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1.
Cancer Imaging ; 21(1): 45, 2021 Jun 30.
Artigo em Inglês | MEDLINE | ID: mdl-34193282

RESUMO

OBJECTIVES: To evaluate gadoxetic acid-enhanced liver MRI (EOB-MRI) versus contrast-enhanced computed tomography (CECT) for preoperative detection of liver metastasis (LM) and reduction of open-close laparotomies for pancreatic ductal adenocarcinoma (PDAC). METHODS: Sixty-six patients with PDAC had undergone preoperative EOB-MRI and CECT. LM detection by EOB-MRI and CECT and their impact on surgical planning, open-close laparotomies were compared by clinical and radiology reports and retrospective analysis of imaging by two blinded independent readers. Histopathology or imaging follow-up was the reference standard. Statistical analysis was performed at patient and lesion levels with two-sided McNemar tests. RESULTS: EOB-MRI showed higher sensitivity versus CECT (71.7% [62.1-80.0] vs. 34% [25.0-43.8]; p = 0.009), comparable specificity (98.6%, [96.9-99.5] vs. 100%, [99.1-100], and higher AUROC (85.1%, [80.4-89.9] vs. 66.9%, [60.9-73.1]) for LM detection. An incremental 7.6% of patients were excluded from surgery with a potential reduction of up to 13.6% in futile open-close laparotomies due to LM detected on EOB-MRI only. CONCLUSIONS: Preoperative EOB-MRI has superior diagnostic performance in detecting LM from PDAC. This better informs surgical eligibility with potential reduction of futile open-close laparotomies from attempted curative intent pancreatic cancer surgery.


Assuntos
Gadolínio DTPA , Laparotomia/métodos , Fígado/diagnóstico por imagem , Imageamento por Ressonância Magnética/métodos , Neoplasias Pancreáticas/cirurgia , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Cuidados Pré-Operatórios , Estudos Retrospectivos
2.
Nihon Shokakibyo Gakkai Zasshi ; 118(7): 679-685, 2021.
Artigo em Japonês | MEDLINE | ID: mdl-34248081

RESUMO

This case report describes a 73-year-old woman with pancreatic adenocarcinoma who had undergone a colectomy for colorectal cancer in 1995 and a right mastectomy and axillary dissection for breast cancer in 2013. In January 2019, a tumor, approximately 20mm in diameter, was detected in the pancreatic body. It contained a cyst noted to have delayed perfusion towards the center on abdominal computed tomography. On T1-weighted magnetic resonance imaging (MRI), almost the entire tumor exhibited low intensity. On T2-weighted MRI, however, the tumor center displayed high intensity, the tumor wall displayed low intensity, and the outermost layer displayed high intensity. On endoscopic ultrasound, the tumor center displayed low echo density, the tumor wall had a slightly elevated echo density, and the outermost layer had a low echo density. A distal pancreatectomy was performed for a suspected metastatic pancreatic cancer, pancreatic neuroendocrine neoplasm, or invasive ductal carcinoma without tubular adenocarcinoma. Histopathological examination revealed that the tumor cells had formed atypical tubular gland ducts with a fibrous stroma in the background. The lesion differed from the histopathological findings of her previous colorectal and breast cancers, and it was ultimately diagnosed as a pancreatic ductal adenocarcinoma. The lumen of the cyst was covered with tumor cells identical to those of the atypical tubular gland ducts in the tumor parenchyma, suggesting that the cyst was a dilated tubular gland duct.


Assuntos
Adenocarcinoma , Neoplasias da Mama , Carcinoma Ductal Pancreático , Cistos , Neoplasias Pancreáticas , Adenocarcinoma/diagnóstico por imagem , Adenocarcinoma/cirurgia , Idoso , Carcinoma Ductal Pancreático/diagnóstico por imagem , Carcinoma Ductal Pancreático/cirurgia , Feminino , Humanos , Mastectomia , Pancreatectomia , Ductos Pancreáticos , Neoplasias Pancreáticas/diagnóstico por imagem , Neoplasias Pancreáticas/cirurgia
3.
Zhonghua Wai Ke Za Zhi ; 59(7): 593-596, 2021 Jul 01.
Artigo em Chinês | MEDLINE | ID: mdl-34256459

RESUMO

The prognosis of pancreatic cancer patients with liver metastasis (PCLM) is very poor and the median overall survival(OS) is less than 6 months.The current standard treatment for PCLM is systematic chemotherapy.Though the chemotherapeutic regimens are better than gemcitabine only,the OS remains dissatisfied.A lot of retrospective studies identified that surgical treatment can only offer survival benefits for highly selected rather than entire PCLM patients.The Chinese Study Group for Pancreatic Cancer (CSPAC) has initiated a multiple-center,prospective,randomized comparison clinical trial,named CSPAC-1 to identify the standard and value of surgical treatment of PCLM patients.This manuscript reviewed the current progress of surgical treatment for pancreatic cancer with liver metastasis and looked forward to opportunities and challenges in the future.


Assuntos
Neoplasias Hepáticas , Neoplasias Pancreáticas , Protocolos de Quimioterapia Combinada Antineoplásica , Humanos , Neoplasias Hepáticas/tratamento farmacológico , Neoplasias Hepáticas/cirurgia , Neoplasias Pancreáticas/tratamento farmacológico , Neoplasias Pancreáticas/cirurgia , Estudos Prospectivos , Estudos Retrospectivos
5.
Zhonghua Wai Ke Za Zhi ; 59(7): 618-623, 2021 Jul 01.
Artigo em Chinês | MEDLINE | ID: mdl-34256463

RESUMO

Objective: To compare short-term efficacy,effectiveness and safety of laparoscopic pancreaticoduodenectomy(LPD) learning curve at different stages and at the same time with open pancreaticoduodenectomy(OPD). Methods: Clinical data of 488 patients who underwent pancreaticoduodenectomy at Department of Biliary-Pancreatic Surgery,Affiliated Tongji Hospital,Tongji Medical College,Huazhong University of Science and Technology from July 2014 to December 2016 were collected. There were 40 cases at the groping stage of LPD surgery(100 cases at the same time of OPD),64 cases at the stable stage (89 cases at the same time of OPD),and 118 cases at the mature stage(77 cases at the same time of OPD).The clinical data of LPD and OPD in the same period were compared and analyzed by χ2 test,t test and U test,respectively. Results: There was no significant difference in preoperative indicators between the two groups at the three stages(all P>0.05). In terms of intraoperative blood volume of the LPD group was significantly lower than that of the OPD group at three stages(M(QR))(111.1(150.0)ml(range:0 to 700 ml) vs. 393.9(400.0)ml(range:0 to 3 000 ml),120.8(115.0)ml(range:0 to 1 000 ml) vs. 442.9(450.0)ml(range:0 to 2 000 ml) and 150.0(200.0)ml(range:10 to 1 500 ml) vs. 364.3(400.0)ml(range:0 to 1 500 ml))(all P<0.05). And in terms of operation time of the LPD group was significantly higher than that of the OPD group at the groping stage((461.1±123.9)min(range:220 to 690 minutes) vs. (385.9±113.9)minutes(range:150 to 655 minutes))(P<0.05),and there was no significant difference between the LPD group and the OPD group at the stable and mature stage(P>0.05). The incidence of B+C level pancreatic fistula of the LPD group was higher than that of the OPD group at groping stage(17.5% vs. 3.0%)(P<0.05). There was no significant difference between the LPD group and the OPD group at the stable and mature stage(P>0.05). The incidence of postoperative rebleeding(27.5%),bile leakage(20.0%) and abdominal infection(20.0%) of the LPD group was higher than those of the OPD group(11.0%(11/100),5.0%(5/100) and 7.0%(7/100)) at groping stage. There were no significant differences between the LPD group and the OPD group at the stable and mature stage(P>0.05). There were no significant differences of incidence gastrointestinal leakage,hepatic failure,renal failure,cardiac failure,pulmonary infection and 30-day death between the LPD group and the OPD group(all P>0.05). The incidence rate of gastroplegia in the LPD group was lower than that in the OPD group at the stable and mature stage(26.5%(17/64) vs. 44.9%(40/89) and 24.5%(29/118) vs. 38.9%(30/77))(all P<0.05),there was no significant difference between the LPD group and the OPD group at the groping stage(P>0.05). In terms of other incidence of complications,there were no significant differences between the LPD group and the OPD group at three stages(all P>0.05). There were no significant differences of positive margin rate of pancreas,bile duct,retroperitoneum,vascular channel,uncinate process and rate of R0 resection between the LPD group and the OPD group at three stages(all P>0.05). In terms of numbers of lymph nodes,there was no significant difference between the LPD group and the OPD group at three stages(all P>0.05).Postoperative hospital stay of the LPD group was shorter than that of the OPD group at the stable stage((14.8±6.9)days(range:10 to 38 days) vs. (17.0±9.0)days(range:4 to 56 days)) and the mature stage((13.0±7.4)days(range:3 to 57 days) vs. (15.8±6.7)days(range:6 to 69 days)(all P<0.05). Conclusion: with the stable and mature learning curve of LPD surgery,compared with traditional OPD surgery,it has the characteristics of less intraoperative bleeding,shorter postoperative hospitalization,lower incidence of delay gastric empty,safe and effective.


Assuntos
Laparoscopia , Neoplasias Pancreáticas , Humanos , Curva de Aprendizado , Tempo de Internação , Neoplasias Pancreáticas/cirurgia , Pancreaticoduodenectomia , Complicações Pós-Operatórias , Estudos Retrospectivos
6.
Zhonghua Wai Ke Za Zhi ; 59(7): 624-630, 2021 Jul 01.
Artigo em Chinês | MEDLINE | ID: mdl-34256464

RESUMO

Objective: To evaluate the value of left-sided uncinate process first approach in pancreaticoduodenectomy. Methods: The clinical data of 152 patients who underwent the left-sided uncinate process first approach during pancreaticoduodenectomy at Pancreas Center, the First Affiliated Hospital of Nanjing Medical University from January 2020 to December 2020 were analyzed retrospectively. There were 64 females and 88 males,with age(M(QR)) of 62.0(14.7)years(range:16.0 to 84.0 years). The clinical date of 117 patients who underwent pancreaticoduodenectomy without using left-sided uncinate process first approach in the same period was selected as the control group,including 65 females and 52 males,with age of 64.0(13.0) years(range:13.0 to 84.0 years). Fisher exact probability method and t test were used to compare the data between the two groups,rank sum test was used for comparison of continuous variables between the two groups. Results: Pancreaticoduodenectomy was successfully performed in 152 patients in left-sided uncinate process first approach group. The operation time was 222.5(77.0) minutes(range:117.0 to 480.0 minutes),the time of uncinate process resection from left-side(the time from jejunum dissection to complete dissociation of the uncinate process) was 11.0(4.5) minutes(range:7.5 to 20.0 minutes),the time of pancreatic head resection (the time from jejunum dissection to pancreaticoduodenal specimen removal) was 26.0(8.5) minutes(range:20.0 to 41.0 minutes),the intraoperative blood loss was 200(150) ml(range:50 to 800 ml),and the intraoperative blood transfusion rate was 9.2% (14/152). Postoperative conditions:The postoperative hospital stay was 12 (9) d(range:6 to 55 d),the overall incidence of postoperative complications was 59.9%(91/152),and there was no perioperative death. Pathological results:The R0 resection rate of periampullary malignant tumor was 64.3%(77/112),with negative rate of uncinate process margin was 91.1%(102/112). The R0 resection rate of pancreatic ductal adenocarcinoma was 46.9%,with negative rate of uncinate process margin was 89.1%(57/64). Compared with the non-left-sided uncinate process first approach group(222.5(77.0) minutes, 9.2%(14/152)),the left-sided uncinate process first approach group had shorter operation time(246.0(94.0) minutes) (Z=3.964,P<0.01),less intraoperative blood loss (18.8%(22/117))(Z=4.843,P<0.01),and lower intraoperative blood transfusion rate(χ²=5.248,P=0.029). However,there were no significant differences between two groups in postoperative hospital stay(Z=1.682,P=0.093),postoperative overall complications(P=0.549),R0 resection rate of periampullary malignant tumor(χ²=2.012,P=0.156),and negative rate of uncinate process margin(χ²=2.108,P=0.147). Conclusions: The "left-sided uncinate process first approach" could completely resect uncinate process under a direct vision,especially when the uncinate process was behind the superior mesenteric artery or beyond the left lateral margin of the superior mesenteric artery. The "left-sided uncinate process first approach" might increase the negative rate of uncinate process margin and R0 resection rate for periampullary malignant tumor.


Assuntos
Laparoscopia , Neoplasias Pancreáticas , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Pâncreas/cirurgia , Neoplasias Pancreáticas/cirurgia , Pancreaticoduodenectomia , Estudos Retrospectivos , Adulto Jovem
7.
Zhonghua Wai Ke Za Zhi ; 59(6): 401-421, 2021 Jun 01.
Artigo em Chinês | MEDLINE | ID: mdl-34102722

RESUMO

Pancreatic neuroendocrine neoplasms (pNENs) are highly heterogeneous, and the management of pNENs patients can be intractable. To address this challenge, an expert committee was established on behalf of the Group of Pancreatic Surgery, Chinese Society of Surgery, Chinese Medical Association, which consisted of surgical oncologists, gastroenterologists, medical oncologists, endocrinologists, radiologists, pathologists, and nuclear medicine specialists. By reviewing the important issues regarding the diagnosis and treatment of pNENs, the committee concluded evidence-based statements and recommendations in this article, in order to further improve the management of pNENs patients in China.


Assuntos
Tumores Neuroendócrinos , Neoplasias Pancreáticas , China , Humanos , Tumores Neuroendócrinos/cirurgia , Tumores Neuroendócrinos/terapia , Pancreatectomia , Neoplasias Pancreáticas/cirurgia , Neoplasias Pancreáticas/terapia
8.
BMJ Case Rep ; 14(6)2021 Jun 04.
Artigo em Inglês | MEDLINE | ID: mdl-34088692

RESUMO

A 61-year-old woman with intraductal papillary mucinous neoplasm (IPMN) infection, who was treated with antibiotics, developed IPMN reinfection with febrile epigastric pain and was febrile. CT showed that the diameter of the IPMN had grown and hardened, with thickening of the cyst wall. Endoscopic retrograde pancreatography was then performed and a nasopancreatic cyst drainage tube was placed into the cyst. Symptoms and inflammatory findings improved considerably 17 days after endoscopic drainage. Few reports and evidence have been found regarding IPMN infections, and the frequency of onset, route of infection and optimal drainage method remain unknown. This study indicated that endoscopic transpapillary pancreatic cyst drainage was effective and is highly recommended for IPMN infection.


Assuntos
Adenocarcinoma Mucinoso , Carcinoma Ductal Pancreático , Cisto Pancreático , Neoplasias Pancreáticas , Adenocarcinoma Mucinoso/diagnóstico por imagem , Adenocarcinoma Mucinoso/cirurgia , Carcinoma Ductal Pancreático/cirurgia , Drenagem , Feminino , Humanos , Pessoa de Meia-Idade , Cisto Pancreático/diagnóstico por imagem , Cisto Pancreático/cirurgia , Neoplasias Pancreáticas/cirurgia
9.
In Vivo ; 35(4): 1907-1911, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34182462

RESUMO

BACKGROUND/AIM: Studies on robotic total pancreatectomy (RTP) have been limited regardless of the increasing evidence on robotic pancreatoduodenectomy. The aim of this study was to review the current status of RTP in terms of surgical techniques and outcomes. MATERIALS AND METHODS: A literature search using PubMed was conducted to investigate surgical techniques and outcomes of RTP. RESULTS: A total of eight case series with 56 patients were included. The indications for RTP consisted of benign or pre-malignant tumors in 43 patients and malignant tumors in 13 patients. Surgical techniques included the "dividing technique" and "en-bloc technique". Regarding surgical outcomes, the rate of conversion to open total pancreatectomy was 3.6% and the incidence of major complications was 10.7%. CONCLUSION: Although evidence for RTP is still lacking, RTP is feasible for selected patients when performed in specialized centers. Further studies are essential to investigate the effectiveness of RTP compared to open total pancreatectomy.


Assuntos
Laparoscopia , Neoplasias Pancreáticas , Procedimentos Cirúrgicos Robóticos , Robótica , Humanos , Pancreatectomia , Neoplasias Pancreáticas/cirurgia , Pancreaticoduodenectomia/efeitos adversos , Complicações Pós-Operatórias
10.
World J Gastroenterol ; 27(23): 3413-3428, 2021 Jun 21.
Artigo em Inglês | MEDLINE | ID: mdl-34163121

RESUMO

BACKGROUND: Currently, the technologies most commonly used to treat locally advanced pancreatic cancer are radiofrequency ablation (RFA), microwave ablation, and irreversible (IRE) or reversible electroporation combined with low doses of chemotherapeutic drugs. AIM: To report an overview and updates on ablative techniques in pancreatic cancer. METHODS: Several electronic databases were searched. The search covered the years from January 2000 to January 2021. Moreover, the reference lists of the found papers were analysed for papers not indexed in the electronic databases. All titles and abstracts were analysed. RESULTS: We found 30 studies (14 studies for RFA, 3 for microwave therapy, 10 for IRE, and 3 for electrochemotherapy), comprising 1047 patients, which were analysed further. Two randomized trials were found for IRE. Percutaneous and laparotomy approaches were performed. In the assessed patients, the median maximal diameter of the lesions was in the range of 2.8 to 4.5 cm. All series included patients unfit for surgical treatment, but Martin et al assessed a subgroup of patients with borderline resectable tumours who underwent resection with margin attenuation with IRE. Most studies administered chemotherapy prior to ablative therapies. However, several studies suggest that the key determinant of improved survival is attributable to ablative treatment alone. Nevertheless, the authors suggested chemotherapy before local therapies for several reasons. This strategy may not only downstage a subgroup of patients to curative-intent surgery but also support to recognize patients with biologically unfavourable tumours who would likely not benefit from ablation treatments. Ablation therapies seem safe based on the 1047 patients assessed in this review. The mortality rate ranged from 1.8% to 2%. However, despite the low mortality, the reported rates of severe post procedural complications ranged from 0%-42%. Most reported complications have been self-limiting and manageable. Median overall survival varied between 6.0 and 33 mo. Regarding the technical success rate, assessed papers reported an estimated rate in the range of 85% to 100%. However, the authors reported early recurrence after treatment. A distinct consideration should be made on whether local treatments induce an immune response in the ablated area. Preclinical and clinical studies have shown that RFA is a promising mechanism for inducing antigen-presenting cell infiltration and enhancing the systemic antitumour T-cell immune response and tumour regression. CONCLUSION: In the management of patients with pancreatic cancer, the possibility of a multimodal approach should be considered, and conceptually, the combination of RFA with immunotherapy represents a novel angle of attack against this tumour.


Assuntos
Técnicas de Ablação , Ablação por Cateter , Neoplasias Pancreáticas , Ablação por Radiofrequência , Técnicas de Ablação/efeitos adversos , Ablação por Cateter/efeitos adversos , Eletroporação , Humanos , Pâncreas , Neoplasias Pancreáticas/cirurgia
11.
Front Immunol ; 12: 577517, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34084158

RESUMO

Background: Extracellular traps (ETs) and tumor-infiltrating immune cells can contribute to disease progression. The clinical significance of tumor-infiltrating neutrophils and macrophages and related extracellular traps in pancreatic neuroendocrine tumors (pNETs) has not been fully elucidated. This study aimed to explore the prognostic value of tumor infiltration and ET formation by neutrophils and macrophages in pNETs. Methods: A total of 135 patients with radical resection of nonfunctional pNETs were analyzed retrospectively. Immunohistochemistry and immunofluorescence were utilized to stain tumor tissue sections. The recurrence-free survival (RFS) of subgroups determined by Kaplan-Meier analysis was compared with the log-rank test. Univariate and multivariate Cox regression analyses were used to identify independent prognostic factors. A nomogram was established to predict 3-year RFS. Results: Patients with high tumor-infiltrating neutrophils or macrophages or positive expression of neutrophils ETs or macrophage ETs displayed worse RFS (all p<0.05). Moreover, univariate and multivariate Cox regression analyses showed that neutrophil and macrophage infiltration and ETs were independent prognostic factors for RFS (all p<0.05). A combined parameter including WHO grade, TNM stage, tumor-infiltrating neutrophils and macrophages, and neutrophil and macrophage ETs had the highest C-index (0.866) and lowest Akaike information criteria (326.557). The calibration plot of nomogram composed of the combined parameter exhibited excellent prognostic values for 3-year RFS. Conclusions: Infiltration and ETs by neutrophils and macrophages can be used as biological indicators of patient prognosis, suggesting the treatment potential for targeting those in nonfunctional pNETs.


Assuntos
Armadilhas Extracelulares/imunologia , Macrófagos/imunologia , Tumores Neuroendócrinos/imunologia , Infiltração de Neutrófilos/imunologia , Neoplasias Pancreáticas/imunologia , Adulto , Feminino , Humanos , Estimativa de Kaplan-Meier , Macrófagos/patologia , Masculino , Pessoa de Meia-Idade , Recidiva Local de Neoplasia , Tumores Neuroendócrinos/patologia , Tumores Neuroendócrinos/cirurgia , Nomogramas , Neoplasias Pancreáticas/patologia , Neoplasias Pancreáticas/cirurgia , Prognóstico , Estudos Retrospectivos
12.
Eur J Radiol ; 141: 109803, 2021 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-34090111

RESUMO

PURPOSE: To assess intra-tumoral heterogeneity (ITH) via fractal analysis of preoperative contrast-enhanced computed tomography (CT) images to predict pathological grades in non-functioning pancreatic neuroendocrine tumors (NF-PNETs) and verify its impact on patient survival. METHODS: This retrospective study enrolled 40 patients with NF-PNET resected in our institution during a period from July 2005 to December 2018, except functioning tumors, unidentified tumors in CT, patients without preoperative contrast-enhanced CT. CT images were analyzed using plugin software for calculating fractal dimension (FD), and the maximum value was denoted as "FDmax," and compared with pathological grades and patient survival between G1 and G2/3 group separating according to two different Ki-67 index thresholds (3% and 5%). All CT images were acquired in three-phases and arterial phase images were examined. RESULTS: Ki-67 index and FDmax showed a direct correlation with significance (p < 0.01). The mean FDmax of the G2/3 tumor group was significantly higher than that of the G1 tumor group (p < 0.01 in both 3% and 5% thresholds). In the ROC analysis, FDmax showed 0.773 of AUC, and cut-off value of 1.036 reported 62.5 % sensitivity, 90.0 % specificity, 86.2 % PPV, and 70.6 % NPV to distinguish G2/3 patients. The high-FD (≥1.036) group showed a significantly shorter disease-free survival (DFS) than the low-FD group (p = 0.0128). In multivariate analysis of prognostic factors, high FD was the only significant factor for DFS (HR, 5.793; 95 % CI: 1.213-27.664; p = 0.028). CONCLUSIONS: The tumor's FDmax using CE-CT analysis might be a potential biomarker for preoperative prediction of G2/3 tumors, and predicting recurrence.


Assuntos
Tumores Neuroendócrinos , Neoplasias Pancreáticas , Fractais , Humanos , Recidiva Local de Neoplasia , Tumores Neuroendócrinos/diagnóstico por imagem , Tumores Neuroendócrinos/cirurgia , Neoplasias Pancreáticas/diagnóstico por imagem , Neoplasias Pancreáticas/cirurgia , Estudos Retrospectivos , Tomografia Computadorizada por Raios X
13.
Eur J Radiol ; 141: 109825, 2021 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-34144309

RESUMO

OBJECTIVE: To assess the diagnostic performance and reader confidence in determining the resectability of pancreatic cancer at computed tomography (CT) using a new deep learning image reconstruction (DLIR) algorithm. METHODS: A retrospective review was conduct of on forty-seven patients with pathologically confirmed pancreatic cancers who underwent baseline multiphasic contrast-enhanced CT scan. Image data sets were reconstructed using filtered back projection (FBP), hybrid model-based adaptive statistical iterative reconstruction (ASiR-V) 60 %, and DLIR "TrueFidelity" at low(L), medium(M), and high strength levels(H). Four board-certified abdominal radiologists reviewed the CT images and classified cancers as resectable, borderline resectable, or unresectable. Diagnostic performance and reader confidence for categorizing the resectability of pancreatic cancer were evaluated based on the reference standards, and the interreader agreement was assessed using Fleiss k statistics. RESULTS: For prediction of margin-negative resections(ie, R0), the average area under the receiver operating characteristic curve was significantly higher with DLIR-H (0.91; 95 % confidence interval [CI]: 0.79, 0.98) than FBP (0.75; 95 % CI:0.60, 0.86) and ASiR-V (0.81; 95 % CI:0.67, 0.91) (p = 0.030 and 0.023 respectively). Reader confidence scores were significantly better using DLIR compared to FBP and ASiR-V 60 % and increased linearly with the increase of DLIR strength level (all p < 0.001). Among the image reconstructions, DLIR-H showed the highest interreader agreement in the resectability classification and lowest subject variability in the reader confidence. CONCLUSIONS: The DLIR-H algorithm may improve the diagnostic performance and reader confidence in the CT assignment of the local resectability of pancreatic cancer while reducing the interreader variability.


Assuntos
Aprendizado Profundo , Neoplasias Pancreáticas , Algoritmos , Humanos , Processamento de Imagem Assistida por Computador , Neoplasias Pancreáticas/diagnóstico por imagem , Neoplasias Pancreáticas/cirurgia , Doses de Radiação , Interpretação de Imagem Radiográfica Assistida por Computador , Estudos Retrospectivos
14.
BMJ Case Rep ; 14(6)2021 Jun 23.
Artigo em Inglês | MEDLINE | ID: mdl-34162618

RESUMO

Pancreatic injuries are often overlooked in view of subtle clinical signs, and high index of suspicion is required to manage these injuries. Management strategies vary depending on the grade of injury and associated solid organ injuries and vascular injuries. Early surgery is advised in patients with duct disruption to avoid complications related to duct disruption. We present a case of 19-year-old man with delayed presentation following pancreatic trauma. During the surgery, changes of pancreatitis were noted and posterior wall of the stomach was adherent to pancreas, and inflammatory changes in vicinity of pancreas posed a significant challenge while dissecting pancreas away from the splenic vein. Spleen-preserving distal pancreatectomty (SPDP) was done. SPDP is time-consuming and technically challenging procedure especially in patients with delayed presentation. It is safe and feasible to consider spleen preservation in pancreatic trauma when patient is haemodynamically stable and expertise is available.


Assuntos
Traumatismos Abdominais , Neoplasias Pancreáticas , Traumatismos Abdominais/cirurgia , Adulto , Humanos , Masculino , Pâncreas/diagnóstico por imagem , Pâncreas/cirurgia , Pancreatectomia , Neoplasias Pancreáticas/cirurgia , Baço/diagnóstico por imagem , Baço/cirurgia , Adulto Jovem
15.
BMJ Case Rep ; 14(6)2021 Jun 24.
Artigo em Inglês | MEDLINE | ID: mdl-34167983

RESUMO

Castleman's disease (CD) is a rare lymphoproliferative disorder. This case report, to the best of our knowledge, is the first report of CD simulating a pancreatic neuroendocrine tumour . The patient was a 58-year-old woman who initially presented with bilateral iritis and underwent investigation for possible systemic rheumatological disease. CT of the chest demonstrated an incidental finding of a well-demarcated retropancreatic mass. As the mass was found to enhance on DOTATATE (tetraazacyclododecanetetraacetic acid-DPhe1-Tyr3-octreotate) positron emission tomography, a diagnosis of pancreatic neuroendocrine tumour was made. The patient underwent an open distal pancreatectomy and splenectomy. Histopathological examination revealed the unexpected diagnosis of hyaline vascular CD of a lymph node posterior to the pancreas. After 2 years of follow-up, there is no evidence of disease recurrence.


Assuntos
Hiperplasia do Linfonodo Gigante , Neoplasias Pancreáticas , Hiperplasia do Linfonodo Gigante/diagnóstico por imagem , Hiperplasia do Linfonodo Gigante/cirurgia , Feminino , Humanos , Pessoa de Meia-Idade , Pancreatectomia , Neoplasias Pancreáticas/diagnóstico por imagem , Neoplasias Pancreáticas/cirurgia , Tomografia por Emissão de Pósitrons , Tomografia Computadorizada por Raios X
16.
Nutrients ; 13(6)2021 May 22.
Artigo em Inglês | MEDLINE | ID: mdl-34067286

RESUMO

Total pancreatectomy (TP) is a highly invasive procedure often performed in patients affected by anorexia, malabsorption, cachexia, and malnutrition, which are risk factors for bad surgical outcome and even may cause enhanced toxicity to chemo-radiotherapy. The role of nutritional therapies and the association between nutritional aspects and the outcome of patients who have undergone TP is described in some studies. The aim of this comprehensive review is to summarize the available recent evidence about the influence of nutritional factors in TP. Preoperative nutritional and metabolic assessment, but also intra-operative and post-operative nutritional therapies and their consequences, are analyzed in order to identify the aspects that can influence the outcome of patients undergoing TP. The results of this review show that preoperative nutritional status, sarcopenia, BMI and serum albumin are prognostic factors both in TP for pancreatic cancer to support chemotherapy, prevent recurrence and prolong survival, and in TP with islet auto-transplantation for chronic pancreatitis to improve postoperative glycemic control and obtain better outcomes. When it is possible, enteral nutrition is always preferable to parenteral nutrition, with the aim to prevent or reduce cachexia. Nowadays, the nutritional consequences of TP, including diabetes control, are improved and become more manageable.


Assuntos
Terapia Nutricional/métodos , Estado Nutricional , Pancreatectomia/métodos , Complicações Pós-Operatórias/epidemiologia , Índice de Massa Corporal , Feminino , Humanos , Transplante das Ilhotas Pancreáticas/métodos , Masculino , Pancreatectomia/efeitos adversos , Neoplasias Pancreáticas/cirurgia , Pancreatite Crônica/cirurgia , Prognóstico , Fatores de Risco , Sarcopenia/epidemiologia , Albumina Sérica/análise
17.
BMC Gastroenterol ; 21(1): 247, 2021 Jun 02.
Artigo em Inglês | MEDLINE | ID: mdl-34078293

RESUMO

BACKGROUND: Undifferentiated carcinoma with osteoclast-like giant cells (UCOGCs) is a rare and aggressive non endocrine pancreatic carcinoma characterized by the presence of osteoclastic giant cells mixed with mononuclear cell. Very few cases have been reported in the literature and the histogenesis is controversial as, at the time of diagnosis, the tumor is often of advanced size and stage and it is difficult to pathologically observe its relationship with the pancreatic duct. CASE PRESENTATION: We present a case of 65-year-old male patient presenting with abdominal pain, nausea, and weight loss, which was treated with surgical resection. Histological examination revealed an undifferentiated pancreatic carcinoma with osteoclast-like giant cells. The patient underwent to a routine pylorus preserving pancreatoduodenectomy. Actually, the patient was in good performance status and disease-free five months. CONCLUSIONS: Based on the present case and limited previous data, further researches preferably with large cohorts are necessary to clarify the pathogenesis of the neoplasm. However, as show in this case, histopathological and immunohistochemically studies are the gold standard for the diagnosis of UCPOGC. Investigation of the genomic alterations in UPOGCs could help to explain the histologic diversity of variant tumor and could provide a genetic basis for prognosis and treatment.


Assuntos
Carcinoma , Neoplasias Pancreáticas , Idoso , Carcinoma/diagnóstico , Carcinoma/cirurgia , Células Gigantes , Humanos , Masculino , Osteoclastos , Neoplasias Pancreáticas/cirurgia , Pancreaticoduodenectomia
18.
J Med Case Rep ; 15(1): 314, 2021 May 31.
Artigo em Inglês | MEDLINE | ID: mdl-34059139

RESUMO

BACKGROUND: Metastatic spread to the pancreas is a rare event. Renal cell carcinoma represents one possible site of origin of pancreatic metastases. Renal cell carcinoma often metastasizes late and exclusively to the pancreas, suggesting a special role of renal cell carcinoma among primaries metastasizing to the pancreas. Even rarer, renal cell carcinoma may occur simultaneously with pancreatic ductal adenocarcinoma. CASE PRESENTATION: We present the case of a 78-year-old male Caucasian patient with a history of clear-cell renal cell carcinoma treated with oncological left nephrectomy 20 years before. The patient was diagnosed with pancreatic ductal adenocarcinoma by fine-needle aspiration cytology. At our institution, he received neoadjuvant therapy with folic acid, fluorouracil, irinotecan, oxaliplatin for borderline-resectable pancreatic ductal adenocarcinoma, and subsequently underwent total pancreatectomy. Upon resection, pancreatic ductal adenocarcinoma as well as two metachronous metastases of clear-cell renal cell carcinoma occurring simultaneously and cospatially with pancreatic ductal adenocarcinoma were diagnosed in the pancreatic body. CONCLUSIONS: Renal cell carcinoma metastases of the pancreas are rare and often occur decades after the initial diagnosis of renal cell carcinoma. The combination of renal cell carcinoma metastases and pancreatic ductal adenocarcinoma is even rarer. However, the possibility should be considered by clinicians, radiologists, and pathologists. The special role of renal cell carcinoma as a site of origin of pancreatic metastasis should be further elucidated.


Assuntos
Adenocarcinoma , Carcinoma de Células Renais , Neoplasias Renais , Neoplasias Pancreáticas , Idoso , Carcinoma de Células Renais/cirurgia , Humanos , Neoplasias Renais/cirurgia , Masculino , Pancreatectomia , Neoplasias Pancreáticas/cirurgia
19.
Medicine (Baltimore) ; 100(25): e26382, 2021 Jun 25.
Artigo em Inglês | MEDLINE | ID: mdl-34160414

RESUMO

RATIONALE: Multiple endocrine neoplasia type 1 (MEN1) is a rare tumor syndrome with an autosomal dominant inheritance, and genetic testing for MEN1 gene is important for both affected individuals and their relatives. We present a 2-person family affected by a germline c.1546dupC MEN1 mutation, and one of them had a full-spectrum of MEN-related endocrine tumors. PATIENT CONCERNS: A female patient aged 32 years presented with jejunal ulcer perforation due to gastrinoma. DIAGNOSES: We conducted genetic analysis and extensive biochemical/radiological evaluation for detecting other endocrine tumors. Multiple pancreatic neuroendocrine tumors (NETs), prolactinoma and primary hyperparathyroidism were diagnosed, and a frame-shift mutation, NM_130799.1:c.1546dupC (p.Arg516Profs∗15), was detected. One daughter of the proband, aged 12 years, had the same mutation for MEN1. INTERVENTION: She underwent pancreatic surgery for pancreatic NETs and total parathyroidectomy for primary hyperparathyroidism. OUTCOMES: After pancreatic surgery, long-term symptoms of epigastric soreness, acid belching, sweating, and palpitation in fasting were improved. Hypercalcemia was improved after parathyroidectomy and she was supplemented with oral calcium and vitamin D. Her daughter showed normal biochemical surveillance until 15 years of age. LESSONS: We report 2 people in a family affected by MEN1 with the heterozygous germline c.1546dupC mutation, a variant that should be surveilled for early development of full-blown MEN1-associated endocrine tumors.


Assuntos
Neoplasia Endócrina Múltipla Tipo 1/diagnóstico , Neoplasias Primárias Múltiplas/diagnóstico , Tumores Neuroendócrinos/diagnóstico , Proteínas Proto-Oncogênicas/genética , Adenoma/diagnóstico , Adenoma/genética , Adenoma/cirurgia , Adulto , Criança , Feminino , Mutação da Fase de Leitura , Gastrinoma/diagnóstico , Gastrinoma/genética , Gastrinoma/cirurgia , Testes Genéticos , Mutação em Linhagem Germinativa , Glucagonoma , Heterozigoto , Humanos , Hiperparatireoidismo Primário/diagnóstico , Hiperparatireoidismo Primário/genética , Hiperparatireoidismo Primário/cirurgia , Insulinoma , Neoplasia Endócrina Múltipla Tipo 1/complicações , Neoplasia Endócrina Múltipla Tipo 1/genética , Neoplasia Endócrina Múltipla Tipo 1/cirurgia , Neoplasias Primárias Múltiplas/genética , Neoplasias Primárias Múltiplas/cirurgia , Tumores Neuroendócrinos/genética , Tumores Neuroendócrinos/cirurgia , Neoplasias Pancreáticas/diagnóstico , Neoplasias Pancreáticas/genética , Neoplasias Pancreáticas/cirurgia , Neoplasias das Paratireoides/diagnóstico , Neoplasias das Paratireoides/genética , Neoplasias das Paratireoides/cirurgia , Paratireoidectomia , Prolactinoma/diagnóstico , Prolactinoma/genética , Prolactinoma/cirurgia
20.
World J Surg Oncol ; 19(1): 166, 2021 Jun 09.
Artigo em Inglês | MEDLINE | ID: mdl-34107980

RESUMO

BACKGROUND: Elevated plasma D-dimer levels have been reported as an unfavorable prognostic indicator in many solid tumors. However, there are limited relevant studies in pancreatic cancer patients following radical surgery, and the clinical significance remains controversial. The aim of this study was to investigate the clinical and prognostic significance of preoperative plasma D-dimer in patients with pancreatic ductal adenocarcinoma (PDAC) undergoing resection. METHODS: A retrospective analysis was performed on all patients who consecutively underwent radical surgery for PDAC by laparotomy or robotic surgery from December 2011 to December 2018. Baseline clinicopathologic characteristics, preoperative laboratory parameters, and follow-up information were collected. Univariate and multivariate analyses were performed to analyze the prognostic value of preoperative plasma D-dimer. RESULTS: Among 1351 patients, elevated preoperative plasma D-dimer levels (≥ 0.55 ng/mL) were found in 417 (30.9%) patients. Three hundred twelve (23.09%) underwent minimally invasive robotic pancreatectomy. The median overall survival (OS) of patients with elevated D-dimer levels was 6.3 months shorter than that of patients with normal D-dimer levels (15.0 months vs 21.3 months, p < 0.001). Multivariate analysis showed that elevated D-dimer levels independently predicted poorer OS (hazard ratio, 1.33; 95% confidence interval, 1.17-1.51, p < 0.001). Subgroup analysis demonstrated that D-dimer was a reliable prognostic factor in patients who underwent R0 resection. In addition, integration of D-dimer, carbohydrate antigen 19-9 (CA19-9), and NLR provided a better prognostic model for PDAC patients before operation. CONCLUSION: An elevated preoperative plasma D-dimer level was a reliable independent prognostic factor for OS in patients with PDAC undergoing resection. Combination of D-dimer, CA19-9, and NLR can enhance the prognostic accuracy before operation.


Assuntos
Carcinoma Ductal Pancreático , Neoplasias Pancreáticas , Carcinoma Ductal Pancreático/cirurgia , Produtos de Degradação da Fibrina e do Fibrinogênio , Humanos , Neoplasias Pancreáticas/cirurgia , Prognóstico , Estudos Retrospectivos
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