Medical versus surgical management for emphysematous pancreatic necrosis: is gas within pancreatic necrosis an absolute indication for surgery?

OBJECTIVES: The aim of this study was to evaluate whether pancreatic necrosis with presence of gas is an absolute indication for surgery or if there is a possibility for the medical management of this pathology. METHODS: This study is a retrospective study including 56 patients with diagnosis of pancreatic necrosis and gas on computed tomography from April 2003 to March 2011. We recorded all the factors related to each group of treatment, including APACHE II score, C-reactive protein level, Tomographic Severity Index, organ and multiorgan failure, and infected necrosis after fine-needle puncture, to evaluate the differences between surgical and medical treatment. RESULTS: Thirty-six (64%) of these patients were submitted to surgery, whereas 20 (36%) were managed conservatively. Twenty-eight patients (78%) who underwent surgery had infected necrosis. Thirty-five percent of the patients (7 patients) in the medical group had organ failure versus 83% of the patients in the surgical group. CONCLUSIONS: Pancreatic necrosis with gas on computed tomography is a relative indication for surgery. Medical management is a feasible and safe possibility for this pathology in selected cases. The presence of organ failure and infected necrosis often precludes a surgical treatment.

Características clínico patológicas de los tumores quísticos del páncreas / Clinicopathologic characteristics of the pancreatic cystic tumors

Los tumores quísticos del páncreas han pasado de ser una entidad poco frecuente a representar hasta el 25% de la patología quirúrgica de este órgano. Objetivo: Evaluar la frecuencia de presentación de cada variedad y el comportamiento de los tumores quísticos de páncreas operados en nuestra unidad. Materiales y métodos: Durante el período comprendido entre octubre de 2002 y diciembre de 2013 en la Unidad de Páncreas han sido operados 708 pacientes con tumores de páncreas, de los cuales se analizan 146 casos de tumores quísticos. Resultados: El diagnóstico preoperatorio de tumor quístico se realizó en el 91% de los casos, sin embargo solo fue posible identificar de qué tipo de tumor quístico se trataba en el 73%. En 128 (88%) casos se pudo resecar el tumor quístico, mientras en 3 pacientes se realizó una cirugía derivativa y en 15 se efectuaron una exploración y biopsia por tratarse de casos avanzados con extensión de la enfermedad. Al evaluar el comportamiento en lo que respecta a la malignidad de cada uno de los cuatro tipos de tumores quísticos, observamos que el que presentaba mayor incidencia de cáncer en la serie fue el intraductal papilar mucinoso con 53%, seguido de las neoplasias mucinosas quísticas con 50% en tanto que el sólido pseudopapilar presentó 29% de degeneración maligna, no existiendo ningún caso de cistoadenocarcinoma seroso con cáncer. Conclusiones: Los tumores quísticos son lesiones frecuentemente encontradas en el páncreas. Es muy importante diferenciar cada uno de ellos debido a que presentan un alto potencial de malignidad, el cual puede llegar hasta 53% como es el caso del intraductal papilar mucinoso...

Formerly an infrequent pathology, pancreatic cystic tumors stand nowadays for 25% of all pancreatic surgical diseases. Objective: Evaluate the frequency of the presentation of each type and the behavior of the pancreatic cystic tumors that went to surgery in our unit. Materials and methods: In our Pancreas Unit, 708 patients with pancreatic tumors underwent surgery in the period between October 2002 and December 2013. 146 cases of pancreatic cystic tumors taken from that group are the topic of the present study. Results: Even when diagnosing pancreatic tumors as cystic tumors was possible in 91% of cases during pre-op evaluation, categorizing the type of cystic tumor was only possible in 73% of cases. In 128 cases (88%), cystic tumors were removable. Due to advanced disease, in 3 cases only diversion surgery was possible and, in 15 cases, exploration and biopsy was the only choice. When the frequency of malignancy was assessed for all four types of pancreatic cystic tumors, the one most frequently becoming malignant was mucinous papillary intraductal (53%), followed by mucinous cystic (50%). Solid pseudopapillary pancreatic cystic tumors became malignant in 29% of cases and for serous cystoadenoma the frequency of malignancy was nihil. Conclusions: Cystic tumors are the most frequent type of pancreatic lesion. ItÆs of paramount importance to categotize them since risk of malignancy can be as high as 52% in case of mucinous intraductal papillary type...

[Clinicopathologic characteristics of the pancreatic cystic tumors]. / Características clínico patológicas de los tumores quísticos del páncreas.

UNLABELLED: Formerly an infrequent pathology, pancreatic cystic tumors stand nowadays for 25% of all pancreatic surgical diseases. OBJECTIVE: Evaluate the frequency of the presentation of each type and the behavior of the pancreatic cystic tumors that went to surgery in our unit. MATERIALS AND METHODS: In our Pancreas Unit, 708 patients with pancreatic tumors underwent surgery in the period between October 2002 and December 2013. 146 cases of pancreatic cystic tumors taken from that group are the topic of the present study. RESULTS: Even when diagnosing pancreatic tumors as cystic tumors was possible in 91% of cases during pre-op evaluation, categorizing the type of cystic tumor was only possible in 73% of cases. In 128 cases (88%), cystic tumors were removable. Due to advanced disease, in 3 cases only diversion surgery was possible and, in 15 cases, exploration and biopsy was the only choice. When the frequency of malignancy was assessed for all four types of pancreatic cystic tumors, the one most frequently becoming malignant was mucinous papillary intraductal (53%), followed by mucinous cystic (50%). Solid pseudopapillary pancreatic cystic tumors became malignant in 29% of cases and for serous cystoadenoma the frequency of malignancy was nihil. CONCLUSIONS: Cystic tumors are the most frequent type of pancreatic lesion. It's of paramount importance to categotize them since risk of malignancy can be as high as 52% in case of mucinous intraductal papillary type.