Clinical outcomes of ERCP-related retroperitoneal perforations.

Endoscopic retrograde cholangiopancreatography (ERCP)-related perforations represent rare but often severe conditions. While lesions with intraperitoneal perforation have an almost imperative indication to surgery, whether or not to manage retroperitoneal perforations surgically is still an area of debate. The aim of the present work was to review the available clinical evidence on the operatively and medically treated ERCP-related retroperitoneal perforations. From MEDLINE/PubMed databases 137 patients with retroperitoneal perforation were included from 12 studies that met the selection criteria for data investigation and analysis. Twenty-four patients were treated by prompt surgery; 113 were primarily managed conservatively and about 20% of these patients required surgery subsequently. Overall, the morbidity and mortality were 15.4% and 6.6%, respectively. Although most patients with retroperitoneal perforation may benefit from a non-operative management, a considerable number of patients fail to respond to medical treatment and require surgery afterwards. Identifying those patients who are at highest risk of poor outcome after conservative treatment should be considered a research priority.

Indications for liver surgery: laparoscopic or robotic approach.

Laparoscopic liver resections have been demonstrated to be safe and effective with the advantages of a shorter hospital stay, less blood loss, less adhesions and better postoperative recovery compared to open surgery. However, indications are usually confined to peripheral, small lesions, due to issues intrinsic to the approach. In the effort to overcome some of these technical limitations, robotic technology has been developed, with encouraging findings. We performed a review of the literature to assess the current indications for laparoscopic hepatic resections and to investigate the role of robotics in broadening the application of minimally invasive liver surgery. Although a paucity of data exists, especially regarding long-term oncological outcomes and specific comparisons with laparoscopy, robotics has been proved to facilitate several complex liver procedures, including parenchyma-saving resections. Thus, the number of patients who can benefit from less invasive, conservative approach is potentially increased.

Metastasis to the Pancreas from Breast Cancer: Difficulties in Diagnosis and Controversies in Treatment.

BACKGROUND: Metastasis to the pancreas originating from malignant tumours is a rare event and, in the literature, we have found only 11 reported cases of solitary pancreatic metastases originating from breast cancer. CASE REPORT: We report a case of a 51-year-old woman with primary breast cancer who developed obstructive jaundice and epigastric pain after 2 years without any symptoms. The pancreatic mass revealed by computed tomography (CT) scan and magnetic resonance imaging (MRI) was not recognised as a metastasis from breast cancer and the patient underwent cephalic pancreaticoduodenectomy. CONCLUSIONS: We discuss all aspects of the case management, stressing the importance of a careful evaluation of the clinical history and the primary cancer features and the usefulness of a multi-disciplinary approach. These aspects are of main importance for a correct diagnostic process and an appropriate therapeutic choice when a pancreatic lesion develops in a patient with prior neoplasm.

Retrograde parotidectomy for pleomorphic adenoma of the parotid gland: a conservative and effective approach.

To compare the extensiveness and the effectiveness of anterograde and retrograde dissections in superficial parotidectomy for pleomorphic adenoma of the parotid gland, a review of medical records and pathology reports of consecutive patients who underwent superficial parotidectomy has been performed. The sizes of the overall pathologic specimen, the tumor within the specimen, and the normal parotid tissue obtained by anterograde and retrograde approaches have been compared. Mann-Whitney and chi tests have been used to reveal significant differences. Sixty-four patients were included in the study, 32 who underwent anterograde (standard) parotidectomy and 32 who underwent retrograde parotidectomy. Anterograde dissection resulted in a significantly larger size of the overall pathologic specimen as compared with retrograde parotidectomy (P = 0.019). The size of the tumor was nonsignificantly larger for patients undergoing standard parotidectomy (P = 0.174). Patients undergoing anterograde parotidectomy also had a significantly much larger volume of normal tissue removed in the course of extirpating the adenoma, as compared with patients undergoing retrograde parotidectomy (P = 0.008). Despite extracapsular dissection and partial superficial parotidectomy being proposed in the last years as conservative techniques, the optimal treatment of pleomorphic adenoma remains the superficial or total parotidectomy with facial nerve primary identification and preservation. Retrograde parotidectomy, reducing the extent of normal parotid gland removal, may permit a more conservative approach than standard parotidectomy, with the same complication rates and surgical effectiveness.