Clinical Analysis of Traumatic Pancreatic Injury

PURPOSE: Althoughpancreas injury is rare in abdominal trauma,it posesa challengeto the surgeon because its clinicalfeaturesare not prominentand the presence of main duct injurycannot be easily identified by imaging studies. Furthermore, severe pancreas injuries require a distal pancreatectomy or a pancreaticoduodnectomy which are associated considerable morbidity and mortality. We reviewed the clinical features of and outcomes for patients with pancreas injury. METHODS: For 10 years from Jan. 2001 to Dec. 2010, thirty-four patients were diagnosedas having pancreas injury by using an explo-laparotomy. Patients successfully treated bynon-operative management were excluded. Patients were divided into early (n=18) and delayed surgery groups (n=11) based on an interval of 24hours between injury and surgery. The clinical features of and the outcomes for the patients in both groups were compared. RESULTS: Males were more commonly injured (82.4% vs.17.6%). The mean age was 37.2 years. The injury mechanisms included vehicle accidents (62.9%, 22/34), assaults (20%, 7/34), and falls (11.4%, 3/34)). The head and neck of the pancreas was most commonly injured, followed by the body and the tail (16, 12, and 6 cases). Of the 34 patients, 26 (76.5%) patients had accompanying injuries. Grade 1 and 2 occurred in 14 (5 and 9) patients, and grade 3, 4, and 5 occurred in 20 (16, 3, and 1) patients. The early and delayed surgery groups showed no difference in surgical outcomes. Two patients with grade 3 in the early surgery group died after surgery,one due tomassive hemorrhage and the other due to septic shock. Of the five patients initially managed non-operatively,three developed peripancreatic necrosis and two developed pseudocyst. All five patients were successfully cured by surgery. CONCLUSION: All cases of pancreas injury in this study involved blunt injury, and accompanying injury to major vessels or the bowel was the major cause of mortality. Surgery delayed for longer than 24 hours after was not associated with adverseoutcomes.

Predictive factors for invasive intraductal papillary mucinous neoplasm of the pancreas

BACKGROUNDS/AIMS: Intraductal papillary mucinous neoplasm (IPMN) of the pancreas has malignant potential. Predicting invasive IPMN has proven difficult and controversial. We tried to identify predictive factors for invasive IPMN. METHODS: Thirty six patients underwent resection for IPMN from February 2001 to July 2011. Clinicopathological features including demographic, imaging, microscopic, and serological findings were retrospectively reviewed. Receiver operating characteristic (ROC) curve analysis was used to analyze sensitivity and specificity of all possible cut-off values for the diameter of the main pancreatic duct and mass size predicting invasive IPMN. Student t-test, chi-square test, and logistic regression were used for univariate and multivariate analysis. RESULTS: The mean age was 63.5+/-8.4 years. Males were more commonly affected (58.3% vs 41.7%). Pancreaticoduodenectomy was performed in 55.6% of patients, distal pancreatectomy in 36.1%, and central pancreatic resection in 8.3%. Non-invasive IPMNs were present in 80.6% (n=29), whereas invasive IPMNs were present in 19.4% (n=7). In univariate analysis, tumor location (p=0.036), Kuroda classification (p=0.048), mural nodule (p=0.016), and main duct dilatation (> or =8 mm) (p=0.006) were statistically significant variables. ROC curve analysis showed that a value of 8 mm for the main duct dilatation and a value of 35 mm for the size of the mass lesion have 80% sensitivity and 75% specificity and 100% sensitivity and 82.6% specificity, respectively. However, in multivariate analysis, main ductal dilatation (> or =8 mm) was identified to be the only independent factor for invasive IPMN (p=0.049). CONCLUSIONS: Main duct dilatation appears to be a useful indicator for predicting invasive IPMN.

Laparoscopic versus Open Approaches for Sigmoid Colon and Rectal Cancer: Comparison of Intraoperative Carcinoembryonic Antigen Elevation / 대한내시경복강경외과학회지

PURPOSE: Although the overall survival and recurrence rates after open or laparoscopic surgery for colorectal cancer are similar, the potential oncological benefits of laparoscopic surgery have not been established. This study compared the effects of the two surgical approaches (open and laparoscopic) on the intraoperative inferior mesenteric vein (IMV) carcinoembryonic antigen (CEA) levels in patients who were undergoing open or laparoscopic surgery for sigmoid colon and rectal cancer. METHODS: Between December 2005 and July 2008, a total of 37 patients were enrolled in this study. Twenty one patients underwent open surgery and 16 patients were operated on laparoscopically. The baseline peripheral CEA level was measured preoperatively. The IMV blood was taken before and after mobilization of the cancer-bearing bowel segment and the CEA levels in the two groups were compared. RESULTS: The baseline CEA levels in the peripheral vein were similar in the two groups. After mobilization, the overall CEA level was elevated. The median pre-mobilization CEA levels of the open and laparoscopic group were 2.3 (range: 1.2~3.7) ng/ml and 1.5 (range: 1.0~2.6) ng/ml, respectively. Hence, the degree of CEA elevation after mobilization was significantly higher in the open surgery group compared with that of the laparoscopic approach (4.2 vs. 1.6, respectively, p=0.004). CONCLUSION: The CEA levels measured from the IMV after mobilization were elevated to a lesser degree after laparoscopic mobilization of the cancer-bearing bowel segment, as compared with that of open surgery. However, the long term oncological effects need to be examined by conducting longer, larger scale studies.