Artículos de revistas: "MCNs, Pancreatic resection, Malignancy"

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Postlewait, Lauren M., Cecilia G. Ethun, Mia R. Mcinnis, Nipun Merchant, Alexander Parikh, Kamran Idrees, Chelsea A. Isom et al. "The Hand-Assisted Laparoscopic Approach to Resection of Pancreatic Mucinous Cystic Neoplasms: An Underused Technique?" American Surgeon 84, n.º 1 (enero de 2018): 56–62. http://dx.doi.org/10.1177/000313481808400123.

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Pancreatic mucinous cystic neoplasms (MCNs) are rare tumors typically of the distal pancreas that harbor malignant potential. Although resection is recommended, data are limited on optimal operative approaches to distal pancreatectomy for MCN. MCN resections (2000–2014; eight institutions) were included. Outcomes of minimally invasive and open MCN resections were compared. A total of 289 patients underwent distal pancreatectomy for MCN: 136(47%) minimally invasive and 153(53%) open. Minimally invasive procedures were associated with smaller MCN size (3.9 vs 6.8 cm; P = 0.001), lower operative blood loss (192 vs 392 mL; P = 0.001), and shorter hospital stay(5 vs 7 days; P = 0.001) compared with open. Despite higher American Society of Anesthesiologists class, hand-assisted (n = 46) had similar advantages as laparoscopic/robotic (n = 76). When comparing hand-assisted to open, although MCN size was slightly smaller (4.1 vs 6.8 cm; P = 0.001), specimen length, operative time, and nodal yield were identical. Similar to laparoscopic/robotic, hand-assisted had lower operative blood loss (161 vs 392 mL; P = 0.001) and shorter hospital stay (5 vs 7 days; P = 0.03) compared with open, without increased complications. Hand-assisted laparoscopic technique is a useful approach for MCN resection because specimen length, lymph node yield, operative time, and complication profiles are similar to open procedures, but it still offers the advantages of a minimally invasive approach. Hand-assisted laparoscopy should be considered as an alternative to open technique or as a successive step before converting from total laparoscopic to open distal pancreatectomy for MCN.

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Ladea, Lidia, Andreea Nicoleta Costache, F. C. Blăjuț y V. Tomulescu. "DIAGNOSIS AND MANAGEMENT OF PANCREATIC MUCINOUS CYSTADENOMA". Journal of Surgical Sciences 2, n.º 2 (1 de abril de 2015): 63–67. http://dx.doi.org/10.33695/jss.v2i2.108.

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Pancreatic mucinous cystadenomas (MCAs) are considered to be benign tumors with a high risk of malignant progression. The pancreatic mucinous cystadenoma is considered to be a rare condition that may lead to pancreatic cancer when not surgically resected. MCAs represent 9.7% of all neoplastic pancreatic cysts. The male:female ratio of MCAs is 1:10. The condition appears mostly in women, mean age in the 5th decade. The cyst is restricted by a fibrous capsule of variable consistency and has usually no communication with the pancreatic ductal system. The MCAs are located mostly in the body or tail of the pancreas. The MCAs located in the head of the pancreas are more likely to be malignant. Complete surgical resection is the recommended therapeutic option. We present a case of a 59-year-old female patient admitted in the Departemt of Surgery and Liver Transplatation of Fundeni Clinical Institute for recurrent episodes of acute pancreatitis. After a thorough investigation was performed, the CT-examination showed a pancreatic mass, located in the tail, measuring 30/40mm. Because the CT aspect was specific for a cystic-like lesion, surgery was recommended. The patient underwent a laparoscopic caudal splenopancreatectomy with a favorable postoperative evolution. The particularity of the case comes from the patient’s clinical presentation, with recurrent acute pancreatitis and the imagistic aspect (ultrasound and CT) that initially suggested a pseudocystic-like lesion, but the elevated CA 15-3 and further elaborated examinations indicated a possible malignant lesion.

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Nguyen, David, David W. Dawson, O. Joe Hines, Howard A. Reber y Timothy R. Donahue. "Mucinous Cystic Neoplasms of the Pancreas: Are we Overestimating Malignant Potential?" American Surgeon 80, n.º 10 (octubre de 2014): 915–19. http://dx.doi.org/10.1177/000313481408001001.

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Surgical resection is recommended for all mucinous cystic neoplasms (MCNs) of the pancreas as a result of: 1) lack of an accurate tumor marker for invasive cancer; 2) young age at diagnosis; and 3) historical studies revealing 36 per cent incidence of malignancy in resected lesions. This study compares the clinicopathologic and prognostic features of our series of resected MCNs to recent studies using the current International Association of Pancreatology (IAP) system. Thirty-eight resected MCNs were identified. Almost all patients were female (97.4%); median age at diagnosis was 53.5 years (interquartile range [IQR], 41.3 to 61.0). The majority occurred in the body/tail of the pancreas (86.8%); median size on computed tomography/magnetic resonance imaging was 5.0 cm (IQR, 3 to 8.8). Comparison of the five high-grade (HG, 13.2%) and 33 low-grade (86.8%) MCNs revealed that 1) patients were similar in age (55.0 vs 52.0 years, respectively) and 2) HG lesions were significantly larger on preoperative imaging (9.9 vs 3.5 cm) and final pathology (10.9 vs 3.5 cm). These data, taken together with five recent studies that adhere to the 2012 IAP criteria (385 total MCNs), reveal that a cutoff of less than 3 cm without mural nodules would have only missed one (0.26%) HG lesion. Surveillance of these lesions may be appropriate for some patients.

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Theruvath, Tom P., Katherine A. Morgan y David B. Adams. "Mucinous Cystic Neoplasms of the Pancreas: How Much Preoperative Evaluation is Needed?" American Surgeon 76, n.º 8 (agosto de 2010): 812–17. http://dx.doi.org/10.1177/000313481007600823.

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Cystic lesions of the pancreas are identified with increasing frequency by modern imaging. The mucinous cystic neoplasm (MCN) is treated with resection for its malignant potential. How much preoperative evaluation is needed before undertaking operation is frequently a diagnostic dilemma. A retrospective review of 32 patients who underwent resection of a MCN between 1994 and 2007 was performed to define the preoperative evaluation and operative treatment of MCN patients. Thirty-two patients (30 women; mean age 49) had histology-proven MCN. Twenty-seven patients had symptomatic cysts (84%). Five had a history of gallstones and/or acute pancreatitis. All patients were worked up with CT and/or MRI. Endoscopic ultrasound was performed in 14 (44%) and endoscopic retrograde cholangiopancreatography in six (18%). Cytology was obtained in 13 (40%). Pathology revealed 22 benign MCNs (68%), five malignant MCNs (16%), and five MCNs with borderline pathology. Preoperative workup including CT or MRI imaging and cytology suggested MCN as the lesion in 15 patients (46%). CT features by itself predicted MCN in three patients (9%). Cytology revealed another six patients (19%) with possible MCN. In this series, preoperative workup did not identify three of five patients with MCN malignancy. A preoperative diagnosis cannot be made in most patients with MCN. Operative treatment can be based on clinical presentation and CT imaging because endoscopic ultrasound and fine needle aspiration for evaluation may be misleading. Middle-aged women with cystic lesions in the tail of the pancreas without prior gallstone or pancreatitis history most typically fit the profile of the MCN patient.

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Newman, Naeem A., John T. Lucas, Diandra A. Peacock, Paul A. Trottman, Shira M. Winters, Sean S. Wentworth, Edward A. Levine y Perry Shen. "Predictors for readmission after pancreatic resection for malignancy." Journal of Clinical Oncology 31, n.º 4_suppl (1 de febrero de 2013): 301. http://dx.doi.org/10.1200/jco.2013.31.4_suppl.301.

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301 Background: Readmission after pancreatic resection has been reported as high as 50%. This study was undertaken to determine factors predicting readmission after pancreatic resection for malignancy. Methods: We reviewed the medical records of 202 patients to identify patients that had a pancreatic resection for malignancy between 2003 and 2010. Outcome measures included patient characteristics, medical comorbidities, and perioperative factors. Results: A total of 202 patients underwent pancreatic resection for malignancy. AJCC T stage was T1, T2, T3, and T4 in 10.9%, 26.3%, 52% and 9.2% respectively. Pancreatic head malignancies made up 84.8% of the patients, 2.3% were pancreatic neck, 8.4% were pancreatic body, and 4.5% were pancreatic tail primaries. Preoperative biliary stents were placed in 58% of patients. Adjuvant radiation and chemotherapy were given in 47.8 and 61.39% respectively. The readmission rate following resection was 20% at 60 days. The most common reasons for readmission within 60 days were delayed wound healing and renal insufficiency. On univariate analysis, factors predicting higher readmission rates included positive retroperitoneal margin (p=0.048), delayed gastric emptying (p=0.015), and presence of wound infection (p=0.0020). Conclusions: Factors related to tumor burden and GI/infectious complications were the most common predictors of readmission after pancreatic resection for malignancy. Though tumor size is a relatively immutable variable, improved management of postoperative complications remains an important factor in decreasing readmission rates after pancreatic resection for malignancy.

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Lee, T., D. Daly y K. Haghighi. "Survival after Pancreatic Resection in Older Patients with Pancreatic Malignancy". HPB 24 (2022): S327. http://dx.doi.org/10.1016/j.hpb.2022.05.692.

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Hatzaras, Ioannis, Carl Schmidt, Dori Klemanski, Peter Muscarella, W. Scott Melvin, E. Christopher Ellison y Mark Bloomston. "Pancreatic Resection in the Octogenarian: A Safe Option for Pancreatic Malignancy". Journal of the American College of Surgeons 212, n.º 3 (marzo de 2011): 373–77. http://dx.doi.org/10.1016/j.jamcollsurg.2010.10.015.

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Mehta, Shreya, Grace I. Tan, Christopher B. Nahm, Terence C. Chua, Andrew Pearson, Anthony J. Gill, Jaswinder S. Samra y Anubhav Mittal. "Pancreatic resection in patients with synchronous extra‐pancreatic malignancy: outcomes and complications". ANZ Journal of Surgery 90, n.º 3 (13 de enero de 2020): 290–94. http://dx.doi.org/10.1111/ans.15651.

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Budde, Cristina N., Lisa S. Merriman, Yiyi Chen, Brett C. Sheppard y Erin W. Gilbert. "Pancreatic resection for malignancy – do patients over 70 benefit?" Journal of the American College of Surgeons 219, n.º 4 (octubre de 2014): e109. http://dx.doi.org/10.1016/j.jamcollsurg.2014.07.677.

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Karamitopoulou, Eva. "Molecular Pathology of Pancreatic Cancer". Cancers 14, n.º 6 (16 de marzo de 2022): 1523. http://dx.doi.org/10.3390/cancers14061523.

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Pancreatic ductal adenocarcinoma (PDAC) is a biologically aggressive malignancy showing a remarkable resistance to existing therapies and is often diagnosed at an advanced stage, leaving only about 15–20% of patients with an option for surgical resection [...]

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Samel-Westerhof, Constanze, Stephan Samel, Walter Back, Jochen Gaa y Jörg Sturm. "Tracking Down Duodenopancreatic Malignancy". HPB Surgery 11, n.º 6 (1 de enero de 2000): 405–11. http://dx.doi.org/10.1155/2000/68578.

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Background Malignant tumours of the duodenum are rare and often difficult to diagnose. Due to the small clinical experience with duodenal malignancies their prognosis is unknown and resection is the treatment of choice.Case report Adding to a small series of incidental tumours, we report the case of a 65-year-old patient with primary extranodal (MALT-) lymphoma of the duodenum infiltrating the pancreatic head. The patient was admitted because of anaemia and epigastric discomfort with a history of Helicobacter- pylori associated gastric ulceration. Physical examination and bloodchemical values were otherwise normal. Endoscopy revealed duodenal ulceration but the biopsies taken from the ulceration did not give any evidence of malignancy or residual Helicobacter pylori infection. But MRT showed a circular intramural tumour of the duodenum. On laparotomy a large duodenal tumour adherent to the pancreatic head was found and a Whipple procedure was performed.Conclusion Apart from describing the case of a rare lymphoproliferative disorder of the duodenum, this report illustrates the diagnostic difficulties with uncommon neoplasm's of the duodenopancreatic region and the value of MRT prior to resection of a duodenopancreatic mass.

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Heerkens, H. D., D. S. J. Tseng, I. M. Lips, H. C. van Santvoort, M. R. Vriens, J. Hagendoorn, G. J. Meijer, I. H. M. Borel Rinkes, M. van Vulpen y I. Q. Molenaar. "Health-related quality of life after pancreatic resection for malignancy". British Journal of Surgery 103, n.º 3 (19 de noviembre de 2015): 257–66. http://dx.doi.org/10.1002/bjs.10032.

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Mirzaev, T. S., D. V. Podluzhny, R. E. Izrailov, Yu I. Patyutko, E. V. Glukhov y A. G. Kotelnikov. "Immediate results of spleen-preserving distal subtotal pancreatic resection". Annaly khirurgicheskoy gepatologii = Annals of HPB Surgery 26, n.º 1 (21 de marzo de 2021): 100–106. http://dx.doi.org/10.16931/1995-5464.20211100-106.

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Aim. To assess the possibility of open spleen-preserving distal subtotal pancreatic resection for tumors of the body and tail of the pancreas.Material and methods. A retrospective comparative analysis of the immediate results of the spleen-preserving interventions in 41 patients was carried out. Mainly benign tumors or tumors with a low malignancy potential of the corpus and (or) the tail of the pancreas were detected. Distal subtotal pancreatectomy with splenectomy was performed in 53 patients with pancreatic tumors of different histogenesis with low malignancy potential (control group).Results. The duration of spleen-preserving distal subtotal pancreatectomy was 12 minutes shorter, compared with the distal subtotal pancreatectomy with splenectomy group (p = 0.180). Significantly lower volume of intraoperative blood loss during spleen-preserving procedure was noted – by 460 ml (p = 0.0001). The level of postoperative complications in the spleen-preserving pancreatectomy group was 15 (37%), while in the group of distal subtotal pancreatectomy with splenectomy was 26 (49%) (p = 0.227), respectively. External pancreatic fistula after spleenpreserving pancreatectomy was noted in 13 (32%) patients, in the other group in 21 (40%; p = 0.429). The duration of hospital stay did not statistically significantly differ in the compared groups and amounted to: 18.6 ± 6.9 and 20.3 ± 5.4 days (p = 0.123), respectively.Conclusion. Open spleen-preserving pancreatectomy is a relatively safe type of surgical treatment for patients with benign tumors and tumors with a low potential for malignancy of the body and/or tail of the pancreas. The surgery is shorter in time, accompanied by a lower level of complications, significantly less intraoperative blood loss, compared with a similar procedure involving splenectomy.

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Gunay, Yusuf, Ebru Demiralay y Alp Demirag. "Pancreatic Metastasis of High-Grade Papillary Serous Ovarian Carcinoma Mimicking Primary Pancreas Cancer: A Case Report". Case Reports in Medicine 2012 (2012): 1–3. http://dx.doi.org/10.1155/2012/943280.

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Introduction. Reports of epithelial ovarian carcinomas metastatic to the pancreas are very rare. We herein present a metastasis of high grade papillary serous ovarian cancer to mid portion of pancreas.Case. A 42-year-old patient was admitted with a non-specified malignant cystic lesion in midportion of pancreas. She had a history of surgical treatment for papillary serous ovarian adenocarcinoma. A cystic lesion was revealed by an abdominal computerized tomography (CT) performed in her follow up . It was considered as primary mid portion of pancreatic cancer and a distal pancreatectomy was performed. The final pathology showed high-grade papillary serous adenocarcinoma morphologically similar to the previously diagnosed ovarian cancer.Discussion. Metastatic pancreatic cancers should be considered in patients who present with a solitary pancreatic mass and had a previous non-pancreatic malignancy. Differential diagnosis of primary pancreatic neoplasm from metastatic malignancy may be very difficult. A biopsy for tissue confirmation is required to differentiate primary and secondary pancreatic tumors. Although, the value of surgical resection is poorly documented, resection may be considered in selected patients.Conclusion. Pancreatic metastasis of ovarian papillary serous adenocarcinoma has to be kept in mind when a patient with pancreatic mass has a history of ovarian malignancy.

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Casadei, Riccardo, Claudio Ricci, Carlo Ingaldi, Alessandro Cornacchia, Marina Migliori, Mariacristina Di Marco, Nico Pagano, Carla Serra, Laura Alberici y Francesco Minni. "External validation of nomogram for predicting malignant intraductal papillary mucinous neoplasm (IPMN): from the theory to the clinical practice using the decision curve analysis model". Updates in Surgery 73, n.º 2 (23 de febrero de 2021): 429–38. http://dx.doi.org/10.1007/s13304-021-00999-4.

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AbstractThe management of IPMNs is a challenging and controversial issue because the risk of malignancy is difficult to predict. The present study aimed to assess the clinical usefulness of two preoperative nomograms for predicting malignancy of IPMNs allowing their proper management. Retrospective study of patients affected by IPMNs. Two nomograms, regarding main (MD) and branch duct (BD) IPMN, respectively, were evaluated. Only patients who underwent pancreatic resection were collected to test the nomograms because a pathological diagnosis was available. The analysis included: 1-logistic regression analysis to calibrate the nomograms; 2-decision curve analysis (DCA) to test the nomograms concerning their clinical usefulness. 98 patients underwent pancreatic resection. The logistic regression showed that, increasing the score of both the MD-IPMN and BD-IPMN nomograms, significantly increases the probability of IPMN high grade or invasive carcinoma (P = 0.029 and P = 0.033, respectively). DCA of MD-IPMN nomogram showed that there were no net benefits with respect to surgical resection in all cases. DCA of BD-IPMN nomogram, showed a net benefit only for threshold probability between 40 and 60%. For these values, useless pancreatic resection should be avoided in 14.8%. The two nomograms allowed a reliable assessment of the malignancy rate. Their clinical usefulness is limited to BD-IPMN with threshold probability of malignancy of 40–60%, in which the patients can be selected better than the “treat all” strategy.

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Tee, Chin Li, Eliz Yuyuan Lin, Manish M. Bundele y Jee Keem Low. "Rare case of pancreatic lipomatous hamartoma". BMJ Case Reports 15, n.º 4 (abril de 2022): e248132. http://dx.doi.org/10.1136/bcr-2021-248132.

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A middle-aged man had an incidental finding of 10.1 cm lipomatous mass arising from pancreatic body/neck detected on CT scan. He was asymptomatic. He underwent surgical resection of the mass due to concern for malignancy. His postoperative course was complicated by a high-volume pancreatic leak of approximately 900 mL/day. He underwent endoscopic retrograde cholangiopancreatography and insertion of a pancreatic stent, with some improvement in the pancreatic leak. His leak eventually settled after 3 months. The final histopathology showed lobules of mature adipocytes with small islands of disorganised benign pancreatic ducts and acini interspersed within them, suggestive of pancreatic hamartoma of lipomatous variant. Pancreatic lipomatous hamartomas are rare and are often diagnosed on final histopathology when the initial resection was performed due to diagnostic uncertainty or concern for malignancy. It is a benign lesion with an indolent course and must be discriminated from other lipomatous lesions of the pancreas. An awareness of the condition is important to help guide management.

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Nichkaode, Prabhat, Shusrut Bhukte y Aakash Bandhe. "Audit of 62 cases of pancreatic resections for pancreatic cancer". International Surgery Journal 4, n.º 10 (27 de septiembre de 2017): 3382. http://dx.doi.org/10.18203/2349-2902.isj20174500.

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Background: Varieties of pancreatic pathologies, needs resection of pancreatic tissue. Adenocarcinoma of the pancreatic duct is the most common malignancy presenting with early metastasis and seen as resistant to alternative treatment regimens currently available. Management and handling of such tumors is a complex and challenging task for a surgeon. Surgical resection offers an improved prognosis, with a median survival after resection of 14-20 months and up to 25% 5-year survival rates. Present study is aimed at presenting data of 62 pancreatic resections for various malignant pancreatic lesions.Methods: This is an ongoing longitudinal study which started in 2009 at teaching institute in central India. Though we had 109 patients for pancreatic resection, only 62 patients were considered suitable for the study. All patients after admission were thoroughly investigated and then considered for surgery. 48 patients were male and 14 patients were female. Age group was ranging from 33 to 65 years with mean age between 45 to 55 years. Spectrum of various malignancies and different types of pancreatic resections were done and results are presented here.Results: Pancreatic adenocarcinoma is an aggressive malignancy responds to surgical treatment better than other alternative modalities. In the present series out of 62 patients 27 patients with pancreatic head cancer, 22 patients with periampullary cancer, 2 patients with duodenal cancer, 6 patients with distal cholangio carcinoma, 1 patient with mucinous cystadenocarcinoma. 4 patients with body and tail of pancreas cancer. Average age 38 to 65 years, 47 males and 15 females. Commonest procedure was Whipple’s operation, and distal pancreatectomy. Survival in present series was 18 -24 months and 5-year survival was 12 % that is seen mainly with Periampullary cancer.Conclusions: Surgery is the only chance of cure or long-term survival in pancreatic cancer. Chemo radiation as a primary therapy is ineffective. But some reports suggest the improved quality of life with palliative chemotherapy. Biology of the disease is the king and dictates the survival, the type of surgical procedure had no impact on survival, nor on morbidity and mortality.

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Shah, Bhavin C., Lynette M. Smith, Fred Ullrich y Chandrakanth Are. "Discharge disposition after pancreatic resection for malignancy: analysis of national trends". HPB 14, n.º 3 (marzo de 2012): 201–8. http://dx.doi.org/10.1111/j.1477-2574.2011.00427.x.

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Zavrtanik, Hana y Aleš Tomažič. "Is Surgery in Autoimmune Pancreatitis Always a Failure?" Medicina 59, n.º 2 (18 de enero de 2023): 193. http://dx.doi.org/10.3390/medicina59020193.

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Autoimmune pancreatitis is a rare form of chronic pancreatitis of presumed autoimmune etiology. Due to significant overlap in clinical and imaging characteristics, misdiagnosis as a pancreatic malignancy is common. As a result, a significant number of patients undergo a major pancreatic resection, associated with considerable morbidity, for a disease process that generally responds well to corticosteroid therapy. In the past ten years, important advances have been made in understanding the disease. Several diagnostic criteria have been developed to aid in diagnosis. Despite this, pancreatic resection may still be required in a subset of patients to reliably exclude pancreatic malignancy and establish a definite diagnosis of autoimmune pancreatitis. This article aimed to define the role of surgery in autoimmune pancreatitis, if any. For this purpose, published case series of patients with a diagnosis of autoimmune pancreatitis, based on the histopathological examination of surgical specimens, were reviewed and patients’ clinical, radiological and serological details were assessed. At the end, histopathologic examinations of patients who underwent pancreatic resection at our department in the last 10 years were retrospectively reviewed in order to identify patients with autoimmune pancreatitis and assess their clinical characteristics.

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Yang, Zhizhou, Jorge G. Zarate Rodriguez, Haley Beck, Kathleen Byrnes, Nikolaos A. Trikalinos y Chet W. Hammill. "Acinar cell carcinoma with PRKAR1A and PTEN alterations and paraneoplastic panniculitis". BMJ Case Reports 15, n.º 12 (diciembre de 2022): e251400. http://dx.doi.org/10.1136/bcr-2022-251400.

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Pancreatic acinar cell carcinoma is a rare type of pancreatic malignancy, which can be confused with pancreatic neuroendocrine neoplasm. Here, we describe a woman in her 80s who presented with abdominal pain and bilateral lower extremity panniculitis. She underwent surgery for a presumed diagnosis of neuroendocrine tumour with PTEN and PRKAR1A alterations; 19 months, later, a recurrence of her pancreatic malignancy was discovered. The patient underwent repeat resection and this time immunohistochemical staining confirmed the diagnosis of acinar cell carcinoma. Staining for acinar cell carcinoma should be prompted based on clinical suspicion in context of PTEN or PRKAR1A mutation when appropriate.

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Kim, Tad, Stephen R. Grobmyer, Lisa R. Dixon y Steven N. Hochwald. "Isolated Lymphoplasmacytic Sclerosing Pancreatitis Involving the Pancreatic Tail". American Surgeon 74, n.º 7 (julio de 2008): 654–58. http://dx.doi.org/10.1177/000313480807400713.

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We present an interesting case of a 62-year-old woman with a 3-month history of vague, left-sided abdominal pain. CT imaging revealed a hypodense lesion in the tail of the pancreas. The patient had no history of pancreatitis or autoimmune diseases. Laboratory testing revealed a normal CA19-9 (33 U/mL) and an elevated IgG4 (133 mg/dL). Due to concerns of pancreatic malignancy, she underwent operation. We found a dense, inflammatory mass in the tail of the pancreas, which was removed via an open distal pancreatectomy with splenectomy. Histologic analysis revealed a pancreas with sclerotic ducts and surrounding lymphoplasmacytic inflammation most consistent with lymphoplasmacytic sclerosing pancreatitis (LPSP). LPSP, also termed autoimmune pancreatitis, is a benign disease of the pancreas, which can mimic pancreatic adenocarcinoma. It is the most common benign finding diagnosed on pathology after pancreatic resection for presumed malignancy. LPSP most commonly involves the head and, more uncommonly, the tail of the pancreas. It can be successfully treated with steroids obviating the need for resection. IgG4 levels may assist in recognition of this disease. As our experience with utilization of IgG4 testing and knowledge of the systemic nature of LPSP increase, patients with this disease may be spared unnecessary resection.

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Huang, Barton, Annie Mooser, Danielle Carpenter, Grace Montenegro y Carrie Luu. "A Rare Case of Pancreatic Endometriosis Masquerading as Pancreatic Mucinous Neoplasm". Case Reports in Surgery 2021 (23 de abril de 2021): 1–4. http://dx.doi.org/10.1155/2021/5570290.

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Endometriosis is a relatively common condition among women, and pancreatic endometriosis has been reported on rare occasions. Such pancreatic lesions are difficult to diagnose and distinguish from other cystic lesions of the pancreas preoperatively. This report describes a case of pancreatic endometriosis in a 51-year-old female patient. Imaging demonstrated an enlarging cyst with findings concerning for a mucinous neoplasm. The patient underwent robotic distal pancreatectomy and splenectomy. Histopathology revealed an endometriotic cyst. Pancreatic endometriosis can be difficult to distinguish from other lesions of the pancreas. Surgical resection should be undertaken in cases where malignancy is suspected.

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Shah, Bhavin C., Lynette M. Smith y Chandrakanth Are. "Tu1562 Preoperative Normogram to Predict Discharge Disposition Following Pancreatic Resection for Malignancy". Gastroenterology 144, n.º 5 (mayo de 2013): S—1127. http://dx.doi.org/10.1016/s0016-5085(13)64200-6.

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Al-Haddad, Mohammad, J. Kirk Martin, Justin Nguyen, Surakit Pungpapong, Massimo Raimondo, Timothy Woodward, George Kim, Kyung Noh y Michael B. Wallace. "Vascular Resection and Reconstruction for Pancreatic Malignancy: A Single Center Survival Study". Journal of Gastrointestinal Surgery 11, n.º 9 (14 de julio de 2007): 1168–74. http://dx.doi.org/10.1007/s11605-007-0216-x.

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Hall, B. R., R. Sleightholm, H. Sayles, L. Smith y C. Are. "Factors associated with return to operating room following pancreatic resection for malignancy". HPB 20 (marzo de 2018): S126. http://dx.doi.org/10.1016/j.hpb.2018.02.525.

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Zhou, WanLi, Timothy Murray, Liliana Cartagena, Howard Lim, David F. Schaeffer, Graham W. Slack, Brian F. Skinnider et al. "IgG4-Related Disease as Mimicker of Malignancy". SN Comprehensive Clinical Medicine 3, n.º 9 (27 de mayo de 2021): 1904–13. http://dx.doi.org/10.1007/s42399-021-00957-6.

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Abstract Background IgG4-related disease (IgG4-RD) is an immune-mediated disease that may present as a tumefactive lesion in nearly any organ. These mass lesions often resemble malignancy both clinically and radiologically, and some patients undergo surgical resection which could possibly be avoided with early recognition of IgG4-RD. We performed a retrospective single-center study examining how many patients with IgG4-RD were initially believed to have malignancy, with particular attention to those who underwent potentially avoidable surgical procedures. Methods Sixty-three patients with biopsy confirmed IgG4-related disease were included. Clinical, laboratory, radiological, and histological data were collected and analyzed. Results Over 60% of patients (38/63) were initially thought to have a malignancy when they initially presented with symptomatic IgG4-RD. The most common types of malignancy suspected were lymphoma (18/38) and pancreatic cancer (11/38). Of the 38 patients with suspected malignancy, 14 underwent an invasive intervention either to alleviate the severity of their symptoms or as treatment for their presumed malignancy. These included Whipple resection/attempted Whipple (3), nephrectomy (3), bile duct resection and reconstruction (1), removal of other abdominal/retroperitoneal masses (3), and stenting of obstructed organs (4). Conclusion IgG4-RD should be on the differential diagnosis of patients with mass lesions, in particular those with pancreatic masses and obstructive jaundice, extensive lymphadenopathy, or retroperitoneal masses. Oncologists and other physicians involved in cancer care should be aware of the various manifestations and diagnostic approach to IgG4-RD in order to provide accurate diagnosis and minimize unnecessary invasive procedures. While some procedures in this study, such as stenting of obstructed organs, were required regardless of diagnosis, others could have potentially been avoided or attenuated with early recognition of IgG4-RD. Patients with mass lesions suspicious for IgG4-RD should have serum protein electrophoresis, IgG subclass measurement, and, where possible, tissue biopsy before undergoing major surgical resection. Consultation with a physician experienced in IgG4-RD is recommended.

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Jabłońska, Beata, Łukasz Braszczok, Weronika Szczęsny-Karczewska, Beata Dubiel-Braszczok y Paweł Lampe. "Surgical treatment of pancreatic cystic tumors". Polish Journal of Surgery 89, n.º 1 (28 de febrero de 2017): 1–8. http://dx.doi.org/10.5604/01.3001.0009.6008.

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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.

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Zinovkin, D. A., S. L. Achinovich, I. V. Mikhailov, E. S. Zinovkina y M. Z. I. Pranjol. "A cystic lesion mimicking pancreatic neoplasm". Acta Gastro Enterologica Belgica 84, n.º 2 (junio de 2021): 381–82. http://dx.doi.org/10.51821/84.2.381.

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A 54-year old male patient was admitted with complaints of periodical pain in the upper abdomen, CA- 19.9-51 U/ml (reference range < 37 U/ml). Blood tests were normal. However, ultrasound scan results revealed growth of a pancreatic tumor over 52×38 mm. A CT scan was performed for further characterization of the lesion. A tumor mass of 54 mm in diameter of the pancreatic body was found. There was no differentiation of lesion border with pancreas body (Fig. 1). Surgical resection was performed without preoperative biopsy following the consensus of the International Study Group of Pancreatic Surgery which states that in the presence of a solid mass suspicious for malignancy, a biopsy proof is not required before proceeding with resection (1). A soft consistence pancreas cyst with pus-like content was resected during surgical operation....

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Garden, O. J. "Liver and Pancreatic Resection in the Elderly". HPB Surgery 10, n.º 4 (1 de enero de 1997): 259–61. http://dx.doi.org/10.1155/1997/84160.

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Background: Liver resection, or pancreaticoduodenectomy, has traditionally been thought to have a high morbidity and. mortality rate among the elderly. Recent improvements in surgical and anesthetic techniques, an increasing number of elderly patients, and an increasing need to justify use of limited health care resources prompted an assessment of recent surgical outcomes.Methods: Five hundred seventy-seven liver resections (July 1985–July 1994) performed for metastatic colorectal cancer and 488 pancreatic resections (October 1983–July 1994) performed for pancreatic malignancies were identified in departmental data bases. Outcomes of patients younger than age 70 years were compared with those of patients age 70 years or older.Results: Liver resection for 128 patients age 70 years or older resulted in a 4% perioperative. mortality rate and a 42% complication rate. Median hospital stay was 13 days, and 8% of the patients required admission to the intensive care unit (ICU). Median survival was 40 months, and the 5-year survival rate was 35%. No difference were found between results for the elderly and those for younger patients who had undergone liver resection, except for a minimally shorter hospital stay fortheyoungerpatients (median, 12 days vs. 13 days p=0.003). Pancreatic resection for 138 elderly patients resulted in a mortality rate of 6% and a complication rate of 45%. Median stay was 20 days, and 19% of the patients required ICU admission, results identical to those for the younger cohort. Long-term survival was poorer for the elderly patients, with a 5-year survival rate of 21% compared with 29% for the younger cohort (p=0.03).Conclusions: Major liver or pancreatic resections can be performed for the elderly with acceptable morbidity and mortality rates and possible long-term survival. Chronologic age alone is not a contraindication to liver or pancreatic resection for malignancy.

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Smith, Wendy M., Joel G. Lucas y Wendy L. Frankel. "Splenic Rupture: A Rare Presentation of Pancreatic Carcinoma". Archives of Pathology & Laboratory Medicine 128, n.º 10 (1 de octubre de 2004): 1146–50. http://dx.doi.org/10.5858/2004-128-1146-srarpo.

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Abstract Context.—Splenic rupture secondary to solid malignancy is an infrequent complication that usually occurs late in the progression of a previously diagnosed cancer. In rare instances, splenic rupture precipitates the discovery of an unsuspected pancreatic carcinoma. We report 2 cases of adenocarcinoma of the pancreas in which the patients presented with splenic rupture. Objectives.—To review the clinicopathologic features of splenic rupture due to pancreatic carcinoma and to increase awareness of malignancy as a possible etiology for atraumatic splenic rupture. Design.—We reviewed the clinical and pathologic data from 2 patients. A literature search was conducted to identify previous reports of splenic rupture associated with pancreatic cancer. We summarized the characteristics of the earlier cases and compared them with those of our patients. Results.—We found only 4 previous reports of splenic rupture preceding the diagnosis of pancreatic cancer. In 3 of these cases, the pancreatic carcinoma grossly invaded the spleen at the time of resection. In contrast, malignancy was not suspected as the etiology of the rupture in our patients until histologic examination of the resected spleen revealed carcinoma. Conclusion.—Splenic rupture is an unusual presentation of cancer of the pancreas, and to our knowledge only 4 cases have been reported previously in the literature. Although an underlying malignancy is relatively rare, spleens resected for atraumatic rupture should be carefully examined for possible neoplastic etiologies.

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31

Fong, Yuman, Leslie H. Blumgart, Joseph G. Fortner y Murray F. Brennan. "Pancreatic or Liver Resection for Malignancy Is Safe and Effective for the Elderly". Annals of Surgery 222, n.º 4 (octubre de 1995): 426–37. http://dx.doi.org/10.1097/00000658-199510000-00002.

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32

Fong, Yuman, Leslie H. Blumgart, Joseph G. Fortner y Murray F. Brennan. "Pancreatic or Liver Resection for Malignancy Is Safe and Effective for the Elderly". Annals of Surgery 222, n.º 4 (octubre de 1995): 426–37. http://dx.doi.org/10.1097/00000658-199522240-00002.

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Schubach, Abigail, Shivangi Kothari y Truptesh Kothari. "Pancreatic Cystic Neoplasms: Diagnosis and Management". Diagnostics 13, n.º 2 (5 de enero de 2023): 207. http://dx.doi.org/10.3390/diagnostics13020207.

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Pancreatic cancer is one of the most lethal cancers, largely related to the difficulties with early detection, as it typically presents in later stages. Pancreatic cystic neoplasms (PCN) are commonly diagnosed as incidental findings on routine imaging. PCN is becoming more frequently detected with the increasing ease and frequency of obtaining cross-sectional images. Certain subtypes of pancreatic cysts have the potential to progress to malignancy, and therefore, clinicians are tasked with creating a patient-centered management plan. The decision of whether to undergo surgical resection or interval surveillance can be challenging given the criteria, including PCN size, pancreatic duct dilation, presence of a mural nodule, and clinical symptoms that play a potential role in risk stratification. Furthermore, the guidelines available from the major gastrointestinal societies all differ in their management recommendations. In this review, we detail an overview of the different types of PCNs and compare major guidelines for both diagnosis and management. We include emerging evidence for next-generation sequencing as well as confocal needle endomicroscopy to aid in the diagnosis and determination of malignancy potential and diagnosis.

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Bohara, S., TY Tamang, DK Maharjan, SK Shrestha y PB Thapa. "Cystic lesions of pancreas: challenges in diagnosis and management". Journal of Society of Surgeons of Nepal 18, n.º 3 (25 de julio de 2016): 53. http://dx.doi.org/10.3126/jssn.v18i3.15315.

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Introduction: Pancreatic cysts are common (2.5%). Cystic neoplasms represent 10% of cystic lesions and 1% of pancreatic tumors. However, it is difficult to differentiate benign cyst from malignant cystic lesions preoperatively.Objective: To study the cases of pancreatic cystic lesion who underwent various forms of pancreatic resection.Materials and Methods: Nine cases of pancreatic cystic lesion who presented to Kathmandu Medical College Teaching Hospital, Surgical Unit 3 within December 2014- November 2015 were evaluated. Four pancreatic cysts who underwent resection are discussed whereas not managed with resection are excluded.Results: There were 4 cases of pancreatic cyst who underwent pancreatic resection. First case underwent pancreaticoduodenectomy for pancreatic mucinous cystadenoma. However histopathological examination revealed a serous cystadenoma. In second case, pancreatic neck lesion suspected to be mucinous cystadenoma or pseudocyst in MRCP, with negative malignant cells in EUS guided FNAC underwent Central pancreatectomy and was found to be serous cystadenoma. The third case with suspected pseudocyst underwent Pancreaticoduodenectomy after a 3X2 cm2 cystic mass was felt at the posteroinferior side of pancreatic head and malignancy was suspected intraoperatively . HPE report was mucinous cystadenoma. The fourth case with pancreatic pseudocyst at tail with duct calculi and chronic pancreatitis underwent distal pancreatectomy with splenectomy with Frey’s procedure.Conclusion: Management of pancreatic cystic lesion is challenging. Though radiological imaging has limited role in accurate diagnosis, endoscopic ultrasound may be of some benefit.

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35

Shakya, Sachin, Sudip Shrestha, Sirish Raj Pandey, Bibek Adhikari, Dhiraj Joshi, Shipra Shrestha, Shreya Bhandari, Shailendra Kumar Yadav y Amrit Lama. "Case Report: Rare presentation of pancreatic ductal adenocarcinoma with severe depressive disorder with catatonia". F1000Research 11 (16 de marzo de 2022): 315. http://dx.doi.org/10.12688/f1000research.109997.1.

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Pancreatic cancer is a highly lethal malignancy with symptoms such as abdominal pain, back pain, loss of appetite, bloating, weight loss, jaundice, nausea, vomiting, etc. It has a relatively late presentation, which makes its only potentially curative treatment, surgical resection, impractical for most patients. However, the prognosis is poor despite complete resection. The occurrence of depression and anxiety is rather common in patients with pancreatic cancer and a biological basis for this is suspected, although not studied in detail. We herein report a case of pancreatic ductal adenocarcinoma in a 57-year-old man who suffered from abdominal pain, constipation, and significant weight loss. The computerized tomography (CT) scan and successive endoscopic ultrasound (EUS) guided biopsy with histopathology confirmed a mass arising from the mid-body of the pancreas with tubular and cystic glands lined by moderately pleomorphic columnar epithelial cells. The patient underwent chemotherapy with the FOLFIRINOX regimen. He eventually developed severe depression with psychotic symptoms and catatonia, which further exacerbated the challenges in the management of the malignancy. In spite of widely available therapeutic options for the management of depression described in the literature, the effectiveness of those in pancreatic cancer patients with concomitant depression is not well established. Hence, more studies are imperative in addressing the neuropsychiatric associations of pancreatic cancer and formulating a protocol for their apt management.

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Cioc, Adina M., E. Christopher Ellison, Daniela M. Proca, Joel G. Lucas y Wendy L. Frankel. "Frozen Section Diagnosis of Pancreatic Lesions". Archives of Pathology & Laboratory Medicine 126, n.º 10 (1 de octubre de 2002): 1169–73. http://dx.doi.org/10.5858/2002-126-1169-fsdopl.

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Abstract Background.—The clinical and radiologic diagnosis of pancreatic cancer and the safety of pancreatic resections have improved. These improvements, together with the indication for resection in some cases of complicated chronic pancreatitis, have reduced the necessity for confirmed preoperative tissue diagnosis. We investigated the clinical use and accuracy of frozen section diagnosis for pancreatic lesions. Design.—We searched archival files for the years 1989–2000 for patients with pancreatic lesions who had received a diagnosis based on frozen section results. We compared the diagnosis of all frozen section slides with that of the permanent sections and reviewed the clinical follow-up notes. We evaluated histologic features useful in differentiating between malignant and benign pancreatic lesions. Results.—A total of 538 patients underwent surgical biopsy and/or resection for suspected pancreatic lesions. Frozen section was requested in 131 cases (284 frozen sections). Ninety cases had frozen section of the pancreatic lesions, 70 cases had frozen section of metastatic sites, and 29 cases had frozen section of surgical margins. Of the 90 cases in which frozen section of the pancreatic lesions was requested, malignancy was diagnosed in 44, a benign lesion was diagnosed in 37, and the diagnosis was atypical and deferred in 9. In total, 3 false-negative frozen sections and 1 false-positive frozen section were identified for respective rates of 1.2% and 0.3%. In all cases in which the frozen section diagnosis was deferred or was inconsistent with the operative impression, and the surgeon acted on his/her impression, the operative diagnoses were subsequently confirmed by additional permanent sections and/or clinical follow-up. The most useful histologic features for the diagnosis of pancreatic adenocarcinoma in frozen sections were variation in nuclear size of at least 4:1, disorganized duct distribution, incomplete duct lumen, and infiltrating single cells. Conclusions.—Frozen sections are useful in conjunction with the impression at surgery for the management of patients with pancreatic lesions. Frozen sections of resection margins were 100% accurate; frozen sections of pancreatic lesions or metastatic sites were accurate in 98.3% of cases. We found an acceptable rate of deferred frozen section (6.6%). The experienced surgeon's impression of malignancy is reliable in cases in which frozen section is deferred or has negative findings.

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Halloran, Christopher M., Trevor F. Cox, Seema Chauhan, Michael G. T. Raraty, Robert Sutton, John P. Neoptolemos y Paula Ghaneh. "Partial Pancreatic Resection for Pancreatic Malignancy Is Associated with Sustained Pancreatic Exocrine Failure and Reduced Quality of Life: A Prospective Study". Pancreatology 11, n.º 6 (diciembre de 2011): 535–45. http://dx.doi.org/10.1159/000333308.

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Chou, Richard Y., Daniel Daly, Pearl Wong, Rafael Gaszynski, Christos Apostolou y Neil Merrett. "Pancreatectomy for metastatic renal cell carcinoma: twenty years of experience at a tertiary centre". International Surgery Journal 9, n.º 8 (26 de julio de 2022): 1460. http://dx.doi.org/10.18203/2349-2902.isj20221901.

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Renal Cell Carcinoma (RCC) accounts for approximately 90% of primary renal malignancies, of which the clear cell subtype is most common. While metastatic disease is common at the time of diagnosis and generally confers a poor prognosis, metastatic RCC may demonstrate relatively indolent behaviour and present many years after resection of the primary tumour, including to the pancreas. The available literature suggested that surgical resection was appropriate for select patients, including those with a solitary pancreatic metastasis, minimal comorbidities and uncomplicated progress from initial treatment of their primary renal malignancy. A retrospective case series of patients presenting with RCC metastases to the pancreas, managed via surgical resection at a tertiary teaching hospital was reviewed. Analysis of patient demographics, investigations, management and outcomes were performed, with a focus on post-operative morbidity and overall survival. Between 2000 and 2020, 7 patients underwent pancreatic resection of RCC metastases at our tertiary teaching hospital with curative intent. Median age at time of resection was 66 years. No post-operative mortality or major morbidity was experienced by the 7 patients, although 4 patients developed some degree of pancreatic insufficiency. Four patients experienced recurrent metastatic RCC, with median time to recurrence of 3.5 years. This was the largest local study to describe an Australian experience of the surgical management of RCC pancreatic metastases. These patients are frequently afforded prolonged survival following pancreatic resection, but often develop other distant sites of disease and second renal tumours.

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39

de Clerck, F., P. Laukens, V. De Wilde, L. Vandeputte, M. Cabooter, J. Van Huysse y H. Orlent. "A Suspicious Pancreatic Mass in Chronic Pancreatitis: Pancreatic Actinomycosis". Case Reports in Oncological Medicine 2015 (2015): 1–3. http://dx.doi.org/10.1155/2015/767365.

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Introduction. Pancreatic actinomycosis is a chronic infection of the pancreas caused by the suppurative Gram-positive bacteriumActinomyces. It has mostly been described in patients following repeated main pancreatic duct stenting in the context of chronic pancreatitis or following pancreatic surgery. This type of pancreatitis is often erroneously interpreted as pancreatic malignancy due to the specific invasive characteristics ofActinomyces.Case. A 64-year-old male with a history of chronic pancreatitis and repeated main pancreatic duct stenting presented with weight loss, fever, night sweats, and abdominal pain. CT imaging revealed a mass in the pancreatic tail, invading the surrounding tissue and resulting in splenic vein thrombosis. Resectable pancreatic cancer was suspected, and pancreatic tail resection was performed. Postoperative findings revealed pancreatic actinomycosis instead of neoplasia.Conclusion. Pancreatic actinomycosis is a rare type of infectious pancreatitis that should be included in the differential diagnosis when a pancreatic mass is discovered in a patient with chronic pancreatitis and prior main pancreatic duct stenting. Our case emphasizes the importance of pursuing a histomorphological confirmation.

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40

He, Jiafa, Heping Liu, Li Deng, Xiangling Wei, Taiying Chen, Shangzhou Xia y Yubin Liu. "Influence of obesity on in-hospital and postoperative outcomes of hepatic resection for malignancy: a 10-year retrospective analysis from the US National Inpatient Sample". BMJ Open 9, n.º 8 (agosto de 2019): e029823. http://dx.doi.org/10.1136/bmjopen-2019-029823.

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ObjectivesThe influence of obesity on the outcomes of curative liver resection for malignancies remains controversial. We aimed to compare the in-hospital outcomes of liver resection for malignancy between obese and non-obese patients.DesignThis was a population-based, retrospective, observational study using data from the Nationwide Inpatient Sample (NIS), the largest all-payer US inpatient care database.SettingHospitalisations of adults ≥18 years old with diagnoses of primary hepatobiliary malignancy or secondary malignant neoplasms of liver in the USA were identified from the NIS database between 2005 and 2014.ParticipantsData of 18 398 patients ≥18 years old and underwent liver resection without pancreatic resection in the NIS were extracted. All included subjects had primary hepatobiliary malignancy or secondary malignant neoplasms of the liver. Patients were divided into obese and non-obese groups. These groups were compared with respect to postoperative complications, length of hospital stay and hospital cost according to surgical extent and approach.InterventionsPatients were undergoing lobectomy of liver or partial hepatectomy.Primary and secondary outcome measuresThe primary endpoints of this study were postoperative complications, length of hospital stay and hospital cost.ResultsAfter adjustment, obese patients were significantly more likely to experience postoperative complications than were non-obese patients (adjusted OR 1.25, 95% CI 1.10 to 1.42), regardless of whether lobectomy or partial hepatectomy was performed. Furthermore, obesity was significantly associated with increased risk of postoperative complications in patients who underwent open liver resection, but not laparoscopic resection. No significant difference was observed in length of hospital stay or total hospital costs between obese and non-obese patients.ConclusionsAfter adjustment for preoperative comorbidities and other potential confounders, obesity is significantly associated with greater risk of complications in patients undergoing open liver resection for malignancy, but not laparoscopic resection.

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Wu, Wen Chuan, Xiu Zhong Yao, Da Yong Jin, Dan Song Wang, Wen Hui Lou y Xin Yu Qin. "Clinical strategies for differentiating autoimmune pancreatitis from pancreatic malignancy to avoid unnecessary surgical resection". Journal of Digestive Diseases 14, n.º 9 (12 de agosto de 2013): 500–508. http://dx.doi.org/10.1111/1751-2980.12075.

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Lieberman, Michael D., Harold Kilburn, Michael Lindsey y Murray F. Brennan. "Relation of Perioperative Deaths to Hospital Volume Among Patients Undergoing Pancreatic Resection for Malignancy". Annals of Surgery 222, n.º 5 (noviembre de 1993): 638–45. http://dx.doi.org/10.1097/00000658-199311000-00006.

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Brennan, Murray F., Peter W. T. Pisters, Mitchell Posner, Ofelia Quesada y Moshe Shike. "A Prospective Randomized Trial of Total Parenteral Nutrition After Major Pancreatic Resection for Malignancy". Annals of Surgery 220, n.º 4 (octubre de 1994): 436–44. http://dx.doi.org/10.1097/00000658-199410000-00003.

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44

Lieberman, Michael D., Harold Kilburn, Michael Lindsey y Murray F. Brennan. "Relation of Perioperative Deaths to Hospital Volume Among Patients Undergoing Pancreatic Resection for Malignancy". Annals of Surgery 222, n.º 5 (noviembre de 1995): 638–45. http://dx.doi.org/10.1097/00000658-199511000-00006.

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45

Le Bricon, Thierry. "A prospective randomized trial of total parenteral nutrition after major pancreatic resection for malignancy". Clinical Nutrition 14, n.º 3 (junio de 1995): 193. http://dx.doi.org/10.1016/s0261-5614(95)80020-4.

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Chilukuri, Durga Sowgandhi, Prithviraj Premkumar, Balasubramanian Venkitaraman y Jagadesh Chandra Bose Soundararajan. "Pancreatic metastasis of dermatofibrosarcoma protuberans: a rare case". BMJ Case Reports 13, n.º 1 (enero de 2020): e232614. http://dx.doi.org/10.1136/bcr-2019-232614.

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Dermatofibrosarcoma protuberans (DFSP) is a rare soft tissue malignancy which is locally aggressive, slow growing. It has a very low metastatic potential and has high risk of local recurrence. We report a 65-year-old man with recurrent DFSP of thigh with pancreatic metastasis. Apart from our patient, only four other cases of pancreatic metastasis of DFSP have been reported. Our patient had a solitary metastasis to pancreas and was treated with distal pancreaticosplenectomy. Outcome of the patient was good. We present this case report to emphasise that resection may be considered for solitary metastasis of DFSP and can be managed successfully.

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Marczell, Arthur P. y Michael Stierer. "Partial Pancreaticoduodenectomy (Whipple Procedure) for Pancreatic Malignancy: Occlusion of a Non-Anastomosed Pancreatic Stump With Fibrin Sealant". HPB Surgery 5, n.º 4 (1 de enero de 1992): 251–60. http://dx.doi.org/10.1155/1992/48946.

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Following partial pancreaticoduodenectomy for periampullary and pancreatic cancer, the complication and mortality rates are particularly high. Various approaches have aimed at improving the postoperative result, with less than complete success. The discouraging results of others, and our own dissatisfaction, led us to evaluate an atraumatic, sutureless method for management of the residual gland. Following head resection, the remaining pancreas is occluded with a fibrin sealant (Tisseel c, Immuno AG, Vienna) via injection into the pancreatic duct, which is then ligated and left free in the peritoneal cavity. Among 44 patients treated with this method, there were no perioperative deaths. Three patients developed local complications (2 fistulae, 1 pancreatitis) due to technical errors that presumably resulted in incomplete occlusion. Evaluation of patients after two to three years indicates that the endocrine function of the pancreas has been largely conserved despite ductal occlusion.

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48

Oermann, Christopher M., Qasem Al-Salmi, Dan K. Seilheimer, Milton Finegold y Nina Tatevian. "Mucinous Cystadenocarcinoma of the Pancreas in an Adolescent with Cystic Fibrosis". Pediatric and Developmental Pathology 8, n.º 3 (mayo de 2005): 391–96. http://dx.doi.org/10.1007/s10024-005-4114-5.

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Epidemiologic studies indicate that the overall risk of malignancy among patients with cystic fibrosis (CF) is similar to that of the general population. However, these studies and a number of case reports suggest that patients with CF may be at increased risk for the development of specific gastrointestinal cancers. Tumors of the esophagus, stomach, small and large bowels, liver and biliary tracts, and pancreas have been described. Previous reports of pancreatic cancers among patients with CF have included only adenocarcinoma in adults. This is the first description of a mucinous cystadenocarcinoma of the pancreas in an adolescent with CF. The tumor developed within a pancreatic cyst that had been initially identified 13 years before resection. Our report highlights the increased risk of pancreatic malignancy among patients who have CF and illustrates the premalignant potential of pancreatic cysts in this at-risk population. Further, it reinforces the need for careful surveillance and suggests a role for more aggressive diagnostic and therapeutic interventions for patients with atypical findings on pancreatic imaging studies.

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Pingpank, James F., John P. Hoffman, Elin R. Sigurdson, Eric Ross, Aaron R. Sasson y Burton L. Eisenberg. "Pancreatic Resection for Locally Advanced Primary and Metastatic Nonpancreatic Neoplasms". American Surgeon 68, n.º 4 (abril de 2002): 337–41. http://dx.doi.org/10.1177/000313480206800405.

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We conducted a retrospective review of our single-institution experience with pancreas resection for locally advanced primary malignancy or metastases from other organs. From January 1989 through April 2001 35 patients underwent pancreatic resection for locally advanced primary (17) and recurrent nonpancreatic (18) tumors. Patient records were examined for recurrence and survival. Seventeen patients with locally advanced primary tumors presented with pancreatic extension either into the head/body (six) or tail (11). Pancreatic resections were completed as en bloc procedures with the primary disease of stomach (five), colon (four), sarcoma (five), adrenal gland (one), or spleen (one). Procedures performed included pancreaticoduodenectomy for proximal lesions and distal pancreatectomy for disease limited to the pancreatic tail. Median overall survival was 56 months. Fourteen of 17 patients remain alive: three with disease and 11 without evidence of recurrence. Eighteen patients presented with recurrent tumor from a previously resected right upper quadrant tumor (nine) or metastases from an intra-abdominal source (nine). The primary source was colon (eight), biliary (three), sarcoma (three), melanoma (two), ovary (one), and unknown primary (one). Patients underwent pancreaticoduodenectomy, distal pancreatectomy, or resection of residual pancreas. Overall median survival was 46 months. In this group of 18 patients there was no increased survival in those patients with a time to recurrence from their primary tumor resection greater than 2 years. We conclude that pancreatic resection for locally advanced nonpancreatic or recurrent intra-abdominal malignancies is possible in properly selected patients. The ability to obtain disease-free margins through en bloc resection is a key component of therapy.

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Iskandar, Mazen E., Michael G. Wayne, Justin G. Steele y Avram M. Cooperman. "Familial Pancreatic Cancer: The Case for Prophylactic Pancreatectomy in Lieu of Serial Screening and Shared Decision Making". Case Reports in Oncological Medicine 2014 (2014): 1–3. http://dx.doi.org/10.1155/2014/737183.

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At-risk family members with familial pancreatic cancer (FCaP) face uncertainty regarding the individual risk of developing pancreatic cancer (CaP) and whether to choose serial screening or prophylactic pancreatectomy to avoid CaP. We treated 2 at-risk siblings with a history of FCaP, congenital hepatic fibrosis (CHF), and jaundice secondary to a bile duct stricture. In one, a pancreaticoduodenal resection was done and in the second a total pancreatectomy. Malignancy was not present, but extensive pancreatic intraepithelial neoplasia (PanIn) 2 was present throughout both pancreata. The clinical course and literature review are presented along with the previously unreported association of CHF and CaP.

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