Vasilescu A

Publications (2)0 Total impact

• Article: TODAY’S POSSIBILITIES IN THE TREATMENT OF BILIARY OBSTRUCTION FROM PANCREATIC HEAD CANCER

  Vasilescu A, Strat V
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  ABSTRACT: In the last years significant progress has been made in the management of patients with pancreatic head cancer. The incidence of adenocarcinoma of the pancreas has been increasing world-wide in recent years, and it is currently the fourth leading cause of cancer-related mortality. Surgical resection offers a low success rate but provides the only chance of cure. Surgery ideally includes a radical (R0) resection and reestablishment of gastrointestinal continuity. A pancreatico-duodenectomy is usually surgical technique and only curative procedure. Contraindications for curative resection are the presence of distant metastases, peritoneal seeding and extension of tumour. Tumour infiltrations into mesenteric and portal vein are relative contraindications. The most important prognostic factors in radical resections has been shown to be surgically negative margins and nodal status. Systemic chemotherapy, radiation or a combination of chemotherapy and radiation have all been used either prior to resection (neoadjuvant therapy) or following surgical resection (adjuvant therapy) in an effort to improve the cure rate achieved with surgery alone.
  Jurnalul de Chirurgie. 01/2009;
• Article: THE ACTUALLY PRINCIPLES IN THE TREATMENT OF BILIARY OBSTRUCTION FROM EXTRAHEPATIC BILE DUCTS CANCER

  Vasilescu A, Strat V
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  ABSTRACT: The most common type of extrahepatic bile ducts cancer is the proximal segment which include the bifurcation of common hepatic duct (Klatskin’s tumors). The diagnosis of these kinds of tumors is always challenging. Magnetic resonance cholangiopancreatography (MRCP) is the best imagistic procedure also for diagnosis and for staging. Surgical resection provides the best chance for cure in patients with biliary malignancy; unfortunately only 30% from patients with Klatskin’s tumors are diagnosed in resectable stages. The type and extension of the resection depends of the tumor stage and site. Resection of the biliary duct associated with hepatectomy and/or pancreaticoduodenectomy (performed especially for limphadenectomy) has good results, from point of view of disease-free survival. In selected cases, the extrahepatic bile duct resection alone and hepatico-jejunal anastomosis is also considered as curative resection. Portal vein resection may be performed and can improve the prognosis. Palliative procedures of nonresectable bile ducts cancer consist in surgical by-pass, percutaneous biliary drainage and endoscopic endoprosthesis. Because long-term relief of jaundice is difficult without using biliary stenting, a combination of radiation therapy and stent placement is commonly used. As radiation therapy, external-beam radiotherapy is usually performed, but combined use of intraluminal brachytherapy with external beam radiation therapy is more useful for making the treatment more effective. Radiation therapy can be associated with chemotherapy (gemcitabine) in unresectable bile duct cancer to extend survival and improve quality of life.
  Jurnalul de Chirurgie. 01/2009;