RESUMEN
INTRODUCTION: Patients undergoing pancreaticoduodenectomy for distal cholangiocarcinoma (dCCA) often develop cancer recurrence. Establishing timing, patterns and risk factors for recurrence may help inform surveillance protocol strategies or select patients who could benefit from additional systemic or locoregional therapies. This multicentre retrospective cohort study aimed to determine timing, patterns, and predictive factors of recurrence following pancreaticoduodenectomy for dCCA. MATERIALS AND METHODS: Patients who underwent pancreaticoduodenectomy for dCCA between June 2012 and May 2015 with five years of follow-up were included. The primary outcome was recurrence pattern (none, local-only, distant-only or mixed local/distant). Data were collected on comorbidities, investigations, operation details, complications, histology, adjuvant and palliative therapies, recurrence-free and overall survival. Univariable tests and regression analyses investigated factors associated with recurrence. RESULTS: In the cohort of 198 patients, 129 (65%) developed recurrence: 30 (15%) developed local-only recurrence, 44 (22%) developed distant-only recurrence and 55 (28%) developed mixed pattern recurrence. The most common recurrence sites were local (49%), liver (24%) and lung (11%). 94% of patients who developed recurrence did so within three years of surgery. Predictors of recurrence on univariable analysis were cancer stage, R1 resection, lymph node metastases, perineural invasion, microvascular invasion and lymphatic invasion. Predictors of recurrence on multivariable analysis were female sex, venous resection, advancing histological stage and lymphatic invasion. CONCLUSION: Two thirds of patients have cancer recurrence following pancreaticoduodenectomy for dCCA, and most recur within three years of surgery. The commonest sites of recurrence are the pancreatic bed, liver and lung. Multiple histological features are associated with recurrence.
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Neoplasias de los Conductos Biliares , Colangiocarcinoma , Recurrencia Local de Neoplasia , Pancreaticoduodenectomía , Humanos , Colangiocarcinoma/cirugía , Colangiocarcinoma/patología , Femenino , Masculino , Estudios Retrospectivos , Neoplasias de los Conductos Biliares/cirugía , Neoplasias de los Conductos Biliares/patología , Recurrencia Local de Neoplasia/epidemiología , Anciano , Persona de Mediana Edad , Factores de Riesgo , Factores de Tiempo , Neoplasias Hepáticas/cirugía , Neoplasias Hepáticas/patología , Neoplasias Pulmonares/cirugía , Neoplasias Pulmonares/patologíaRESUMEN
BACKGROUND: Accurate pancreatic and periampullary cancer staging with resectability assessment is vital to optimize surgical management and improve patient outcomes. The aim of this study is to assess the usefulness of a standardized reporting template. METHODS: Retrospective review of all surgically managed patients with pancreatic or periampullary malignancy between January 2018 and June 2019. Pre-operative CT imaging report was anonymised and audited against a modified NCCN reporting template. The same imaging studies were re-reported by two experienced GI radiologists using the same template. RESULTS: Fifty-nine patients (37 male) with median age of 68 years (36-83) underwent surgery for suspected pancreatic/peri-ampullary malignancy. The median time between pre-operative CT scan and surgery was 56.5 days (14-225). The use of reporting template resulted in significant increase in number of reported key features (p < 0.005), interobserver agreed features (p < 0.005) and overall k-value assessed interobserver agreement (p < 0.005). Template reports correlated closely with key intraoperative findings whilst primary free text reports did not (k-value 0.85-0.96 versus 0.20-0.46, p < 0.05). CONCLUSION: The use of a reporting template resulted in a more complete and accurate pancreatic/peri-ampullary tumour evaluation, improved inter-observer relatability and correlation with intraoperative findings.
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Adenocarcinoma , Neoplasias Pancreáticas , Adenocarcinoma/patología , Adulto , Anciano , Anciano de 80 o más Años , Humanos , Masculino , Persona de Mediana Edad , Estadificación de Neoplasias , Páncreas/diagnóstico por imagen , Páncreas/patología , Páncreas/cirugía , Neoplasias Pancreáticas/diagnóstico por imagen , Neoplasias Pancreáticas/patología , Neoplasias Pancreáticas/cirugía , Tomografía Computarizada por Rayos XRESUMEN
We describe a remote sensing and GIS-based study that has three objectives: (1) characterize fine particulate matter (PM2.5), insolation and land surface temperature using NASA satellite observations, EPA ground-level monitor data and North American Land Data Assimilation System (NLDAS) data products on a national scale; (2) link these data with public health data from the REasons for Geographic And Racial Differences in Stroke (REGARDS) national cohort study to determine whether these environmental risk factors are related to cognitive decline, stroke and other health outcomes; and (3) disseminate the environmental datasets and public health linkage analyses to end users for decision-making through the Centers for Disease Control and Prevention (CDC) Wide-ranging Online Data for Epidemiologic Research (WONDER) system. This study directly addresses a public health focus of the NASA Applied Sciences Program, utilization of Earth Sciences products, by addressing issues of environmental health to enhance public health decision-making.
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Enfermedad de Erdheim-Chester/diagnóstico por imagen , Anciano , Biopsia , Medios de Contraste , Diagnóstico Diferencial , Humanos , Fracturas del Húmero/diagnóstico por imagen , Masculino , Radiofármacos , Medronato de Tecnecio Tc 99m , Tomografía Computarizada de Emisión , Tomografía Computarizada por Rayos XAsunto(s)
Cistocele/complicaciones , Cistocele/patología , Procedimientos Quirúrgicos Ginecológicos/métodos , Músculo Esquelético/diagnóstico por imagen , Músculo Esquelético/patología , Prolapso de Órgano Pélvico/etiología , Prolapso de Órgano Pélvico/cirugía , Adulto , Anciano , Anciano de 80 o más Años , Fenómenos Biomecánicos , Colágeno/fisiología , Femenino , Estudios de Seguimiento , Humanos , Imagen por Resonancia Magnética , Persona de Mediana Edad , Diafragma Pélvico/diagnóstico por imagen , Diafragma Pélvico/patología , Estudios Prospectivos , Calidad de Vida , Radiografía , Resultado del TratamientoRESUMEN
Benign biliary strictures (BBS) are difficult to treat. The majority of them are treated either endoscopically or using percutaneous techniques either with stents or conventional angioplasty balloons. To our knowledge we present the first case of use of a cutting balloon in the treatment of BBS through a percutaneous approach.
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Enfermedades de los Conductos Biliares/cirugía , Cateterismo/instrumentación , Conducto Colédoco , Adulto , Pancreatocolangiografía por Resonancia Magnética , Constricción Patológica/cirugía , Femenino , HumanosRESUMEN
A 20-year-old woman with Down syndrome (trisomy 21) and acute lymphoblastic leukemia presented with severe respiratory compromise secondary to bilateral chylothorax as a result of central venous thrombosis and extensive upper-limb deep venous thrombosis. The chylothorax was successfully managed by catheter-directed thrombolysis and angioplasty of the venous occlusions. The development of venous thrombosis was likely to have been multifactorial. It is recognized that there is an increased incidence of congenital lymphatic anomalies in Down syndrome, which may have been a contributing factor in the development of chylothorax in this patient. This report illustrates the angiographic findings, demonstrates the successful vascular recanalization, and discusses the etiology and management of central venous thrombosis and chylothorax. The case is also presented to contribute to the expanding evidence in support of catheter-directed venous thrombolysis in selected clinical circumstances.