Peter W T Pisters

• University of Texas MD Anderson Cancer Center

Background The risk of surgery, particularly for older cancer patients with serious, extensive comorbidities, can make this otherwise curative modality precarious. Leveraging data from the American College of Surgeons Oncology Group, this study sought to characterize age-based comparative demographics, adverse event rates, and study completion rate...

Background There is considerable interest in a neoadjuvant approach for resectable pancreatic ductal adenocarcinoma (PDAC). This study evaluated perioperative gemcitabine + erlotinib (G+E) for resectable PDAC. Methods A multicenter, cooperative group, single-arm, phase II trial was conducted between April 2009 and November 2013 (ACOSOG Z5041). Pat...

Background: The purpose of this study was to evaluate a single-institution experience with delivery of preoperative therapy to patients with pancreatic ductal adenocarcinoma (PDAC) prior to pancreatoduodenectomy (PD). Methods: Consecutive patients (622) with PDAC who underwent PD following chemotherapy and/or chemoradiation between 1990 and 2014...

Background: This study was performed to determine the maximum tolerated dose (MTD) of gemcitabine given concurrently with preoperative, fixed-dose external-beam radiation therapy (EBRT) for patients with resectable, high-risk extremity and trunk soft tissue sarcoma (STS). Methods: Gemcitabine was administered on days 1, 8, 22, 29, 43, and 50 wit...

Liposarcomas are soft tissue sarcomas of adipocyte origin. We describe a case of a dedifferentiated retroperitoneal liposarcoma with an unusual presentation on recurrence as a large, multicystic tumour. The patient was a 72-year-old woman who had undergone multiple treatments including two prior resections. For her most recent locoregional disease...

Significant advances have been made over the past decade in the understanding of clinicopathologic prognostic factors for soft tissue sarcoma. Foremost among these advances is an improved ability to recognize the subset of patients at high risk for recurrent disease and tumor‐related death based on clinicopathologic data available at the time of in...

Pancreatic ductal adenocarcinoma (PDAC) is one of the most lethal human malignancies with less than 5% five-year survival rate. Despite significant improvements in medical and surgical oncology and postoperative mortality rate, the overall survival for patients with pancreatic cancer has not changed significantly in the last four decades. Neoadjuva...

Well-differentiated (WD)/dedifferentiated (DD) liposarcoma is the most common soft tissue sarcoma of the retroperitoneum. The frequency of distant metastasis is low and the major burden of disease is locoregional. We sought to define the patterns of locoregional disease to help guide surgical decision making. Data were collected from 247 patients w...

Management of gastrointestinal stromal tumors (GISTs) has been transformed with tyrosine kinase inhibitors (TKIs). While data on optimal duration of adjuvant imatinib remains elusive, guidelines for administration of neoadjuvant TKIs remain unknown. Under an institutional review board-approved protocol, patients at our institution with a diagnosis...

The ACOSOG (American College of Surgeons Oncology Group) Z9001 (Alliance) study, a randomized, placebo-controlled trial, demonstrated that 1 year of adjuvant imatinib prolonged recurrence-free survival (RFS) after resection of primary GI stromal tumor (GIST). We sought to determine the pathologic and molecular factors associated with patient outcom...

Barriers to multimodality therapy (MMT) completion among patients with resectable pancreatic adenocarcinoma include early cancer progression and postoperative major complications (PMC). We sought to evaluate the influence of these factors on MMT completion rates of patients treated with neoadjuvant therapy (NT) and surgery-first (SF) approaches. We...

We previously described the clinical classification of patients with resectable pancreatic tumor anatomy but marginal performance status (PS) or reversible comorbidities as "borderline resectable type C" (BR-C). This study was designed to analyze the incidence and risk factors for post-pancreaticoduodenectomy (PD) morbidity/mortality in a multi-ins...

Venous resection may be required to achieve complete resection of pancreatic cancers. We assessed the ability of radiographic criteria to predict the need for superior mesenteric-portal vein (SMV-PV) resection and the presence of histologic vein invasion. All patients who underwent pancreaticoduodenectomy from 2004 to 2011 at the authors' instituti...

The purpose of this study was to determine the relationship between carbohydrate antigen (CA) 19-9 levels and outcome in patients with borderline resectable pancreatic cancer treated with neoadjuvant therapy (NT). This study included all patients with borderline resectable pancreatic cancer, a serum CA 19-9 level of ≥40 U/ml and bilirubin of ≤2 mg/...

The fear of an early post-pancreatectomy haemorrhage (PPH) may prevent surgeons from prescribing post-operative venous thromboembolism (VTE) chemoprophylaxis. The primary hypothesis of this study was that the national post-pancreatectomy early PPH rate was lower than the rate of VTE. The secondary hypothesis was that patients at high risk for post-...

To conduct the first adjuvant trial of imatinib mesylate for treatment of gastrointestinal stromal tumor (GIST). GIST is the most common sarcoma. Although surgical resection has been the mainstay of therapy for localized, primary GIST, postoperative tumor recurrence is common. The KIT protooncogene or, less frequently, platelet-derived growth facto...

Background: Methodological limitations of prior studies have prevented progress in the treatment of patients with borderline resectable pancreatic adenocarcinoma. Shortcomings have included an absence of staging and treatment standards and pre-existing biases with regard to the use of neoadjuvant therapy and the role of vascular resection at pancr...

Background: Few data exist to guide oncologic surveillance following curative treatment of pancreatic cancer. We sought to identify a rational, cost-effective postoperative surveillance strategy. Methods: We constructed a Markov model to compare the cost-effectiveness of 5 postoperative surveillance strategies. No scheduled surveillance served a...

Experience with preoperative therapy for other cancers has led to an assumption that borderline resectable pancreatic cancers can be converted to resectable cancers with preoperative therapy. In this study, the authors sought to determine the rate at which neoadjuvant therapy is associated with a reduction in the size or stage of borderline resecta...

Background: For ampullary carcinoma (AC), the lymph node ratio (LNR) has been associated with overall survival. However, the use of the LNR to predict distant recurrence risk remains unknown. The purpose of this study was to determine if the LNR is associated with distant recurrence risk. Methods: One hundred forty three patients with AC who und...

Background: Fear of disease recurrence is well documented among cancer survivors, but its significance among patients treated for solid pancreatic and periampullary neoplasms is unknown despite the known risk of recurrence associated with these tumors. We hypothesized that fear of cancer recurrence (FCR) represents a common source of psychosocial...

Historically, liver surgeons have withheld venous thromboembolism (VTE) chemoprophylaxis due to perceived postoperative bleeding risk and theorized protective anticoagulation effects of a hepatectomy. The relationships between extent of hepatectomy, postoperative VTE and bleeding events were evaluated using the National Surgical Quality Improvement...

Pancreatectomy with aggressive vascular resection is increasingly being recognized as an appropriate treatment strategy for patients with borderline resectable PDAC after administration of chemotherapy and/or chemoradiation. Because tumor downstaging is an uncommon event, both venous and hepatic arterial resection and reconstruction might be necess...

Studies have shown that superior mesenteric vein (SMV)/portal vein (PV) resection with pancreaticoduodenectomy (PD) is safe and feasible for patient with pancreatic adenocarcinoma (PAC). However, the prognostic significance of tumor involvement of the resected vein in patients who received neoadjuvant therapy is unclear. The authors evaluated 225 c...

Little is known about the outcomes of patients with microscopically positive (R1) resections for primary gastrointestinal stromal tumors (GIST) because existing retrospective series contain small numbers of patients. The objective of this study was to analyze factors associated with R1 resection and assess the risk of recurrence with and without im...

BACKGROUND Several grading schemes for the extent of residual tumor in posttreatment pancreaticoduodenectomy (PD) specimens have been proposed. However, the prognostic significance of these grading schemes is unknown. METHODS Histopathologic slides of 223 cases who received neoadjuvant chemoradiation and PD were reviewed. The extent of residual tu...

Following potentially curative resection at this centre, patients with pancreatic adenocarcinoma (PAC) are routinely enrolled in a programme of clinical and radiographic surveillance. This study sought to evaluate its diagnostic yield. All patients who underwent pancreaticoduodenectomy for PAC at this institution during 1998-2008 were identified. P...

Resection of certain recurrent malignancies can prolong survival, but resection of recurrent pancreatic ductal adenocarcinoma is typically contraindicated because of poor outcomes. All patients from 1992 to 2010 with recurrent pancreatic cancer after intended surgical cure were retrospectively evaluated. Clinicopathologic features were compared fro...

10088 Background: The GIST registry (reGISTry) is an observational database designed to determine diagnostic method and evaluation of GIST patients outside of clinical trials. We previously described differences in treatment of patients in community versus academic centers (Pisters, Ann Oncol 2011;22:2523-9). Herein we present distinct differences...

The incidence rate of adenocarcinoma of the esophagogastric junction (AEG) is increasing in association with the epidemiologic rise in distal esophageal adenocarcinoma and gastric cardial (AEG type III) tumors [1-4]. The overall survival rate is poor in most patients with AEG because lymph node or visceral metastases are frequently present at the t...

To calculate conditional survival estimates for patients with pancreatic adenocarcinoma. We constructed separate multivariate survival models adjusted for 7 clinicopathologic factors for patients who did and did not undergo radical surgical resection. Patients with pancreatic adenocarcinoma diagnosed between 1988 and 2005 included in the Surveillan...

252 Background: Resection of recurrent disease in malignancies such as colorectal cancer has been shown to prolong survival but resection for recurrent pancreatic ductal adenocarcinoma (PDAC) is viewed as futile. We sought to identify factors that may be associated with prolonged survival following resection of recurrent PDAC. Methods: A retrospect...

289 Background: Fear of Cancer Recurrence (FCR) is well documented among survivors of breast, colon and prostate cancer. Incurable recurrence is common following resection of pancreatic and periampullary neoplasms. The incidence and significance of FCR in this population is unknown. We hypothesized that FCR represents an important source of psychos...

293 Background: We previously introduced a novel classification system for assessing “operability” in patients with localized pancreatic adenocarcinoma (PDAC) that integrates cancer biology, patient physiology, and tumor anatomy. We sought to analyze resection rates, reasons for no resection, and outcomes after neoadjuvant therapy (NT) of patients...

We previously introduced a classification system for patients with localized pancreatic adenocarcinoma that integrates assessments of tumor anatomy, cancer biology, and patient physiology. By means of this system, we sought to analyze outcomes of patients with resectable anatomy but heterogeneous biology and physiology who were treated with neoadju...

Concurrent chemotherapy and radiotherapy (chemoradiotherapy) for the management of pancreatic adenocarcinoma in either adjuvant or locally regional advanced settings produces predictable acute toxicities that are proportional in severity to the intensity and type of systemic therapy and to the parameters of radiotherapy. In addition, relevant to th...

Background: Neoadjuvant chemoradiation before surgery is an emerging treatment modality for pancreatic ductal adenocarcinoma (PDAC). However, analysis of prognostic factors is limited for patients with PDAC treated with neoadjuvant chemoradiation and pancreaticoduodenectomy (PD). Methods: The study population was comprised of 240 consecutive pat...

To determine the influence of neoadjuvant chemoradiation and standardized dissection of the superior mesenteric artery upon the oncologic outcome of patients with localized pancreatic adenocarcinoma. One hundred ninety-four patients with pancreatic adenocarcinoma who underwent pancreaticoduodenectomy between 2004 and 2008 were evaluated. The retrop...

Several grading schemes for the extent of residual tumor in posttreatment pancreaticoduodenectomy (PD) specimens have been proposed. However, the prognostic significance of these grading schemes is unknown. Histopathologic slides of 223 cases who received neoadjuvant chemoradiation and PD were reviewed. The extent of residual tumor was graded using...

Neoadjuvant chemoradiation before surgery is an emerging treatment modality for pancreatic ductal adenocarcinoma (PDAC). However, analysis of prognostic factors is limited for patients with PDAC treated with neoadjuvant chemoradiation and pancreaticoduodenectomy (PD). The study population was comprised of 240 consecutive patients with PDAC who rece...

Gastrointestinal stromal tumors (GIST) treatment changed considerably with introduction of imatinib in 2001 and reports of early successes. However, little is known about imatinib incorporation into practice. Our objective was to examine the integration of adjuvant systemic therapy into GIST management. Patients with gastric GIST were identified (n...

We conducted a phase II trial to assess the survival duration and quality of life of patients who received adjuvant interferon-based chemoradiation for pancreatic adenocarcinoma after pancreaticoduodenectomy. Patients with a performance status of 0 or 1 were enrolled to receive interferon-alfa-2b (3 million units MWF), cisplatin (30 mg/m(2), 6 dose...

Pleomorphic liposarcoma (PLS) is a rare high-grade sarcoma that has lipoblastic differentiation. In this study, the authors evaluated PLS natural history, patient outcomes, and commonly deregulated protein biomarkers. Medical records from patients (n = 155) who had PLS from 1993 to 2010 were reviewed. Univariate and multivariate analyses were condu...

Pancreatic cancer is the fifth leading cause of adult cancer mortality. The etiology of cancer of the pancreas remains a mystery despite the implication of various agents, such as coffee, alcohol, and cigarettes. The current management of patients with pancreatic cancer at our institution involves: (1) a selective approach to the use of laparotomy...

This chapter focuses on recent developments in soft tissue sarcoma of the extremities. Rather than provide a broad overview of the disease, which has been thoroughly reviewed in several recent book chapter [1,2], we wanted to provide a more in-depth perspective on developments in the field. We have selected four specific issues in extremity soft ti...

Although international studies of young gastric cancer patients have mainly reported favorable survival outcomes compared with older patients, US-based experiences have shown a wider spectrum of outcomes. We examined the impact of young age (under 45 years) on the presentation and survival outcomes of gastric adenocarcinoma. A total of 33,236 patie...

94 Background: Gastrointestinal stromal tumor (GIST) treatment has changed considerably with introduction of imatinib in 2001, initiation of ACOSOG adjuvant trial in 2002, and FDA adjuvant approval in 2008. However, little is known about how imatinib has been incorporated over time. Our objective was to examine the evolution of multimodality manage...

475 Background: To identify quality improvement opportunities, hospitals can use ACS NSQIP to compare their risk-adjusted performance to other hospitals. However, Cancer Centers have few opportunities to compare their outcomes to similar hospitals for oncologic operations. Our objective was to develop an oncology-specific version of ACS NSQIP (Onc-...

Standardization of surgical and pathologic techniques is crucial to the interpretation of studies evaluating adjuvant therapies for pancreatic cancer (PC). To assess the degree to which treatment administered prior to enrollment of patients in trials of adjuvant therapy is quality controlled, the operative and pathology reports of patients in Ameri...

The success of any future trial relies on the adoption of a single objective definition of borderline resectable PDAC. At present, two definitions have been proposed. We developed the MDACC definition, used by Stokes et al., in an attempt to identify patients with primary tumor anatomy, cancer biology, or patient physiology which places them at the...

Learning Objectives After completing this course, the reader will be able to: Explain the rationale for the use of adjuvant and neoadjuvant chemoradiation and/or chemotherapy in the treatment of patients with potentially resectable pancreatic cancer.Describe the limitations of prior prospective, randomized trials of adjuvant therapy strategies and...

Herein, we review the current management of localized and advanced gastrointestinal stromal tumors (GISTs). Although surgery remains the standard of care for patients with localized GIST, adjuvant imatinib can delay recurrence in some of these patients. In patients with advanced or metastatic disease, the standard of care is imatinib and surgery of...

The standard of care for managing patients with gastrointestinal stromal tumors (GISTs) rapidly changed after the introduction of effective molecularly targeted therapies involving tyrosine kinase inhibitors (TKIs), such as imatinib mesylate and sunitinib malate. A better understanding of the molecular characteristics of GISTs have improved the dia...

The Makuuchi or J incision completely exposes the liver and right-sided retroperitoneal organs. The modified Makuuchi incision also achieves a superb en face view of critical structures, including the hepatocaval junction and the esophageal hiatus, but does not divide the intercostal muscles, thus reducing muscle atrophy and postoperative pain. Thi...

The role of carbohydrate antigen (CA) 19-9 in the evaluation of patients with resectable pancreatic cancer treated with neoadjuvant therapy prior to planned surgical resection is unknown. We evaluated CA 19-9 as a marker of therapeutic response, completion of therapy, and survival in patients enrolled on two recently reported clinical trials. We an...

Herein, we review the current management of localized and advanced gastrointestinal stromal tumors (GISTs). Although surgery remains the standard of care for patients with localized GIST, adjuvant imatinib can delay recurrence in some of these patients. In patients with advanced or metastatic disease, the standard of care is imatinib and surgery of...

The authors compared disease-specific survival (DSS) in stage-specific subgroups of patients with clear cell sarcoma, including those with lymph node metastases (N1M0) and those with distant metastases (N0M1). Clinical data regarding soft tissue sarcoma patients were obtained from The University of Texas M. D. Anderson Cancer Center (MDACC) (1980-2...

10557 Background: This observational reGISTry, initiated 11/04, characterizes the evolving patterns of care for GIST, such as the recent use and approval of Imatinib mesylate (IM) in adjuvant GIST. Methods: Data from consented pts (e.g. demographics, clinical characteristics, therapy, outcomes) are entered onto a web-based database. Updated analyse...

To examine the influence of obesity, as measured by body mass index (BMI) (calculated as weight in kilograms divided by height in meters squared), on clinicopathologic factors and survival after pancreatectomy to treat adenocarcinoma. Retrospective review and statistical analysis using prospectively collected data. Referral center with a dedicated...

Gastrointestinal stromal tumour is the most common sarcoma of the intestinal tract. Imatinib mesylate is a small molecule that inhibits activation of the KIT and platelet-derived growth factor receptor alpha proteins, and is effective in first-line treatment of metastatic gastrointestinal stromal tumour. We postulated that adjuvant treatment with i...

To describe our approach to resection of pancreatic head cancers, which involve 1 or both of the first-order branches of the superior mesenteric vein (SMV). In contrast to tumors which involve the proximal SMV, cancers in the inferior aspect of the pancreatic head or root of mesentery (mid gut carcinoid) may involve one of the 2 primary branches of...

Pearls and PitfallsHigh index of suspicion of small bowel malignancy is necessary for early detection.Favorable prognostic factors: no tumor rupture, localized lesion, low-grade neoplasm, and tumor CT can often aid in differentiation between sarcoma, adenocarcinoma, carcinoid, and lymphoma.Primary therapy for patients with localized sarcomas and ga...

The purpose of this study was to identify clinicopathologic factors associated with positive peritoneal cytology (PPC) in patients with gastric cancer and to compare the overall survival (OS) of patients with PPC treated with and without neoadjuvant therapy. The medical records of 3,747 patients with gastric or gastroesophageal adenocarcinoma prese...

To retrospectively determine the incidence and patterns (in-field, marginal, or out-of-field) of locoregional gastric cancer recurrence in patients who received preoperative chemoradiotherapy and to determine the outcome in these patients. Between 1994 and 2004, 149 patients with gastric carcinoma were treated according to institutional protocols w...

We conducted a phase II trial of preoperative gemcitabine and cisplatin chemotherapy in addition to chemoradiation (Gem-Cis-XRT) and pancreaticoduodenectomy (PD) for patients with stage I/II pancreatic adenocarcinoma. Chemotherapy consisted of gemcitabine (750 mg/m(2)) and cisplatin (30 mg/m(2)) given every 2 weeks for four doses. Chemoradiation co...

We conducted a phase II trial to assess the outcomes of patients who received preoperative gemcitabine-based chemoradiation and pancreaticoduodenectomy (PD) for stage I/II pancreatic adenocarcinoma. Eligible patients with pancreatic head/uncinate process adenocarcinoma and radiographically defined potentially resectable disease received chemoradiat...

Regional-based studies have indicated that ethnicity is associated with presentation and outcome in patients with gastric adenocarcinoma. To validate this observation in a large cohort, the authors of this report used the National Cancer Data Base (NCDB) to determine whether self-reported ethnicity influences presentation and survival in this patie...

Patients with borderline resectable pancreatic adenocarcinoma (PA) include those with localized disease who have tumor or patient characteristics that preclude immediate surgery. There is no optimal treatment schema for this distinct stage of disease, so the role of surgery is undefined. We defined patients with borderline resectable PA as fitting...

The integration of biospecimens with reliable clinical data is critical to advance molecular findings from the laboratory to the clinic. We describe the development of an integrated pancreatic tissue bank (PTB) and clinical database for patients with pancreatic cancer and other pancreatic disorders. A clinical database and PTB were created in 1990...

Recent isolated case reports have suggested a potential role for neoadjuvant chemotherapy in patients with angiosarcoma. The goal of this report was to investigate the overall treatment outcomes and the neoadjuvant chemotherapy-specific outcomes in patients with cutaneous angiosarcoma of the face with periorbital involvement. Our tumor database was...

4505 Background: In 2003, ACOSOG began a multicenter phase II trial (Z05031) using novel chemoradiation with radiotherapy (XRT), cisplatin (C), 5-FU (F) and alpha-interferon (INT). Initial trial results (abs #125 Proc ASCO GI 2008) are now reported after further follow- up (f/u). Methods: Patient (pt) eligibility requirements included 1) head of pa...

Background Recent isolated case reports have suggested a potential role for neoadjuvant chemotherapy in patients with angiosarcoma. The goal of this report was to investigate the overall treatment outcomes and the neoadjuvant chemotherapy–specific outcomes in patients with cutaneous angiosarcoma of the face with periorbital involvement.Methods Our...

Pancreatic cancer remains one of the greatest challenges within oncology. Among resected patients, 5-year survival is typically only 10-25%. Among eight major randomized trials for resected pancreas cancer, five (GITSG, EORTC, ESPAC-1, RTOG 9704, and CONKO-1), containing a total of over 1,200 patients, have shaped world opinion on this subject. The...

Previous studies have suggested that the prognosis in patients with extremity soft-tissue sarcomas (ESTS) with isolated lymph node (LN) metastases (stage IV) is comparable to that of patients with high-risk ESTS without metastases (stage III). This study was performed to determine the outcomes of patients who underwent aggressive therapy, including...

While gastric cancer remains one of the most common malignancies diagnosed worldwide, its incidence continues to decrease in Western countries. This change has been accompanied by a proximal migration in cancer localization. Postoperative chemotherapy plus chemoradiation therapy, in the Gastrointestinal Cancer Intergroup 0116 trial, prolonged overa...

We conducted a prospective trial to define the local recurrence rates for selected patients with T1 soft tissue sarcomas (STS) treated by surgery alone. Retrospective data suggest that some patients with small STS can be safely treated by surgery alone. There are no defined criteria to select patients for such treatment. Patients with T1 primary ST...

To evaluate prognostic factors and treatment outcomes in patients with localized synovial sarcoma treated with conservation surgery and radiotherapy (RT). Between 1960 and 2003, 150 patients with nonmetastatic synovial sarcoma were treated with conservation surgery and RT. The majority of patients (81%) were aged >20 years. Sixty-eight percent rece...

Although not universally accepted, 5-fluorouracil (5-FU)-based chemoradiation is considered a standard treatment for patients with localized pancreatic cancer. Randomized trials have indicated that chemoradiation improves median survival of both locally advanced and resected pancreatic cancer. While the use of adjuvant chemoradiation in pancreatic...

Treatment of peritoneal recurrence following surgical resection of intra-abdominal sarcomas presents a significant challenge to clinicians. Historically, treatment with systemic chemotherapy has been ineffective and surgical resection alone has not been durable. We prospectively evaluated the feasibility of cytoreductive surgery followed by hyperth...

The NCCN Soft Tissue Sarcoma Guidelines include a subsection about treatment recommendations for gastrointestinal stromal tumors (GISTs). The standard of practice rapidly changed after the introduction of effective molecularly targeted therapy (such as imatinib and sunitinib) for GIST. Because of these changes, NCCN organized a multidisciplinary pa...

To better understand the impact of a microscopically positive margin (R1) on patterns of disease recurrence and survival after pancreaticoduodenectomy (PD) for pancreatic adenocarcinoma. A positive resection margin after PD is considered to be a poor prognostic factor, and some have proposed that an R1 margin may be a biologic predictor of more agg...

We investigated whether Rad51 overexpression plays a role in soft tissue sarcoma (STS) chemoresistance as well as the regulatory mechanisms underlying its expression. The studies reported here show that Rad51 protein is overexpressed in a large panel of human STS specimens. Human STS cell lines showed increased Rad51 protein expression, as was also...

This study compared a large series of desmoid patients treated at a single institution to a previously published series from the same institution to determine if patient population characteristics, treatment approaches, and clinical outcomes had undergone change over the two study periods. Data from a prospective soft tissue tumor database was used...

Pancreatic surgery is technically complex. We hypothesized that a learning curve existed for pancreaticoduodenectomy even for surgeons who had completed their training. During 1990 to 2004, we studied 650 consecutive patients who underwent pancreaticoduodenectomy by 3 surgeons who began their attending careers at 1 center. Operative time, estimated...

There has been a gradual migration in the local treatment of soft tissue sarcomas from amputation and similar radical resectional approaches to more conservative, function-preserving surgery combined with radiotherapy. This progress has been made possible by small, single-institution, randomized trials that demonstrated the superiority of this more...

Delayed recovery after pancreaticoduodenectomy (PD) is believed to preclude adjuvant therapy for approximately 30% of patients who undergo elective PD as initial treatment for pancreatic adenocarcinoma. This study reexamined the frequency of delayed recovery and assessed other factors associated with adjuvant therapy administration after PD at a hi...