Bibliographies thématiques / MCNs, Pancreatic resection, Malignancy

Littérature scientifique sur le sujet « MCNs, Pancreatic resection, Malignancy »

Auteur : Grafiati

Publié le 11 mars 2023

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Articles de revues sur le sujet "MCNs, Pancreatic resection, Malignancy"

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 (janvier 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 et V. Tomulescu. « DIAGNOSIS AND MANAGEMENT OF PANCREATIC MUCINOUS CYSTADENOMA ». Journal of Surgical Sciences 2, n^o 2 (1 avril 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 et Timothy R. Donahue. « Mucinous Cystic Neoplasms of the Pancreas : Are we Overestimating Malignant Potential ? » American Surgeon 80, n^o 10 (octobre 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 et David B. Adams. « Mucinous Cystic Neoplasms of the Pancreas : How Much Preoperative Evaluation is Needed ? » American Surgeon 76, n^o 8 (août 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 et Perry Shen. « Predictors for readmission after pancreatic resection for malignancy. » Journal of Clinical Oncology 31, n^o 4_suppl (1 février 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 et 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 et Mark Bloomston. « Pancreatic Resection in the Octogenarian : A Safe Option for Pancreatic Malignancy ». Journal of the American College of Surgeons 212, n^o 3 (mars 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 et Anubhav Mittal. « Pancreatic resection in patients with synchronous extra‐pancreatic malignancy : outcomes and complications ». ANZ Journal of Surgery 90, n^o 3 (13 janvier 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 et Erin W. Gilbert. « Pancreatic resection for malignancy – do patients over 70 benefit ? » Journal of the American College of Surgeons 219, n^o 4 (octobre 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 mars 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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Thèses sur le sujet "MCNs, Pancreatic resection, Malignancy"

SHAMALI, Awad. « Surgical management of Pancreatic Mucinous Cystic Neoplasms (MCNs) ». Doctoral thesis, 2017. http://hdl.handle.net/11562/961830.

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Background: Pancreatic mucinous cystic neoplasms (MCN) are rare mucin-producing cystic tumors. They are predominantly found, incidentally, in middle-aged women and usually located in the pancreatic body or tail. They are differentiated from other mucin producing neoplasms by the presence of ovarian-type stroma. The current management of MCN is defined by the consensus European, International Association of Pancreatology (IAP) and the American Association of Gastroenterology guidelines. However, the malignant potential of these lesions remains uncertain, with differing rates of malignant potential being described. Since the criteria for surgical resection differs between the current guidelines, the aims of this large multi-institution study were to determine the rate of associated malignancy in resected MCNs and to determine predictor features, clinical and radiological, for malignant transformation in MCN. Methods: All surgically resected MCNs between January 2003 and December 2015 were included in this international multicentre retrospective study. Lesions without ovarian type stroma were excluded. All lesions found in men had the diagnosis of MCN confirmed by two experienced pancreatic pathologists. Malignant MCNs were defined by the presence of invasive adenocarcinoma. Results: 211 patients with a confirmed and surgically resected MCN were included. Median age was 53 (range 18–82) years, and 95.7% (202/211) were in women. Median pre-operative tumour size was 52 (range 12-230) mm. 16.1% (34/211) were malignant. The rates of malignancy (33.3% (3/9) vs. 15.3% (31/202)) and high-grade dysplasia (33.3% (3/9) vs. 15.8% (32/202) were double in men compared to women. In all cases of malignancy or high-grade dysplasia, at least one of the following characteristics was seen: male patient, symptoms, or a preoperative worrisome feature (solid component, septations, main pancreatic duct dilatation >6mm, elevated serum ca 19-9). A total of five cases of malignant transformation occurred in MCNs less than 4 cm in size. All these cases were associated with features of concern on pre-operative cross-sectional imaging. Conclusion: In female patients in this large multicentre study, malignancy or high-grade dysplasia was solely seen in MCNs with symptoms or worrisome features on preoperative imaging, regardless of the size of the tumour. In males, the risk of malignancy was significantly higher than in females, suggesting that operative treatment should be considered in all male patients with a suspected MCN of any size. In female patients, conservative management seems to be a safe approach for suspected MCNs of any size without symptoms or worrisome features.

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