Predicting Progression, Recurrence, and Survival in Pancreatic Neuroendocrine Tumors: A Single Center Analysis of 174 Patients.

Introduction: The European Neuroendocrine Tumor Society, ENETS, reports variables of prognostic significance in pancreatic neuroendocrine tumors (PNET). However, studies have short follow-ups, and the optimal treatment remains controversial. We aimed to determine overall survival (OS), progression-free survival (PFS) after conservative treatment, and recurrence-free survival (RFS) after surgery and further to find predictors of aggressive PNET behavior to support treatment decisions. Methods: 174 patients with PNET treated at Aarhus University Hospital from 2011 to 2021 were included in a retrospective cohort study. Patients were divided into surgically resected (SUR, n=91) and medically or conservatively treated (MED, n=83). Variables were tested in univariate and multivariate survival analysis. Median follow-up time was 3.4 years in the MED group and 4.5 years in the SUR group. Results: The 5-year OS was 95% and 65% for the SUR and MED groups, respectively. The 5-year RFS in the SUR group was 80% whereas the 5-year PFS in the MED group was 41%. Larger tumor size, Ki67 index, tumor grade, and stage were predictive of shorter OS, RFS, and PFS. Further, chromogranin A was a predictor of OS. Larger tumor size was associated with higher stage and grade. Only 1 of 28 patients with stage 1 disease and size ≤2 cm developed progression on a watch-and-wait strategy during a median follow-up of 36 months. Conclusion: This study supported the ENETS staging and grading system to be useful to predict OS, PFS, and RFS in PNET. Further, our data support that small, localized, low-grade PNETS can be followed with active surveillance.

Non-operative management of blunt splenic injuries in a paediatric population: a 12-year experience.

INTRODUCTION: Non-operative management (NOM) is now the primary treatment for blunt splenic injuries in children. Only one study has examined the use of NOM in a Scandinavian population. Thus, the purpose of this study is to report our experience in treating children with blunt splenic injuries with NOM at a Danish university hospital. METHODS: We conducted a retrospective observational study of 34 consecutive children (aged 16 years or less) admitted to our level 1-trauma centre with blunt splenic injury in the 12-year period from 1 January 2001 to 31 December 2012. Data on patients and procedures were obtained by review of all medical records and re-evaluation of all initial computed tomographies (CT). RESULTS: We included 34 children with a median age of 10.5 years (67.6% males) in this study. All patients were scheduled for NOM, and two (5.9%) patients underwent splenic artery embolisation (SAE). Two (5.9%) patients later needed surgical intervention. The NOM success rate was 88% (95% confidence interval (CI): 73-97%) without SAE and 94% (95% CI: 80-99%) with SAE. We found no difference in the American Association for the Surgery of Trauma grade when comparing the initial CT evaluation (mean 2.59 ± 1.1) with the CT re-evaluation (mean 2.71 ± 0.94); p = 0.226. CONCLUSION: We demonstrated a high degree of success and safety of non-operative treatment in children with blunt splenic injury in a Scandinavian setting. Our results are comparable to international findings.

Combined ablation and resection (CARe) as an effective parenchymal sparing treatment for extensive colorectal liver metastases.

BACKGROUND: Combined intra-operative ablation and resection (CARe) is proposed to treat extensive colorectal liver metastases (CLM). This multicenter study was conducted to evaluate overall survival (OS), local recurrence-free survival (LRFS), hepatic recurrence-free survival (HRFS) and progression-free survival (PFS), to identify factors associated with survival, and to report complications. MATERIALS AND METHODS: Four centers combined retropectively their clinical experiences regarding CLM treated by CARe. CLM characteristics, pre- and post-operative chemotherapy regimens, surgical procedures, complications and survivals were analyzed. RESULTS: Of the 288 patients who received CARe, 210 (73%) had synchronous and 255 (88%) had bilateral CLM. Twenty-two patients (8%) had extrahepatic disease. Median follow-up was 3.17 years (95%CI 2.83-4.08). Median OS was 3.33 years (95%CI 3.08-4.17) and 5-year OS was 37% (95%CI 29-45). One- and 5-year LRFS from ablated lesions were 87.9% (95%CI 83.3-91.2) and 78.0% (95%CI 71-83), respectively. Median HRFS and PFS were 14 months (95%CI 11-18) and 9 months (95%CI 8-11), respectively. One hundred patients experienced complications: 29 grade I, 68 grade II-III-IV, and three deaths. In the multivariate models adjusted for center, the occurrence of complications was confirmed as a major independent factor associated with 3-year OS (HR 1.80; P = 0.008). Five-year OS was 25.6% (95%CI 14.9-37.6) for patients with complications and 45% (95%CI 33.3-53.4) for patients without. CONCLUSIONS: Recent strategies facing advanced CLM include non-anatomic resections, portal-induced hypertrophy of the future remnant liver and aggressive medical preoperative treatments. CARe has the qualities of an approach that allows effective tumor clearance while maintaining good tolerance for the patient.

Acceptable results using small radio frequency ablation needle for liver parenchyma transection.

INTRODUCTION: The aim of this study was to investigate a single-electrode radio frequency ablation (RFA) needle as an instrument for liver resections with special emphasis on operation time, time of liver ischaemia, intra-operative blood loss and post-operative complications. MATERIAL AND METHODS: A total of 40 consecutive patients having a liver transection performed by an RFA single electrode from 1 September 2011 to 28 February 2012 were included in the study. Data concerning type of liver resection, liver parenchyma transection time, intraoperative bleeding and transfusions were prospectively recorded and registered. Furthermore, complications were recorded with special emphasis on bile fistulas and abscesses. RESULTS: In all, 20 females and 20 males had a liver resection performed by a single RFA electrode. The mean bleeding was 520 ml ± 469 ml, and the mean liver parenchyma transection time was 52 min. ± 22 min. Three patients, all of whom underwent major resections, received blood transfusions. Five patients developed bile fistulas and two abscesses. There were no re-operations for bleeding and no 30-day mortality. CONCLUSION: A single electrode RFA needle is a suitable tool for liver parenchyma transection with regard to operation time and intraoperative bleeding, but the frequency of bile leakage seems to be unacceptably high in cases of hemi-hepatectomies. FUNDING: The authors have no conflicts of interest or financial support to declare. TRIAL REGISTRATION: not relevant.

[Epidemiology of primary and secondary liver cancers]. / Epidemiologi, primaer og sekundaer leverkraeft.

Most primary liver cancers are hepatocellular carcinomas (HCC) or cholangiocarcinomas. In clinical practice, the majority of secondary liver cancers are metastases from colorectal cancer. The HCC incidence rate is constant in Denmark (2 per 100,000 per year), which is lower than in many other countries due to the low prevalence of viral hepatitis. The incidence rate of cholangiocarcinoma is slightly lower, and decreasing. The incidence rate of liver metastases is at least 40 per 100,000 per year. The prognosis for patients with liver cancer is poor, but seems to be improving.

[Laparoscopic liver surgery]. / Laparoskopisk leverkirurgi.

Laparoscopic liver surgery has evolved rapidly since it was introduced in the early 1990s. Today every kind of liver resection is carried out by the laparoscopic approach in selected centres. No randomized clinical trials have yet been performed to compare laparoscopic to open hepatic resection and the literature consists mainly of retrospective studies. Laparoscopic liver surgery seems to be superior to open liver surgery with regard to morbidity and mortality, as it also seems superior in cost benefit analysis. There are no data on long-term oncological results.

[Endoclip on the cystic duct after laparoscopic cholecystectomy]. / Klips i de dybe galdeveje efter laparoskopisk kolecystektomi.

We report on a case that occurred after laparoscopic cholecystectomy in a 70-year-old man, where a polymer endoclip placed on the cystic duct migrated into the common bile duct. The clip migration was detected two months after surgery during endoscopic retrograde cholangiography, when a stone and the clip were removed. Based on this and other similar cases, we suggest the use of absorbable clips in laparascopic cholecystectomy.

Improved physical performance and increased lean tissue and fat mass in patients with ulcerative colitis four to six years after ileoanal anastomosis with a J-pouch.

PURPOSE: This study was designed to examine the long-term changes in physical performance, body composition, and bone mineral density in patients with ulcerative colitis undergoing ileoanal anastomosis with J-pouch. Patients were also screened for abnormalities in blood biochemistry. METHODS: Maximal isometric strength (sum of pinching, hand grip, arm flexion, and knee extension), work capacity (ergometer test at 1.5 W/kg), pulmonary function, body composition (dual-energy x-ray absorptiometry scan), and fatigue level were assessed before surgery and four to six years later. RESULTS: Of 24 patients examined preoperatively, 12 females and 8 males were retested. At follow-up, their mean age +/- standard deviation was 38 +/- 9 years, weight was 76 +/- 14 kg, and height was 173 +/- 7 cm. Compared with preoperative assessments, muscular strength had increased 10.6 +/- 17.2 percent (P = 0.015), work capacity 10.4 +/- 13.3 percent (P = 0.003), total tissue mass 4.6 +/- 5.4 kg (P = 0.001), lean tissue mass 2.3 +/- 2.2 kg (P < 0.001), fat mass 2.2 +/- 3.7 kg (P = 0.014), and bone mineral density 1.6 +/- 2.4 percent (P = 0.008). Seventeen of 20 patients had biochemical abnormalities. CONCLUSIONS: After ileoanal anastomosis with J-pouch, muscular strength and work capacity improved concomitant with an increase in total tissue mass, lean tissue mass, fat mass, and bone mineral density. Biochemical abnormalities were common.

[Cystic parathyroid adenoma. A rare cause of primary hyperparathyroidism]. / Cystisk parathyroideaadenom. En sjaeldnere årsag til primaer hyperparatyroidisme.

Two cases of primary hyperparathyroidism associated with parathyroid cysts were identified by an elevated plasma Ca++ level. The diagnosis was established preoperatively by the presence of high quantities of PTH in the cyst fluid in one of the patients. Cysts in the neck or superior mediastinum should raise suspicion of primary hyperparathyroidism.