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Singapore Medical Journal Nov 2008Splenectomy is routinely performed in conventional distal pancreatectomies. Spleen removal with its possible sequelae of infections and haematological complications has...
INTRODUCTION
Splenectomy is routinely performed in conventional distal pancreatectomies. Spleen removal with its possible sequelae of infections and haematological complications has prompted the development of spleen-preserving techniques. This study aimed to evaluate the safety and clinical outcomes of distal pancreatectomy with preservation of the spleen.
METHODS
A retrospective review of 24 consecutive patients who underwent spleen-preserving distal pancreatectomy in a tertiary care hospital was conducted.
RESULTS
There were 17 female and seven male patients, and the mean age was 47 (range 14-77) years. Median American Society of Anesthesiologists score was II (range I-III) . The indications were as follows : mucinous cystadenoma (n = 7), serous cystadenoma (n = 6), insulinoma (n = 3), intraductal papillary mucinous tumour (n = 2), pseudocyst (n = 3), papillary cystic adenoma (n = 1), neuroendocrine neoplasm (n = 1), and metastatic carcinoma of the thyroid (n = 1). Two patients developed postoperative pancreatic fistula and another two patients developed postoperative ileus with spontaneous resolution. Mean operative time was 172 (range 105-250) minutes. Mean length of postoperative hospital stay was 6.7 (range 5-11) days. There was no perioperative mortality in this series.
CONCLUSION
Spleen-preserving distal pancreatectomy can be safely performed with low morbidity, and should be considered in the surgical management of distal pancreatic disease.
Topics: Adolescent; Adult; Aged; Female; Humans; Male; Middle Aged; Pancreatectomy; Pancreatic Diseases; Retrospective Studies; Spleen; Splenectomy; Treatment Outcome
PubMed: 19037554
DOI: No ID Found -
Diagnostics (Basel, Switzerland) Aug 2021To review the current options in the management of Warthin tumors (WTs) and to propose a working management protocol. (Review)
Review
PURPOSE
To review the current options in the management of Warthin tumors (WTs) and to propose a working management protocol.
METHODS
A systematic literature search was conducted using PubMed and ScienceDirect database. A total of 141 publications were selected and have been included in this review. Publications were selected based on relevance, scientific evidence, and actuality.
RESULTS
The importance of parotid WTs is increasing due to its rising incidence in many countries, becoming the most frequently encountered benign parotid tumor in certain parts of the world. In the past, all WTs were treated with surgery, but because of their slow growth rate, often minimal clinical symptoms, and the advanced age of many patients, active observation has gradually become more widely used. In order to decide on active surveillance, the diagnosis of WT must be reliable, and clinical, imaging, and cytological data should be concordant. There are four clear indications for upfront surgery: uncertain diagnosis; cosmetic problems; clinical complaints, such as pain, ulceration, or recurrent infection; and the patient's wish to have the tumor removed. In the remaining cases, surgery can be elective. Active surveillance is often suggested as the first approach, with surgery being considered if the tumor progresses and/or causes clinical complaints. The extent of surgery is another controversial topic, and the current trend is to minimize the resection using partial parotidectomies and extracapsular dissections when possible. Recently, non-surgical options such as microwave ablation, radiofrequency ablation, and ultrasound-guided ethanol sclerotherapy have been proposed for selected cases.
CONCLUSIONS
The management of WT is gradually shifting from superficial or total parotidectomy to more conservative approaches, with more limited resections, and to active surveillance in an increasing number of patients. Additionally, non-surgical treatments are emerging, but their role needs to be defined in future studies.
PubMed: 34441400
DOI: 10.3390/diagnostics11081467 -
Arquivos Brasileiros de Cirurgia... 2023Pancreatic cystic lesions are a group of pancreatic neoplasms with different behavior and risk of malignancy. Imaging diagnosis and differentiation of these lesions...
BACKGROUND
Pancreatic cystic lesions are a group of pancreatic neoplasms with different behavior and risk of malignancy. Imaging diagnosis and differentiation of these lesions remain a challenge.
AIMS
The aim of this study was to evaluate the agreement between computed tomography and/or magnetic resonance imaging and post-operative pathologic diagnoses of Pancreatic cystic lesions in a University Hospital of São Paulo State.
METHODS
A total of 39 patients with surgically diagnosed Pancreatic cystic lesions were enrolled, as a study cohort from 2009 to 2019. Preoperative radiological and final pathological diagnosis was correlated to measure computed tomography and/or magnetic resonance imaging diagnostic. Pancreatic adenocarcinoma, choledochal pancreatic cyst, mucinous cystadenoma, serous cystadenoma, intraductal papillary mucinous neoplasms, and pancreatic pseudocyst were classified as neoplastic cysts.
RESULTS
It was noted that 27 patients (69.23%) had preoperative computed tomography and magnetic resonance imaging, 11 patients (28.20%) had preoperative computed tomography only, and 1 patient had preoperative magnetic resonance imaging only. The values for diagnoses made only with computed tomography (p=0.47) and from the combination of computed tomography+magnetic resonance imaging (p=0.50) did also point to moderate agreement with the anatomopathological findings. The values pointed to a fair agreement for the diagnosis of mucinous cystadenoma (p=0.3), moderate agreement for intraductal papillary mucinous neoplasms (p= 0.41), good agreement for serous cystadenoma (p=0.79), and excellent agreement for choledochal pancreatic cyst (p=1), pancreatic pseudocyst (p=0.84), and Frantz tumor (p=1) (p<0.05).
CONCLUSIONS
The findings of computed tomography and/or magnetic resonance imaging have an equivalent diagnostic agreement with an anatomopathological diagnosis for differentiating benign from malignant Pancreatic cystic lesions and in suggesting a specific diagnosis. There is no statistical difference between the use of computed tomography alone and computed tomography+magnetic resonance imaging in the improvement of diagnostic accuracy.
Topics: Humans; Pancreatic Cyst; Pancreatic Pseudocyst; Pancreatic Neoplasms; Cystadenoma, Mucinous; Cystadenoma, Serous; Adenocarcinoma; Brazil; Magnetic Resonance Imaging; Diagnosis, Differential
PubMed: 37255104
DOI: 10.1590/0102-672020230017e1735 -
BMC Surgery Sep 2023The procedure of total duodenum-preserving pancreatic head resection (DPPHRt) has been reported frequently, but rare in minimally invasive procedure, especially...
BACKGROUND
The procedure of total duodenum-preserving pancreatic head resection (DPPHRt) has been reported frequently, but rare in minimally invasive procedure, especially robotic-assisted operation. Here we share our experience and analyze the clinical outcomes of minimally invasive DPPHRt in the treatment of benign lesions or low-grade malignant tumors of the pancreatic head in this study.
MATERIALS AND METHODS
From October 2016 to January 2022, three patients received robot-assisted DPPHRt(RA-DPPHRt), and seventeen patients received laparoscopic DPPHRt(LDPPHRt). Data were retrospectively collected in terms of demographic characteristics (age, gender, body mass index, and pathological diagnosis), intraoperative variables (operative time, estimated blood loss), and post-operative variables (post-operative hospital stay, and complications).
RESULTS
All 20 patients received minimally invasive total duodenum-preserving pancreatic head resection successfully without conversion, including 8 males and 12 females. Pathological diagnosis suggested 1 case of serous cystadenoma (SCA), 4 cases of intraductal papillary mucinous neoplasm (IPMN) ,5 cases of mucinous cystic neoplasm (MCN), 4 cases of pancreatic neuroendocrine neoplasm (PNET), 2 cases of chronic pancreatitis (CP),4 case of solid pseudopapillary tumor (SPT). The average operation time was (285.35 ± 95.13 min), ranging from 95 to 420 min. The average estimate blood loss was (196.50 ± 174.45ml) ,ranging from 10 to 600ml.The average post-operative hospital stay was(20.90 ± 14.44days),ranging from 8 to 54 days. Postoperative complications occurred in 10 patients (50%). A total of 5 patients (20%) suffered grade B or C pancreatic fistula. Two patients (10%) suffered from biliary fistula. Two patients (10%) suffered from delayed gastric emptying. One patient (5%) suffered from abdominal bleeding. The 90-day mortality was 0. No patient was observed tumor recurrence and new-onset diabetes but one developed diarrhea.
CONCLUSION
RA-DPPHRt or LDPPHRt provided a minimally invasive approach with good organ-preservation for patients with benign and low-grade malignant pancreatic head tumor. It is only recommended to be performed in high-volume pancreatic centers by experienced pancreatic surgeons.
Topics: Female; Male; Humans; Retrospective Studies; Neoplasm Recurrence, Local; Pancreatectomy; Pancreas; Pancreatic Neoplasms; Duodenum
PubMed: 37735367
DOI: 10.1186/s12893-023-02170-9 -
Chirurgia (Bucharest, Romania : 1990) 2017We notice an increasing frequency in the detection and evaluation of pancreatic cystic lesions (PCLs) over the last three decades. They show awide spectrum of imaging... (Review)
Review
We notice an increasing frequency in the detection and evaluation of pancreatic cystic lesions (PCLs) over the last three decades. They show awide spectrum of imaging and clinical features. The diagnosis and discrimination of these lesions are very important because of the risk for concurrent or later development of malignancy. The main reason is the increased awareness of these lesions and the extensive use of cross-sectional imaging, an always improving technique (1). Commonly, PCLs are diagnosed incidentally during investigation for often unrelated and nonspecific abdominal complaints using state-of-the art abdominal imaging (CT, MRT). The term PCN denotes a histologically heterogeneous collection of neoplasms showing a wide spectrum of diagnoses, ranging from completely benign to potentially malignant, to carcinoma in situ, to frankly invasive and malignant (2,3). In 1978, Compagno and Oertel were the first to recognize the crucial distinction between the serous and the mucinous cystic neoplasms of the pancreas by explaining the importance of identifying the mucinous neoplasms because of their overt or latent malignant potential (4,5). Since then, the interest in PCLs increased markedly, especially so with the recognition of the importance and prevalence of intraductal papillary mucinous neoplasms (IPMNs). Nowadays, PCLs represent a common and often difficult challenge in clinical practice, because of the increase in their detection in asymptomatic patients and our still immature understanding of some aspects of their biologic behavior. Their important differences regarding their outcome and the fact of being increasingly often identified has put a special focus on these neoplasms by surgeons, pathologists, gastroenterologists, radiologists, and oncologists alike. Management of patients with PCNs can be challenging and varies considerably among the various subtypes of PCNs. Their treatment ranges from resection of malignant lesions, to resection and/or surveillance in the case of premalignant lesions, to simple observation in the case of benign or indolent lesions. Under these circumstances, the accurate classification of PCNs becomes crucial. Therapeutic decision making and classification rely mainly on the presenting symptoms and radiologic findings, often without actual histologic tissue. It is of extreme importance to identify suspicious features indicating potential or certain malignancy in order to select the appropriate treatment. The risk of overtreatment (unnecessary pancreatectomy) should he balanced carefully with the risk of under treatment (missing the opportunity to cure a potentially curable malignant or premalignant disease).
Topics: Adenocarcinoma, Mucinous; Cystadenoma, Serous; Humans; Pancreatectomy; Pancreatic Cyst; Pancreatic Neoplasms; Risk Assessment; Treatment Outcome
PubMed: 28463669
DOI: 10.21614/chirurgia.112.2.97 -
Visceral Medicine Jul 2018A precise diagnosis of the nature of pancreatic cystic neoplasm (PCN) is crucial since it determines the patients in need of rapid surgical resection as well as those... (Review)
Review
A precise diagnosis of the nature of pancreatic cystic neoplasm (PCN) is crucial since it determines the patients in need of rapid surgical resection as well as those who can be followed up, and, accordingly, the frequency and modalities of surveillance. Endoscopic ultrasound (EUS) and especially fine needle aspiration (FNA) are invasive methods, with specific adverse events occurring in 2.7-5%. Thus, they should only be used as a third-line tool in the absence of characteristic radiographic features on computed tomography (CT) scan and magnetic resonance imaging (MRI). The most difficult aspects of differential diagnosis are: intraductal papillary mucinous neoplasm (IPMN) versus chronic pancreatitis; unifocal IPMN versus serous cystic neoplasm (SCN); macrocystic SCN versus mucinous cystic neoplasm (MCN); cystic neuroendocrine tumors versus MCN; solid serous cystadenoma versus neuroendocrine tumors versus small solid pseudopapillary tumors; pseudocyst versus MCN; low-grade, high-grade, or invasive IPMN. When classical radiological and EUS features are not conclusive, EUS-FNA may be helpful by analyzing cytological, chemical, and/or molecular data. The addition of EUS-FNA to CT scan and MRI increased the overall accuracy for diagnosing PCN by 36 and 54%, respectively. Analysis of molecular markers in pancreatic cyst fluid might increase the limited accuracy of EUS-FNA by using cytology and chemical and/or tumor marker analysis alone. Current evidence suggests that contrast-enhanced EUS (CH-EUS) is highly accurate for distinguishing non-neoplastic cysts from neoplastic cysts. CH-EUS might also be useful for distinguishing mural epithelial nodules from mucinous clots. Needle-based confocal laser endomicroscopy (nCLE) images a target tissue at a subcellular level of resolution, providing real-time in-vivo optical biopsy. nCLE is feasible during EUS-FNA and allows in-vivo diagnosis of PCN with high accuracy. In conclusion, EUS is a third-line tool in the diagnosis of PCN. Clinical context as well as careful evaluation of CT scan and magnetic resonance cholangiopancreatography images by specialized radiologists are crucial in the diagnosis process. Nowadays it is inconceivable to skip these steps.
PubMed: 30140684
DOI: 10.1159/000489242 -
Journal of Visceral Surgery Apr 2013Incidentally discovered cystic tumors of the pancreas (CTP) are an increasingly frequent entity. It is essential to differentiate lesions whose malignant potential is... (Review)
Review
Incidentally discovered cystic tumors of the pancreas (CTP) are an increasingly frequent entity. It is essential to differentiate lesions whose malignant potential is either nil or negligible (pseudocyst, serous cystadenoma, simple cysts) from lesions with intermediate malignant potential (intraductal papillary mucinous tumor of the pancreas [IPMN] involving the secondary ducts, cystic endocrine tumor) or those with high malignant potential (mucinous cystadenoma, solid pseudopapillary tumors and IPMN involving the main pancreatic duct). The approach to defining malignant potential is based on diagnostic CT scan, magnetic resonance imaging (MRI), and endoscopic ultrasound (EUS), often complemented by EUS-guided cyst puncture for biochemical and cytological analysis of cyst fluid. Surgery for diagnostic purposes should be avoided because of its significant morbidity. For pseudocysts, simple cysts and serous cystadenomas, abstention is the general rule. Resection, preserving as much pancreatic parenchyma as possible, is the rule for IPMN involving the main pancreatic duct, mucinous cystadenomas, solid and pseudopapillary tumors, and cystic endocrine tumors. Resection is rarely indicated at the outset for IPMN involving secondary pancreatic ducts; morphologic observation is the general rule and preventive excision may be indicated secondarily. Good collaboration between surgeons, radiologists and endosonographists is necessary for optimal management of CTP.
Topics: Carcinoma, Pancreatic Ductal; Cystadenocarcinoma; Cystadenoma; Diagnosis, Differential; Endosonography; Humans; Magnetic Resonance Imaging; Pancreatectomy; Pancreatic Cyst; Pancreatic Neoplasms; Pancreatic Pseudocyst; Tomography, X-Ray Computed; Treatment Outcome; Watchful Waiting
PubMed: 23518192
DOI: 10.1016/j.jviscsurg.2013.02.003 -
World Journal of Gastrointestinal... Mar 2015Rapid advances in radiologic technology and increased cross-sectional imaging have led to a sharp rise in incidental discoveries of pancreatic cystic lesions. These... (Review)
Review
Rapid advances in radiologic technology and increased cross-sectional imaging have led to a sharp rise in incidental discoveries of pancreatic cystic lesions. These cystic lesions include non-neoplastic cysts with no risk of malignancy, neoplastic non-mucinous serous cystadenomas with little or no risk of malignancy, as well as neoplastic mucinous cysts and solid pseudopapillary neoplasms both with varying risk of malignancy. Accurate diagnosis is imperative as management is guided by symptoms and risk of malignancy. Endoscopic ultrasound (EUS) allows high resolution evaluation of cyst morphology and precise guidance for fine needle aspiration (FNA) of cyst fluid for cytological, chemical and molecular analysis. Initially, clinical evaluation and radiologic imaging, preferably with magnetic resonance imaging of the pancreas and magnetic resonance cholangiopancreatography, are performed. In asymptomatic patients where diagnosis is unclear and malignant risk is indeterminate, EUS-FNA should be used to confirm the presence or absence of high-risk features, differentiate mucinous from non-mucinous lesions, and diagnose malignancy. After analyzing the cyst fluid for viscosity, cyst fluid carcinoembryonic antigen, amylase, and cyst wall cytology should be obtained. DNA analysis may add useful information in diagnosing mucinous cysts when the previous studies are indeterminate. New molecular biomarkers are being investigated to improve diagnostic capabilities and management decisions in these challenging cystic lesions. Current guidelines recommend surgical pancreatic resection as the standard of care for symptomatic cysts and those with high-risk features associated with malignancy. EUS-guided cyst ablation is a promising minimally invasive, relatively low-risk alternative to both surgery and surveillance.
PubMed: 25789091
DOI: 10.4253/wjge.v7.i3.213 -
Polski Przeglad Chirurgiczny Feb 2017The aim of this study was to assess short-term outcomes of surgical treatment of pancreatic cystic tumors (PCTs).
UNLABELLED
The aim of this study was to assess short-term outcomes of surgical treatment of pancreatic cystic tumors (PCTs).
MATERIAL AND METHODS
We retrospectively reviewed medical records of 46 patients (31 women and 15 men) who had undergone surgery for pancreatic cystic tumors in our department.
RESULTS
Pancreatic cystic tumors were located within the pancreatic head (21), body (11), tail (13), and whole pancreas (1). The following surgical procedures were performed: pancreatoduodenectomy (20), central pancreatectomy (9), distal pancreatectomy (3), distal pancreatectomy with splenectomy (3), distal extended pancreatectomy with splenectomy (2), total pancreatectomy (1), duodenum preserving pancreatic head resection (1), local tumor resection (4), and other procedures (2). Histopathological tumor types were as follows: serous cystadenoma (14), intraductal papillary mucinous adenoma (5), intraductal papillary mucinous carcinoma (5), solid pseudopapillary tumor (5), mucinous cystadenoma (5), mucinous cystadenoma with border malignancy (1), mucinous cystadenocarcinoma (2), adenocarcinoma (4), and other tumors (5). Early postoperative complications were observed in 14 (30.43%) patients. Reoperations were performed in 9 (19.56%) patients. The perioperative mortality rate was 6.52%.
CONCLUSIONS
Serous cystadenoma was the most common pancreatic cystic tumor in the analyzed group. PCTs were most frequently located within the pancreatic head. Pancreatic resection was possible in most patients, and pancreatoduodenectomy was the most common pancreatic resection type.
Topics: Cystadenoma, Mucinous; Cystadenoma, Serous; Female; Humans; Male; Pancreas; Pancreatectomy; Pancreatic Cyst; Pancreaticoduodenectomy; Poland; Retrospective Studies; Treatment Outcome
PubMed: 28522787
DOI: 10.5604/01.3001.0009.6008 -
Annals of Surgery Feb 1996The authors compared the clinicopathologic features of the intraductal papillary and mucinous cystic neoplasms of the pancreas and clarified the similarities as well as... (Comparative Study)
Comparative Study Review
OBJECTIVE
The authors compared the clinicopathologic features of the intraductal papillary and mucinous cystic neoplasms of the pancreas and clarified the similarities as well as the differences between these two tumors. In addition, they reviewed 104 cases of the intraductal papillary neoplasm in the English literature to provide a global view of the condition.
SUMMARY BACKGROUND DATA
Controversy about the term and clinicopathologic entity still exist regarding intraductal papillary neoplasm of the pancreas. Currently, with only a few cases of this rare tumor in each report, there continues to be inadequate knowledge available regarding the tumor and methods by which to distinguish it from the mucinous cystic neoplasm.
METHODS
Multiple demographic and clinicopathologic parameters were compared between intraductal papillary and mucinous cystic neoplasms identified from 1985 to 1994 in the Medical Center, Veterans General Hospital--Taipei.
RESULTS
There were four intraductal papillary adenocarcinomas and 10 mucinous cystic neoplasms (8 cystadenocarcinoma and 2 cystadenoma). The sex, age, size, tumor location, and pathologic findings were quite different between these two groups. Clinical presentation of intraductal papillary adenocarcinomas were similar to those of periampullary tumors. The most common presentations of mucinous cystic neoplasm were epigastric pain and abdominal mass. All four intraductal papillary adenocarcinoma showed mucin secretion from a patulous orifice of the ampulla of Vater and filling defects in the dilated main pancreatic duct by endoscopic retrograde cholangiopancreatography (ERCP). Accurate preoperative diagnosis was not easy regarding either group. Serum carbohydrate antigen 19-9 (CA 19-9) was more useful for diagnosis in both groups.
CONCLUSIONS
The intraductal papillary neoplasm is a unique clinical entity but not a variant of mucinous cystic neoplasm in terms of sex, age, size, tumor location, or pathologic picture. The pathognomonic findings of ERCP should lead to diagnosis. Very aggressive surgical procedures should be attempted for these two mucin-producing neoplasms with low-grade malignancy.
Topics: Adenocarcinoma, Papillary; Adult; Aged; Cystadenoma, Mucinous; Female; Humans; Middle Aged; Mucins; Pancreatic Ducts; Pancreatic Neoplasms; Retrospective Studies
PubMed: 8597507
DOI: 10.1097/00000658-199602000-00005