Neoplasia mucinosa papilar intraductal del páncreas: características clínico-patológicas y supervivencia a largo plazo de pacientes sometidos a pancreatectomía / Intraductal papillary mucinous neoplasm of pancreas: clinicopathological features and long-term survival after surgical resection

Introducción La neoplasia mucinosa papilar intraductal (NMPI) del páncreas puede progresar de displasia de bajo grado a displasia de alto grado y carcinoma invasivo asociado. El objetivo de este trabajo fue describir las características clínico-patológicas y los resultados de seguimiento a largo plazo de pacientes con pancreatectomía por NMPI. Métodos En este estudio retrospectivo de un solo centro, se analizan los resultados de los pacientes sometidos a resección pancreática, con diagnóstico anatomopatológico de NMPI, desde enero del 2009 a diciembre del 2019. Resultados Un total de 31 pacientes tuvieron diagnóstico de NMPI. Nueve pacientes fueron varones y 22 mujeres. La edad media fue de 67 años. Veintisiete pacientes (87%) presentaron síntomas. Los estigmas de alto riesgo se encontraron en 20 pacientes (64,5%) y las características preocupantes («worrisome features») en 10 pacientes (32,2%). Siete pacientes tuvieron NMPI tipo conducto principal, 13 NMPI tipo rama y 11 NMPI tipo mixto. El carcinoma invasivo asociado estuvo presente en 13 pacientes (41,9%), la displasia de alto grado en 4 pacientes (12,9%) y la displasia de bajo grado en 14 pacientes (45,2%). El tiempo de seguimiento fue de 2 a 12 años. La supervivencia media de los pacientes con NMPI y carcinoma invasivo asociado fue de 45,8 meses y la supervivencia libre de enfermedad de estos pacientes fue de 40,8 meses. Conclusiones En nuestros pacientes operados, la NMPI tuvo mayor prevalencia en mujeres, fue predominantemente sintomática y tuvo una elevada incidencia de carcinoma invasivo asociado a las de tipo rama. La supervivencia a 5 años fue buena aun con carcinoma invasivo asociado. (AU)

Introduction Intraductal papillary mucinous neoplasm (IPMN) of pancreas can progress from low grade dysplasia to high grade dysplasia and invasive carcinoma. Methods in this single center retrospective series we analyze the clinicopathological features and long-term follow up of patients who underwent pancreatic resection for IPMN, from January 2009 to December 2019. Results 31 patients were diagnosed with IPMN. Nine males and 22 females. The mean age was 67 years. Twenty-seven patients (87%) were symptomatic. Seven patients had main duct IPMN, 11 branch type IPMN and 13 mixed type IPMN. High-risk stigmata were found in 20 patients (64.5%) and worrisome features in 10 patients (32.2%). Thirteen patients (41.9%) had an associated invasive carcinoma, 4 (12.9%) high-grade dysplasia and 14 (45.2%) low-grade dysplasia. The follow-up was from 2 to 12 years. Median survival for patients with IPMN and associated invasive carcinoma was 45.8 months and disease-free survival was 40.8 months. Conclusions IPMN had higher prevalence in females, mostly symptomatic and high incidence of associated invasive carcinoma with branch type. The 5-year survival was good even with associated invasive carcinoma. (AU)

Intraductal papillary mucinous neoplasm of pancreas: Clinicopathological features and long-term survival after surgical resection.

INTRODUCTION: Intraductal papillary mucinous neoplasm (IPMN) of the pancreas can progress from low-grade dysplasia to high-grade dysplasia and invasive carcinoma. METHODS: In this single-center retrospective series, we analyze the clinicopathological features and long-term follow up of patients who underwent pancreatic resection for IPMN, from January 2009 to December 2019. RESULTS: 31 patients were diagnosed with IPMN: 9 males and 22 females. Mean age was 67 years. Twenty-seven patients (87%) were symptomatic. Seven patients had main duct IPMN, 11 branch-type IPMN and 13 mixed-type IPMN. High-risk stigmata were found in 20 patients (64.5%) and worrisome features in 10 patients (32.2%). Thirteen patients (41.9%) had an associated invasive carcinoma, 4 (12.9%) high-grade dysplasia and 14 (45.2%) low-grade dysplasia. The follow-up was from 2 to 12 years. Median survival for patients with IPMN and associated invasive carcinoma was 45.8 months, and disease-free survival was 40.8 months. CONCLUSIONS: IPMN had a higher prevalence in females, mostly symptomatic and high incidence of associated invasive carcinoma with branch type. The 5-year survival was good even with associated invasive carcinoma.

Distal pancreatectomy: experience in a National Hospital.

AIMS: To compare the short-term outcomes of patients undergoing open DP (ODP) and laparoscopic DP (LDP); and to analyze the association between the section site of the pancreas and pancreatic fistula. MATERIALS AND METHODS: Clinical, perioperative, and histopathologic data of patients who underwent ODP and LDP between 2009 and 2019 were retrospectively analyzed. RESULTS: 70 patients were included. 39 (56%) underwent ODP and 31 (44%) underwent LDP. The tumor size in ODP group was 70mm and in LDP group was 45mm (p = 0,032) Blood loss was lower in LDP group (229mL versus 498mL) (p = 0,001). Operative time, spleen preservation, B/C pancreatic fistula, major morbidity, reoperation, and length of hospital stay, were similar in both groups. There was no postoperative mortality. No differences were found in B/C pancreatic fistula rate regarding to pancreatic transection site. CONCLUSIONS: LDP is a safe procedure, with perioperative outcomes similar to ODP and with less blood loss. The pancreatic transection site did not influence post-operative pancreatic fistula rate.

OBJETIVOS: Comparar los resultados a corto plazo de pacientes intervenidos mediante pancreatectomía distal abierta (PDA) y laparoscópica (PDL); y analizar si el lugar de la sección del páncreas tiene relación con la formación de fístula pancreática. MATERIALES Y MÉTODOS: Serie retrospectiva y descriptiva de las PD realizadas, desde enero del 2009 a diciembre del 2019. Se compararon las características clínicas, perioperatorias e histopatológicas de pacientes con PDA y PDL. RESULTADOS: Se incluyeron 70 pacientes. Treinta y nueve casos (56%) con PDA y 31 casos (44%) con PDL. El tamaño tumoral promedio en la PDA fue de 70 mm y en la PDL 45 mm (p = 0.032). La pérdida sanguínea fue menor en la PDL (229 vs. 498 ml) (p = 0.001). No se encontró diferencia significativa en tiempo operatorio, porcentaje de preservación esplénica, fístula pancreática B/C, reoperación, morbilidad mayor y estancia hospitalaria. No hubo mortalidad postoperatoria. No hubo diferencias en la formación de fístula pancreática con respecto al lugar de sección del páncreas. CONCLUSIONES: La PDL es un procedimiento seguro, con resultados perioperatorios similares a la PDA y con menor pérdida sanguínea. El lugar de sección del páncreas no tuvo relación con la formación de fístula pancreática.

Laparoscopic splenectomy and proximal splenorenal shunt for portal hypertension due to portal vein thrombosis in a patient with protein S deficiency.

Portal vein thrombosis (PVT) is a rare condition in the general population that develops serious complications if left untreated for long time. We present a case of a 29-year-old woman who developed PVT due to protein S deficiency versus neonatal funiculitis. Over time, the patient developed upper gastrointestinal bleeding due to esophageal varices and hypersplenism with splenic sequestration that caused minor bleeding episodes. Laparoscopic splenectomy and proximal splenorenal shunt with distal pancreatectomy due to aneurysmal dilatations of the splenic artery were successfully performed to avoid mayor progression of portal hypertension. Patient was discharged with indefinite anticoagulation and after surgery platelets raised up to 200x103/mm3. Laparoscopic splenectomy and proximal splenorenal shunt for portal hypertension due to portal vein thrombosis is an adequate surgery procedure which should be applied in these medical cases.

Laparoscopic splenectomy and proximal splenorenal shunt for portal hypertension due to portal vein thrombosis in a patient with protein S deficiency

Portal vein thrombosis (PVT) is a rare condition in the general population that develops serious complications if left untreated for long time. We present a case of a 29-year-old woman who developed PVT due to protein S deficiency versus neonatal funiculitis. Over time, the patient developed upper gastrointestinal bleeding due to esophageal varices and hypersplenism with splenic sequestration that caused minor bleeding episodes. Laparoscopic splenectomy and proximal splenorenal shunt with distal pancreatectomy due to aneurysmal dilatations of the splenic artery were successfully performed to avoid mayor progression of portal hypertension. Patient was discharged with indefinite anticoagulation and after surgery platelets raised up to 200x103/mm3. Laparoscopic splenectomy and proximal splenorenal shunt for portal hypertension due to portal vein thrombosis is an adequate surgery procedure which should be applied in these medical cases.

La trombosis de la vena porta (TVP) es una afección poco común en la población general que desarrolla complicaciones graves si no se trata durante mucho tiempo. Presentamos el caso de una mujer de 29 años que desarrolló TVP por deficiencia de proteína S versus funiculitis neonatal. Con el tiempo, la paciente desarrolló hemorragia digestiva alta por varices esofágicas e hiperesplenismo con secuestro esplénico que provocó episodios hemorrágicos menores. La esplenectomía laparoscópica y la derivación esplenorrenal proximal con pancreatectomía distal por dilataciones aneurismáticas de la arteria esplénica se realizaron con éxito para evitar una mayor progresión de la hipertensión portal. La paciente fue dada de alta con anticoagulación indefinida y tras la cirugía se elevaron las plaquetas hasta 200x103/mm3. La esplenectomía laparoscópica y la derivación esplenorrenal proximal para la hipertensión portal por trombosis de la vena porta es un procedimiento quirúrgico adecuado que debe aplicarse en estos casos médicos.