nonoperatively. However, the controversy over operative versus nonoperative management started more than a hundred years ago. The aim of this review is to highlight some of the key past observations and summarize the current knowledge and guidelines in the management of solid abdominal organ injuries. A non-systematic search through historical articles and references on the management practices of abdominal injuries was conducted utilizing early printed volumes of major surgical and medical journals from the late 19th century onwards. Until the late 19th century, the standard treatment of penetrating abdominal injuries was nonoperative. The first article advocating formal laparotomy for abdominal gunshot wounds was published in 1881 by Sims. After World War I, the policy of mandatory laparotomy became standard practice for penetrating abdominal trauma. During the latter half of the 20th century, the concept of selective nonoperative management, initially for anterior abdominal stab wounds and later also gunshot wounds, was adopted by major trauma centers in South Africa, the United States, and little later in Europe. In blunt solid abdominal organ injuries, the evolution from surgery to nonoperative management in hemodynamically stable patients aided by the development of modern imaging techniques was rapid from 1980s onwards. With the help of modern imaging techniques and adjunctive radiological and endoscopic interventions, a major shift from mandatory to selective surgical approach to solid abdominal organ injuries has occurred during the last 30-50 years.

An exploratory study to perfect the Letournel classification of acetabular fractures

Objectives To put forward the modified Letournel classification of acetabular fractures, and evaluate the guiding role of the modified Letournel classification in clinical work. Methods A retrospective study of 170 patients (178 sides) with acetabular fractures treated at Nanfang Hospital between January 2006 and August 2018 was performed. Among them 129 cases were males and 41 were females. The average age was 40.2±14.2 years (range, 14-82 years). According to the Letournel classification, unclassifiable/atypical acetabular fractures were found out with plain X-ray and plain CT scan and three-dimensional CT, and then their unclassifiable reasons were analyzed. Based on anatomical landmarks, clear boundaries of acetabular walls were defined on the 3D printed pelvic model. The structure of each column is a trihedron. The wall’s fracture and column’s fracture were distinguished using a theory that the wall’s fracture involved two surfaces of column with interruption of continuity and column’s fracture involved three. When column’s fracture associated with wall’s fracture, lowercase a, p and q were used representing comminuted areas of corresponding anterior and posterior wall, quadrilateral plate respectively. When column’s fracture didn’t associates with wall’s fracture, it is marked with number 0. Finally, all fractures were classified according to the modified Letournel classification. The relationship between fracture type and surgical approach was analyzed. Results There was 51.7% (92 sides) of acetabular fractures that couldn’t be classified by the Letournel classification. Incomplete fracture lines (49 sides, 53.3%), comminuted fractures (28 sides, 30.4%), both of them (15 sides, 16.3%) were their unclassifiable reasons. There were 8 types in the modified Letournel classification, including posterior wall fracture, posterior column fracture, anterior wall fracture, anterior column fracture, transverse fracture, T-shaped fracture, anterior column+posterior hemitransverse fracture, and both columns fracture. Posterior column+posterior wall fracture, transverse+posterior wall fracture had respectively become a form of posterior column fracture and of transverse fracture. According to the modified Letournel classification, the reclassification rate of 178 side fractures was 100%, which was significantly higher than 48.3% (86/178) of the traditional Letournel classification, and the difference was statistically significant (χ2=124.06, P< 0.001) . 100% of posterior wall fracture and 80.00% of posterior column fracture were treated by posterior approach. 100% of anterior column fracture and 73.68% of both columns fracture were treated by anterior approach. Conclusion All acetabular fractures can be classified by the modified Letournel classification. The orientation of the comminuted walls reflects in part severity of the injury, better helps orthopaedic surgeons understand the morphology of acetabular fractures and select appropriate surgical approach. Key words: Acetabulum; Fractures, bone; Classification

Tailored surgery according to molecular analysis in differentiated thyroid carcinomas

Papillary thyroid carcinoma (PTC) is an often indolent disease implying a long survival and in most of the cases an excellent prognosis, but there is still a limited percentage of cases where, in spite of their pre-operative conventional staging, these tumors could better be treated through a more selective surgical approach. Small PTC in fact are generally considered as "low risk" tumors but using simply a TNM classification might lead to a limited surgery such as unilateral hemithyroidectomy, in particular according to the most recent guidelines of the American Thyroid Association. On the other hand though, an absence of the mutation could allow simplifying the follow-up of these patients, for example avoiding unnecessary radioactivated iodine therapy after surgery or even limiting to a unilateral thyroidectomy the operative procedure for these cases. Molecular testing has a peculiar interest for surgeons in two different ways: (I) with respect to diagnosis, in order to reduce the number of indeterminate citologies; (II) with respect to prognosis after both cytology and histology, in order to improve risk stratification and help the surgeon in developing a tailored surgical therapy. The aim of this review is the second issue: how to implement the concept of a tailored surgery according to molecular analysis in differentiated thyroid carcinomas (DTC).

Tailored approach to gastroparesis significantly improves symptoms.

Gastroparesis is difficult to treat and many patients do not report relief of symptoms with medical therapy alone. Several operative approaches have been described. This study shows the results of our selective surgical approach for patients with gastroparesis. This is a retrospective study of prospective data from our electronic medical record and data symptom sheet. All patients had a pre-operative gastric emptying study showing gastroparesis, an esophagogastroduodenoscopy, and either a CT or an upper GI series with small bowel follow-through. All patients had pre- and post-operative symptom sheets where seven symptoms were scored for severity and frequency on a scale of 0-4. The scores were analyzed by a professional statistician using paired sample t test. 58 patients met inclusion criteria. 33 had gastric stimulator (GES), 7 pyloroplasty (PP), 16 with both gastric stimulator and pyloroplasty (GSP), and 2 sleeve gastrectomy. For patients in the GSP group, the second procedure was performed if there was inadequate improvement with the first procedure. There was no mortality. The follow-up period was 6-316weeks (mean 66.107, SD 69.42). GES significantly improved frequency and severity for all symptoms except frequency of bloating and postprandial fullness. PP significantly improved nausea and vomiting severity, frequency of nausea, and early satiety. Symptom improvement for GSP was measured from after the first to after the second procedure. GSP significantly improved all but vomiting severity and frequency of early satiety, postprandial fullness, and epigastric pain. All procedures significantly improved symptoms, although numbers are small in the PP group. GES demonstrates more improvement than PP, and if PP or GES does not adequately improve symptoms GSP is appropriate. In our practice, gastrectomy was reserved as a last resort.

Molecular profiling of locally-advanced rectal adenocarcinoma using microRNA expression (Review).

Treatment for locally-advanced rectal cancer (LARC) typically consists of neoadjuvant chemoradiation followed by total mesorectal excision. Recently, there has been growing interest in non-operative management for patients who are medically-inoperable or wish to avoid surgical morbidity and permanent colostomy. Approximately 50% of patients who receive pre-operative neoadjuvant chemoradiation develop some degree of pathologic response. Approximately 10-20% of patients are found to have a complete pathologic response, a finding which has frequently been shown to predict better clinical outcomes, including local-regional control, distant metastasis and survival. Many recent studies have evaluated the role of molecular biomarkers in predicting response to neoadjuvant therapy. MicroRNAs (miRNAs) are an emerging class of biomarkers that have the potential to predict which patients are most likely to benefit from pre-operative therapy and from a selective surgical approach. Here, we review the published literature on microRNAs as prognostic and predictive biomarkers in rectal cancer after pre-operative therapy. In the future, the development of prospectively validated miRNA signatures will allow clinical implementation of miRNAs as prognostic and predictive signatures in LARC.

Outcomes of a Highly Selective Surgical Approach to Oligometastatic Lung Cancer

A highly selected subset of patients with oligometastatic non-small cell lung cancer (NSCLC) will be cured after all sites of established disease (primary and metastases) have been eliminated by surgery or radiation (ie, "curative intent" approach). Mediastinal lymph node metastases (N2) have been found retrospectively to predict a poor prognosis in this setting (5-year survival of 4% for N2-positive versus 31% for N2-negative). Hence, our institution has programmatically limited the use of curative intent local therapy to oligometastatic NSCLC patients confirmed to be free of N2 disease. However, it is unclear whether the exclusion of N2-positive patients is an effective prospective selection step to aggressively treat oligometastatic NSCLC. A prospectively maintained institutional tumor registry was reviewed for oligometastatic stage IV NSCLC patients evaluated for curative intent treatment from 2005 to2014. All synchronous oligometastatic NSCLC cases were evaluated by invasive mediastinal staging before treatment. Twenty-two patients without N2 disease underwent curative intent treatment, and 13 patients with N2 disease were treated palliatively. The groups were similar by bivariate analyses. The N2-negative patients treated with curative intent had a superior 5-year survival compared with N2-positive patients treated palliatively (58% versus 0%, respectively; p= 0.028). Using invasive mediastinal staging to exclude N2 disease has a role in surgical decision making and achieving long-term survival among oligometastatic NSCLC patients. Further study is warranted to determine whether a subset of patients with N2 disease also have the potential for long-term survival with local therapy.

Anatomy and surgical approach of rat’s vestibular sensors and nerves

BackgroundThe rat is one of the most used species in the neurosciences, but how to selectively reach each of its 5 vestibular sensors has never been described. Besides, new functions of the vestibular system have been recently discovered in the rat involving vegetative, circadian and cognitive functions. But the central pathways sustaining these functions and the role of each of the vestibular sensors are not clear. New methodsHere we want to describe the anatomy and look for a direct surgical approach to the 5 vestibular sensors in rats, as an indispensable technique to further study the central vestibular pathways.To do so we studied 10 rats either by microtomography with osmium tetroxide staining, histology with hematoxilyn-eosine staining or microsurgical dissection. ResultsThe microtomography allows a 3D representation of the 5 vestibular sensors and their nerves, with precise landmarks confirmed by the histological analysis. Each of the landmarks are illustrated and a selective surgical approach to each sensor and their nerves, is described step by step. Comparison with existing methodSelective approaches to the vestibular sensors have been used in other species such as cats, monkeys and recently humans but the current study is the first allowing this technique in rats. ConclusionEach vestibular sensor of the rat can be reached by a selective surgical approach. This allows further techniques such as electrophysiology or neurotracing of the central vestibular pathways. This also indicates the rat as a potential model for vestibular prostheses.

Deep anterior lamellar keratoplasty using precut anterior lamellar cap for herpes simplex keratitis: a long-term follow-up study

PurposeTo evaluate the feasibility, safety and efficacy of deep anterior lamellar keratoplasty (DALK) using precut anterior lamellar cap (ALC) for patients with herpes simplex keratitis.MethodsIn this single-centre retrospective study, 48...

Final results of RTOG 0246: A phase II study of selective surgical resection for locoregionally advanced esophageal cancer treated with a paclitaxel-based chemoradiation regimen.

7 Background: The organ preserving strategy of selective esophageal resection after definitive chemoradiation was evaluated in a multi-center, prospective Phase II trial. Methods: Treatment involved induction chemotherapy with 5-FU (650 mg/mg2/d), cisplatin (15 mg/mg2/d) and paclitaxel (200 mg/mg2/d) for 2 cycles followed by concurrent chemoradiation with 50.4 Gy (1.8 Gy/fx) and daily 5-FU (300 mg/mg2/d) with cisplatin (15 mg/mg2/d) over the first 5 days. Following definitive chemoradiation, pts were evaluated for residual locoregional disease with chest and abdominal CT scans, EUS and optional PET scans. If there was no suspected residual disease patients were observed and monitored serially for recurrent disease at 3 mos x 2, 6 mos x 3 and then yrly. Esophageal resection was considered only for pts with suspected residual or recurrent locoregional esophageal cancer that did not have systemic disease. Results: 43 pts from Sept 2003 to March 2006 with non-metastatic resectable esophageal cancer were entered from 19 sites to RTOG 0246. 41 pts were eligible for analysis. 29 pts (73%) were adenocarcinoma histology with pretreatment clinical stage T3 or greater in 31 pts (76%) and N1 in 29 pts (71%). Following induction chemotherapy and chemoradiation 3 pts (7.3%) died of treatment related deaths and 1 pt died of disease progression. 21 pts (51%) underwent surgical resection following chemoradiation because of suspected residual disease 17 pts (41%), pt choice (1) or recurrent locoregional disease 3 pts (7%). 1 pt died postoperatively from esophageal anastomotic leak. 11 pts (27%) are alive and free of disease 70 to 90 months after chemoradiation, of which 5 (12%) did not have esophagectomy. With a median follow-up of 6.7 yrs (for 16 alive pts), the estimated overall 2.5 and 5-year survival rates (95% CI) are 46.3% (30.7%-60.6%) and 36.6% (22.3%-51.0%). Conclusions: The long-term results from this multi-center, prospective Phase II trial demonstrates the efficacy of a selective surgical resection approach following definitive chemoradiation in a predominantly adenocarcinoma population of locoregionally advanced esophageal cancer. Clinical trial information: NCT00081289.

Hirurške procedure u lečenju dijabetesnog stopala

Nowadays complications of diabetes mellitus are very often the main cause of the most serious diseases and disabilities. Changes caused by diabetes are the most common cause of lower limb amputations in adults. Surgical treatment of complications is usually a radical treatment chosen in complicated situations when there is no other possibility. Taking etiopathogenesis of diabetic foot into consideration, it is clear that surgery is present in every stage of the changes that appear on diabetic foot. Surgical techniques for treating the foot deformities which lead to ulceration or cause trophic changes are applied in order to prevent complications. The treatment of acute stages includes surgical procedures such as incision, drainage, necrectomy and debridement. Reconstructive procedures are applied in the case of remission in acute phases or in the case of chronic ulcers: surgical reconstructive techniques for closing or covering the persistent defect of the skin and foot parts. Today, amputations are not the first choice in the case of diabetic foot, although they are still very common. The aim of this study is to review different surgical procedures which are used for prevention and treatment of diabetic foot complications. The method used in this study is the review of clinical cases and outcomes of surgical treatment in: 1. preulcerative phases, 2. phases of acute inflammation, 3. phases of chronic ulceration and infection, with or without satisfactory circulation and 4. specificities of amputation surgery in the case of reduced tissue vitality, significant comorbidity and limited regenerative potential. The results indicate that selective surgical approach and differentiated therapy in relation to various stages of diabetic foot have an impact on prevention, in the way that they reduce and delay the development of ulcers, reduce disability, improve the quality of life and reduce the number of amputations. A well - timed, appropriate surgical procedure in different phases of the changes that appear on diabetic foot, shortens the healing process, reduces further complications, enables function saving in the case of amputations on the foot level and enables saving patients' life in the case of amputations under and above the knee. Surgical treatment has its place in every phase of diabetic foot. Surgical procedure is chosen according to the noticed problem with an aim of treating and preventing further complications.

1263 RENAL NEPHROMETRY SCORE AND SELECTION OF OPERATIVE MODALITY FOR PARTIAL NEPHRECTOMY

INTRODUCTION AND OBJECTIVES: The RENAL nephrometry score quantifies anatomical characteristics of renal tumors. Although preliminary studies have shown this system to be reproducible, data is lacking regarding its clinical utility for surgical planning. We sought to identify if an association exists between nephrometry score and selected partial nephrectomy (PN) modality. METHODS: We conducted a retrospective analysis of patients undergoing PN for renal masses from 3/2000 for 6/2010. PN modalities included open (OPN), laparoscopic (LPN), and robotic (RPN). Demographic and clinicopathological characteristics were compared. Nephrometry sum was compared between groups (Simple 4–6, Intermediate 7–9, Complex 10; and 8 vs. 8). Factors associated with treatment modality selection were entered into a multivariate model. RESULTS: Of 153 OPN, 100 LPN and 26 RPN patients, there were no significant demographic or clinicopathological differences. Median tumor size (cm) was larger in the open group (OPN 4.2 vs. LPN 2.4 vs. RPN 2.0, p 0.001). Median operative time (min) and warm ischemia time (min) were shorter in the open group (OPN 190 and 25 vs. LPN 200 and 29 vs. RPN 196 and 30, p 0.027 and p 0.001), while EBL(mL) was lowest in the robotic group (OPN 250 vs. LPN 200 vs. RPN 125, p 0.001). High-grade Clavien complications occurred more often in OPN 22% vs. LPN 7% vs. RPN 8%, p 0.004. Mean RENAL nephrometry score was highest with OPN 8 2 vs. LPN 6.3 1.8 vs. RPN 6.7 1.7, p 0.001. Significant differences in surgical modality were noted for nephrometry scores 8, (OPN 38%, LPN 75%, and RPN 69%) vs. 8 (OPN 62%, LPN 25%, RPN 31%, p 0.001). Complex lesions including those with Radius 7 cm, Nearness to the collecting system 4 mm, (A)Posterior location, Location spanning polar line, and Hilar involvement were more likely to undergo OPN (p 0.001 in all). On multivariate analysis, lesions with Simple or Intermediate nephrometry scores were more likely to be treated with LPN and RPN vs. OPN (OR 13.6 and 3.5, p 0.005). No factors were identified that predicted a greater odds of LPN over RPN. CONCLUSIONS: Nephrometry score correlated with the perceived complexity of surgical excision and renorrhaphy of kidney tumors and was associated with type of surgical approach. Simple and Intermediate RENAL scores were equally associated with LPN and RPN, while Complex scores increased the odds of OPN. Although prospective studies are ideal, nephrometry score quantifies anatomical features of renal tumors and may be clinically useful as a decision instrument to help select surgical approach.

Long-Term Results of a Selective Surgical Approach to Management of Zollinger-Ellison Syndrome in Patients with MEN-1

The role of operation in patients with Multiple Endocrine Neoplasia Type 1 (MEN-1) and Zollinger-Ellison Syndrome (ZES) is controversial. Our institutional bias for this disease has, in general, been towards aggressive imaging and operative removal of localized gastrinomas. Few studies have reported long-term outcomes in patients with MEN-1 and ZES. A single institution retrospective review of all patients with MEN-1 and ZES from 1970 to present was performed. Twelve patients were identified (median age = 37 years at diagnosis). The median follow-up was 18 years from diagnosis of ZES. Common symptoms associated with gastrinoma in these patients were diarrhea (n = 6), abdominal pain (n = 4), and nausea/vomiting (n = 4). Most commonly identified sites of gastrinoma were: pancreas (n = 10), duodenum (n = 4), lymph nodes (n = 3), and liver (n = 1). Fifteen celiotomies were performed in total (median = 1; range 0-3). Operative procedures performed included: distal pancreatectomy (n = 4), acid reducing procedure (n = 4), enucleation of pancreatic gastrinoma (n = 3), duodenal resection (n = 3), pancreaticoduodenectomy (n = 1), and other (n = 7). One patient had a transient biochemical cure after operation lasting 3 years. Only one patient in this series had documented liver metastases of gastrinoma and no patients expired of metastatic gastrinoma. There was one postoperative patient death, secondary to respiratory arrest thought to be a result of aspiration or pulmonary embolus. Three patients died of nondisease related causes, and seven patients were alive at the time of last follow-up. Operations rarely result in biochemical cures in patients with MEN-1 and ZES. In our experience, resection of localized gastrinomas often did not require extended surgical resection and were associated with excellent long-term outcomes.

Surgical treatment of combined hepatic and pulmonary colorectal cancer metastases

Aims Surgical resection of combined hepatic and pulmonary metastases remains controversial in light of limited supportive evidence. This study aimed to audit our initial experience with this aggressive surgical strategy. Methods Between 1997 and 2006 we assessed 19 patients with colorectal cancer metastases for combined liver and lung metastasectomy, of whom 16 patients underwent surgery. We retrospectively reviewed perioperative and survival data. Results Synchronous liver metastases were present in three out of 16 patients at time of diagnosis of the primary tumour, and one out of 16 patients had synchronous lung and liver metastases with the primary tumour. Of those 12 patients who developed metachronous metastases five patients developed liver metastases first, one patient developed pulmonary metastases first, and six patients developed synchronous liver and lung metastases. Thirty nine operations were performed on 16 patients. The median hospital stay was 5.5 (2–10) days for the pulmonary and 7 (1–23) days for the hepatic resections. There were no in-hospital deaths. Chemotherapy was given to five patients prior to metastasectomy and nine received adjuvant chemotherapy following metastasectomy. Median survival from diagnosis of metastatic disease was 44 months (8–87 months). Estimated 1-year survival from diagnosis of metastatic disease was 94%, estimated 5-year survival was 20%. Conclusion We believe an aggressive but selective surgical approach to combined hepatic and pulmonary colorectal metastases is justified by limited resource requirements and encouraging survival.

A Phase II Study of a Paclitaxel Based Chemoradiation Regimen With Selective Surgical Salvage for Resectable Locoregionally Advanced Esophageal Cancer: Initial Reporting of RTOG 0246

A Phase II Study of a Paclitaxel Based Chemoradiation Regimen With Selective Surgical Salvage for Resectable Locoregionally Advanced Esophageal Cancer: Initial Reporting of RTOG 0246

Tumour characteristics predictive of survival following resection for ductal adenocarcinoma of the head of pancreas

Aims We have maintained a highly conservative policy in selecting patients with carcinoma of the head of pancreas for resection. This has been based on tumour size, evidence of lymph node involvement or local invasion outside of the gland at laparotomy, laparoscopy or CT imaging. This study investigated our survival rates following pancreatic resection and examined clinicopathological predictors of survival. Methods Sixty-two consecutive patients undergoing pancreatic resections for malignancy were identified from 1999 onwards. Thirty-three underwent resection for pancreatic ductal adenocarcinoma and were included in our analysis, the remainder included resections for ampullary adenocarcinoma ( n = 20) or other malignancies ( n = 9). Patient, tumour and operative characteristics were analysed to assess predictors of survival following resection (Kaplan–Meier survival curves). Results Median survival following resection for ductal pancreatic adenocarcinoma was 54 months (ampullary adenocarcinomas achieved a median survival of 62 months) and thirty-day mortality was 2.7% ( n = 1). Survival was not associated with any demographic or intraoperative factors, such as blood loss, operative duration or anaesthetic technique. Survival curves were significantly worse when perineural or vascular invasion was evident histologically ( p = 0.023 and 0.0023 respectively). Patients with positive lymph nodes had a significantly shorter survival ( p = 0.0030) especially when lymph node status was expressed as a percentage of total lymph node yield. If more than 20% of retrieved lymph nodes were positive for tumour, this was a clear predictor of survival ( p < 0.0001). A positive resection margin was also associated with shortened survival ( p = 0.0291). Conclusion Despite the advances made in the management of pancreatic cancer, tumour biology still dictates long-term survival. A highly selective surgical approach to the management of these patients results in good long-term survival.