We conclude that, in pancreaticoduodenectomy for patients with organized CA occlusion, precise assessment of the vascular anatomy and preservation of the main collateral pathway are essential for carrying out a successful operation. Celiac axis (CA) stenosis is a fairly common condition in candidates for upper abdominal surgery. In this report, we have documented 5 patients with CA stenosis or occlusion who underwent pancreaticoduodenectomy, and we have discussed the surgical strategy for this condition.

Background and Objectives The importance of nodal involvement as a prognostic factor in differentiated carcinoma of the thyroid gland remains controversial. We therefore attempted to confirm the prognostic factors in differentiated thyroid carcinoma, with special reference to nodal status. Patients and Methods A total of 139 patients with differentiated thyroid cancer followed for 2–27 years, with a median follow‐up of 7 years were studied. All patients underwent surgical resection, either subtotal, total, or lobectomy, with modified radical neck dissection. Survival was calculated using the Kaplan–Meier method. Results Ten (7%) patients have died from thyroid cancer. Adverse prognostic factors included age >45 years (P = 0.0120), the presence of distant metastases (P = 0.0006), and TNM stage (P = 0.0002). The number of lymph nodes dissected ranged from 6 to 92, with an average of 26. Lymph node metastases were found in 102 (73%) patients. There was no difference in survival according to the level of nodal disease by the TNM classification. Furthermore, the number of cervical lymph nodes involved had no effect on the survival. Conclusion Our results suggest that the presence of histologically confirmed lymph node metastases is not an important prognostic factor in patients with differentiated thyroid carcinoma. J. Surg. Oncol. 1998;69:151–155. © 1998 Wiley‐Liss, Inc.

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Resting energy expenditure (REE) was studied in five patients undergoing transhiatal and in 14 undergoing transthoracic oesophagectomy for carcinoma. All resections were performed with an intention to cure. REE was measured by indirect calorimetry before operation and on days 1, 3, 5 and 7 after surgery. Following transthoracic oesophagectomy, REE increased significantly on days 1, 3, 5 and 7 after operation, and on day 7 the value was significantly higher (P < 0.05) than that obtained after transhiatal surgery. Energy expenditure following transhiatal oesophagectomy is lower than that after transthoracic oesophagectomy; this may be a result of reduced surgical stress.

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