Prognostic Factors in Intrahepatic Cholangiocarcinoma - A Systematic Review.

Introduction: intrahepatic cholangiocarcinoma (ICCA) are rare, aggressive cancers that develop in second order or smaller bile ducts. The aim of this review is to systematically review the most important prognostic factors affecting the long-term outcomes of these patients. Material and Methods: articles conducted on this issue, written in English, published between from January 2000 to December 2023 in Cochrane Library, PubMed, Embase, MedLine, Web of Science, Elsevier, Google Scholar were systematically researched and reviewed. Results: ICCA are usually late diagnosed cancers because of the asymptomatic character, and curative procedures are often not feasible, only 20 to 30% of patients being fit for surgery. With the prognostic of this aggressive malignancy being baleful, the most important risk factors but also prognosis factors seem to be represented by socioeconomic factors, morphological presentation, dimensions, number and extension of the tumor as well as resection margins. Conclusions: once these factors are widely recognized and identified in each case, the clinician will be able to find the best treatment for these patients in order to improve the long-term outcomes.

Recurrence and Carcinogenetic Rates of Colorectal Polyps.

AIM: to determin the recurrence rate of benign recto-colonic polyps in a 5-year interval, and compare the development rate of intrapolypoid carcinomatous lesions in polypectomized versus nonpolypectomized subjects. MATERIAL AND METHOD: a group of 77 patients diagnosed with recto-colonic polypoid lesions during the period 2014-2019 underwent colonoscopy at the time of study initiation and then annually during a five-year interval. Results: The recurrence rate of polyps increased annually from 5 to 12.5%; the highest rate was noted in the last two years. The five-year cumulative risk of neoplastic lesions was 73% in patients without polypectomy and 20% among those with endoscopic resection (p 0.05). Comparing the recurrence rate of benign lesions (60%) in patients without neoplastic findings with the recurrence rate of adenomas in patients with benign lesions (40%), a higher risk of recurrence was found in the first category, and seemed to be influenced by the personal history of pre-existing adenomatous lesions. CONCLUSION: an increased risk of colorectal polyps recurrence was reported during five year follow up; moreover, during the first three years an increased risk of malignant transformation was observed among cases in which endoscopic resection was not feasible when compared to those in which complete excision was feasible.

Prognostic Significance of Preoperative Inflammation Markers on the Long-Term Outcomes in Peritoneal Carcinomatosis from Ovarian Cancer.

Ovarian cancer remains one of the most lethal gynaecological malignancies affecting women worldwide; therefore, attention has been focused on identifying new prognostic factors which might help the clinician to select cases who could benefit most from surgery versus cases in which neoadjuvant systemic therapy followed by interval debulking surgery should be performed. The aim of the current paper is to identify whether preoperative inflammation could serve as a prognostic factor for advanced-stage ovarian cancer. Material and methods: The data of 57 patients who underwent to surgery for advanced-stage ovarian cancer between 2014 and 2020 at the Cantacuzino Clinical Hospital were retrospectively reviewed. The receiver operating characteristic curve was used to determine the optimal cut-off value of different inflammatory markers for the overall survival analysis. The analysed parameters were the preoperative level of CA125, monocyte-to-lymphocyte ratio (MLR), platelet-to-lymphocyte ratio (PLR), neutrophil-to-lymphocyte ratio (NLR) and systemic inflammation index (SII). Results: Baseline CA125 > 780 µ/mL, NLR ≥ 2.7, MLR > 0.25, PLR > 200 and a systemic immune inflammation index (SII, defined as platelet × neutrophil-lymphocyte ratio) ≥ 84,1000 were associated with significantly worse disease-free and overall survival in a univariate analysis. In a multivariate analysis, MLR and SII were significantly associated with higher values of overall survival (p < 0.0001 and p = 0.0124); meanwhile, preoperative values of CA125, PLR and MLR were not associated with the overall survival values (p = 0.5612, p = 0.6137 and p = 0.1982, respectively). In conclusion, patients presenting higher levels of MLR and SII preoperatively are expected to have a poorer outcome even if complete debulking surgery is performed and should be instead considered candidates for neoadjuvant systemic therapy followed by interval surgery.

A Nanocomposite Sol-Gel Film Based on PbS Quantum Dots Embedded into an Amorphous Host Inorganic Matrix.

In this study, a sol-gel film based on lead sulfide (PbS) quantum dots incorporated into a host network was synthesized as a special nanostructured composite material with potential applications in temperature sensor systems. This work dealt with the optical, structural, and morphological properties of a representative PbS quantum dot (QD)-containing thin film belonging to the Al2O3-SiO2-P2O5 system. The film was prepared using the sol-gel method combined with the spin coating technique, starting from a precursor solution containing a suspension of PbS QDs in toluene with a narrow size distribution and coated on a glass substrate in a multilayer process, followed by annealing of each deposited layer. The size (approximately 10 nm) of the lead sulfide nanocrystallites was validated by XRD and by the quantum confinement effect based on the band gap value and by TEM results. The photoluminescence peak of 1505 nm was very close to that of the precursor PbS QD solution, which demonstrated that the synthesis route of the film preserved the optical emission characteristic of the PbS QDs. The photoluminescence of the lead sulfide QD-containing film in the near infrared domain demonstrates that this material is a promising candidate for future sensing applications in temperature monitoring.

Obtaining and conductive properties of a vanadate-borate-phosphate glass.

Vanadate glasses exhibit semiconducting property at certain temperatures. This work demonstrates the conductivity of the composition 45V2O5-25B2O3-30P2O5, which is a new glass in the vanadium-boron-phosphorus ternary system that expands the glass forming area reported in literature data. The glass was obtained through a classical melt-quenching technique. The structural composition of the obtained glass was revealed with Raman spectroscopy and the amorphous characteristic has been highlighted with X-ray diffraction. The characteristic temperatures and the thermal expansion coefficient were determined by dilatometry. Based on the experimental measurements of electrical resistance, mathematical calculations were performed, resulting in a conductivity of 2.04·10-6 S/cm at 125 °C, and an activation energy of 42.91 kJ/mol for this glass. Impedance spectroscopy in DC and AC at 100 V and 100 Hz to 2 MHz, respectively, showed a lower activation energy of about 0.166 eV and transition temperatures of 24 °C and 11 °C, respectively. These results were compared with those from the literature considering the temperatures at which the reported conductivities were measured. This glass has potential applications in electronic devices and temperature sensors.

Effect of P2O5 Content on Luminescence of Reduced Graphene-Oxide-Doped ZnO-P2O5 Nano-Structured Films Prepared via the Sol-Gel Method.

A convenient and low-cost sol-gel approach for the one-step synthesis of ZnO-P2O5-rGO nanostructures with tuned bandgap and fluorescence was investigated. The obtained hybrid nanostructures exploit the properties of zinc oxide, graphene oxide and phosphorous oxide as promising candidates for a wide range of optoelectronic applications. A predominant amorphous structure, ZnO-P2O5-rGO, containing ZnO nanorods was evidenced by X-ray diffraction analysis (XRD) and scanning electron microscopy (SEM). The estimated size of the ZnO nanorods in nanostructures with P2O5 was noticed to decrease when the P2O5/ZnO ratio was increased. The presence of ZnO, P2O5 and rGO was confirmed by Fourier-transform infrared spectroscopy (FTIR) and Raman investigation. P2O5 was noticed to tune the bandgap and the fluorescence emissions of the nanostructured films, as estimated by UV-Vis-NIR and fluorescence spectroscopy, respectively. The electrical measurements performed at room temperature showed that the main influence on the film's resistivity does not come from the 1% rGO doping but from the P2O5/ZnO ratio. It was found that a 10/90 molar ratio of P2O5/ZnO decreases the resistivity almost seven-fold compared with rGO-doped ZnO films.

Surgical Options for Peritoneal Surface Metastases from Digestive Malignancies-A Comprehensive Review.

The peritoneum is a common site for the dissemination of digestive malignancies, particularly gastric, colorectal, appendix, or pancreatic cancer. Other tumors such as cholangiocarcinomas, digestive neuroendocrine tumors, or gastrointestinal stromal tumors (GIST) may also associate with peritoneal surface metastases (PSM). Peritoneal dissemination is proven to worsen the prognosis of these patients. Cytoreductive surgery (CRS), along with systemic chemotherapy, have been shown to constitute a survival benefit in selected patients with PSM. Furthermore, the association of CRS with hyperthermic intraperitoneal chemotherapy (HIPEC) seems to significantly improve the prognosis of patients with certain types of digestive malignancies associated with PSM. However, the benefit of CRS with HIPEC is still controversial, especially due to the significant morbidity associated with this procedure. According to the results of the PRODIGE 7 trial, CRS for PSM from colorectal cancer (CRC) achieved overall survival (OS) rates higher than 40 months, but the addition of oxaliplatin-based HIPEC failed to improve the long-term outcomes. Furthermore, the PROPHYLOCHIP and COLOPEC trials failed to demonstrate the effectiveness of oxaliplatin-based HIPEC for preventing peritoneal metastases development in high-risk patients operated for CRC. In this review, we discuss the limitations of these studies and the reasons why these results are not sufficient to refute this technique, until future well-designed trials evaluate the impact of different HIPEC regimens. In contrast, in pseudomyxoma peritonei, CRS plus HIPEC represents the gold standard therapy, which is able to achieve 10-year OS rates ranging between 70 and 80%. For patients with PSM from gastric carcinoma, CRS plus HIPEC achieved median OS rates higher than 40 months after complete cytoreduction in patients with a peritoneal cancer index (PCI) ≤6. However, the data have not yet been validated in randomized clinical trials. In this review, we discuss the controversies regarding the most efficient drugs that should be used for HIPEC and the duration of the procedure. We also discuss the current evidence and controversies related to the benefit of CRS (and HIPEC) in patients with PSM from other digestive malignancies. Although it is a palliative treatment, pressurized intraperitoneal aerosolized chemotherapy (PIPAC) significantly increases OS in patients with unresectable PSM from gastric cancer and represents a promising approach for patients with PSM from other digestive cancers.

Intrahepatic Cholangiocarcinoma - Where Do We Stand Today? Literature Review.

Intrahepatic cholangiocarcinomas represent rare and aggressive malignancies developing from the second order bile ducts to the smaller biliary branches. The aim of this narrative review is to discuss about the main diagnostic and therapeutic challenges in order to help medical and surgical oncologists to gain familiarity in regard to this subject. Articles discussing about epidemiology, histology, diagnostic, perioperative management and surgery which were published from January 2000 to September 2023 included in Cochrane Library, PubMed, Embase, MedLine, Web of Science, Elsevier, Google Scholar databases were reviewed. Articles reviewed in the current paper came to demonstrate that the main problem in such cases is related to the fact that most cases remain asymptomatic for a long period of time and therefore are diagnosed in advanced stages of the disease when curative procedures are feasible after performing extended visceral sacrifice or even worse, are no longer possible; however, the most efficient therapeutic strategy in order to improve the long term outcomes remains radical surgery. In this respect, attention was focused on improving the accuracy of the diagnostic tools and on identifying non-surgical therapeutic options which might increase the chances of achieving complete resection. Intrahepatic cholangiocarcinoma represent rare aggressive tumors with poor outcomes especially if radical surgery is not feasible.

Nanostructured PbS-Doped Inorganic Film Synthesized by Sol-Gel Route.

IV-VI semiconductor quantum dots embedded into an inorganic matrix represent nanostructured composite materials with potential application in temperature sensor systems. This study explores the optical, structural, and morphological properties of a novel PbS quantum dots (QDs)-doped inorganic thin film belonging to the Al2O3-SiO2-P2O5 system. The film was synthesized by the sol-gel method, spin coating technique, starting from a precursor solution deposited on a glass substrate in a multilayer process, followed by drying of each deposited layer. Crystalline PbS QDs embedded in the inorganic vitreous host matrix formed a nanocomposite material. Specific investigations such as X-ray diffraction (XRD), optical absorbance in the ultraviolet (UV)-visible (Vis)-near infrared (NIR) domain, NIR luminescence, Raman spectroscopy, scanning electron microscopy-energy dispersive X-ray (SEM-EDX), and atomic force microscopy (AFM) were used to obtain a comprehensive characterization of the deposited film. The dimensions of the PbS nanocrystallite phase were corroborated by XRD, SEM-EDX, and AFM results. The luminescence band from 1400 nm follows the luminescence peak of the precursor solution and that of the dopant solution. The emission of the PbS-doped film in the NIR domain is a premise for potential application in temperature sensing systems.

Laparoscopic Restorative Proctocolectomy for Ulcerative Colitis - How I Do It?

Total proctocolectomy with ileal pouch anal anastomosis (IPAA) is nowadays the gold standard in patients with ulcerative colitis requiring surgery. It is a complex procedure, being associated with a significant rate of morbidity and mortality. In order to obtain better results, the timing of surgery is essential. In the last decades, with the expansion of the minimally invasive techniques, the procedure can be performed feasible and safe by laparoscopy, bringing all the short term advantages associated with this approach. Due to the long term advantages regarding improved female fecundity function and fewer adhesions the laparoscopic approach is now recommended by the European Crohn's and Colitis Organization in centers with appropriate expertise.

Investigations Regarding the Addition of ZnO and Li2O-TiO2 to Phosphate-Tellurite Glasses: Structural, Chemical, and Mechanical Properties.

Phosphate and tellurite glasses can be used in optics, optoelectronics, magneto-optics, and nuclear and medical fields. Two series of phosphate-tellurite glasses, (50-x)ZnO-10Al2O3-40P2O5-xTeO2 and (40-x)Li2O-10Al2O3-5TiO2-45P2O5-xTeO2 (x = 5, 10), were synthesized by a non-conventional wet-route, and the mechanical properties as key performance measures for their application in optoelectronics were investigated. X-ray Diffraction (XRD) measurements revealed the vitreous nature of the investigated materials. Instrumented indentation tests allowed the calculation of hardness (H) and Young's modulus (E) using the Oliver and Pharr model. The influence of increasing the TeO2 content, as well as the substitution of ZnO by Li2O-TiO2, on the variation of hardness, Young's modulus, penetration depth (PD), and fracture toughness (FT) was evaluated in both series. As a general trend, there is a decrease in the hardness and Young's modulus with increasing penetration depth. The addition of Li2O and TiO2 instead of ZnO leads to improved hardness and elastic modulus values. Regarding the H/E ratio, it was found that the samples with lower TeO2 content should be significantly more crack-resistant compared to the higher TeO2 content samples. The H3/E2 ratio, being lower than 0.01, revealed a poor resistance of these glasses to plastic deformation. At the same time, a decrease of the fracture toughness with increasing TeO2 content was noticed for each glass series. Based on dilatometry measurements, the thermal expansion coefficient as well as the characteristic temperatures of the glasses were measured. Field Emission Scanning Electron Microscopy-Energy Dispersive X-ray analysis (FESEM-EDX) revealed a uniform distribution of the elements in the bulk samples. The mechanical properties of these vitreous materials are important in relation to their application as magneto-optical Faraday rotators in laser cavities.

A New Zinc Phosphate-Tellurite Glass for Magneto-Optical Applications.

This work investigates the structural, magnetic and magneto-optical properties of a new zinc phosphate-tellurite glass belonging to the 45ZnO-10Al2O3-40P2O5-5TeO2 system. The glass was prepared by a wet method of processing the starting reagents followed by suitable melting-stirring-quenching-annealing steps. Specific parameters such as density, average molecular mass, molar volume, oxygen packaging density, refractive index, molar refractivity, electronic polarizability, reflection loss, optical transmission, band gap and optical basicity have been reported together with thermal, magnetic and magneto-optical characteristics. Absorption bands appear in the blue and red visible region, while over 600 nm the glass becomes more transparent. FTIR and Raman spectra evidenced phosphate-tellurite vibration modes proving the P2O5 and TeO2 network forming role. Magnetic measurements reveal the diamagnetic character of the Te-doped glass with an additional weak ferromagnetic signal, specific to diluted ferromagnetic oxides. Positive Faraday rotation angle with monotonous decreasing value at increasing wavelength was evidenced from magneto-optical measurements. The final product is a composite material comprising of a non-crystalline vitreous phase and Te-based nanoclusters accompanied by oxygen vacancies. The metallic-like Te colloids are responsible for the dark reddish color of the glass whereas the accompanying oxygen vacancies might be responsible for the weak ferromagnetic signal persisting up to room temperature.

Influence of Sintering Strategy on the Characteristics of Sol-Gel Ba1-xCexTi1-x/4O3 Ceramics.

Single-phase Ce3+-doped BaTiO3 powders described by the nominal formula Ba1-xCexTi1-x/4O3 with x = 0.005 and 0.05 were synthesized by the acetate variant of the sol-gel method. The structural parameters, particle size, and morphology are strongly dependent on the Ce3+ content. From these powders, dense ceramics were prepared by conventional sintering at 1300 °C for 2 h, as well as by spark plasma sintering at 1050 °C for 2 min. For the conventionally sintered ceramics, the XRD data and the dielectric and hysteresis measurements reveal that at room temperature, the specimen with low cerium content (x = 0.005) was in the ferroelectric state, while the samples with significantly higher Ce3+ concentration (x = 0.05) were found to be in the proximity of the ferroelectric-paraelectric phase transition. The sample with low solute content after spark plasma sintering exhibited insulating behavior, with significantly higher values of relative permittivity and dielectric losses over the entire investigated temperature range relative to the conventionally sintered sample of similar composition. The spark-plasma-sintered Ce-BaTiO3 specimen with high solute content (x = 0.05) showed a fine-grained microstructure and an almost temperature-independent colossal dielectric constant which originated from very high interfacial polarization.

Minimally Invasive Colorectal Surgery - Present and Future Trends.

In the last decades, surgical techniques have evolved, introducing better, more sophisticated devices, aimed at providing the least traumatizing surgical operations, with improved perioperative and longtime results. Based on the results of randomized control trials, current guidelines recommend laparoscopic approach for the treatment of colonic cancer where there is appropriate expertise. Compared with colonic resection, laparoscopic rectal resections are technically challenging procedures associated with a low adoption rate, high conversion rate, debatable functional and oncological results. These drawbacks created the need for a better tool. Robotic surgery emerged to overcome the limits of laparoscopy in terms of visibility and instrument maneuverability. Laparoscopic approach is best suited for colon and superior rectal cancers, while robotic approach is best indicated in medium and inferior rectal cancers(especially in men with a narrow pelvis and in patients with high BMI). In these cases the robotic approach greatly facilitate the minimally invasive approach and, most of the time, allow preservation of the pelvic autonomic nerves leading to a better quality of life. Due to increased costs and relative unavailability of this method, it is difficult to anticipate if the adoption rate of minimally invasive surgery in colorectal cancer will increase significantly.

Male gender and increased body mass index independently predicts clinically relevant morbidity after spleen-preserving distal pancreatectomy.

AIM: To identify risk factors for clinically relevant complications after spleen-preserving distal pancreatectomy (SPDP). No previous studies explored potential predictors of morbidity after SPDP. METHODS: The data of 41 patients who underwent a SPDP in a single surgical center between 2000 and 2015 were retrospectively reviewed from a prospectively maintained electronic database established in our Department of Surgery. The database included demographic, clinical, bioumoral, pathological, intraoperative and postoperative parameters. Uni- and multivariate analyses were performed to assess potential predictors of clinically relevant morbidity. Postoperative morbidity was defined as in-hospital complications and mortality was assessed at 90 d. Clinically relevant morbidity was defined as complication ≥ grade 2 Dindo. RESULTS: Overall morbidity rate was 34.1% (14 patients): grade I (6 patients, 14.6%), grade II (2 patients, 4.8%), grade IIIa (1 patient, 2.4%), and grade IIIb (5 patients, 12.2%). A number of 5 patients (12.2%) required re-laparotomy for postoperative complications. There was no postoperative mortality. Thus, at least one clinically relevant complication occurred in 8 patients (19.5%). Univariate analysis identified male gender (P = 0.034), increased body mass index (P = 0.002) and neuroendocrine pathology (P = 0.013) as statistically significant risk factors. Multivariate analysis identified male gender [odds ratio (OR): 1.29, 95%CI: 1.07-1.55, P = 0.005] and increased body mass index (OR: 23.18, 95%CI: 1.72-310.96, P = 0.018) as the only independent risk factors of clinically relevant morbidity after SPDP. CONCLUSION: Male gender and increased body mass index are independently associated with increased risk of clinically relevant morbidity after SPDP. These findings may assist a surgeon in clinical decision-making to better select patients suitable for SPDP.

Is Radical Antegrade Modular Pancreatosplenectomy the Solution? A Systematic Literature Review and Meta-Analysis.

Background: RAMPS is considered, in high volume centers, as the best treatment for adenocarcinoma of the body and tail of the pancreas. Methods: PubMed database was searched. The results of studies that compared RAMPS with SRPS were analyzed by meta-analytical methods. Results: Five studies, published between 2013 and 2016, were suitable for quantitative synthesis. 285 unique patients were included, 135 patients in the RAMPS group and 150 patients in the SRPS group. Regarding retrieved lymph nodes, the mean difference was 6.54. This difference was considered to be statistical significant, P 0.00001. A complete tumor resection was observed in 115 of 129 patients who underwent RAMPS and in the case of the standard procedure a R0 resection was obtained in 107 cases out of 137, the RR was 1.17 (95% CI, 1.04, 1.32). One-year overall survival was found to be 79.2% in the RAMPS groups compared with 64.29% in the SRPS group. This difference is considered statistically significant, with a P value of 0.02. Conclusions: RAMPS is a safe procedure for the treatment of adenocarcinomas of the body and tail of the pancreas. RAMPS procedure is superior to SRPS in terms of lymph node retrieval and R0 resections.

Surgical Treatment of Splenic Artery Pseudoaneurysm with Digestive Tract Communication - Presentation of Two Cases.

Splenopancreatectomy performed for pancreatic pseudo-cyst with splenic artery pseudo-aneurysm and communication with the digestive tract (stomach or colon) is a very rare indication and a small number of these procedures are described in literature. Managing peri-pancreatic pseudo-aneurysm is complex and can be challenging. Surgical treatment is of curative intent and can involve multiple visceral resections. Surgery can be performed in an emergency setting, if the patient presents cataclysmic bleeding, or in a planned manner if the pseudo-aneurysm is discovered incidentally or if the patient manages to overcome the initial bleeding. In this paper we present two cases of pancreatic pseudo-cysts with splenic artery pseudo-aneurysms and communication with the digestive tract (one with pseudo-cystic-colonic communication and the other one with gastric communication). Both patients were males, suffered from chronic pancreatitis and were known to have pancreatic pseudo-cysts. For the treatment of the first patient, surgery was performed in an elective setting, after intensive investigations. The other patient presented with cataclysmic bleeding and emergency surgery was performed in order to control the bleeding. We conclude that surgery remains the main option of treatment for these patients. It can be used as a first line of treatment or secondary to endovascular procedures.

Emergency Pancreatico-Duodenectomy with Superior Mesenteric and Portal Vein Resection and Reconstruction Using a Gore-Tex Vascular Graft.

Emergency pancreatico-duodenectomy(EPD) is a very rare procedure and few reports are present in medical literature. It is an uncommon approach, usually used for emergency surgical treatment of abdominal trauma that involves the head of the pancreas or the duodenum, but it is also a surgical tool for the treatment of ruptured aneurysms, bleeding pseudocysts, duodenal perforations, uncontrollable hemorrhage from ulcers and tumors, severe infectious complications of acute pancreatitis or endoscopic retrograde cholangiopancreatography related complications (1,2). It is rarely used as the first line of treatment in case of acute bleeding from arterial pseudoaneurysm of the cephalad region of the pancreas. We present the case of a bleeding pseudoaneurysm of the cefalic region of the pancreas in a young patient with previously undiagnosed chronic pancreatitis and with suspicion of a malignant process located in the head of the pancreas. We performed a pancreatico-duodenectomy with resection of superior mesenteric and portal vein with reconstruction using Gore-Tex vascular graft due to probable venous abutment. Postoperative course was without any major complications, only minor grad-I pancreatic fistula was present. We determine that EPD is a useful tool in the treatment of such cases. It can be used as a first line of treatment or secondary to endovascular stenting or embolization.

Pancreatic metastases originating from uterine leiomyosarcoma: a case report.

In this report, we describe the case of a 67-year-old woman with metastatic pancreatic uterine leiomyosarcoma. She underwent a total hysterectomy and adnexectomy in December 2009. The resected uterine specimen was characterized as a leiomyosarcoma. The patient was free of disease until November 2010, when three pulmonary tumoral lesions detected by follow-up chest computed tomography were diagnosed as metastatic lesions. Wedge resections and enucleoresection of the pulmonary tumoral nodules were performed, and the patient received adjuvant chemotherapy. Ten months after the lung resection, an abdominal examination showed two tumoral masses in the pancreas and no extrapancreatic recurrence. In April 2014, a pylorus-preserving pancreaticoduodenectomy was performed. To date, the patient is alive, without any evidence of recurrence, and she has received chemotherapy. Surgery can be considered in cases in which the pancreas is a unique metastatic site or even in cases with resectable oligometastases.