Solid pancreatic pseudopapillary tumor managed laparoscopically: A case report and review of the literature.

BACKGROUND: Solid pancreatic pseudopapillary tumors are a rare neoplasms, about 1-3% of all pancreatic neoplasms. This cancer mainly affects women between the third and fourth decade of life. They are not well known; the molecular origins represent a low degree of malignancy, in which the complete resection is curative. We report our experience with a case report of SPT in a young man. PRESENTATION OF CASE: Thirty-six years old male patient with a mass about 10 cm in the pancreatic tail and splenic ilum. After following CT and MR, the patient was subjected to surgery. Histophatological result was solid tumor pseudopapillary of pancreas with no pathological lymph nodes. DISCUSSION AND CONCLUSION: Solid pseudopapillary neoplasm shows histological characteristic solid and pseudopapillary proliferation. Immunohistochemistry detects, among the causes of tumor development, a correlation between the Beta-catenin mutations, alteration of the E-cadherin. In the most cases, therapy is surgical treatment with laparoscopic.

Laparoscopic gastrectomy for treatment of advanced gastric cancer: preliminary experience on 38 cases.

AIM: In the last 20 years the laparoscopic surgery rapidly and successfully diffused for the treatment of benign diseases and recently also for the treatment of malignancy; newerteless, the laparoscopic gastrectomy for gastric cancer is still controversial, in relation to extreme difficulty of a radical surgical resection performing with an accurate lymphadectomy. The authors present a surgical experience of patients affected by advanced gastric cancer who underwent total or subtotal gastrectomy with videoassisted or entirely laparoscopic technique in order to evaluate the safety, feasibility, advantages and limits of this surgical approach. METHODS: between January 2002 and August 2007 we performed 40 laparoscopic procedure for advanced gastric cancer; of these, 38 (95%) patients underwent a laparoscopic gastric resection and 2 (5%) patients underwent a palliative surgical treatment (laparoscopic gastro-entero-anastomosis). In the 38 patients which underwent laparoscopic gastrectomy, the anatomical localization of cancer, ASA score, pTNM classification, type of surgical laparoscopic technique (videoassisted or entirey laparoscopic technique), mean number of lymph nodes harvested, mean operative time, rate of conversion, postoperative morbidity and mortality and rate of local recurrence at 24 mounths follow-up were retrospectively analyzed. RESULTS: Thirty-eight laparoscopic gastrectomies for gastric cancer were performed: in relation to surgical technique, 4 (10.5%) of these were video-assisted gastric resection (left subcostal minilaparotomy and extracorporeal anastomosis) and 34 (89.5%) were entirely laparoscopic gastrectomy; regarding to extension of surgical resection, there were 16 (42%) total D2 gastrectomies and 22 (58%) subtotal gastrectomies, of which 19 D2 gastrectomy and 3 D1 gastrectomy. Regarding the ASA score, 23% of patients were in ASA I, 52% in ASA II, 25% in ASA III. The mean operative time was 225 minutes (range 160-285) for total gastrectomy and 183 minutes (range 70-270) for subtotal gastrectomy. Overall, on 38 laparoscopic gastric resection, the conversion rate was 7.8% (3 patients). The number of lymph nodes harvested was 28 (range 5-53). No major intraoperative complications were observed. Overall morbidity was 31.5% (12 patients); the rate of postoperative surgical complications was 8% (3 patients). One patient (2.6%) dead for a sepsis subsequent to leak of esophagojejunal anastomosis. Mean hospital stay was 16 days for total gastrectomies and 12 days for subtotal gastrectomies. Three cases (7.9%) of cancer recurrence were observed in 3 patients (2 patiens UICC IIIa, one patient UICC IIIb) at 20th, 23th, 24th postoperative month and one case (2.6%) of peritoneal carcinosis at 18th month. No port-site metastasis were observed at 24-month follow-up. CONCLUSIONS: On the basis of this surgical preliminary experience, laparoscopic gastrectomy for malignancy resulted a technically safe surgical procedure if performed by an advanced laparoscopic surgical team, with additional benefits, time to resumption of oral intake, morbidity rate, and acceptance from patients. A radical laparoscopic gastrectomy via laparoscopic approach is advisable until UICC stage II, in patients with ASA score I-III and minimal endoabdominal adhesion. The safe and efficacy of laparoscopic treatment in locoregional limph nodes dissection is still controversial. However, long-term results of prospective and comparative trials will be necessary to show the real oncologically benefits of laparoscopic approach.

Laparoscopic approach to morbid obesity: personal experience of 250 gastric bypasses. Analysis of different techniques and results.

AIM: Severe obesity is a major health problem affecting more than 1,000,000 people in Italy, with a 95% failure rate of nonsurgical treatments. We report our over five-years experience with laparoscopic Roux-en-Y gastric bypass (LRYGBP), evaluating the postoperative course of the patients undergoing 3 different gastro-esophageal anastomosis technique: Gagner procedure (87 cases) (34.8%), the purse-string approach (93 cases) (37.2%), robotic-assisted gastric bypass (68 cases) (27.2%) and by laparoscopic hand sewn anastomosis (2 cases) (0.8%). METHODS: Between October 2000 and February 2006, we performed LRYGBP on 250 patients (77 male and 173 female aged from 16 to 65 years [mean age 43.1 years] and with an average body mass index of 51.1 kg/m(2) [35-99]). Comorbidities were: hypertension, type II diabetes, hyperlipemia, osteoarthritis, chronic restrictive pulmonary insufficiency, sleep apnea, deep venous thrombosis. RESULTS: The mean operative time was 142.3 min (80-420) with a mean hospitalization of 9.8 days (5-44). Eighteen major complications were recorded. There were no deaths. The mean percent excess body weight loss was 47.2+/-18.2% after 1 year (212 patients), 66.2+/- 19.4% after 2 years (178 patients), 78.2+/-12.4% after 3 years (139 patients), 80.6+/-11.7% after 4 years (101 patients), and 82.5+/-10.2% after 5 years (67 patients). Nearly all of the comorbidities were solved or improved. Bariatric analysis and reporting outcome system results after 5 years were excellent, good or fair in 100% of the subject evaluated. CONCLUSIONS: Although requiring the skill of an expert surgeon, LRYGBP is one of the most effective procedure available today to induce long-term weight loss, with limited nutritional risks and better prospects for improved quality of life.

Laparoscopic gastric bypass performed with the Da Vinci Intuitive Robotic System: preliminary experience.

BACKGROUND: This study aimed to analyze retrospectively the authors' preliminary experience using the Da Vinci Intuitive Robotic System for gastric bypass in managing morbid obesity, and to determine its efficacy and safety in relation to other standardized laparoscopic surgical techniques. METHODS: From October 2000 to March 2004 the authors performed 146 laparoscopic gastric bypasses, 17 of which were robot assisted using the Da Vinci Intuitive Robotic System. The last patients were 7 men and 10 women with a mean age of 44 years. The mean weight was 139 kg, and the mean body mass index (BMI) was 49.8 kg/m at first postoperative recovery. The mean excess body weight (EBW) was 131%. Follow-up assessment, performed at months 1, 3, 6, and 12, then yearly thereafter, included evaluation of the variations in BMI and the percentage of excess body weight loss (EBWL%). All the patients were informed of the risks inherent with each surgical procedure as well as the potential benefits. RESULTS: The mean operative time was 201 min (range, 90-300 min). No intraoperative complications and no conversion occurred in this series. The mean hospital stay was 9 days (range, 6-18 days). The patients in this series experienced a normal postoperative course without anastomotic complications. The mortality rate was zero. No robot-related complications were noted. The analysis of follow-up assessment at months 1, 3, 6, and 12 showed a progressive decrease in BMI and an increment of EBWL%. CONCLUSIONS: The authors' early experience with robotic surgery suggests that it is safe and could be an effective alternative to conventional laparoscopic surgery. The authors believe that robotic surgery, with its ability to restore the hand-eye coordination and three-dimensional view lost in laparoscopic surgery, could allow complex procedures to be performed with greater precision and better results.

[Antithrombotic prophylaxis in day surgery: proposal of a clinical protocol]. / La profilassi antitrombotica in day surgery. Proposta di un protocollo clinico.

The considerable diffusion of the day surgery has new problems such as the use of antithrombotic prophylaxis, now carried out systematically in major surgery. An the basis of the poor data present in the literature, a protocol of study is proposed to evaluate the real effectiveness of this type of prophylaxis in DS, dividing the patients into 3 groups, according to the patient's risk factors to the intervention and to the disease.

[The timing in differential diagnosis of cystic tumors of the pancreas: clinical report of three cases of cystadenocarcinoma]. / Il "timing" nella diagnosi differenziale dei tumori cistici del pancreas: contributo clinico su tre casi di cistoadenocarcinoma.

The Authors analyze their own twelve-years experience about the Cystic Tumors of the Pancreas, considering the data existing in the literature. In particular, after a description of anatomo-pathological and clinical characteristics, they set out the problems in the differential diagnosis between the Cystadenocarcinomas and the other benign cystic lesions of the Pancreas. The solution of this problem is often reached only during the operation with multiple biopsies. Moreover they pay attention to the therapeutic choices, determined by the symptomatology of the patients and the localization and the histological kind of the lesions.

[A case of anaplastic thyroid carcinoma]. / Un caso di carcinoma anaplastico della tiroide.

The Authors report a case of anaplastic thyroid carcinoma surviving more than 20 months from the time of diagnosis and still living. The patient underwent surgery (total thyroidectomy), chemotherapy (cisplatin and doxorubicin according to Schlumberger), and radiotherapy (5000 Gy).