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BACKGROUND: Pancreas transplant biopsy practices for the diagnosis of rejection or other pathologies are not well described. METHODS: We conducted a survey of staff at US pancreas transplant programs (March 22, 2022, to August 22, 2022) to assess current program practices and perceptions about the utility and challenges in the performance and interpretation of pancreas allograft biopsies. RESULTS: Respondents represented 65% (76/117) of active adult pancreas transplant programs, capturing 66% of recent pancreas transplant volume in the United States. Participants were most often nephrologists (52%), followed by surgeons (46%), and other staff (4%). Pancreas allograft biopsies were performed mostly by interventional radiologists (74%), followed by surgeons (11%), nephrologists (8%), and gastroenterologists (1%). Limitations in the radiologist's or biopsy performer's comfort level or expertise to safely perform a biopsy, or to obtain sufficient/adequate samples were the two most common challenges with pancreas transplant biopsies. Pancreas transplant biopsies were read by local pathologists at a majority (86%) of centers. Challenges reported with pancreas biopsy interpretation included poor reliability, lack of reporting of C4d staining, lack of reporting of rejection grading, and inconclusive interpretation of the biopsy. Staff at a third of responding programs (34%) stated that they rarely or never perform pancreas allograft biopsies and treat presumed rejection empirically. CONCLUSIONS: This national survey identified significant variation in clinical practices related to pancreas allograft biopsies and potential barriers to pancreas transplant utilization across the United States. Consideration of strategies to improve program experience with percutaneous pancreas biopsy and to support optimal management of pancreas allograft rejection informed by histology is warranted.
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Rejeição de Enxerto , Transplante de Pâncreas , Humanos , Estados Unidos , Biópsia/estatística & dados numéricos , Rejeição de Enxerto/patologia , Pâncreas/patologia , Pâncreas/cirurgia , Consenso , Padrões de Prática Médica , Inquéritos e Questionários/estatística & dados numéricos , Pesquisas sobre Atenção à SaúdeRESUMO
Background: Intraductal papillary neoplasm of the bile duct is a rare variant of bile duct tumors, which is characterized by papillary or villous growth inside the bile duct. Having papillary and mucinous features such as those found in pancreatic intraductal papillary mucinous neoplasm (IPMN) is extremely rare. We report a rare case of intraductal papillary mucinous neoplasm of the intrahepatic bile duct. Case report: A 65-year-old male Caucasian with multiple comorbidities presented to the emergency room with moderate constant pain at the right upper quadrant (RUQ) abdomen for the last several hours. On physical examination, he was found to have normal vital signs, with icteric sclera and pain on deep palpation at the RUQ region. His laboratory results were significant for jaundice, elevated liver function tests and creatinine, hyperglycemia, and leukocytosis. Multiple imaging studies revealed a 5â cm heterogeneous mass in the left hepatic lobe that demonstrated areas of internal enhancement, mild gall bladder wall edema, dilated gall bladder with mild sludge, and 9â mm common bile duct (CBD) dilatation without evidence of choledocholithiasis. He underwent a CT-guided biopsy of this mass, which revealed intrahepatic papillary mucinous neoplasm. This case was discussed at the hepatobiliary multidisciplinary conference, and the patient underwent an uneventful robotic left partial liver resection, cholecystectomy, and lymphadenectomy. Conclusion: IPMN of the biliary tract may represent a carcinogenesis pathway different from that of CBD carcinoma arising from flat dysplasia. Complete surgical resection should be performed whenever possible because of its significant risk of harboring invasive carcinoma.
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Adenocarcinoma/diagnóstico , Neoplasias Pancreáticas/diagnóstico por imagem , Tomografia Computadorizada por Raios X/métodos , Adenocarcinoma/cirurgia , Humanos , Neoplasias Pancreáticas/cirurgia , Valor Preditivo dos Testes , Prognóstico , Estudos Retrospectivos , Sensibilidade e Especificidade , Neoplasias PancreáticasRESUMO
Exocrine cancer of pancreas is the fourth leading cause of death in the USA among both men and women. Contrast enhanced multidetector-row computer tomography (MDCT) is the current modality of choice for the detection of distant metastasis in pancreatic cancer as a part of pre-operative workup, which helps decide on resectability. Authors present a first ever reported case of an incidental liver metastasis found on intra-operative wedge hepatic biopsy during Whipple's procedure for pancreatic cancer. This pancreatic cancer was initially thought to be resectable based on MDCT staging per guidelines. The case highlights the importance of diagnostic staging laparoscopy and neoadjuvant chemotherapy before resecting pancreatic adenocarcinoma.
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INTRODUCTION: Although a volume-outcome relationship has been well established for pancreatectomy, little is known about differences in mortality by facility type. The objective of this study is to evaluate the impact of facility type on short-term and long-term survival outcomes for patients with pancreatic adenocarcinoma who underwent pancreatectomy and identify determinants of overall survival (OS). METHODS: A cohort of 33,382 patients with Stage I-III pancreatic adenocarcinoma diagnosed between 1998 and 2011 were evaluated from the National Cancer Data Base. Clinicopathological, sociodemographic and treatment variables were compared among three facility types where patients received resection: (i) community cancer program (CCP), (ii) comprehensive community cancer program (CCCP), and (iii) academic research program (ARP). 5-year OS was calculated using the Kaplan-Meier method. RESULTS: Despite ARP having significantly higher percentage of poorly differentiated tumors, higher T-stage tumors, more positive lymph nodes, and greater circle distance compared to the other facilities, it had the highest 5-yr OS. The 5-yr OS for CCP, CCCP, and ARP was 11.2%, 13.2%, and 16.6%, respectively (P < 0.0001) and the median survival time (months) was 12.4, 15.6 and 19.1, respectively. CONCLUSION: Patients receiving pancreatic resection at an ARP yielded a higher 5-year OS compared to CCP or CCCP.
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Centros Médicos Acadêmicos , Adenocarcinoma/cirurgia , Centros Comunitários de Saúde , Pancreatectomia , Neoplasias Pancreáticas/cirurgia , Adenocarcinoma/mortalidade , Adenocarcinoma/secundário , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Diferenciação Celular , Bases de Dados Factuais , Feminino , Humanos , Estimativa de Kaplan-Meier , Metástase Linfática , Masculino , Pessoa de Meia-Idade , Estadiamento de Neoplasias , Pancreatectomia/efeitos adversos , Pancreatectomia/mortalidade , Neoplasias Pancreáticas/mortalidade , Neoplasias Pancreáticas/patologia , Modelos de Riscos Proporcionais , Fatores de Risco , Fatores de Tempo , Resultado do Tratamento , Estados Unidos , Adulto JovemRESUMO
Kidney transplant in patients with liver cirrhosis and nondialysis chronic kidney disease (CKD) is controversial. We report 14 liver cirrhotic patients who had persistently low MDRD-6 estimated glomerular filtration rate (e-GFR) <40 mL/min/1.73 m2 for ≥3 months and underwent either liver transplant alone (LTA; n=9) or simultaneous liver-kidney transplant (SLKT; n=5). Pretransplant, patients with LTA compared with SLKT had lower serum creatinine (2.5±0.73 vs 4.6±0.52 mg/dL, P=.001), higher MDRD-6 e-GFR (21.0±7.2 vs 10.3±2.0 mL/min/1.73 m2 , P=.002), higher 24-hour urine creatinine clearance (34.2±8.8 vs 18.0±2.2 mL/min, P=.002), lower proteinuria (133.2±117.7 vs 663±268.2 mg/24 h, P=.0002), and relatively normal kidney biopsy and ultrasound findings. Post-LTA, the e-GFR (mL/min/1.73 m2 ) increased in all nine patients, with mean e-GFR at 1 month (49.8±8.4), 3 months (49.6±8.7), 6 months (49.8±8.1), 12 months (47.6±9.2), 24 months (47.9±9.1), and 36 months (45.1±7.3) significantly higher compared to pre-LTA e-GFR (P≤.005 at all time points). One patient developed end-stage renal disease 9 years post-LTA and another patient expired 7 years post-LTA. The low e-GFR alone in the absence of other markers or risk factors of CKD should not be an absolute criterion for SLKT in patients with liver cirrhosis.
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Doença Hepática Terminal/cirurgia , Cirrose Hepática/complicações , Transplante de Fígado , Insuficiência Renal Crônica/complicações , Adulto , Idoso , Tomada de Decisão Clínica , Doença Hepática Terminal/complicações , Feminino , Seguimentos , Taxa de Filtração Glomerular , Humanos , Cirrose Hepática/diagnóstico , Cirrose Hepática/fisiopatologia , Transplante de Fígado/métodos , Masculino , Pessoa de Meia-Idade , Insuficiência Renal Crônica/diagnóstico , Insuficiência Renal Crônica/fisiopatologia , Estudos Retrospectivos , Transplante Homólogo , Resultado do TratamentoRESUMO
Despite recent advances, iatrogenic bile duct injury remains one of the most common complications of laparoscopic cholecystectomy. Aberrant biliary tract anatomy is one of the major risk factors for iatrogenic bile duct injury. In this case report, for the first time, we report a case of aberrant left main bile duct draining directly into the cystic duct or gallbladder that presented with bile duct injury after laparoscopic cholecystectomy. We hope that the diagnostic and management approach used in this case will help physicians to identify and manage their patients should they face such a rare anatomy.
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Ductos Biliares , Colangiografia , Colecistectomia Laparoscópica/efeitos adversos , Vesícula Biliar , Cálculos Biliares , Pancreatite , Idoso , Ductos Biliares/anormalidades , Ductos Biliares/diagnóstico por imagem , Ductos Biliares/lesões , Feminino , Vesícula Biliar/diagnóstico por imagem , Vesícula Biliar/cirurgia , Cálculos Biliares/diagnóstico por imagem , Cálculos Biliares/cirurgia , Humanos , Pancreatite/diagnóstico por imagem , Pancreatite/cirurgiaRESUMO
OBJECTIVE: To evaluate the safety and survival benefit of combined curative resection (CR) of the pancreas and major venous resection in the management of borderline resectable pancreatic adenocarcinoma. METHODS: In this IRB approved retrospective cohort study, patients who had pancreatic surgery (n=274) between 1998-2012 were reviewed. One hundred and seventy-five patients had malignant causes, of which 119 underwent CR. One hundred and two patients who did not require venous resection/repair (Group-I) were compared with 17 patients who had major vascular involvement (portal-vein/superior-mesenteric-vein) and underwent a vascular resection/repair (Group-II) during the CR. Demographics, operative and follow-up data were reviewed. RESULT: Type of the operations were: standard Whipple (n=53), pylorus-sparing-Whipple (n=41), total pancreatectomy (n=11), and distal pancreatectomy (n=13). In Group-II, venous involvement was excised and primarily repaired (n=12), or repaired using other veins (n=4) or a synthetic patch (n=1). Group-II had a significantly larger tumor size and more perineural invasion and peripancreatic soft tissue involvement (P<0.05). While complication rate, margin status, and duration of stay were not different between the groups, the median-overall-survival was higher for Group-I (15.34 months) than Group-II patients (7.18 months) (P=0.003). CONCLUSION: Pancreatic CR requiring intra-operative venous resection/repair is feasible and safe, but the survival of the patients who have pancreatic adenocarcinoma with venous involvement is poor irrespective of a successful venous resection.
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Mucinous cystic neoplasms (MCNs) are among the most common primary cystic neoplasms of pancreas. These lesions usually occur in body and tail of the pancreas and are characterized by the presence of ovarian type stroma in the pathological evaluation. Mucinous cystic neoplasms have significant malignant potential; therefore, their diagnosis and resection is of utmost importance. Mucinous cystic neoplasms typically occur in women. Only a few cases have been previously reported in male patients. In this case report, we present a 48-year-old man who was referred to our center due to an incidentally found cystic lesion in the tail of the pancreas that was increasing in size in serial evaluation. The patient underwent open distal pancreatectomy. The pathology showed mucinous cystic neoplasm with characteristic ovarian type stroma and positive staining for estrogen and progesterone receptors. This case report shows that mucinous cystic neoplasms can occur in men and should be considered in differential diagnosis of cystic pancreatic lesions in this population.
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Cistadenoma Mucinoso/patologia , Cistadenoma Mucinoso/cirurgia , Neoplasias Pancreáticas/patologia , Neoplasias Pancreáticas/cirurgia , Feminino , Humanos , Masculino , Pessoa de Meia-IdadeRESUMO
The impact of cancer involving the peripancreatic soft tissue (PST), irrespective of margin status, following a resection of pancreatic adenocarcinoma is not known. The purpose of this study is to determine such an impact on a cohort of patients. Data from 274 patients who underwent pancreatic surgery by our team between 1998 and 2012 was reviewed. Of those 119 patients who had pancreatic resection for adenocarcinoma were retrospectively analyzed. Patients were categorized into 3 groups: Group 1 = R1 resection (N = 39), Group 2 = R0 with involved PST (N = 54), and Group 3 = R0 with uninvolved PST (N = 26). Demographics, operative data, tumor characteristics and overall survival (OS) were evaluated. Operations performed were: Whipple (N = 53), pylorus sparing Whipple (N = 41), total pancreatectomy (N = 11), and other (N = 14). Median OS for Groups 1, 2, and 3 were 8.5 months, 12 months, and 69.6 months respectively (P < 0.001). Tumor size (P = 0.016), margin status (P = 0.006), grade (P = 0.001), stage (P = 0.037), PST status (P < 0.001), complications (P = 0.046), transfusion history (P = 0.003) were all predictors of survival. Cox regression analysis demonstrated that grade (HR = 3.1), PST involvement (HR = 2.7), transfusion requirement (HR = 2.6) and margin status (HR = 2.0) were the only independent predictors of mortality. PST is a novel predictor of poor outcome for patients with resected pancreatic cancer.
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Adenocarcinoma/patologia , Pancreatectomia , Neoplasias Pancreáticas/patologia , Neoplasias de Tecidos Moles/patologia , Adenocarcinoma/mortalidade , Adenocarcinoma/cirurgia , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Estimativa de Kaplan-Meier , Masculino , Pessoa de Meia-Idade , Invasividade Neoplásica , Estadiamento de Neoplasias , Neoplasias Pancreáticas/mortalidade , Neoplasias Pancreáticas/cirurgia , Modelos de Riscos Proporcionais , Estudos Retrospectivos , Neoplasias de Tecidos Moles/mortalidade , Neoplasias de Tecidos Moles/cirurgia , Taxa de Sobrevida , Resultado do TratamentoRESUMO
BACKGROUND: High fasting plasma glucose (FPG) levels before fluorodeoxyglucose (FDG) administration for positron emission tomography/computed tomography (PET/CT) might affect the accuracy of 18-fluoro-deoxy-glucose-positron emission tomography-computed tomography (FDG-PET/CT) in diagnosis of pancreatic lesions. Current guidelines require FPG levels of < 200 mg/dL before FDG administration; however, the literature on the effect of FPG levels of < 200 mg/dL on the accuracy of FDG-PET/CT is scarce. OBJECTIVES: The aim of this study was to evaluate the effect of FPG levels of < 200 mg/dL on the accuracy of FDG-PET/CT in diagnosis of pancreatic lesions. PATIENTS AND METHODS: In this retrospective study, 161 patients who had FDG-PET/CT for initial diagnosis of pancreatic lesions were included. Fasting plasma glucose levels before FDG administration were recorded. Accuracy of FDG-PET/CT in diagnosis of pancreatic lesions was compared between patients who were non diabetic (FPG < 126 mg/dL) and hyperglycemic (126 ≤ FPG < 200 mg/dL). RESULTS: Thirty-four patients were hyperglycemic and 127 non diabetic. Sensitivity, specificity, positive predictive value and negative predictive value of FDG-PET/CT were 90%, 88%, 87% and 91% in non diabetic and 82%, 92%, 95% and 73% in hyperglycemic patients, respectively. Overall, the accuracy was higher in non diabetic than hyperglycemic patients (89% vs. 85%). CONCLUSIONS: Accuracy of FDG-PET/CT for primary diagnosis of pancreatic lesions is higher in patients with FPG levels < 126 mg/dL than in patients with FPG levels between 126 and 200 mg/dL.
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BACKGROUND: Laparoscopic liver resection (LLR) is proposed as an alternative to open liver resection (OLR) for treatment of liver tumors. The aim of this study was to compare the surgical and oncological outcomes of LLR versus OLR in benign and malignant solid liver tumors. STUDY DESIGN: In this case-matched study, charts of 497 patients with liver lesions who had LLR or OLR in our center were retrospectively reviewed. Among them, 54 consecutive patients with benign or malignant solid liver tumors who had LLR were matched with a similar number of patients with OLR based on the pathology and extent of liver resection. Additionally, the surgical and oncological outcomes such as operating room time, amount of blood transfusion requirement, free resection margin rate, length of hospital stay, complication rate, perioperative mortality, and survival were compared between the two groups. RESULTS: Demographics, pathological characteristics of the tumor, and extent of liver resection were similar between the two groups. Twenty-nine (54%) patients in each group had malignant lesions. There were no statistically significant differences between the two groups in terms of operating room time, amount of blood transfusion requirement, free resection margin, or postoperative complication rate or survival. However, hospital stay was significantly shorter in the laparoscopic group (5.9 versus 9 days, P=.006). Although no perioperative mortality was observed in patients with benign tumors, among the patients with malignant tumors, 2 died perioperatively in each group. CONCLUSIONS: Our results in accordance with previous studies demonstrated that although the oncological outcomes of LLR and OLR were comparable, LLR patients had a shorter hospital stay.
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Carcinoma/cirurgia , Hepatectomia , Laparoscopia , Neoplasias Hepáticas/patologia , Neoplasias Hepáticas/cirurgia , Adenoma/mortalidade , Adenoma/patologia , Adenoma/cirurgia , Idoso , Carcinoma/mortalidade , Carcinoma/patologia , Feminino , Hiperplasia Nodular Focal do Fígado/mortalidade , Hiperplasia Nodular Focal do Fígado/patologia , Hiperplasia Nodular Focal do Fígado/cirurgia , Hamartoma/mortalidade , Hamartoma/patologia , Hamartoma/cirurgia , Hemangioma/mortalidade , Hemangioma/patologia , Hemangioma/cirurgia , Humanos , Tempo de Internação , Neoplasias Hepáticas/mortalidade , Masculino , Pessoa de Meia-Idade , Tumores Neuroendócrinos/mortalidade , Tumores Neuroendócrinos/patologia , Tumores Neuroendócrinos/cirurgia , Duração da Cirurgia , Estudos Retrospectivos , Taxa de Sobrevida , Resultado do TratamentoRESUMO
CONTEXT: We compared the accuracy of fluorodeoxyglucose positron emission tomography-CT (FDG-PET-CT), multi-detector computed tomography (MDCT) and CA 19-9 levels in detecting pancreatic cancer recurrence in patients with resected CA 19-9 positive pancreatic adenocarcinomas. METHODS: We retrospectively evaluated 122 patients with pancreatic adenocarcinomas who underwent surgical resection of the tumor between January 2002 and December 2011. Twenty-five patients had MDCT, FDG-PET-CT and CA 19-9 levels performed no less than six weeks post-operation and within 8 weeks of each other for detection of tumor recurrence. Of these, 20 patients had high pre-operative CA 19-9 levels that dropped to a normal level postoperatively which will be the focus of this study. The sensitivity, specificity, positive and negative predictive value (PPV, NPV), and accuracy of MDCT, FDG-PET-CT, and CA 19-9 in detecting recurrence were compared. RESULTS: Operations performed included pyloric sparing pancreaticoduodenectomy (n=9), pancreaticoduodenectomy (n=7), distal pancreatectomy (n=3) and total pancreatectomy (n=1). Three patients had no recurrence, but local recurrence and distant metastasis were seen in 8 (40%) and 12 (60%) patients, respectively. In our study, sensitivity, specificity, PPV, NPV and diagnostic effectiveness (accuracy) were: 82%, 100%, 100%, 50%, 85% for MDCT; 82%, 100%, 100%, 50%, 85% for FDG-PET-CT and 94%, 100%, 100%, 75%, 95% for CA 19-9. The difference in recurrence detection accuracy of the tests was not statistically significant. A combination of CA 19-9 with MDCT or FDG-PET-CT was 100% accurate in detecting cancer recurrence in our patients. CONCLUSION: Our data suggests that CA 19-9 levels can be used reliably to detect recurrent pancreatic adenocarcinomas in patients with CA 19-9-positive primary tumors. Combination of CA 19-9 with MDCT or FDG-PET-CT is potentially the most accurate approach in detecting pancreatic cancer recurrence.
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Adenocarcinoma/diagnóstico , Antígeno CA-19-9/metabolismo , Tomografia Computadorizada Multidetectores/métodos , Neoplasias Pancreáticas/diagnóstico , Tomografia por Emissão de Pósitrons/métodos , Tomografia Computadorizada por Raios X/métodos , Adenocarcinoma/metabolismo , Idoso , Idoso de 80 Anos ou mais , Feminino , Fluordesoxiglucose F18 , Humanos , Masculino , Pessoa de Meia-Idade , Recidiva Local de Neoplasia , Neoplasias Pancreáticas/metabolismo , Reprodutibilidade dos Testes , Estudos Retrospectivos , Sensibilidade e EspecificidadeRESUMO
UNLABELLED: There is a lack of technical guidelines for image-guided percutaneous drainage (IGPD) of pancreatic fluid collections (PFCs). To fill that void, we present a strategy and guidelines for systematic IGPD for effective PFCs evacuation. METHODS: Institutional Review Board (IRB)-approved study of 121 pancreatitis patients with symptomatic PFCs that underwent IGPD. IGPD strategy aimed at evacuation of the PFCs compartments using vigorous catheter drainage and manipulations. PFCs resolution and patients' outcome were measured. RESULTS: Pancreatitis pathogenesis and etiology included: necrotizing, 79 patients (alcoholic, 40; biliary, 20; hyperlipidemia, 8; other, 11); traumatic, 32 patients; and chronic ductal, 10 patients (pseudocysts). An ipsilateral retroperitoneal access was used for pararenal spaces PFCs (61, 50% patients), a transabdominal IGPD approach for anterior PFCs (49 patients, 41%), an intercostal/subcostal access for left subphrenic PFCs (22 patients, 18%), and a transgastric drainage route for retrogastric PFCs (9 patients, 7%). Table 1 lists the site of the pancreatic fluid collections and number and size of the catheter(s) used for IGPD of the PFCs in the 121 patients. Fifty-seven (47%) patients had positive cultures PFCs. Of these, 24 (20%) had polymicrobial infections, and 18 (15%) had fungal infections. There were 20 (11%) patients with multi-compartment drainage. PFCs resolution occurred in 102 (84%) patients. PFCs recurrence was treated by surgery (four patients) or IGPD (one patient). Pancreatic fistulas closed, except in one patient. Nine patients (7%) experienced multiorgan failure/death; 5 (4%) were lost to follow-up.
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Cateterismo/métodos , Drenagem/métodos , Pancreatite/terapia , Terapia Assistida por Computador/métodos , Tomografia Computadorizada por Raios X , Ultrassonografia de Intervenção , Adolescente , Adulto , Idoso , Algoritmos , Cateterismo/efeitos adversos , Criança , Pré-Escolar , Drenagem/efeitos adversos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Pancreatite/diagnóstico por imagem , Estudos RetrospectivosRESUMO
Heterotopic pancreatic tissue is not uncommon. Although the cancerous transformation of heterotopic pancreatic tissue is a theoretical possibility, it is an extremely rare phenomenon. The majority of the heterotopic pancreatic malignancies reported in the literature are adenocarcinomas (32 cases). An Acinar Cell Carcinoma (ACC) arising from heterotopic pancreatic tissue is even less common with only six cases being reported. This report presents an extremely rare case of heterotopic pancreatic ACC presenting as a duodenal mass. We propose that heterotopic pancreatic ACC should be considered as a possibility in the differential diagnosis of a duodenal mass.
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Carcinoma de Células Acinares/patologia , Coristoma/patologia , Duodenopatias/patologia , Pâncreas/patologia , Carcinoma de Células Acinares/diagnóstico , Coristoma/diagnóstico , Diagnóstico Diferencial , Duodenopatias/diagnóstico , Humanos , Masculino , Pessoa de Meia-IdadeRESUMO
INTRODUCTION: Reflecting the resected portion of the proximal jejunum behind the mesenteric vessels during a pancreaticoduodenectomy (Whipple) procedure can be a challenging maneuver. METHODS: We describe a simple technique employing a penrose drain that is sutured to the resected "specimen" portion of the jejunum and then pulling it behind the mesenteric vessels. RESULTS: Seven patients underwent this procedure over a 2-month period without difficulties. CONCLUSIONS: This simple technique helps simplify one of the key maneuvers in performing a Whipple procedure.
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Pancreaticoduodenectomia/métodos , Adulto , Idoso , Feminino , Humanos , Jejuno/cirurgia , Masculino , Pessoa de Meia-Idade , Pancreaticoduodenectomia/instrumentaçãoRESUMO
BACKGROUND: Liver cysts are often asymptomatic. Symptomatic liver cysts are uncommon and can be managed by percutaneous aspiration, laparoscopic/open marsupialization, or resection. Our aim is to review our experience with management of giant liver cysts (GLC). MATERIALS AND METHODS: An IRB approved chart review of patients with liver cysts between 1995-2009 was performed. There were 34 GLC in 24 patients, 20 (83%) were females (mean age of 59.2 y). Pain was the main symptom in 20 patients. The average cyst size was 15.66 cm (6-32 cm) with 14 cysts over 15 cm in size. Two patients with GLC (11 and 15 cm) decided not to have surgery; 16 patients underwent laparoscopic surgery with one recurrence. One patient with laparoscopic marsupialization at another center was managed by open marsupialization and repair of the bile leak. Four of the patients underwent open marsupialization and one underwent open resection. Four patients with prior percutaneous aspiration had recurrences (100%), three underwent laparoscopic and one open marsupialization. An 8-wk pregnant patient underwent percutaneous aspiration of a 32 cm cyst to alleviate symptoms until delivery. RESULTS: The mean hospital stay for laparoscopic marsupialization was 5.57 d compared with 9.2 d for open procedure. Three (18.7%) postoperative complications (bile leak, recurrence, bleeding) occurred in the laparoscopic group, and one (20%) bile leak in the open group, with a mean follow-up of 41 mo. CONCLUSION: Laparoscopic marsupialization of GLC is as effective and safe as open procedures in preventing cyst recurrence regardless of cyst size and location, and affords a relatively shorter hospital stay.