[Pancreatic lipomatous hamartoma: A case report and literature review]. / Hamartoma lipomatoso pancreático: Reporte de caso y revisión de la literatura.

Pancreatic hamartomas (PH) are extremely unusual non-neoplastic tumor-like lesions and accounts for <1% of all hamartomas. Moreover, there is a distinct variant of PH denominated Pancreatic lipomatous hamartoma (PLH), that is even rarer, with only 5 cases, including the present case, reported in the literature. PLH lacks well-defined features and clinically can be mistaken with other lipomatous lesions of the pancreas, including lipoma, pancreatic lipomatosis, PEComa, liposarcoma, and malignant tumors with lipomatous components. Here, we describe a case of PLH in a 70-year-old male with abdominal pain and a lesion, which was preoperatively diagnosed as a pancreatic no functional low-grade neuroendocrine tumor, and subsequent underwent a laparoscopic enucleation of the tumor. The postoperative pathology and immunohistochemical analyses confirmed the diagnosis of PLH.

Hamartoma lipomatoso pancreático: Reporte de caso y revisión de la literatura

Los hamartomas pancreáticos (HP) son lesiones no neoplásicas extremadamente inusuales y representan < 1% de todos los hamartomas. Además, existe una variante distintiva denominada Hamartoma Lipomatoso Pancreático (HLP), que es aún más raro, con solo 5 casos, incluyendo el presente reporte, descritos en la literatura. HLP carecen de características específicas y clínicamente puede ser confundido con otras lesiones lipomatosas pancreáticas, como lipoma, lipomatosis pancreática, PEComa, liposarcoma y tumores malignos con componentes lipomatosos. El presente reporte describe un caso de HLP en un paciente varón de 70 años, que aquejaba de dolor y masa abdominal, preoperatoriamente diagnosticado como tumor neuroendocrino de bajo grado no funcionante pancreático. Subsecuentemente, fue sometido a enucleación laparoscópica del tumor. El reporte patológico postoperatorio y los estudios de inmunohistoquímica confirmaron el diagnóstico de HLP.

Pancreatic hamartomas (PH) are extremely unusual non-neoplastic tumor-like lesions and accounts for <1% of all hamartomas. Moreover, there is a distinct variant of PH denominated Pancreatic lipomatous hamartoma (PLH), that is even rarer, with only 5 cases, including the present case, reported in the literature. PLH lacks well-defined features and clinically can be mistaken with other lipomatous lesions of the pancreas, including lipoma, pancreatic lipomatosis, PEComa, liposarcoma, and malignant tumors with lipomatous components. Here, we describe a case of PLH in a 70-year-old male with abdominal pain and a lesion, which was preoperatively diagnosed as a pancreatic no functional low-grade neuroendocrine tumor, and subsequent underwent a laparoscopic enucleation of the tumor. The postoperative pathology and immunohistochemical analyses confirmed the diagnosis of PLH.

Clinicopathological factors associated with the presence of tumor deposits in resected gastric cancer patients.

PURPOSE: The role of tumor deposits (TDs) in the staging of gastric cancer is currently debatable. TDs are defined as tumoral nodules in perigastric adipose tissue with no evidence of lymphatic, vascular, or neural structures. Clinicopathological factors related to the presence of TDs are not well defined. This study aimed to identify the clinicopathological factors associated with the presence of TDs in resected gastric cancer patients. MATERIALS AND METHODS: This prospective study included patients diagnosed with gastric cancer and treated with D2 radical gastrectomy from January 2019 to January 2020. Univariate and multivariate analyses were performed to determine the factors related to the presence of TDs. RESULTS: A total of 111 patients were eligible and TDs were present in 31 of them (28%). In the univariate analysis, male gender (p = 0.027), tumor size ≥ 5cm (p = ≤0.001), serosa and adjacent organs invasion (pT4a and pT4b) (p = ≤0.001), ≥16 metastatic lymph nodes (pN3b) (p = ≤0.001), and TNM stage III tumors (p = ≤0.001) were significantly associated with the presence of TDs. The multivariate analysis showed that a tumors size ≥5 cm (OR = 3.69, 95% CI: 1.17-11.6), serosa and adjacent organs invasion (pT4a and pT4b) (OR = 3.78, 95% CI: 1.31-10.86) and ≥16 metastatic lymph nodes (pN3b) (OR = 3.21, 95%CI:1.06-9.7) were independent risk factors for the presence of TDs. CONCLUSIONS: Larger tumors (tumor size ≥ 5cm), serosa and adjacent organs invasion (pT4 and pT4b), and ≥16 metastatic lymph nodes (pN3b) were independent risk factors for the presence of TDs.

Recuperación mejorada después de cirugía en cáncer colorrectal. Instituto Nacional de Enfermedades Neoplásicas / Enhanced recovery after surgery in colorectal cancer. Instituto Nacional de Enfermedades Neoplásicas

RESUMEN Objetivo : Describir y analizar la seguridad de la aplicación del programa de "Recuperación Mejorada Después de Cirugía" (ERAS) para cirugía electiva por cáncer colorrectal. Materiales y Métodos : Estudio observacional retrospectivo de 272 pacientes con cáncer colorrectal operados con cirugía electiva entre enero 2019 y setiembre 2020 en el Instituto Nacional de Enfermedades Neoplásicas, Perú. Se utilizó la Prueba U de Mann-Whitney, Chi-cuadrado de Pearson, y odds ratios (OR) para el análisis estadístico. Resultados : 90 pacientes ingresaron al programa ERAS con una mediana de estancia hospitalaria postoperatoria de 3 días (rango 3-19). La cirugía laparoscópica se realizó en el 53 % de los casos, con una estancia hospitalaria significativamente menor que los pacientes con cirugía convencional (p=0,035). El inicio de la tolerancia oral < 24 horas se realizó en el 91 % de casos y la deambulación temprana en 89 %. La incidencia de complicaciones postoperatorias fue de 29 %, mayor en los pacientes con resección de recto/ano que en el grupo con resección de colon (40 % vs 20 %, p=0,043) (OR=2,67, IC del 95 %: 1,02 - 7,01). Ocho pacientes presentaron complicación mayor, 4 con dehiscencia de anastomosis y 4 requirieron readmisión hospitalaria. Conclusiones : El manejo según ERAS para cirugía electiva por cáncer colorrectal es seguro y factible con un riesgo de morbimortalidad perioperatoria aceptable.

ABSTRACT Aim : Describe and analyze the safety of the "Enhanced Recovery After Surgery" (ERAS) protocol in elective procedures for colorectal cancer. Materials and Methods : Observational study of 272 patients with colorectal cancer who underwent elective surgery from January 2019 to September 2020 at the "Instituto Nacional de Enfermedades Neoplásicas", Peru, were retrospectively collected. U Mann-Whitney test, Pearson chi-square test and odds ratios (OR) were used for statistical analysis. Results : 90 patients were included in the ERAS program with a median postoperative hospital stay of 3 days (range 3-19). Laparoscopic surgery was performed in 53% of the patients with significantly shorter postoperative hospital stay in comparison with the patients who had open surgery (p=0,035). Oral food intake less than 24 hours postoperatively was 91%, and early mobilization in 89% of the cases. The postoperative complication rate was 29%, higher in rectal/anus resection than in colonic resections (40% vs 20%, p=0,043) (OR=2,67, CI 95%: 1,02 - 7,01). Eight patients had a major postoperative complication, four with anastomotic leakage and four required hospital readmission. Conclusions : The perioperative management of ERAS program for colorectal cancer in elective surgery is safe and feasible with acceptable morbimortality risk.

Preoperative Predictors for 90-Day Mortality after Pancreaticoduodenectomy in Patients with Adenocarcinoma of the Ampulla of Vater: A Single-Centre Retrospective Cohort Study.

BACKGROUND: The standard treatment for ampullary adenocarcinoma is pancreaticoduodenectomy. Identification of preoperative risk factors might help the clinician to select patients fit for resection and potentially decrease morbidity and mortality after PD. We conducted a cohort study to determine the preoperative factors related to 90-day severe morbidity and mortality after PD. METHODS: We conducted a retrospective cohort study in patients with a diagnosis of ampullary adenocarcinoma who underwent an open PD between January 2010 and December 2019 at our tertiary centre. RESULTS: Independent preoperative predictors of mortality were the albumin-bilirubin (ALBI) grade 3 (OR: 21.7; CI 95: 2.1-226.9; p=0.01) and the estimated glomerular filtration rate (eGFR) <90 mL/min/1.73 m2 (OR: 17.7; CI 95: 1.8-172.6; p=0.013). The eGFR <90 mL/min/1.73 m2 (OR = 6.6; CI 95: 1.9-23.4; p=0.003) and prothrombin time (OR = 1.5; CI 95; 1.1-2.1; p=0.005) were independent predictors for severe morbidity. CONCLUSION: These findings suggest that baseline renal function measured by the eGFR and liver function categorized with the ALBI grading are predictors of severe morbidity and mortality. Thus, they should be considered when selecting patients for PD or the use of neoadjuvant treatments. Further research is warranted.

TransAnal Total Mesorectal Excision (TaTME) in Peru: Case series.

INTRODUCTION: Describe and demonstrate the feasibility and safety of TaTME in short term outcomes in the Instituto Nacional de Enfermedades Neoplásicas (INEN) in Peru. MATERIALS AND METHODS: Case series with retrospective and prospective data collection of patients with middle and inferior rectal cancer who underwent TaTME between January 2015 and March 2020. Patients and tumor characteristics, operative details, postoperative complications and pathological results were analyzed. RESULTS: Nineteen patients were included. The median age was 56 years old (range 40-69). Ten were female. The median distance from the anal verge was 4 cm (range 3-6) and 17 cases were located in the inferior rectum. Eleven patients with clinical stage III. Thirteen (68.4%) patients received neoadjuvant treatment. There was no conversion to open surgery reported. Ten (52.6%) cases had intersphincteric resection and 18 (94.7%) had primary coloanal anastomosis, 13 (72.2%) of them with hand-sewn. All patients had a diversion with ileostomy. The median operative time was 330 min (range 270-480). Median postoperative hospital stay of 5 days (range 3-18). The overall rate of postoperative complication was 21.1%, two cases (10.5%) had anastomotic leakage and mortality was present in one (5.3%) patient. 94.5% had an optimal TME specimen, only one case (5.3%) had positive circumferential resection margin and positive distal margin. The median tumor size in the specimen was 4 cm (range 2-11) and nine (47.4%) patients had ypT3 on pathology. CONCLUSION: TaTME is a safe and feasible technique with good pathological results.

Benign Multicystic Peritoneal Mesothelioma in a Male Teen: Case Report and Review of the Literature.

The case of a Peruvian 15-year-old male with a left-flank abdominal mass suspected to be a peritoneal pseudomyxoma is presented. The patient underwent a R0 surgery, and the pathology review showed a benign multicystic peritoneal mesothelioma. Characterized by recurrent mesothelial peritoneal cysts originating in the epithelial and mesenchymal elements of mesothelial tissue, this benign tumor is unusual among young males.

Monosegmental ALPPS: a long-term survival alternative to liver transplant in PRETEXT IV hepatoblastoma.

A 3-year-old female was treated with neoadjuvant chemotherapy (NACT) for a PRETEXT IV hepatoblastoma. POST-TEXT IV findings merited a liver transplant (LT), but multiple limitations precluded it. The initial future liver remnant (FLR) was small (21.3%). Monosegment 6 ALPPS was a rational approach given that the inferior right hepatic vein (IRHV) provided adequate outflow. Therefore, the procedure was performed after parental informed consent. On PO15 of the first stage, FLR had reached 32.6% and then the second-stage was carried out. The patient was discharged on POD 31, and she is about to reach the 5-year disease-free survival milestone.

[Prognostic value of lymph node ratio (LNR) in patients who underwent radical gastrectomy]. / Valor pronóstico de la razón de ganglios metastásicos en pacientes con cáncer gástrico operados.

The study objective was to evaluate the prognostic value of lymph node ratio (LNR) in patients with gastric cancer who underwent radical gastrectomy D2. MATERIALS AND METHODS: We reviewed retrospectively 498 medical records of patients with gastric cancer who were attended at the National Institute of Neoplastic Diseases (INEN) between 2008 and 2011and met the inclusion and exclusion criteria. They were distributed into 4 groups according to their LNR, LNR0: 0, LNR1: 0-0.13, LNR2: 0.14-0.4 and LNR3: = 0.4. RESULTS: The median of resected lymph nodes was 42 [range; 8.153] and 494 (99.2%) patients had more than 15 lymph nodes retrieved. 340 (68.5%) patients had lymph node involvement and 175 (35.1%) cases (35.1%) were classified as pN3, 94 (18.5%) pN2 and 72 (14.5%) were pN1. 285 (57.2%) patients had stage III disease. There was a significant difference between groups of LNR in overall survival (OS) and disease-free survival (DFS) curves (p <0.05). According to the LNR groups there was significant differences according to age, lesion size, lymph node involvement (pN), Lauren classification, vascular invasion and lymphatic invasion (p <0.05). LNR is an important prognostic factor to explain the time of death (LNR3: HR: 6.77, 95% CI: 3.346-13.706, p <0.05) and recurrence time (LNR3: 95% CI: 2.104-13.439, p <0.05). CONCLUSION: LNR remains as an important independent prognostic factor in patients undergoing radical gastrectomy and D2 lymphadenectomy for gastric cancer.

Valor pronóstico de la razón de ganglios metastásicos en pacientes con cáncer gástrico operados / Prognostic value of lymph node ratio (LNR) in patients who underwent radical gastrectomy

Objetivo: El objetivo del estudio fue evaluar el valor pronóstico de la razón de ganglios metastásicos (LNR) en los pacientes con cáncer gástrico operados de gastrectomía radical D2. Materiales y métodos: Se revisaron retrospectivamente las historias clínicas de 498 pacientes del Instituto Nacional de Enfermedades Neoplásicas (INEN) entre los años 2008 y 2011 que cumplían los criterios de inclusión y exclusión. Se dividieron en 4 grupos de acuerdo a su LNR; LNR0: 0, LNR1: 0-0,13, LNR2: 0,14-0,4 y LNR3: ≥ 0,4. Resultados: La mediana de ganglios resecados fue de 42 [rango 8-153] y 494 (99,2%) pacientes tuvieron más de 15 ganglios resecados. 340 (68,5%) pacientes presentaron compromiso ganglionar y 175 (35,1%) fueron clasificados como pN3, 94 (18,5%) pN2 y 72 (14,5%) como pN1. 285 (57,2%) pacientes tuvieron estadío III. Hubo diferencias significativas entre los grupos del LNR en las curvas de sobrevida global (SV) y de sobrevida libre de enfermedad (SVLE) (p <0,05). Según los grupos del LNR existen diferencias según la edad, el tamaño de la lesión, el nivel de compromiso ganglionar (pN), la clasificación Lauren, la invasión vascular y la invasión linfática (p <0,05). El LNR es un factor pronóstico importante para explicar el tiempo de muerte (LNR3: HR: 6,77, 95%CI: 3,346-13,706, p <0,05) y de recurrencia (LNR3: HR: 5,3, 95%CI: 2,104-13,439, p <0,05). Conclusión: El LNR es un factor pronóstico independiente importante en los pacientes operados de gastrectomía radical con linfadenectomia D2 por cáncer gástrico.

Objective: The study objective was to evaluate the prognostic value of lymph node ratio (LNR) in patients with gastric cancer who underwent radical gastrectomy D2. Materials and methods: We reviewed retrospectively 498 medical records of patients with gastric cancer who were attended at the National Institute of Neoplastic Diseases (INEN) between 2008 and 2011and met the inclusion and exclusion criteria. They were distributed into 4 groups according to their LNR, LNR0: 0, LNR1: 0-0.13, LNR2: 0.14-0.4 and LNR3: ≥ 0.4. Results: The median of resected lymph nodes was 42 [range; 8.153] and 494 (99.2%) patients had more than 15 lymph nodes retrieved. 340 (68.5%) patients had lymph node involvement and 175 (35.1%) cases (35.1%) were classified as pN3, 94 (18.5%) pN2 and 72 (14.5%) were pN1. 285 (57.2%) patients had stage III disease. There was a significant difference between groups of LNR in overall survival (OS) and disease-free survival (DFS) curves (p <0.05). According to the LNR groups there was significant differences according to age, lesion size, lymph node involvement (pN), Lauren classification, vascular invasion and lymphatic invasion (p <0.05). LNR is an important prognostic factor to explain the time of death (LNR3: HR: 6.77, 95% CI: 3.346-13.706, p <0.05) and recurrence time (LNR3: 95% CI: 2.104-13.439, p <0.05). Conclusion: LNR remains as an important independent prognostic factor in patients undergoing radical gastrectomy and D2 lymphadenectomy for gastric cancer.

Tumor sólido pseudopapilar de páncreas: Tumor de Frantz / Solid pseudopapillary tumor of the pancreas: Frantz´s tumor

El tumor pseudopapilar de páncreas, también conocido como tumor de Frantz, es una enfermedad muy rara en nuestro medio, comprende menos del 3 % de los tumores pancreáticos (1). Su etiología es desconocida, y su incidencia se observa en mujeres jóvenes con predominancia de la tercera década de la vida. Presentamos el caso de una mujer de 23 años que ingresa por epigastralgia urente desde hace 3 meses, además de llenura precoz. Al examen presenta dolor a la palpación profunda. Cuenta con perfil bioquímico, hepático, marcadores tumorales dentro de valores normales, la tomografía espiral multicorte (TEM) abdomino-pélvica reporta lesión neoformativa sólida quística de morfología redondeada de bordes bien definidos, la patología confirma tumor sólido pseudopapilar de páncreas. La paciente se somete a resección de tumor, con evolución favorable.

The solid pseudopapillary tumor of the pancreas, also known as Frantz's tumor, is a very rare disease in our country, comprising less than 3 % of pancreatic tumors (1). Its etiology is unknown and it is predominantly found in young women in their third decade of life. We present the case of a 23-year-old woman who was admitted due to a 3-month burning epigastralgia and early satiety. On examination, she had pain with deep palpation. Her biochemical profile, liver profile, and tumor markers were within normal values. An abdomen and pelvis multislice helical/spiral computed tomography (CT) scan showed a solid cystic neoformative lesion with rounded structure and well-defined borders. Pathology confirmed a solid pseudopapillary tumor of the pancreas. The patient underwent a tumor resection with favorable evolution.

[Pancreatic lipoma: presentation of a case and review of literature]. / Lipoma pancreático: presentación de un caso y revisión de la literatura.

Diagnosis of pancreatic lipoma, is very rare. We presented the case of a 51 years woman who show a tumor of 9x8 cm. at the head and neck of the pancreas. A pancreatoduodenectomy was performed with favorable result. We discuss the therapeutic decision.

Lipoma pancreático: presentación de un caso y revisión de la literatura / Pancreatic lipoma: presentation of a case and review of literature

El diagnóstico de lipoma pancreático, es muy poco frecuente. Presentamos el caso de una mujer de 51 años con una lesión de 9 por 8 cm. A nivel de la cabeza y cuello del páncreas, a quien se le realizó una pancreatoduodenectomia proximal. Se discute la decisión terapéutica.

Diagnosis of pancreatic lipoma, is very rare. We presented the case of a 51 years woman who show a tumour of 9x8 cm. at the head and neck of the pancreas. A pancreatoduodenectomy was performed with favourable evolution. We discuss the therapeutic decision.

Resultados a corto y largo plazo de la resección hepática por hepatocarcinoma: análisis de 232 resecciones consecutivas / Short and long-term results of liver resection for hepatocarcinoma in peru: a peruvian single center experience on 232 cases

ANTECEDENTES: Para evaluar la morbilidad, mortalidad post operatoria sobrevida yrecurrencia luego de las resecciones hepáticas por carcinoma hepatocelular (HCC) se realizóun análisis en 232 pacientes consecutivos con HCC resecados entre enero de 1990 y Diciembredel 2006 en el departamento de abdomen del Instituto de Enfermedades Neoplasicas (INEN).METODOS:La sobrevida global y libre de enfermedad fue calculada por el metodo deKaplan-Meier, los factores pronósticos fueron evaluados utilizando análisis univariadoy multivariado (Cox).RESULTADOS.- La media de edad fue 36 años, 44.2 tuvieron infección por virus de lahepatitis, solo el 16.3 por ciento tuvo cirrosis. La media de AFP fue de 5,467 ng/ml. la medianadel tamaño del HCC fue 15 cms.La mayoría de pacientes tuvo una resección hepática mayor (74.2 por ciento tuvo 4 o mássegmentos resecados).La morbilidad y mortalidad post operatoria fue de 13.7 ciento y 5.3 por ciento respectivamente. Despuésde una media de seguimiento de 40 meses el 53.3% de los pacientes presentó recurrencia.La sobrevida global a 1, 3 y 5 años fue de 66.5 por ciento , 38.7 por ciento y 26.7 por ciento respectivamente. Lasobrevida libre de enfermedad a 1, 3 y 5 años fue de 53.7 por ciento , 27.6 por ciento y 19.9 por ciento .En análisis multivariado, la presencia de múltiples nódulos (p<0.000), la cirrosis (p<0.001)y la invasión vascular macroscopica (p<0.001) fueron factores independientes asociadosa una pobre sobrevida.CONCLUSION: La resección quirúrgica es el tratamiento de elección para elhepatocarcinoma y puede realizarse en el Departamento de Abdomen del INEN con bajamorbi-mortalidad y adecuada sobrevida.

BACKGROUND: To evaluate the short and long term outcome of liver resections for hepatocellular carcinoma a retrospective analysis was performed on 232 consecutive patients with hepatocellular carcinoma resected between January 1990 and December 2006 at the Department of Abdomen of the Instituto de Enfermedades Neoplasicas of Lima Peru. METHODS: Disease-free survival (DFS) and overall survival (OS) were determined by Kaplan- Meier method, Prognostic factors were evaluated using univariate and multivariate analysis RESULTS: The median age was 36 years. 44.2% were associated with hepatitis B, only16.3% had cirrhosis. The median size of the tumors was 15 cm. The median value of AFP was 5,467 ng/ml. The majority of patients underwent a major hepatectomy (74.2 % hadfour or more segments resected)Overall morbidity and mortality were 13.7% and 5.3% respectively. After a median followup of 40 months, tumour recurrence appeared in 53.3% of the patients. The 1, 3, and 5 year overall survival rates were 66.5%, 38.7% and 26.7%respectively. The 1, 3, and 5year disease-free survival rates were 53.7%, 27.6%, and 19.9%. On multivariate analysis, presence of multiple nodules (p<0.000), cirrhosis (p=0.001), and macroscopic vascularinvasion (p=0.001) were found to be independent prognostic factors related to a worse long-term survival.CONCLUSIONS: Surgical resection is the optimal therapy for large HCC and can be safely performed with a reasonable long-term survival.

[Localization of pancreatic insulinoma with ultrasonography laparoscopy]. / Localización de insulinoma pancreático con ultrasonografía laparoscópica.

The case of a 51-year-old woman with a clinical history of hipoglicemia caused by a presumed pancreatic insulinoma is reported. Laboratory tests pointed out for a insulinoma, but imaginologic studies could not locate the tumor. Under this circumstances, the patient was laparoscopically approached. By means of the ultrasonography device the tumor was located at the uncinate process of the pancreas and, eventually treated by laparoscopic enucleation.

Localización de insulinoma pancreático con ultrasonografía laparoscópica / Location of insulinoma pancreatic with laparoscopic ultrasonography

Se presenta el caso de una paciente de 51 años con cuadro clínico de hipoglicemia por un probable insulinoma pancreático. Los exámenes de laboratorio confirmaron la sospecha de insulinoma, pero los estudios por imágenes no pudieron demostrar el tumor. Bajo estas circunstancias, la paciente tuvo abordaje laparoscópico y con la ayuda del ultrasonido intraoperatorio se localizó el tumor en el proceso uncinado del páncreas y, finalmente, se procedió a la enucleación laparoscópica.

The case of a 51-year-old woman with a clinical history of hipoglicemia causedby a presumed pancreatic insulinoma is reported. Laboratory tests pointed outfor a insulinoma, but imaginologic studies could not locate the tumor. Under this circumstances, the patient was laparoscopically approached. By means of the ultrasononography device the tumor was located at the uncinate process of the pancreas and, eventually treated by laparoscopic enucleation.

[Reconstruction following proximal pancreatoduodenectomy by simplified pancreatojejunal anastomosis. Operation results in 198 patients]. / Reconstrucción después de pancreatoduodenectomia proximal mediante anastomosis pancreatoyeyunal simplificada. Resultados operatorios en 198 pacientes.

INTRODUCTION: The pancreatojejunal anastomosis is considered the weak spot when carrying out a duodenopancreatectomy, because it causes most of the complications following a Whipple surgery. Here we present a series of cases using a single technique for performing this anastomosis. MATERIAL AND METHODS: During the period between October 2002 and August 2005, 49 duodenopancreatectomies were performed at the 3AII Department of the National Hospital Edgardo Rebagliati Martins (H.N.E.R.M.) in 31 of these cases a lateral mucosa to mucosa pancreatojejunal anastomosis was carried out by the same surgeon. RESULTS: The most frequent complication was infection of the operating wound followed by pancreatic fistula and intra-abdominal hemorrhage and the overall morbidity was 29%. Pancreatic fistula developed in 13% of the cases; however, no patient required additional treatment and the fistula closed maximum twenty days after the surgery. On average, patients resumed oral food intake after 6 days and remained hospitalized for 16 days. Mortality was 3%, because a patient developed a pseudo-aneurysm of the hepatic artery, which ruptured 17 days after the operation. CONCLUSIONS: The mucosa to mucosa pancreatojejunal anastomosis is a safe technique with a low index of pancreatic fistula and mortality.

[Central pancreatectomy. Indications and perisurgical results of a pancreatic tissue conservation technique]. / Pancreatectomia central: Indicaciones y resultados peri operatorios de una técnica de conservación de tejido pancreático.

INTRODUCTION: Proximal or distal pancreatectomy is the standard treatment for non-resectable benign pancreatic tumors. These procedures imply a radical resection as well as a significant loss of distal normal pancreatic tissue for the standard resection, which may cause an endocrine and/or exocrine pancreatic failure. PURPOSE: Report our experience in central pancreatectomy for the treatment of benign/low malignancy potential tumors in the body and neck of the pancreas by emphasizing the indications and perisurgical results. METHODS: Prospective study of patients with suspected benign tumors in the body of pancreas. SURGICAL TECHNIQUE: Resection of central pancreas through a Roux-en-Y pancreatojejunal anastomosis. RESULTS: From March 1997 to May 2005, 12 patients underwent central pancreatectomy through pancreatojejunal anastomosis. 6 benign tumors were found in the islets of Langerhans: 3 microcystic cystadenomas, 1 mucinous cystadenoma, 1 pseudopapillary solid tumor, and 1 serous cystadenoma. Morbidity rate was 33.3% with no post-surgery deaths. Pancreatic failure was not reported during follow up. CONCLUSION: Some selected cases of benign/low malignancy potential tumors may be treated with central pancreatectomy and pancreatojejunal anastomosis with acceptable morbidity levels and minimum mortality levels. The benefit from preserving the greatest extension of healthy pancreatic tissue as possible is translated into a preservation of the endocrine and exocrine functions of the pancreas.

[Laparoscopic treatment of insulinoma: surgical technique and perisurgical results]. / Tratamiento laparoscópico del Insulinoma pancreático. Técnica quirúrgica y resultados peri operatorios.

AIM: Our experience with the laparoscopic treatment of pancreatic insulinomas is reported. PATIENTS AND METHODS: Four patients with clinical and radiological diagnosis of insulinoma were treated between January 2000 and September 2005. RESULTS: All the patients were laparoscopically approached to attempt the tumor enucleation. In three cases complete enucleation was possible; the remaining case was converted to perform the resection of the middle portion of the pancreas. One patient developed a pancreatic fistula that closed spontaneously. In all cases histological evaluation of the tumor showed benign islet cell tumor. Blood glucose levels returned to normality. CONCLUSION: Laparoscopic enucleation of pancreatic insulinoma is a feasible and safe technique.

Tratamiento laparoscópico del insulinoma pancreático: técnica quirúrgica y resultados perioperatorios / Laparoscopic treatment of insulinoma pancreatic: surgical technique and perisurgical results

Objetivo: Reportar nuestra experiencia en el tratamiento de insulinoma pancreático vía laparoscópica. Pacientes y métodos: Entre Enero del 2000 a Setiembre del 2005, acudieron a nuestra institución cuatro pacientes con diagnóstico clínico y radiológico de insulinoma. Resultados: Todos fueron abordados vía laparoscópica con la intención de enuclear el tumor. En tres de ellos se pudo realizar la enucleación laparoscópica completa, y en el paciente restante se convirtió a laparotomía para realizar una resección de la porción central de páncreas. Una paciente presentó una fístula pancreática que cerró espontáneamente. El estudio anatomopatológico reveló en todos los casos un tumor benigno de los islotes del páncreas. La glicemia retornó a valores normales en todos los casos. Conclusión: La enucleación laparoscópica del insulinoma pancreático es factible y segura.

Aim.- Our experience with the laparoscopic treatment of pancreatic insulinomas is reported. Patients and Methods.- Four patients with clinical and radiological diagnosis of insulinoma were treated between January 2000 and September 2005. Results.- All the patients were laparoscopically approached to attempt the tumor enucleation. In three cases complete enucleation was possible; the remaining case was converted to perform the resection of the middle portion of the pancreas. One patient developed a pancreatic fistula that closed spontaneously. In all cases histological evaluation of the tumor showed benign islet cell tumor. Blood glucose levels returned to normality. Conclusion.- Laparoscopic enucleation of pancreatic insulinoma is a feasible and safe technique.