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Journal of B.U.ON. : Official Journal... 2018Pancreatic and periampullary adenocarcinoma have not generally been included in the tumour types considered for metastasectomy. However, there is an increasing interest... (Meta-Analysis)
Meta-Analysis
PURPOSE
Pancreatic and periampullary adenocarcinoma have not generally been included in the tumour types considered for metastasectomy. However, there is an increasing interest that metastasectomy in well-selected patients can prolong survival. This review aims to establish the recent evidence on the surgical management of oligometastatic disease and survival outcome in patients who underwent metastasectomy focusing on isolated hepatic and pulmonary metastases.
METHODS
A systematic search was performed in the PubMed database to identify all original articles on the role of metastasectomy for oligometastasis of pancreatic and periampullary adenocarcinoma. Data on methodologies used, 1,3,5 - year survival and median overall survival were summarized, and used to address relevant clinical questions related to the survival outcome in patients who underwent metastasectomy.
RESULTS
Sixteen studies were included in this review. All the studies included were retrospective and heterogenous in nature and did not have a uniform reporting on survival outcomes.
CONCLUSION
There is insufficient evidence to support a change of current practice in managing metastatic pancreatic and periampullary cancer. However, patients with ampullary cancer as the primary and any patients with first recurrence as isolated pulmonary metastases had better prognosis than patients with synchronous metastasis or metastases to the liver. This need to be explored in future studies.
Topics: Adenocarcinoma; Ampulla of Vater; Common Bile Duct Neoplasms; Humans; Metastasectomy; Neoplasms; Pancreatic Neoplasms; Prognosis; Survival Rate
PubMed: 30610789
DOI: No ID Found -
BMJ Case Reports Nov 2019A 64-year-old woman presented with bilateral visual loss with shimmering photopsias as the only clinical manifestation of an occult pancreatic ampullary adenocarcinoma...
A 64-year-old woman presented with bilateral visual loss with shimmering photopsias as the only clinical manifestation of an occult pancreatic ampullary adenocarcinoma causing duct dilatation. Abnormal electroretinograms led to suspicion of cancer-associated retinopathy (CAR), and CT of the abdomen showed an underlying pancreatic malignancy, detected with subclinical liver function tests following diagnosis of CAR. Biopsy showed a T2N0M0 ampullary adenocarcinoma. The patient was managed with Whipple's procedure and adjuvant chemotherapy and has made a good recovery with no progression of her retinopathy. To our knowledge, this is one of the first descriptions of CAR in the context of pancreatic malignancy. It is atypical in its asymmetric presentation and favourable patient outcome. CAR is an important diagnosis to make, as ocular manifestations can be the only indication of an occult malignancy, resulting in a swifter diagnosis and potentially life-saving early intervention.
Topics: Adenocarcinoma; Ampulla of Vater; Female; Humans; Middle Aged; Pancreatic Neoplasms; Retinal Diseases; Vision Disorders
PubMed: 31712238
DOI: 10.1136/bcr-2019-231444 -
Journal of Visceral Surgery Jun 2020
Topics: Adenocarcinoma; Digestive System Surgical Procedures; Duodenum; Humans
PubMed: 31221550
DOI: 10.1016/j.jviscsurg.2019.06.002 -
The Oncologist Mar 2018Small bowel adenocarcinoma is a rare disease occurring 50–100‐fold less often than colorectal cancer. This commentary describes similarities and differences between...
Small bowel adenocarcinoma is a rare disease occurring 50–100‐fold less often than colorectal cancer. This commentary describes similarities and differences between the two diseases and related results of recent clinical trials.
Topics: Adenocarcinoma; Ampulla of Vater; ErbB Receptors; Humans; Lung Neoplasms; Panitumumab
PubMed: 29438094
DOI: 10.1634/theoncologist.2017-0688 -
BMJ Case Reports Jan 2013We report a case of duodenal adenocarcinoma, who presented to the emergency ward, with features of acute cholecystitis and peptic ulcer disease. Ultrasonography and...
We report a case of duodenal adenocarcinoma, who presented to the emergency ward, with features of acute cholecystitis and peptic ulcer disease. Ultrasonography and upper gastrointestinal (GI) endoscopy failed to pick up duodenal pathology, previously two times. Only third time endoscopy showed circumferential thickening of first and second part of the duodenum. On diagnosis laparoscopy mass at the D1/2 junction with apparent involvement of head of pancreas was noted. Pancreatoduodenectomy was performed. Histopathological examination showed it to be primary duodenal adenocarcinoma with extension in to head of pancreas. His postoperative course was uneventful. After 4-month follow-up the patient remained well.
Topics: Adenocarcinoma; Cholecystitis, Acute; Diagnosis, Differential; Duodenal Neoplasms; Duodenal Ulcer; Humans; Laparoscopy; Male; Middle Aged; Pancreaticoduodenectomy; Tomography, X-Ray Computed
PubMed: 23345487
DOI: 10.1136/bcr-2012-007922 -
Internal Medicine (Tokyo, Japan) 2012Small bowel tumors are rare; most are single and located in the duodenum. When a patient presents with unreasonable abdominal pain and distension, with normal upper... (Review)
Review
Small bowel tumors are rare; most are single and located in the duodenum. When a patient presents with unreasonable abdominal pain and distension, with normal upper gastrointestinal endoscopy and colonoscopy, it is important to consider this disease. Here, we report a case of segmental and multiple adenocarcinoma of the small bowl presenting with unreasonable abdominal pain and distension in a 76-year-old woman, and provide a brief review on this subject. Our report highlights the fact that segmental and multiple small bowel tumors are very rare and the clinical characteristics are generally vague and nonspecific.
Topics: Adenocarcinoma; Aged; Female; Humans; Intestinal Neoplasms
PubMed: 22504242
DOI: 10.2169/internalmedicine.51.6999 -
Revista Da Associacao Medica Brasileira... 2002To revise literature data about adenocarcinoma of the duodenum comparing to our results.
PURPOSE
To revise literature data about adenocarcinoma of the duodenum comparing to our results.
METHODS
Six patients with this kind of cancer, excluding periampullary lesions, were treated from 1991 to 1999 in the Department of Surgery, Santa Casa of São Paulo Medical School. Five of them were males in theirs fifties. The commonest signs and symptoms were those of gastrointestinal obstruction and weight loss. All patients were evaluated by duodenoscopy. Ultrasonography and CT scans played an important role with regard to preoperative staging. Three patients underwent a segmental resection and the others were submitted to a palliative duodenal bypass.
RESULTS
Post-operative hospitalization varied from 5 to 9 days (7,3 days average). The operative mortality was 16.6% (one patient). Patients were not submitted to chemo or radiotherapy. Follow-up has been done. Patients with curative resection were free from recurrence. Two patients submitted to palliative operations were lost to follow-up.
CONCLUSION
Rarity of duodenum carcinomas and few patients in the literature did not permit conclusions.
Topics: Adenocarcinoma; Aged; Aged, 80 and over; Duodenal Neoplasms; Female; Follow-Up Studies; Humans; Laparotomy; Length of Stay; Male; Middle Aged
PubMed: 12353109
DOI: 10.1590/s0104-42302002000300038 -
Medical Molecular Morphology Sep 2022A non-ampullary duodenal mixed adenoneuroendocrine carcinoma (MANEC), consisting of a conventional adenocarcinoma and a neuroendocrine carcinoma (NEC), is exceedingly...
A non-ampullary duodenal mixed adenoneuroendocrine carcinoma (MANEC), consisting of a conventional adenocarcinoma and a neuroendocrine carcinoma (NEC), is exceedingly rare. Moreover, mismatch repair (MMR) deficient tumors have recently attracted attention. The patient, a 75-year-old woman with epigastric pain and nausea, was found to have a type 2 tumor of the duodenum, which was diagnosed on biopsy as a poorly differentiated carcinoma. A pancreaticoduodenectomy specimen showed a well-defined 50 × 48 mm tumor in the duodenal bulb, which was morphologically composed of glandular, sheet-like, and pleomorphic components. The glandular component was a tubular adenocarcinoma, showing a MUC5AC-positive gastric type. The sheet-like component consisted of homogenous tumor cells, with chromogranin A and synaptophysin diffusely positive, and a Ki-67 index of 72.8%. The pleomorphic component was diverse and prominent atypical tumor cells proliferated, focally positive for chromogranin A, diffusely positive for synaptophysin, and the Ki-67 index was 67.1%. The sheet-like and pleomorphic components were considered NEC, showing aberrant expression of p53, retinoblastoma, and p16. Notably, all three components were deficient in MLH1 and PMS2. We diagnosed a non-ampullary duodenal MANEC with MMR deficiency. This tumor has a unique morphology and immunohistochemical profile, and is valuable for clarifying the tumorigenesis mechanism of a non-ampullary duodenal MANEC.
Topics: Adenocarcinoma; Aged; Brain Neoplasms; Carcinoma, Neuroendocrine; Chromogranin A; Colorectal Neoplasms; Duodenum; Female; Humans; Ki-67 Antigen; Neoplastic Syndromes, Hereditary; Synaptophysin
PubMed: 35596001
DOI: 10.1007/s00795-022-00324-x -
Medicine Aug 2017To date, because of their rarity, the clinicopathological features and surgical outcomes of small bowel adenocarcinomas (SBAs) have been insufficiently explored. We...
To date, because of their rarity, the clinicopathological features and surgical outcomes of small bowel adenocarcinomas (SBAs) have been insufficiently explored. We evaluated the clinicopathological features and long-term outcomes of patients who underwent surgery for SBA.This retrospective study (from 1999 to 2016) examined patients with SBA treated surgically at the China National Cancer Center/Cancer Hospital. Clinicopathological features, preoperative evaluation, surgical treatment, and outcome parameters were reviewed and analyzed.Among the 241 patients studied, pancreaticoduodenectomies were performed in 51.0%, partial resection in 24.5%, palliative bypass surgery in 23.7%, and abdominal exploration in 0.8% of the patients. Majority of the patients were diagnosed at an advanced disease stage, and the duodenum was the most common tumor site. Postoperative complications occurred in 44.4% of the patients. Median overall and progression-free survival rates were 22.0 and 13.0 months, respectively. The 5-year overall and progression-free survival rates for patients with duodenal adenocarcinoma were 30.2% and 21.7%, respectively. Duodenal adenocarcinomas, lymph node metastases, distant metastases, poor differentiation, and lymphovascular invasion were associated with poor overall survival outcomes. The 3 factors associated with progression-free survival were the degree of differentiation, lymph node metastases, and distant metastases.Surgery remains the mainstay of treatment for SBA. A poor prognosis could be owing to the site, metastasis, differentiation, and lymphovascular invasion; however, the prognosis may improve through early diagnosis and operation.
Topics: Adenocarcinoma; Adult; Aged; Digestive System Surgical Procedures; Disease-Free Survival; Female; Humans; Intestinal Neoplasms; Intestine, Small; Kaplan-Meier Estimate; Lymphatic Metastasis; Male; Middle Aged; Multivariate Analysis; Retrospective Studies; Treatment Outcome; Young Adult
PubMed: 28767610
DOI: 10.1097/MD.0000000000007713 -
Annals of Surgery Aug 1979Fourteen patients with primary malignant duodenal tumors are studied. Twelve patients had adenocarcinomas and two patients had malignant lymphomas. Preoperative...
Fourteen patients with primary malignant duodenal tumors are studied. Twelve patients had adenocarcinomas and two patients had malignant lymphomas. Preoperative diagnostic procedures, such as radiographic study of duodenum with hypotonic duodenography, complete duodenoscopy with biopsy and artertiographic studies are discussed. Early diagnosis is the key for curative surgical treatment since these tumors seem to disseminate rather late. In patients with primary duodenal carcinoma the resectability rate was 66.7%-seven Whipple resections and one segmental resection. Only one patient in our series died after a Whipple resection. There was no mortality after other procedures. The five year survival rate was 14.2%. There is a definite correlation between regional lymph node involvement and survival time. The mean survival period after Whipple resection without lymph node invasion is 56.5 months in our series. The survival period after Whipple resection for adenocarcinoma with regional lymph node invasion (6 months) is identical to the survival after palliative internal derivations for duodenal adenocarcinoma (5.8 months). It is concluded that a positive peroperative frozen section of a regional lymph node should exclude resective procedures (except in patients who hemorrhage) because they have a higher mortality rate as derivative procedures. Fifty per cent of the patients treated for malignant duodenal lymphoma is tumor free two years after a radical surgical therapy combined with chemotherapeutical treatment from the early postoperative period.
Topics: Adenocarcinoma; Adult; Aged; Duodenal Neoplasms; Female; Humans; Lymphatic Metastasis; Lymphoma; Male; Middle Aged; Prognosis
PubMed: 464691
DOI: 10.1097/00000658-197908000-00010