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AJR. American Journal of Roentgenology Nov 2017The purpose of this study is to retrospectively evaluate the differential CT features of isolated benign and malignant main pancreatic duct (MPD) dilatation and to...
OBJECTIVE
The purpose of this study is to retrospectively evaluate the differential CT features of isolated benign and malignant main pancreatic duct (MPD) dilatation and to investigate whether the diagnostic performance of radiologists can be improved with knowledge of these differential CT features.
MATERIALS AND METHODS
Forty-one patients who had isolated MPD dilatation without any visible mass on CT from January 2000 to October 2016 were retrospectively enrolled in the study. Two radiologists reviewed CT images in consensus for the location, shape (smooth vs abrupt), length of transition, dilated pancreatic duct (PD) diameter, presence of duct penetrating sign, parenchymal atrophy, attenuation difference, associated pancreatitis, calcification, PD or common bile duct (CBD) enhancement, and perilesional cyst. The chi-square test, Fisher exact test, and t test were used to find the differential CT features of benign and malignant MPD dilatation. Two successive review sessions for differentiation between the two disease entities were then independently performed by three other reviewers with differing expertise, with the use of a 5-point confidence scale. The first session provided no information for differentiation; however, reviewers were aware of the results of univariate analyses in the second session. The diagnostic performance of the radiologists was evaluated using a pairwise comparison of ROC curves.
RESULTS
A total of 19 benign and 22 malignant MPD dilatations were identified. In patients with benign MPD dilatation, transition areas were frequently located in the head (57.9% [11/19] vs 13.6% [3/22], p = 0.003) and showed significantly shorter (< 6.1 mm) (78.9% [15/19] vs 9.1% [2/22], p < 0.0001) and smooth transition (89.5% [17/19] vs 9.1% [2/22], p < 0.0001). Duct penetrating sign was exclusively observed in patients with benign MPD dilatation (73.7% [14/19] vs 0% [0/22], p < 0.0001). In contrast, malignant MPD dilatation frequently was accompanied by attenuation difference (63.6% [14/22] vs 10.5% [2/19], p = 0.001) and associated PD or CBD enhancement (36.4% [8/22] vs 0% [0/19], p = 0.003). The AUC values of three reviewers significantly increased from 0.653, 0.587, and 0.884 to 0.864, 0.964, and 0.908, respectively, with knowledge of significant CT features (p = 0.013, p < 0.0001, and p = 0.701, respectively).
CONCLUSION
Distal, long (≥ 6.1 mm), and abrupt transition, the absence of duct penetrating sign, and the presence of attenuation difference and PD or CBD enhancement were highly suggestive CT findings for differentiation of malignant from benign MPD dilatation. The diagnostic performance of radiologists with regard to differentiation was significantly improved with knowledge of these highly suggestive CT criteria.
Topics: Aged; Carcinoma, Pancreatic Ductal; Diagnosis, Differential; Dilatation, Pathologic; Female; Humans; Male; Middle Aged; Pancreatic Ducts; Pancreatic Neoplasms; Retrospective Studies; Tomography, X-Ray Computed
PubMed: 28858540
DOI: 10.2214/AJR.17.17963 -
ANZ Journal of Surgery May 2024Pancreatic cancer recurrence following surgery is a significant challenge, and personalized surgical care is crucial. Topographical variations in pancreatic duct anatomy...
INTRODUCTION
Pancreatic cancer recurrence following surgery is a significant challenge, and personalized surgical care is crucial. Topographical variations in pancreatic duct anatomy are frequent but often underestimated. This study aimed to investigate the potential importance of these variations in outcomes and patient survival after Whipple's procedures.
METHODS
Data were collected from 105 patients with confirmed pancreatic head neoplasms who underwent surgery between 2008 and 2020. Radiological measurements of pancreatic duct location were performed, and statistical analysis was carried out using IBM SPSS.
RESULTS
Inferior pancreatic duct topography was associated with an increased rate of metastatic spread and tumour recurrence. Additionally, inferior duct topography was associated with reduced overall and recurrence-free survival. Posterior pancreatic duct topography was associated with decreased incidence of perineural sheet infiltration and improved overall survival.
DISCUSSION
These findings suggest that topographical diversity of pancreatic duct location can impact outcomes in Whipple's procedures. Intraoperative review of pancreatic duct location could help surgeons define areas of risk or safety and deliver a personalized surgical approach for patients with beneficial or deleterious anatomical profiles. This study provides valuable information to improve surgical management by identifying high-risk patients and delivering a personalized surgical approach with prognosis stratification.
Topics: Humans; Pancreatic Neoplasms; Male; Female; Pancreatic Ducts; Aged; Middle Aged; Pancreaticoduodenectomy; Retrospective Studies; Neoplasm Recurrence, Local; Treatment Outcome; Prognosis
PubMed: 38426386
DOI: 10.1111/ans.18903 -
Georgian Medical News Apr 2022The main purpose of this study was to conduct retrospective clinical analysis of patients with malignant tumor of the periampullary zone who underwent Whipple procedure...
The main purpose of this study was to conduct retrospective clinical analysis of patients with malignant tumor of the periampullary zone who underwent Whipple procedure surgery depending on the pancreatic thickness and pancreatic duct diameter and to assess the development of pancreatic fistulas in the postoperative period. A retrospective review was performed to 108 patients with resectable periampular zone tumors. All patients were divided into two groups depending on the pancreatic thickness, 58 (53.7%) patients in soft thickness, 50 (46.3%) patients in hard thickness. In two groups, pancreatic fistulas were observed in 27 (25.0%) patients, where the majority of cases occurred with soft gland in 20 (18.6%) patients than with hard gland in 7 (6.4%) patients. Thus, the efficiency of pancreatojunoanastomosis formation depends on the pancreatic thickness and the pancreatic duct diameter. Pancreatic fistula after pancreatoduodenal resection was more observed with soft gland than with hard gland, and with a pancreatic duct diameter of more than 3.0 mm, pancreatic fistula developed 2 times less than with a diameter of less than 3.0 mm.
Topics: Humans; Pancreas; Pancreatic Ducts; Pancreatic Fistula; Pancreaticoduodenectomy; Postoperative Complications; Retrospective Studies
PubMed: 35920575
DOI: No ID Found -
Nagoya Journal of Medical Science Nov 2023Endoscopic papillectomy is widely performed to treat duodenal papillary tumors, particularly at high-volume centers. It is indicated for adenomas without intraductal... (Review)
Review
Endoscopic papillectomy is widely performed to treat duodenal papillary tumors, particularly at high-volume centers. It is indicated for adenomas without intraductal extension of the bile or pancreatic ducts. However, despite numerous reports of carcinomas that expand the indications to include well-differentiated adenocarcinomas that do not invade the sphincter of Oddi, the low agreement between biopsy and final pathological diagnosis, as well as the current inability of imaging modalities to diagnose sphincter of Oddi invasion, makes it difficult to consider expanding indications. Although complications can be prevented by certain methods, such as pancreatic duct stenting, and the frequency of severe complications has decreased, the safety of the procedure remains unconfirmed. In the future, this technology is expected to progress and enable wider applications, including those in tumors with extensive horizontal spread and those with intraductal extension of the bile and pancreatic ducts. Such technology may also improve the safety and accuracy of diagnosis.
Topics: Humans; Ampulla of Vater; Endoscopy; Pancreatic Ducts; Biopsy; Adenocarcinoma; Treatment Outcome
PubMed: 38155621
DOI: 10.18999/nagjms.85.4.648 -
Pancreatology : Official Journal of the... Jul 2015Pancreatic ducts secrete 2.5 l of alkaline, HCO3(-)-rich fluid daily which greatly contributes to the homeostasis of the pancreas. Ducts are also important in the... (Review)
Review
Pancreatic ducts secrete 2.5 l of alkaline, HCO3(-)-rich fluid daily which greatly contributes to the homeostasis of the pancreas. Ducts are also important in the pathophysiology of the pancreas; alteration of ductal function can lead to severe diseases such as cystic fibrosis and chronic pancreatitis. The role of pancreatic ducts in the development of acute pancreatitis has only been uncovered recently. Pancreatitis inducing agents like bile acids and ethanol dose-dependently affect pancreatic ductal secretion; low concentrations stimulate, whereas high concentrations inhibit secretion. The majority of the review will focus on the central role of cystic fibrosis transmembrane conductance regulator (CFTR), a critical protein in the regulation of ductal secretion, in the pathogenesis of acute pancreatitis which is highlighted by numerous investigations. Downregulation of CFTR expression results in increased severity of acute pancreatitis in mice. Furthermore, human genetic studies have demonstrated statistically significant association of CFTR mutations with acute recurrent pancreatitis. Overall, the data support the involvement of pancreatic ducts in the pathogenesis of acute pancreatitis.
Topics: Acute Disease; Animals; Bile Acids and Salts; Humans; Pancreatic Ducts; Pancreatitis, Alcoholic
PubMed: 25921231
DOI: 10.1016/j.pan.2015.03.010 -
Journal of Hepato-biliary-pancreatic... Feb 2021Pancreatic trauma is reportedly associated with high morbidity and mortality. Main pancreatic duct (MPD) injury is critical for treatment.
BACKGROUND
Pancreatic trauma is reportedly associated with high morbidity and mortality. Main pancreatic duct (MPD) injury is critical for treatment.
METHODS
As a study project of the Japanese Society for Abdominal Emergency Medicine (JSAEM), we collected the data of 163 patients with pancreatic trauma who were diagnosed and treated at JSAEM board-certified hospitals from 2006 to 2016. Clinical backgrounds, diagnostic approaches, management strategies, and outcomes were evaluated.
RESULTS
Sixty-four patients (39%) were diagnosed as having pancreatic trauma with MPD injury that resulted in 3% mortality. Blunt trauma and isolated pancreatic injury were independent factors predicting MPD injury. Nine of 11 patients with MPD injury who were initially treated nonoperatively had serious clinical sequelae and five (45%) required surgery as a secondary treatment. Among all cases, the detectability of MPD injury of endoscopic retrograde pancreatography (ERP) was superior to that of other imaging modalities (CT or MRI), with higher sensitivity and specificity (sensitivity = 0.96; specificity = 1.0).
CONCLUSIONS
Acceptable outcomes were observed in pancreatic trauma patients with MPD injury. Nonoperative management should be carefully selected for MPD injury. ERP is recommended to be performed in patients with suspected MPD injury and stable hemodynamics.
Topics: Abdominal Injuries; Cholangiopancreatography, Endoscopic Retrograde; Humans; Japan; Pancreatic Ducts; Wounds, Nonpenetrating
PubMed: 33280257
DOI: 10.1002/jhbp.877 -
Journal of Vascular and Interventional... Oct 2022Interventional radiology can be used to perform complex pancreatic duct (PD) interventions in cases in which PD abnormalities limit the feasibility of an endoscopic...
Interventional radiology can be used to perform complex pancreatic duct (PD) interventions in cases in which PD abnormalities limit the feasibility of an endoscopic approach. A multidisciplinary approach with gastroenterology using the rendezvous technique can improve procedural success. The establishment of through-and-through access to the PD via a combined percutaneous and endoscopic approach can be used when endoscopy alone fails. In this study, 3 cases are presented in which the rendezvous technique was successfully employed to access the PD for subsequent interventions.
Topics: Abdomen; Cholangiopancreatography, Endoscopic Retrograde; Drainage; Endoscopy, Gastrointestinal; Humans; Pancreatic Ducts
PubMed: 36182255
DOI: 10.1016/j.jvir.2022.06.021 -
Asian Journal of Surgery Sep 2023
Topics: Humans; Pancreaticojejunostomy; Pancreatic Ducts; Pancreatic Fistula; Stents; Pancreaticoduodenectomy; Postoperative Complications
PubMed: 37037747
DOI: 10.1016/j.asjsur.2023.03.145 -
Journal of Gastroenterology and... May 2022
Review
Topics: Catheter Ablation; Cholangiopancreatography, Endoscopic Retrograde; Constriction, Pathologic; Humans; Pancreatic Ducts; Pancreatic Neoplasms; Radiofrequency Ablation
PubMed: 34761433
DOI: 10.1111/jgh.15724 -
Surgical Laparoscopy, Endoscopy &... Jun 2023The objective of this study was to investigate the feasibility of simplified duct-to-mucosa pancreaticojejunostomy in a nondilated pancreatic duct in laparoscopic...
OBJECTIVE
The objective of this study was to investigate the feasibility of simplified duct-to-mucosa pancreaticojejunostomy in a nondilated pancreatic duct in laparoscopic surgery.
MATERIALS AND METHODS
The data of 19 patients who underwent laparoscopic pancreaticoduodenectomy (LPD) and 2 patients who underwent laparoscopic central pancreatectomy were retrospectively analyzed.
RESULTS
All patients underwent pure laparoscopic surgery successfully with simplified duct-to-mucosa pancreaticojejunostomy. The operation time of LPD was 365.11±41.56 minutes, the time of pancreaticojejunostomy was 28.39±12.58 minutes, and postoperative hospitalization time was 14.16±6.88 days on average. Postoperative complications occurred in 3 patients of LPD, including 2 cases of class B postoperative pancreatic fistula and 1 case of gastroparesis followed by gastrointestinal anastomotic perforation. The operative time of laparoscopic central pancreatectomy was 191.00±12.73 minutes, the time of pancreaticojejunostomy 36.00±5.66 minutes, and the postoperative hospitalization time 12.5±0.71 days on average.
CONCLUSIONS
The described technique is a simple and safe reconstruction procedure and suitable for patients with nondilated pancreatic duct.
Topics: Humans; Pancreaticojejunostomy; Retrospective Studies; Pancreatic Neoplasms; Pancreatic Ducts; Pancreaticoduodenectomy; Pancreatic Fistula; Laparoscopy; Postoperative Complications
PubMed: 37010359
DOI: 10.1097/SLE.0000000000001084