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1.
Nihon Shokakibyo Gakkai Zasshi ; 117(8): 706-712, 2020.
Artigo em Japonês | MEDLINE | ID: mdl-32779588

RESUMO

A 42-year-old man, after remission of MALT lymphoma of the small intestine, was repeatedly hospitalized because of abdominal pain and severe dehydration caused by frequent vomiting and watery diarrhea. His symptoms would improve quickly every time when he was fasted and inserted a nasogastric tube. We were unable to find abnormalities on endoscopic examination and computed tomography. He was suspected to have gastrinoma because of active bleeding from a duodenal ulcer. High-level serum gastrin, endoscopic ultrasound, somatostatin receptor scintigraphy, and selective arterial calcium injection test were done. He was diagnosed with pancreatic gastrinoma in the pancreatic head by endoscopic ultrasound fine needle aspiration and subsequently underwent pancreatoduodenectomy. Histopathologic findings showed a 3-mm neuroendocrine tumor located in the duodenal submucosal layer. The presence of metastasis was confirmed in one of the peripancreatic lymph nodes. The pancreatic gastrinoma in the pancreatic head that we initially diagnosed was a lymph node metastasis behind the pancreas. Because additional resection was performed on the duodenum, we were able obtain a diagnosis of duodenal gastrinoma.


Assuntos
Neoplasias Duodenais/cirurgia , Gastrinoma/cirurgia , Tumores Neuroendócrinos/cirurgia , Neoplasias Pancreáticas/cirurgia , Adulto , Humanos , Masculino , Pancreaticoduodenectomia
2.
Tokai J Exp Clin Med ; 45(2): 75-80, 2020 Jul 20.
Artigo em Inglês | MEDLINE | ID: mdl-32602105

RESUMO

CASE PRESENTATION: The patient was a 72-year-old man who consulted with his previous physician for chief complaints of palpitations, fatigue, and blackish feces persisting for 1 month. After confirming the presence of anemia, the patient was referred to our hospital. Blood test findings upon hospital arrival revealed a hemoglobin (Hb) level of 6.0 g/dL. Computed tomography revealed a tumor of 32 mm × 30 mm with a low-density area extending from the bulb to the second part of the duodenum. Magnetic resonance imaging revealed high signal intensity on T1- and T2-weighted imaging and low signal intensity on fat-suppressed T2-weighted imaging, findings consistent with lipoma. Upper gastrointestinal endoscopy revealed a yellowish submucosal tumor that had perforated into the intestinal tract from the external wall extending from the upper corner to the second part of the duodenum. After determining that the tumor was sessile, laparoscopic partial duodenectomy with Roux-en-Y reconstruction was planned and performed. Pathology revealed a yellowish tumor 4 cm × 4 cm in size extending from the pyloric area to the duodenal bulb arising from the tunica muscularis. The present case report details our experience involving a patient who underwent surgical resection for hemorrhagic duodenal lipoma.


Assuntos
Procedimentos Cirúrgicos do Sistema Digestório/métodos , Duodenopatias/cirurgia , Neoplasias Duodenais/cirurgia , Duodeno/cirurgia , Hemorragia Gastrointestinal/cirurgia , Laparoscopia/métodos , Lipoma/cirurgia , Idoso , Anastomose em-Y de Roux , Imagem de Difusão por Ressonância Magnética , Duodenopatias/patologia , Neoplasias Duodenais/diagnóstico por imagem , Neoplasias Duodenais/patologia , Duodeno/patologia , Hemorragia Gastrointestinal/diagnóstico por imagem , Hemorragia Gastrointestinal/patologia , Humanos , Lipoma/diagnóstico por imagem , Lipoma/patologia , Masculino
3.
Medicine (Baltimore) ; 99(22): e20414, 2020 May 29.
Artigo em Inglês | MEDLINE | ID: mdl-32481436

RESUMO

Endoscopic treatment of duodenal papillary tumors is well described. This study aims to provide new evidence for the treatment of benign papillary tumors through comparisons between endoscopic snare papillectomy (ESP) and endoscopic mucosal resection (EMR).Between May 2010 and December 2017, 72 patients were enrolled. Diagnosis and treatment procedures were ESP and EMR. Endoscopic follow-up evaluation was done periodically as a surveillance measurement for recurrence.Seventy-two patients with ampullary tumors were enrolled, of which 66 had adenomas including 9 high-grade intraepithelial neoplasias and 2 carcinomas in adenoma. Complete resections with tumor-free lateral and basal margins were achieved in all patients. Postoperative complications were bleeding (9.5% in EMR vs 10% in ESP) and pancreatitis (2.4% in EMR and 3.3% in ESP), with no occurrence of perforation, cholangitis or papillary stenosis. Adenoma recurrence was found in 7 patients (14.3% in EMR vs 3.3% in ESP) at 1 year.The ESP procedure is safe and effective for benign ampullary adenoma, high-grade intraepithelial neoplasias, and noninvasive cancer without intraductal tumor growth, which has a shorter procedural duration, as well as lower complication, recurrence rates and hospitalization costs.


Assuntos
Neoplasias Duodenais/cirurgia , Endoscopia Gastrointestinal , Adenoma/diagnóstico por imagem , Adenoma/patologia , Adenoma/cirurgia , Adulto , Idoso , Idoso de 80 Anos ou mais , Carcinoma/diagnóstico por imagem , Carcinoma/patologia , Carcinoma/cirurgia , Neoplasias Duodenais/diagnóstico por imagem , Neoplasias Duodenais/patologia , Endoscopia Gastrointestinal/economia , Endoscopia Gastrointestinal/métodos , Feminino , Seguimentos , Hospitalização/economia , Humanos , Masculino , Pessoa de Meia-Idade , Gradação de Tumores , Duração da Cirurgia , Complicações Pós-Operatórias , Estudos Retrospectivos , Resultado do Tratamento , Adulto Jovem
4.
Dig Dis ; 38(5): 364-372, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32516770

RESUMO

BACKGROUND AND AIMS: Endoscopic treatment for duodenal neoplasms is associated with a high risk of perforation. This study aimed to determine the feasibility of endoscopic treatment for sporadic nonampullary duodenal adenoma (SNDA). METHODS: Consecutive patients undergoing endoscopic treatment for SNDA between January 2005 and December 2015 were included in the study. Clinical characteristics and endoscopic outcomes were analyzed using medical records. Long-term outcome was assessed in patients whose follow-up period was >12 months >1 year. RESULTS: A total of 95 lesions (92 patients) were treated with argon plasma coagulation (APC) ablation (n = 25), endoscopic mucosal resection (EMR, n = 59), or endoscopic submucosal dissection (ESD, n= 11). The median age was 54.9 years, and 63% were male. In patients who underwent EMR and ESD, the en bloc resection rate was 83.1 and 90.0% (p > 0.99); and the complete resection rate was 81.4 and 80% (p > 0.99), respectively. Perforation occurred in 8 patients (8.7%), 4 of whom required surgery. The ESD group showed a significantly higher perforation rate than APC or EMR group (45.5 vs. 0 and 5.1%; p < 0.001). During the median follow-up period of 19 months (range 12-137 months), one patient in the APC ablation group experienced recurrence; no recurrences were seen among EMR and ESD groups. CONCLUSIONS: Favorable long-term outcomes indicate that endoscopic treatment is an effective approach for the treatment of SNDA. Considering the high risk of perforation associated with ESD, APC, or EMR may be an acceptable alternative.


Assuntos
Adenoma/cirurgia , Neoplasias Duodenais/cirurgia , Endoscopia , Adenoma/patologia , Coagulação com Plasma de Argônio , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Fatores de Tempo , Resultado do Tratamento
5.
J Surg Oncol ; 122(3): 442-449, 2020 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-32470159

RESUMO

BACKGROUND: To investigate the short- and long-term outcomes of patients undergoing pancreaticoduodenectomy (PD) for duodenal neuroendocrine tumors (dNETs) vs pancreatic neuroendocrine tumors (pNETs). METHOD: Patients undergoing PD for dNETs or pNETs between 1997 and 2016 were identified from a multi-institutional database. Overall survival (OS) and recurrence-free survival (RFS) were evaluated. RESULTS: Among 276 patients who underwent PD, 244 (88.4%) patients had a primary pNET, whereas 32 (11.6%) patients had a dNET. Following PD, postoperative morbidity and mortality were comparable. While the total number of lymph nodes examined was similar between the two groups (median, dNETs 15.0 vs pNETs 13.0; P= .648), patients with dNETs had a higher incidence of lymph node metastasis (LNM) (60.0% vs 38.2%; P = .022) and a larger number of metastatic nodes (median, 3.5 vs 2.0; P = .039). No differences in OS or RFS were noted among patients with dNETs vs pNETs in both unadjusted and adjusted analyses. Among patients who recurred after PD, patients with dNETs were more likely to recur early (within 2 years, 100% vs 49.2%; P = .029) and at an extrahepatic site (intrahepatic-only recurrence, 20.0% vs 54.1%; P = 0.142) vs patients with pNETs. CONCLUSIONS: Patients with dNETs and pNETs had a similar prognosis following PD. Data on differences in the incidence of LNM, as well as in recurrence time and patterns may help to inform the treatment of these patients.


Assuntos
Neoplasias Duodenais/cirurgia , Tumores Neuroendócrinos/cirurgia , Neoplasias Pancreáticas/cirurgia , Idoso , Estudos de Coortes , Neoplasias Duodenais/patologia , Feminino , Humanos , Linfonodos/patologia , Metástase Linfática , Masculino , Pessoa de Meia-Idade , Recidiva Local de Neoplasia/patologia , Tumores Neuroendócrinos/patologia , Neoplasias Pancreáticas/patologia , Pancreaticoduodenectomia/efeitos adversos , Pancreaticoduodenectomia/métodos , Pontuação de Propensão , Taxa de Sobrevida , Resultado do Tratamento
6.
Z Gastroenterol ; 58(8): 767-772, 2020 Aug.
Artigo em Alemão | MEDLINE | ID: mdl-32380553

RESUMO

BACKGROUND: Pyloric gland adenomas (PGAs) are very rare and underdiagnosed, mostly be founded in the stomach. Similar to colorectal adenomas they have a high risk of malignant transformation to adenocarcinoma up to 12-47 %. Endoscopic resections in the duodenum harbor a significant risk of complications. EMR is the current standard technique for treatment of duodenal non-ampullary adenomas. Complete resection rates are considerably high at about 90 %. Adverse events as bleeding was reported up to 25 %. ESD is not recommended for resection of duodenal lesions since the perforation rate may be as high as 35 %. Use of EFTR in the duodenum are limited to a single case study of 20 patients. CASE: A 67 year old patient with attenuated polyposis coli presented for screening. Gastroscopy showed a 20 mm large, non-ampullary lesions in the proximal duodenum (pars I). The margins of the duodenal lesions were marked with a high-frequency (HF) probe. An integrated balloon dilatation (20 mm) of the upper esophageal sphincter and the pylorus was performed to facilitate advancing of the gastroduodenal FTRD® (Ovesco Endoscopy AG). After pulling the duodenal lesion into the cap with a grasper the FTRD clip was deployed and the lesion immediately resected with the preloaded snare. A single-shot antibiotic prophylaxis with 2 g ceftriaxone i. v. was administered during the intervention. Second-look endoscopy was scheduled 24 h after resection. The resectat showed histologically a gastric type adenoma of 18 mm in the proximal duodenum (immunohistochemistry positive for Mucin-1, Mucin-5, Mib 1). CONCLUSION: Herein we present the first case of duodenal EFTR in a patient with attenuated FAP and a PGA. There are currently no specific guidelines for the removal and surveillance. ASGE recommends resection and surveillance endoscopy at 3-5 years interval.


Assuntos
Adenoma/cirurgia , Polipose Adenomatosa do Colo/cirurgia , Neoplasias Duodenais/cirurgia , Duodenoscopia/métodos , Adenoma/patologia , Polipose Adenomatosa do Colo/patologia , Idoso , Neoplasias Duodenais/patologia , Duodenoscopia/instrumentação , Duodeno , Humanos , Masculino , Piloro , Resultado do Tratamento
7.
Gan To Kagaku Ryoho ; 47(1): 108-110, 2020 Jan.
Artigo em Japonês | MEDLINE | ID: mdl-32381874

RESUMO

A 62 year-old female presenting with shortness of breath and severe anemia(Hb level 4.4 g/dL)was diagnosed with tumor bleeding and duodenal cancer by gastrointestinal endoscopy.Computed tomography scan revealed multiple liver metastases.After admission, the Hb level dropped from 9.1 g/dL to 5.1 g/dL in one night, and emergency pancreaticoduodenectomy( PD)was performed to control the bleeding.The postoperative course was uneventful, and the patient was discharged on postoperative day(POD)16.Systemic chemotherapy was initiated 1 month after surgery, but the patient died from the disease 13 months after surgery.Emergency PD could be a treatment option in patients with uncontrolled tumor bleeding and fatal conditions.


Assuntos
Neoplasias Duodenais , Hemorragia/etiologia , Neoplasias Hepáticas , Neoplasias Duodenais/cirurgia , Endoscopia Gastrointestinal , Feminino , Hemorragia/cirurgia , Humanos , Neoplasias Hepáticas/secundário , Pessoa de Meia-Idade , Pancreaticoduodenectomia
8.
Gan To Kagaku Ryoho ; 47(4): 625-627, 2020 Apr.
Artigo em Japonês | MEDLINE | ID: mdl-32389965

RESUMO

A 60-year-old man underwent surgical distal gastrectomy 10 years prior to receiving treatment for stomach cancer. He visited our hospital with complaints of abdominal fullness and weight loss. Abdominal computed tomography(CT)revealed intestinal blockage starting at the duodenum near the Treitz ligament. During upper alimentary canal endoscopy, a type 2 tumor coveringthe entire circumference of the horizontal duodenum was found, and biopsy results indicated that the tumor was a well-differentiated adenocarcinoma. Although no distant metastasis was observed in the abdominal CT scan, multiple attached bulky lymph nodes were observed leadingto a suspicion of metastasis. Finally, the patient was diagnosed as having progressive duodenal cancer accompanied with advanced lymph node metastasis. A gastrojejunal bypass surgery with laparoscopy was performed. When the patient's overall condition improved, mFOLFOX6 chemotherapy was started, and 6 courses were completed. As the sizes of the primary tumor and bulky lymph nodes decreased, surgery to completely remove the cancer was performed. UFT/UZEL supplemental postoperative chemotherapy was administered for 6 months. The patient remained alive, with no remissions 3 years post-surgery.


Assuntos
Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , Neoplasias Duodenais , Procedimentos Cirúrgicos do Sistema Digestório , Neoplasias Duodenais/tratamento farmacológico , Neoplasias Duodenais/cirurgia , Humanos , Linfonodos , Metástase Linfática , Masculino , Pessoa de Meia-Idade , Terapia Neoadjuvante
9.
Gan To Kagaku Ryoho ; 47(3): 499-501, 2020 Mar.
Artigo em Japonês | MEDLINE | ID: mdl-32381928

RESUMO

The use of endoscopic submucosal dissection(ESD)for the treatment of duodenal tumors has increased recently. ESD is less invasive than surgical resection of duodenal tumors. However, a high rate of complication, including perforation and bleeding, has been reported to be associated with ESD. Here, we report the minimally invasive surgical procedure called "endoscopy guided single-incision laparoscopic partial duodenectomy" for the treatment of duodenal tumors, along with its and safety and treatment outcomes. Five patients were included in this study. We mounted the LAP PROTECTORTM and EZ access®in the umbilical incision. Single-incision laparoscopic surgery was performed using 3 trocars(5mm)that were placed into the EZ access®. First, we mobilized the duodenum and pancreatic head from the retroperitoneum using the laparoscopic "Kocher maneuver". Next, the peritumoral site was marked by an endoscopic procedure using a clip and electric needle knife. Using an endoscope, we performed laparoscopic full-thickness resection of the duodenal wall including the tumor. The defect in the duodenal wall was then closed by suturing.


Assuntos
Neoplasias Duodenais , Ressecção Endoscópica de Mucosa , Laparoscopia , Anastomose Cirúrgica , Neoplasias Duodenais/cirurgia , Duodeno , Endoscopia do Sistema Digestório , Humanos
10.
Trop Doct ; 50(1): 68-70, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31451057

RESUMO

Brunner's gland hamartoma (or Brunneroma) is an uncommon tumour with an incidence of <0.01%, accounting for approximately 5-10% of benign duodenal tumours. Usually asymptomatic, it may manifest occasionally with duodenal obstruction or upper gastrointestinal haemorrhage and rarely with biliary fistulation, cholestatic jaundice and intussusception. It may be associated with uraemia and chronic pancreatitis. The diagnosis is usually confirmed by imaging studies and upper gastrointestinal endoscopy. Surgical excision or endoscopic resection is preferred for symptomatic large hamartomas. Here we report a case of 45-year-old man presenting with features of pancreatitis and gastric outlet obstruction due to a large Brunner's gland hamartoma, on his endoscopic, radiologic, surgical and pathologic findings.


Assuntos
Glândulas Duodenais/patologia , Neoplasias Duodenais/complicações , Obstrução da Saída Gástrica/etiologia , Hamartoma/complicações , Pancreatite/etiologia , Glândulas Duodenais/diagnóstico por imagem , Glândulas Duodenais/cirurgia , Neoplasias Duodenais/diagnóstico por imagem , Neoplasias Duodenais/patologia , Neoplasias Duodenais/cirurgia , Obstrução da Saída Gástrica/diagnóstico por imagem , Obstrução da Saída Gástrica/patologia , Obstrução da Saída Gástrica/cirurgia , Hamartoma/diagnóstico por imagem , Hamartoma/patologia , Hamartoma/cirurgia , Humanos , Masculino , Pessoa de Meia-Idade , Pancreaticoduodenectomia , Pancreatite/diagnóstico por imagem , Pancreatite/patologia , Pancreatite/cirurgia , Resultado do Tratamento
11.
Ann Surg ; 271(3): 549-558, 2020 03.
Artigo em Inglês | MEDLINE | ID: mdl-30216219

RESUMO

OBJECTIVE: We evaluated the prognostic impact of circulating tumor cells (CTCs) for patients with presumed resectable pancreatic and periampullary cancers. SUMMARY OF BACKGROUND DATA: Initial treatment decisions for this group are currently taken without a reliable prognostic marker. The CellSearch system allows standardized CTC-testing and has shown excellent specificity and prognostic value in other applications. METHODS: Preoperative blood samples from 242 patients between September 2009 and December 2014 were analyzed. One hundred seventy-nine patients underwent tumor resection, of whom 30 with stage-I tumors and duodenal cancer were assigned to the low-risk group, and the others to the high-risk group. Further 33 had advanced disease, 30 benign histology. Observation ended in December 2016. Cancer-specific survival (CSS) and disease-free survival (DFS) were calculated by log-rank and Cox regression. RESULTS: CTCs (CTC-positive; ≥1 CTC/7.5 mL) were detected in 6.8% (10/147) of the high-risk patients and 6.2% (2/33) with advanced disease. No CTCs (CTC-negative) were detected in the low-risk patients or benign disease. In high-risk patients, median CSS for CTC-positive versus CTC-negative was 8.1 versus 20.0 months (P < 0.0001), and DFS 4.0 versus 10.5 months (P < 0.001). Median CSS in advanced disease was 7.7 months. Univariate hazard ratio (HR) of CTC-positivity was 3.4 (P < 0.001). In multivariable analysis, CTC-status remained independent (HR: 2.4, P = 0.009) when corrected for histological type (HR: 2.7, P = 0.030), nodal status (HR: 1.7, P = 0.016), and vascular infiltration (HR: 1.7, P = 0.001). CONCLUSION: Patients testing CTC-positive preoperatively showed a detrimental outcome despite successful tumor resections. Although the low CTC-rate seems a limiting factor, results indicate high specificity. Thus, preoperative analysis of CTCs by this test may guide treatment decisions and warrants further testing in clinical trials.


Assuntos
Adenocarcinoma/cirurgia , Ampola Hepatopancreática/patologia , Neoplasias do Ducto Colédoco/cirurgia , Neoplasias Duodenais/cirurgia , Células Neoplásicas Circulantes/patologia , Neoplasias Pancreáticas/cirurgia , Adenocarcinoma/mortalidade , Adulto , Idoso , Idoso de 80 Anos ou mais , Biomarcadores Tumorais/sangue , Neoplasias do Ducto Colédoco/mortalidade , Neoplasias Duodenais/mortalidade , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estadiamento de Neoplasias , Neoplasias Pancreáticas/mortalidade , Prognóstico , Fatores de Risco , Taxa de Sobrevida
12.
Ann R Coll Surg Engl ; 102(2): e29-e32, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-31508985

RESUMO

Although the optimal surgical procedure for the resection of duodenal gastrointestinal stromal tumours has not yet been characterised due to the low prevalence of these tumours and the anatomical complexity of the duodenopancreatic region, difficult surgical procedures such as pancreaticoduodenectomy are often proposed for stromal tumours located in the second portion of the duodenum. Our case report highlights a novel surgical strategy that can be implemented as an alternative to pancreaticoduodenectomy for such tumours close to the duodenal ampulla. A 70-year-old man incidentally diagnosed with a stromal tumour close to the duodenal ampulla in the second portion of the duodenum underwent local resection guided by an endoscopic nasobiliary drainage tube with primary closure. This tube was converted to a percutaneous trans-small intestinal biliary drainage tube during the procedure to prevent biliary leakage biliary stasis due to swelling of the duodenal ampulla. He also underwent a simple distal gastrectomy with Roux-en-Y reconstruction. This resulted in successful R0 resection. There were no procedure-related complications or post-surgery weight changes. Our simple novel surgical strategy may therefore be useful for avoiding pancreaticoduodenectomy and maintaining quality of life in patients with stromal tumours close to the duodenal ampulla.


Assuntos
Neoplasias Duodenais/cirurgia , Tumores do Estroma Gastrointestinal/cirurgia , Idoso , Ampola Hepatopancreática , Neoplasias Duodenais/diagnóstico por imagem , Neoplasias Duodenais/patologia , Endoscopia do Sistema Digestório , Gastrectomia/métodos , Tumores do Estroma Gastrointestinal/diagnóstico por imagem , Tumores do Estroma Gastrointestinal/patologia , Humanos , Masculino , Tomografia Computadorizada por Raios X
13.
Acta Chir Belg ; 120(1): 16-22, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-30424714

RESUMO

Background: This retrospective comparative case series study aims to analyze the pancreatic fistula rates of internal and external stenting of the pancreatojejunostomy (PJ) anastomosis in patients who underwent pancreatoduodenectomy (PD) for periampullary tumors.Methods: Ninety-eight patients with periampullary tumors who were operated between 2010 and 2017 were enrolled in this study. A classic open PD with Roux-en-Y PJ reconstruction was performed in all cases.Results: The PJ anastomosis of 53 patients (54%) were stented internally whereas in 45 patients (46%) external stenting was preferred. Pancreatic fistula was observed in 29 patients (29.6%). Internal stenting and soft pancreatic tissue were found to be related to higher pancreatic fistula rates with odds ratios of 3.27 (p = .024) and 3.4 (p = .017), respectively. When only grade B and grade C fistulas were taken into account, the type of stenting has lost its significance but the texture of the remnant pancreas was still associated with 'clinically important' pancreatic fistula.Conclusions: We concluded that the external stenting of the PJ anastomosis may be considered as an effective approach for reducing postoperative pancreatic leaks in PD-planned patients for periampullary tumors. Although our study was retrospectively designed, we used standard charts to gather patient data and compared two stenting methods among homogeneous patient groups.


Assuntos
Fístula Pancreática/epidemiologia , Pancreaticoduodenectomia/efeitos adversos , Pancreaticojejunostomia/efeitos adversos , Complicações Pós-Operatórias/epidemiologia , Stents/efeitos adversos , Idoso , Ampola Hepatopancreática , Anastomose em-Y de Roux/efeitos adversos , Neoplasias do Ducto Colédoco/cirurgia , Neoplasias Duodenais/cirurgia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Neoplasias Pancreáticas/cirurgia , Estudos Retrospectivos
15.
BMC Surg ; 19(1): 169, 2019 Nov 12.
Artigo em Inglês | MEDLINE | ID: mdl-31718616

RESUMO

BACKGROUND: Duodenal fibrolipoma and duodenum-jejunum intussusception are both rare occasions in clinical practice. The diagnosis of duodenal fibrolipoma mainly depends on endoscopy examination, supplemented by CT and MRI. As the tumor grows, some severe symptoms need surgical intervention. As the development of endoscopic techniques, the operation plan should be made individually. CASE PRESENTATION: A 47-year-old female with the complaint of upper abdominal pain and melena was reported. Abdominal examination revealed upper abdomen lightly tender and blood test showed severe anemia. Image and endoscopy examination exhibited "a giant mass" in the descending (D2) part of duodenum, dragged by the tumor into the distal intestinal canal and causing intussusception. Intermittent blood transfusion treatment, enteral and parenteral nutrition were adopted to adjust her general state. Two weeks later, the mass was resected together with the basement intestinal wall via the jejunum incision and then the intussuscepted D2 part was restored. The paraffin pathological diagnosis correlated with the preoperative judgment of fibrolipoma and the patient was discharged healthy on POD 14. CONCLUSIONS: Duodenal fibrolipoma is a rare disease, infrequently causing intussusception and severe upper GIB. Duodenoscopy and endoscopic ultrasound contribute to making an appropriate diagnosis, and for patients with severe symptoms needed surgical intervention, operation plan should be individualized depending on the size and location of the lesion.


Assuntos
Duodenopatias/diagnóstico , Neoplasias Duodenais/complicações , Hemorragia Gastrointestinal/diagnóstico , Intussuscepção/diagnóstico , Doenças do Jejuno/diagnóstico , Lipoma/complicações , Duodenopatias/etiologia , Duodenopatias/cirurgia , Neoplasias Duodenais/diagnóstico , Neoplasias Duodenais/cirurgia , Duodenoscopia/métodos , Endossonografia , Feminino , Hemorragia Gastrointestinal/etiologia , Hemorragia Gastrointestinal/cirurgia , Humanos , Intussuscepção/etiologia , Intussuscepção/cirurgia , Doenças do Jejuno/etiologia , Doenças do Jejuno/cirurgia , Laparoscopia , Lipoma/diagnóstico , Pessoa de Meia-Idade , Tomografia Computadorizada por Raios X
16.
Anticancer Res ; 39(11): 6347-6353, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31704866

RESUMO

BACKGROUND/AIM: The aim of this study was to determine the significance of immunonutritional and physical index in the assessment of risk associated with pancreaticoduodenectomy (PD) in the elderly. PATIENTS AND METHODS: This study enrolled 92 patients who underwent PD. They were divided into 2 groups: Group A included patients 79 years and younger (n=79) and Group B patients 80 years and older (n=13). Among 37 patients, physical function and body composition were also evaluated. RESULTS: Significantly higher neutrophil-lymphocyte ratio, lower prognostic nutritional index (PNI), and controlling nutritional score were observed in Group B. Muscle strength and walking ability were significantly impaired in Group B, although there was no significant difference in body composition. Age was not correlated with the incidence of postoperative complications, overall survival or recurrence-free survival by univariate and multivariate analysis. CONCLUSION: PD is justified for the elderly, with acceptable morbidity and prognosis. However, immunonutritional status and physical function are significantly impaired; thus, appropriate case selection and active nutritional support are required for the elderly.


Assuntos
Limitação da Mobilidade , Força Muscular , Estado Nutricional , Pancreaticoduodenectomia/efeitos adversos , Complicações Pós-Operatórias , Adulto , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Análise de Variância , Neoplasias dos Ductos Biliares/cirurgia , Composição Corporal , Comorbidade , Neoplasias Duodenais/cirurgia , Feminino , Humanos , Contagem de Leucócitos , Contagem de Linfócitos , Masculino , Pessoa de Meia-Idade , Neutrófilos/citologia , Avaliação Nutricional , Neoplasias Pancreáticas/cirurgia , Pancreaticoduodenectomia/mortalidade , Complicações Pós-Operatórias/epidemiologia , Estudos Retrospectivos , Medição de Risco , Albumina Sérica/análise
17.
J Surg Oncol ; 120(8): 1302-1310, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31680243

RESUMO

BACKGROUND: The current study sought to investigate the impact of tumor size and total number of LN examined (TNLE) on the incidence of lymph node metastasis (LNM) among patients with duodenal neuroendocrine tumor (dNET). METHODS: Patients who underwent curative resection for dNETs between 1997-2016 were identified from 8 high-volume US centers. Risk factors associated with overall survival and LNM were identified and the optimal cut-off of TNLE relative to LNM was determined. RESULTS: Among 162 patients who underwent resection of dNETs, median patient age was 59 (interquartile range [IQR], 51-68) years and median tumor size was 1.2 cm (IQR, 0.7-2.0 cm); a total of 101 (62.3%) patients underwent a concomitant LND at the time of surgery. Utilization of lymphadenectomy (LND) increased relative to tumor size (≤1 cm:52.2% vs 1-2 cm:61.4% vs >2 cm:93.8%; P < .05). Similarly, the incidence of LNM increased with dNET size (≤1 cm: 40.0% vs 1-2 cm:65.7% vs >2 cm:80.0%; P < .05). TNLE ≥ 8 had the highest discriminatory power relative to the incidence of LNM (area under the curve = 0.676). On multivariable analysis, while LNM was not associated with prognosis (hazard ratio [HR] = 0.9; 95% confidence intervals [95%CI], 0.4-2.3), G2/G3 tumor grade was (HR = 1.5; 95%CI, 1.0-2.1). CONCLUSIONS: While the incidence of LNM directly correlated with tumor size, patients with dNETs ≤ 1 cm had a 40% incidence of LNM. Regional lymphadenectomy of a least 8 LN was needed to stage patients accurately.


Assuntos
Neoplasias Duodenais/patologia , Excisão de Linfonodo , Tumores Neuroendócrinos/patologia , Idoso , Neoplasias Duodenais/mortalidade , Neoplasias Duodenais/cirurgia , Endoscopia do Sistema Digestório , Feminino , Humanos , Laparoscopia , Metástase Linfática , Masculino , Pessoa de Meia-Idade , Análise Multivariada , Tumores Neuroendócrinos/mortalidade , Tumores Neuroendócrinos/cirurgia , Prognóstico , Carga Tumoral
18.
World J Gastroenterol ; 25(40): 6116-6128, 2019 Oct 28.
Artigo em Inglês | MEDLINE | ID: mdl-31686767

RESUMO

BACKGROUND: For periampullary adenocarcinoma, the histological subtype is a better prognostic predictor than the site of tumor origin. Intestinal-type periampullary adenocarcinoma (IPAC) is reported to have a better prognosis than the pan-creatobiliary-type periampullary adenocarcinoma (PPAC). However, the classification of histological subtypes is difficult to determine before surgery. Apparent diffusion coefficient (ADC) histogram analysis is a noninvasive, non-enhanced method with high reproducibility that could help differentiate the two subtypes. AIM: To investigate whether volumetric ADC histogram analysis is helpful for distinguishing IPAC from PPAC. METHODS: Between January 2015 and October 2018, 476 consecutive patients who were suspected of having a periampullary tumor and underwent magnetic resonance imaging (MRI) were reviewed in this retrospective study. Only patients who underwent MRI at 3.0 T with different diffusion-weighted images (b-values = 800 and 1000 s/mm2) and who were confirmed with a periampullary adenocarcinoma were further analyzed. Then, the mean, 5th, 10th, 25th, 50th, 75th, 90th, and 95th percentiles of ADC values and ADCmin, ADCmax, kurtosis, skewness, and entropy were obtained from the volumetric histogram analysis. Comparisons were made by an independent Student's t-test or Mann-Whitney U test. Multiple-class receiver operating characteristic curve analysis was performed to determine and compare the diagnostic value of each significant parameter. RESULTS: In total, 40 patients with histopathologically confirmed IPAC (n = 17) or PPAC (n = 23) were enrolled. The mean, 5th, 25th, 50th, 75th, 90th, and 95th percentiles and ADCmax derived from ADC1000 were significantly lower in the PPAC group than in the IPAC group (P < 0.05). However, values derived from ADC800 showed no significant difference between the two groups. The 75th percentile of ADC1000 values achieved the highest area under the curve (AUC) for differentiating IPAC from PPAC (AUC = 0.781; sensitivity, 91%; specificity, 59%; cut-off value, 1.50 × 10-3 mm2/s). CONCLUSION: Volumetric ADC histogram analysis at a b-value of 1000 s/mm2 might be helpful for differentiating the histological subtypes of periampullary adenocarcinoma before surgery.


Assuntos
Adenocarcinoma/diagnóstico , Neoplasias do Sistema Biliar/diagnóstico , Imagem de Difusão por Ressonância Magnética/métodos , Neoplasias Duodenais/diagnóstico , Neoplasias Pancreáticas/diagnóstico , Adenocarcinoma/patologia , Adenocarcinoma/cirurgia , Adulto , Idoso , Ampola Hepatopancreática/diagnóstico por imagem , Ampola Hepatopancreática/patologia , Ampola Hepatopancreática/cirurgia , Neoplasias do Sistema Biliar/patologia , Neoplasias do Sistema Biliar/cirurgia , Diagnóstico Diferencial , Neoplasias Duodenais/patologia , Neoplasias Duodenais/cirurgia , Feminino , Humanos , Interpretação de Imagem Assistida por Computador , Masculino , Pessoa de Meia-Idade , Neoplasias Pancreáticas/patologia , Neoplasias Pancreáticas/cirurgia , Pancreaticoduodenectomia , Prognóstico , Curva ROC , Reprodutibilidade dos Testes , Estudos Retrospectivos
19.
Cir. Esp. (Ed. impr.) ; 97(9): 523-530, nov. 2019. ilus, graf, tab
Artigo em Espanhol | IBECS | ID: ibc-187629

RESUMO

Introducción: El adenocarcinoma de duodeno es una neoplasia poco frecuente, sobre la que existen pocas experiencias publicadas de los resultados tras su resección. El objetivo es analizar los resultados obtenidos en nuestro centro tras la resección curativa del adenocarcinoma duodenal (AD). Métodos: Estudio retrospectivo de los pacientes intervenidos con resección curativa por AD entre 1990 y 2017 en nuestro hospital. Resultados: Se intervino a 27 pacientes. En 23 casos (85%) se realizó duodenopancreatectomía cefálica (DPC) y en 4 casos (15%) con localización en la 3.ª-4.ª porción duodenal se realizó duodenectomía (DD) segmentaria. La morbilidad postoperatoria global fue del 67% (18 pacientes). La mortalidad postoperatoria global fue 7% (2 pacientes), sin embargo, la mortalidad postoperatoria relacionada con la cirugía fue de 4% (un paciente). El estudio anatomopatológico evidenció resección con márgenes libres en todos los casos intervenidos. La mediana de adenopatías resecadas fue 18 (0 a 38), siendo 1 (0 a 8) las adenopatías afectadas. Tras una mediana de seguimiento de 23 (9-69,7) meses, la supervivencia actuarial fue de 62,2 (25,2 a 99,1) meses y la supervivencia actuarial libre de enfermedad fue de 49 (0 a 133) meses. Conclusiones: La resección quirúrgica del AD comporta una elevada morbilidad postoperatoria, sin embargo, consigue una supervivencia prolongada. Dependiendo de la localización y en ausencia de infiltración pancreática, la DD segmentaria con márgenes libres es una alternativa a la DPC


Introduction: Duodenal adenocarcinoma is a rare malignancy. Given the rarity of the disease, there is limited data related to resection results. The objective is to analyze results at our hospital after the curative resection of duodenal adenocarcinoma (DA). Methods: The variables were retrospectively collected from patients operated on between 1990 and 2017 at our hospital. Results: A total of 27 patients were treated. Twenty-three patients (85%) underwent pancreaticoduodenectomy, and 4 patients (15%) with tumors located in the third and fourth portions of the duodenum underwent segmental duodenal resection. The overall postoperative morbidity was 67% (18 patients). Postoperative mortality was 7% (2 patients); however, postoperative mortality related to surgery was 4% (1 patient). All patients had negative resection margins. A median of 18 lymph nodes (range, 0-38) were retrieved and evaluated, with a median of 1 involved node (range, 0-8). Median follow up was 23 (9-69.7) months. Actuarial overall survival was 62.2 (25.2-99.1) months. Actuarial disease-free survival was 49 (0-133) months. Conclusions: The surgical treatment of duodenal adenocarcinoma is associated with a high morbidity, although it achieves considerable survival. Depending on the tumor location and if there is no pancreatic infiltration, segmental duodenal resection with negative margins is an alternative to cephalic pancreaticoduodenectomy


Assuntos
Humanos , Masculino , Feminino , Adulto , Pessoa de Meia-Idade , Idoso , Idoso de 80 Anos ou mais , Adenocarcinoma/cirurgia , Duodeno/cirurgia , Neoplasias Duodenais/cirurgia , Linfonodos/patologia , Pancreaticoduodenectomia/métodos , Duodeno/patologia , Neoplasias Duodenais/patologia , Linfonodos/cirurgia , Metástase Linfática , Margens de Excisão , Morbidade/tendências , Complicações Pós-Operatórias/mortalidade , Estudos Retrospectivos , Espanha/epidemiologia
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