RESUMO
The incidence of cancer in choledochal cysts (CCs) in adults was calculated to determine the timing and need for surgery. In 78 publications (1996-2010), 434 of 5780 reported CCs patients had cancer. Cholangiocarcinoma (70.4 %) and gallbladder cancer (23.5 %) were the most common malignancies. Only nine malignancies were reported before age 18 (0.42 %). In contrast, the incidence of malignancy in adults was 11.4 %. The median age for diagnosis of cancer was 42 years, and the incidence increased with each decade.
Assuntos
Neoplasias dos Ductos Biliares/epidemiologia , Ductos Biliares Intra-Hepáticos , Colangiocarcinoma/epidemiologia , Cisto do Colédoco/epidemiologia , Cisto do Colédoco/patologia , Neoplasias da Vesícula Biliar/epidemiologia , Fatores Etários , Neoplasias dos Ductos Biliares/patologia , Colangiocarcinoma/patologia , Cisto do Colédoco/cirurgia , Neoplasias da Vesícula Biliar/patologia , Humanos , IncidênciaRESUMO
Three sporadic, synchronous, and separate lesions in the ampulla of Vater and the head of the pancreas presented in an 81-year-old male. One was symptomatic and two were incidental. One was detected preoperatively (the ampullary lesion) and two by examination of the resected specimen (the neuroendocrine and pancreatic carcinomas). The case is summarized and the literature and the issue of commonality are reviewed.
Assuntos
Adenocarcinoma/patologia , Ampola Hepatopancreática/patologia , Carcinoma Adenoescamoso/patologia , Carcinoma Neuroendócrino/patologia , Neoplasias do Ducto Colédoco/patologia , Neoplasias Primárias Múltiplas/patologia , Neoplasias Pancreáticas/patologia , Idoso de 80 Anos ou mais , Humanos , Masculino , PrognósticoRESUMO
Molecular-based methods to monitor point mutations require special and expensive equipment unavailable in most hospitals. Colorimetric-based analysis is an ideal platform for K-ras codon 12 gene point mutations because it uses commonly found hospital equipment. The colorimetric assay is sensitive and specific, detecting mutated DNA levels as low as 1% in a wild-type background. Paired genomic DNA extracts of fixed tissue and cellular fractions of peripheral blood are more sensitive and accurate than unpaired samplings. This approach has the potential to improve K-ras point mutation scans as well as to detect micrometastases in circulating tumor cells.
Assuntos
Códon/genética , Colorimetria/métodos , DNA/sangue , DNA/genética , Pancreatopatias/genética , Mutação Puntual/genética , Proteínas Proto-Oncogênicas/genética , Proteínas ras/genética , Humanos , Pancreatopatias/sangue , Pancreatopatias/patologia , Proteínas Proto-Oncogênicas p21(ras)RESUMO
BACKGROUND: Central pancreatectomy has a unique application for lesions in the neck of the pancreas. It preserves the distal pancreas and its endocrine functions. It also preserves the spleen. METHODS: This is a retrospective review of 10 patients who underwent central pancreatectomy without pancreatico-enteric anastomosis between October 2005 and May 2009. The surgical indications, operative outcomes, and pathologic findings were analyzed. RESULTS: All 10 lesions were in the neck of the pancreas and included: 2 branch intraductal papillary mucinous neoplasms (IPMNs), a mucinous cyst, a lymphoid cyst, 5 neuroendocrine tumors, and a clear cell adenoma. CONCLUSION: Central pancreatectomy without pancreatico-enteric anastomosis for lesions in the neck and proximal pancreas is a safe and effective procedure. Morbidity is low because there is no anastomosis. Long term endocrine and exocrine function has been maintained.
Assuntos
Adenocarcinoma Mucinoso/cirurgia , Carcinoma Ductal Pancreático/cirurgia , Carcinoma Papilar/cirurgia , Pancreatectomia , Neoplasias Pancreáticas/cirurgia , Adenocarcinoma Mucinoso/secundário , Adulto , Idoso , Anastomose Cirúrgica , Carcinoma Ductal Pancreático/secundário , Carcinoma Papilar/secundário , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Invasividade Neoplásica , Recidiva Local de Neoplasia , Estadiamento de Neoplasias , Neoplasias Pancreáticas/patologia , Prognóstico , Estudos Retrospectivos , Taxa de Sobrevida , Resultado do TratamentoRESUMO
BACKGROUND: Pancreaticoduodenectomy is the procedure of choice for tumors of the head of the pancreas and periampulla. Despite advances in surgical technique and postoperative care, the procedure continues to carry a high morbidity rate. One of the most common morbidities is delayed gastric emptying with rates of 15%-40%. Following two prolonged cases of delayed gastric emptying, we altered our reconstruction to avoid this complication altogether. Subsequently, our patients underwent a classic pancreaticoduodenectomy with an undivided Roux-en-Y technique for reconstruction. METHODS: We reviewed the charts of our last 13 Whipple procedures evaluating them for complications, specifically delayed gastric emptying. We compared the outcomes of those patients to a control group of 15 patients who underwent the Whipple procedure with standard reconstruction. RESULTS: No instances of delayed gastric emptying occurred in patients who underwent an undivided Roux-en-Y technique for reconstruction. There was 1 wound infection (8%), 1 instance of pneumonia (8%), and 1 instance of bleeding from the gastrojejunal staple line (8%). There was no operative mortality. CONCLUSION: Use of the undivided Roux-en-Y technique for reconstruction following the Whipple procedure may decrease the incidence of delayed gastric emptying. In addition, it has the added benefit of eliminating bile reflux gastritis. Future randomized control trials are recommended to further evaluate the efficacy of the procedure.
Assuntos
Anastomose em-Y de Roux/métodos , Neoplasias Pancreáticas/cirurgia , Pancreaticoduodenectomia , Idoso , Idoso de 80 Anos ou mais , Feminino , Esvaziamento Gástrico , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Resultado do TratamentoRESUMO
Preventing cancer has much to offer. Aside from plummeting health care costs, we might enjoy a healthier life free of cancer and chronic disease. Prevention requires the adoption of healthier choices and a moderate amount of exercise. The supporting evidence is observational, clinical, and partly common sense. Further investigations reveal several substances in a whole-food plant-based diet that have protective effects and an inhibitory effect on tumor development. For pancreatic cancer, the basis of cure remains a century old operation that rarely cures. With little to lose, prevention deserves center stage and additional studies.
Assuntos
Diagnóstico por Imagem/métodos , Detecção Precoce de Câncer , Neoplasias Pancreáticas/diagnóstico , Neoplasias Pancreáticas/prevenção & controle , Dieta , Exercício Físico , Humanos , Estilo de VidaRESUMO
Asymptomatic non-functioning pancreatic neuroendocrine tumors are indolent, slow-growing tumors, and surveillance is safe and reasonable. Despite consensus, size may be less important than grade and Ki-67 when making decisions regarding optimal therapy. Plans to proceed with surveillance or surgical resection require a multidisciplinary approach and a shared decision making process with colleagues, patients, and families. Decisions should be based on tumor characteristics, patient morbidities, preferences, and risks. As molecular diagnostics evolve, preoperative acquisition of tissue samples may become even more critical in choosing between operative management and surveillance.
Assuntos
Diagnóstico por Imagem/métodos , Achados Incidentais , Pancreatectomia/métodos , Neoplasias Pancreáticas/diagnóstico , Neoplasias Pancreáticas/cirurgia , Doenças Assintomáticas , Diagnóstico Diferencial , HumanosRESUMO
Preoperative drainage of an obstructed biliary tree before pancreaticoduodenal resection (PDR) and placement of intraabdominal drains following pancreatic resection have been suggested to be both unnecessary and associated with a higher complication rate. The evidence for and against that practice is presented and analyzed to highlight its risks and benefits. A selective approach on an individual basis for preoperative biliary decompression is advocated, based on multiple factors. Additionally, the evidence for routine use of surgical drains after PDR is critically reviewed and the rationale for routine drainage is made.
Assuntos
Ducto Colédoco/cirurgia , Drenagem/métodos , Icterícia Obstrutiva , Neoplasias Pancreáticas , Pancreaticoduodenectomia/métodos , Cuidados Pré-Operatórios/métodos , Stents , Colangiopancreatografia Retrógrada Endoscópica , Ducto Colédoco/diagnóstico por imagem , Humanos , Icterícia Obstrutiva/diagnóstico , Icterícia Obstrutiva/etiologia , Icterícia Obstrutiva/cirurgia , Neoplasias Pancreáticas/complicações , Neoplasias Pancreáticas/diagnóstico , Neoplasias Pancreáticas/cirurgiaRESUMO
Complications after pancreaticoduodenal resection occur in at least 30% of patients. Most are a direct result of an intraoperative event, dissection, or anastomoses which account for the most serious morbidities, sepsis, pseudoaneurysms, and hemorrhage. Rarely, complications are due to the systemic impact of the procedure even if the procedure itself was unremarkable. Rare systemic complications after PDR (Transfusion transmitted Babesiosis, pituitary apoplexy, and TRALI) and a number of uncommon and unusual other complications are discussed. Pancreaticoduodenal resection is a significant operation with serious consequences. Decisions on selection of candidates and safe operations should be thoughtful and always in surgeons' minds.
Assuntos
Lesão Pulmonar Aguda/etiologia , Babesiose/etiologia , Neoplasias Pancreáticas/cirurgia , Pancreaticoduodenectomia/efeitos adversos , Apoplexia Hipofisária/etiologia , Complicações Pós-Operatórias/etiologia , Doenças Raras , Transfusão de Sangue , HumanosRESUMO
Cancer of the pancreas (CaP) is a dismal, uncommon, systemic malignancy. This article updates an earlier experience of actual long-term survival of CaP in patients treated between 1991 to 2000, and reviews the literature. Survival is expressed as actual, not projected, survival.
Assuntos
Previsões , Neoplasias Pancreáticas/mortalidade , Seguimentos , Saúde Global , Humanos , Taxa de Sobrevida/tendênciasRESUMO
Pancreatic and biliary fistulas and delayed gastric emptying are the most common complications after pancreatoduodenectomy. The development and bleeding of visceral arterial pseudoaneurysms are rare phenomena and pose diagnostic and treatment dilemmas. We describe 5 recent patients who developed bleeding from visceral artery pseudoaneurysms after pancreatoduodenectomy. These patients all had "herald" bleeding from their abdominal drains. Subsequent angiography and therapeutic embolizations were successfully performed.
Assuntos
Falso Aneurisma/etiologia , Artéria Hepática , Pancreaticoduodenectomia , Hemorragia Pós-Operatória/etiologia , Idoso , Falso Aneurisma/complicações , Falso Aneurisma/diagnóstico por imagem , Falso Aneurisma/terapia , Embolização Terapêutica , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , RadiografiaRESUMO
Pancreatic cancer is a systemic disease for most patients. Operations with the intent to cure may be done safely (mortality, < 3%) with shorter hospital stays. Surgery has been minimally effective as a long-term cure. Endoscopic palliation of jaundice is becoming standard practice. Common sense dictates a defined and clear role for surgery (i.e., strict patient selection criteria). Surgery is of great value for small, localized lesions; of clear value as palliative therapy when nonoperative measures fail; and perhaps best applied after neoadjuvant chemoradiotherapy. Surgery is just part of the armamentarium available to treat pancreatic cancer. Novel systemic therapies, including chemotherapy, immunotherapy, and so-called targeted therapies, are becoming increasingly valuable in the management of this systemic disease and are discussed in detail in other articles in this issue.
Assuntos
Adenocarcinoma/cirurgia , Neoplasias Pancreáticas/cirurgia , Adenocarcinoma/complicações , Adenocarcinoma/diagnóstico , Adenocarcinoma/patologia , Idoso , Idoso de 80 Anos ou mais , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , Caquexia/etiologia , Caquexia/terapia , Quimioterapia Adjuvante , Colestase/etiologia , Colestase/cirurgia , Terapia Combinada , Diagnóstico por Imagem , Endoscopia , Feminino , Obstrução da Saída Gástrica/etiologia , Obstrução da Saída Gástrica/cirurgia , Humanos , Laparotomia , Masculino , Pessoa de Meia-Idade , Terapia Neoadjuvante , Cuidados Paliativos , Neoplasias Pancreáticas/complicações , Neoplasias Pancreáticas/diagnóstico , Neoplasias Pancreáticas/patologia , Pancreaticoduodenectomia , Radiossensibilizantes/uso terapêutico , Radioterapia Adjuvante , StentsRESUMO
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.