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1.
PLoS One ; 14(1): e0211019, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30673748

RESUMO

OBJECTIVES: Although endoscopic papillectomy is useful for treating papillary tumors, it is associated with a high rate of complications including pancreatitis; therefore, safer treatment options are needed. We examined the utility of wire-guided endoscopic papillectomy by comparing the pancreatic duct stenting and pancreatitis rates before and after wire-guided endoscopic papillectomy was introduced at our institution. METHODS: We retrospectively examined the data from 16 consecutive patients who underwent conventional endoscopic papillectomy between November 1995 and July 2005 and the data from 33 patients in whom wire-guided endoscopic papillectomy was first attempted at our institution between August 2005 and April 2017. We compared the pancreatic duct stenting and pancreatitis rates between the two groups. RESULTS: Of the 33 patients in whom wire-guided endoscopic papillectomy was first attempted, the procedure was completed in 21. Pancreatic duct stenting was possible in 30 of the 33 patients in whom wire-guided endoscopic papillectomy was attempted (91%), and this rate was significantly higher than that before the introduction of wire-guided endoscopic papillectomy (68.8%). The incidence of pancreatitis before the introduction of wire-guided endoscopic papillectomy was 12.5%, but after August 2005, the incidence was reduced by half to 6.1%, which includes those patients in whom wire-guided endoscopic papillectomy could not be completed. CONCLUSIONS: Although wire-guided endoscopic papillectomy cannot be completed in some patients, we believe that this method shows some potential for reducing the total incidence of post-endoscopic papillectomy pancreatitis owing to more successful pancreatic duct stenting.


Assuntos
Colangiopancreatografia Retrógrada Endoscópica , Ductos Pancreáticos/cirurgia , Pancreatite , Complicações Pós-Operatórias/epidemiologia , Idoso , Neoplasias do Ducto Colédoco/epidemiologia , Neoplasias do Ducto Colédoco/cirurgia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Pancreatite/epidemiologia , Pancreatite/etiologia
2.
Minerva Gastroenterol Dietol ; 65(2): 85-90, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-30488680

RESUMO

BACKGROUND: Ampullary cancer accounts for only 0.2% of gastrointestinal cancers. The objective of this study was to investigate the incidence, demographics, tumor characteristics, treatment, and survival of patients with ampullary tumors. METHODS: Data on ampullary cancer between 2004 and 2013 was extracted from the Surveillance, Epidemiology and End Results (SEER) Registry. The clinical epidemiology of these tumors was analyzed using SEER*Stat. RESULTS: A total of 6803 patients with ampullary cancer were identified. Median age at diagnosis was 71±13 years. The overall age-adjusted incidence of ampullary cancer was 0.59 per 100,000 per year. A higher incidence of ampullary cancer was observed in males compared to females (0.74 vs. 0.48 per 100,000 per year). Most tumors were moderately differentiated (39.5%). The most common stage at presentation was Stage I (21%), followed by Stage II (20%). The majority (63%) of these tumors were surgically resected while 20% of patients received radiotherapy. One and 5-year cause-specific survival for ampullary cancer was 71.7% and 38.8% respectively, with a median survival of 31 months. On Cox regression analysis, black race, increasing cancer stage and grade, N1 stage, and non-surgical treatment were associated with poorer prognosis. Those who were not treated with surgical intervention were at 4.5 times increased risk for death (hazard ratio 4.5, 95% CI: 3.93-5.09, P=0.000). CONCLUSIONS: The annual incidence of ampullary cancer has been fairly constant, though males are more likely to be affected. While its incidence increases with age, patients who are treated by surgical intervention have significantly better outcomes. Additionally, through the use of endoscopic techniques, ampullary cancer can be detected and treated much earlier.


Assuntos
Ampola Hepatopancreática , Neoplasias do Ducto Colédoco , Idoso , Idoso de 80 Anos ou mais , Estudos de Coortes , Neoplasias do Ducto Colédoco/diagnóstico , Neoplasias do Ducto Colédoco/epidemiologia , Neoplasias do Ducto Colédoco/mortalidade , Neoplasias do Ducto Colédoco/terapia , Demografia , Feminino , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Programa de SEER , Taxa de Sobrevida
3.
J Surg Oncol ; 119(3): 303-317, 2019 03.
Artigo em Inglês | MEDLINE | ID: mdl-30561818

RESUMO

BACKGROUND AND OBJECTIVES: Periampullary adenocarcinoma (PAC) is stratified anatomically: ampullary adenocarcinoma (AA), distal cholangiocarcinoma (DCC), duodenal adenocarcinoma (DA), and pancreatic ductal adenocarcinoma (PDAC). We aimed to determine differences in incidence, prognosis, and treatment in stage-matched PAC patients in a longitudinal study. METHODS: PAC patients were identified in The National Cancer Database from 2004 to 2012. Clinicopathological variables were compared between subtypes. Covariate-adjusted treatment use and OS were compared. RESULTS: The 116 705 patients with PAC were identified: 1320 (9%) AA, 3732 (3%) DCC, 7142 (6%) DA, and 95 511 (82%) PDAC. DA, DCC, and PDAC were associated with worse survival compared with AA (hazard ratio [HR], 1.10; 95% CI, 1.1-1.1; HR, 1.50; 95% CI, 1.4-1.6, and HR, 1.90; 95% CI, 1.8-1.9). Among resected patients, DA was associated with improved survival compared with AA (HR, 0.70; 95% CI, 0.67-0.75); DCC and PDAC were associated with worse survival (HR, 1.41; 95% CI, 1.31-1.53 and HR, 2.041; 95% CI, 1.07-2.12). Resected AA, PDAC, and DA, but not DCC, demonstrated significantly improved survival over the studied period. While all patients had increased adjuvant therapy (AT) receipt over time (P < 0.001), only patients with PDAC had increased neoadjuvant therapy (NAT) receipt ( P < 0.001). CONCLUSION: Resected PDAC, AA, and DA were associated with clinically significant improved survival over time, mirroring a concurrent associated increased receipt of AT.


Assuntos
Adenocarcinoma/mortalidade , Ampola Hepatopancreática/patologia , Neoplasias dos Ductos Biliares/mortalidade , Carcinoma Ductal Pancreático/mortalidade , Colangiocarcinoma/mortalidade , Neoplasias do Ducto Colédoco/mortalidade , Neoplasias Pancreáticas/mortalidade , Adenocarcinoma/epidemiologia , Adenocarcinoma/terapia , Idoso , Neoplasias dos Ductos Biliares/epidemiologia , Neoplasias dos Ductos Biliares/terapia , Carcinoma Ductal Pancreático/epidemiologia , Carcinoma Ductal Pancreático/terapia , Colangiocarcinoma/epidemiologia , Colangiocarcinoma/terapia , Terapia Combinada , Neoplasias do Ducto Colédoco/epidemiologia , Neoplasias do Ducto Colédoco/terapia , Feminino , Seguimentos , Humanos , Incidência , Estudos Longitudinais , Masculino , Pessoa de Meia-Idade , Terapia Neoadjuvante , Neoplasias Pancreáticas/epidemiologia , Neoplasias Pancreáticas/terapia , Prognóstico , Taxa de Sobrevida , Texas/epidemiologia
4.
Rev Esp Patol ; 51(4): 210-215, 2018.
Artigo em Espanhol | MEDLINE | ID: mdl-30269771

RESUMO

INTRODUCTION: Ampullary adenocarcinoma seems less aggressive than other pancreato-biliary neoplasms. The aim of this study is to define determining prognostic factors. MATERIAL AND METHODS: Retrospective case series from a large tertiary Hospital including all patients diagnosed with ampullary adenocarcinoma who underwent cephalic pancreatoduodenectomy with curative intent. Outcome variables have been progression free survival and overall survival. RESULTS: 24 patients were included. 54.2% were females and the mean age was 72.5 (45-85). Most cases were of intestinal type (50%), followed by pancreatobiliary (37.5%) and mucinous. Only 8.3% were high histopathological grade. Vessel invasion was detected in 31.8% of the cases and perineural infiltration in 20.8%. A large percentage of cases showed no lymph node involvement at the time of diagnosis (54.1%). Most cases were stage T1 or T3 (39.1 y 43.5%, respectively). 34.8% of the patients recurred, mainly in regional lymph nodes (62.5% of the recurrences) and they all died of tumor, mainly during the first year after diagnosis. Multivariate analysis with Cox regression model revealed that only lymph node involvement was independently associated to a shorter disease free progression interval and overall survival. CONCLUSIONS: Lymph node involvement was the most important predictive factor for ampullary adenocarcinoma in this series.


Assuntos
Adenocarcinoma/epidemiologia , Ampola Hepatopancreática/patologia , Neoplasias do Ducto Colédoco/epidemiologia , Adenocarcinoma/patologia , Adenocarcinoma/cirurgia , Idoso , Idoso de 80 Anos ou mais , Ampola Hepatopancreática/cirurgia , Neoplasias do Ducto Colédoco/patologia , Neoplasias do Ducto Colédoco/cirurgia , Comorbidade , Diabetes Mellitus/epidemiologia , Feminino , Humanos , Inflamação , Estimativa de Kaplan-Meier , Metástase Linfática , Masculino , Pessoa de Meia-Idade , Invasividade Neoplásica , Pancreaticoduodenectomia , Prognóstico , Intervalo Livre de Progressão , Modelos de Riscos Proporcionais , Estudos Retrospectivos , Fumar/epidemiologia
5.
Eur J Surg Oncol ; 42(2): 197-204, 2016 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-26687069

RESUMO

BACKGROUND: Intraductal papillary mucinous neoplasms (IPMN) have been reported to be associated with concurrent, distinct pancreatic ductal adenocarcinoma (con-PDAC) in about 8% (range, 4-10%) of resected branch duct (BD) lesions. In addition, other pancreatic and ampullary tumors are occasionally diagnosed with IPMN in patients undergoing pancreatic surgery. The objective of this study is to describe the prevalence, clinicopathologic characteristics and prognosis of IPMN with concurrent pancreatic and ampullary neoplasms, especially con-PDAC. METHODS: The combined databases of pancreatic resections from the Massachusetts General Hospital and the Negrar Hospital, Italy, were analyzed for patients who had been diagnosed with IPMN and concurrent pancreatic or ampullary neoplasms. RESULTS: 2762 patients underwent pancreatic surgery from January 2000 to December 2012. Sixteen percent (n = 441) had pathologically confirmed IPMN and 11% of these (n = 50) had a different distinct synchronous pancreatic neoplasm. The majority of these, 62%, were con-PDAC, followed by neuroendocrine neoplasms (10%) and ampullary carcinoma (10%). Less frequently, mucinous (6%) as well as serous cystic neoplasms (6%), adenosquamous carcinoma (4%) and distal bile duct cancer (2%) were diagnosed. Among all patients with synchronous neoplasms, 66% harbored BD-IPMN, 28% combined IPMN and 6% main duct IPMN. Abdominal pain and/or jaundice were the leading symptoms in half of patients. CONCLUSION: IPMN, mainly BD-IPMN, are associated with con-PDAC in about 7% of patients and account for 62% of all concurrent pancreatic/ampullary neoplasms. Other synchronous neoplasms may be found sporadically with IPMN without a suspected association.


Assuntos
Adenocarcinoma Mucinoso/patologia , Ampola Hepatopancreática , Carcinoma Adenoescamoso/patologia , Carcinoma Ductal Pancreático/patologia , Neoplasias do Ducto Colédoco/patologia , Neoplasias Primárias Múltiplas/patologia , Tumores Neuroendócrinos/patologia , Neoplasias Pancreáticas/patologia , Dor Abdominal/etiologia , Adenocarcinoma Mucinoso/epidemiologia , Adenocarcinoma Mucinoso/cirurgia , Idoso , Idoso de 80 Anos ou mais , Carcinoma Adenoescamoso/epidemiologia , Carcinoma Adenoescamoso/cirurgia , Carcinoma Ductal Pancreático/epidemiologia , Carcinoma Ductal Pancreático/cirurgia , Quimioterapia Adjuvante , Neoplasias do Ducto Colédoco/epidemiologia , Neoplasias do Ducto Colédoco/cirurgia , Feminino , Humanos , Achados Incidentais , Icterícia/etiologia , Masculino , Pessoa de Meia-Idade , Neoplasias Primárias Múltiplas/epidemiologia , Neoplasias Primárias Múltiplas/cirurgia , Tumores Neuroendócrinos/epidemiologia , Tumores Neuroendócrinos/cirurgia , Neoplasias Pancreáticas/epidemiologia , Neoplasias Pancreáticas/cirurgia , Prevalência , Prognóstico , Taxa de Sobrevida
6.
Asian Pac J Cancer Prev ; 16(17): 7541-6, 2015.
Artigo em Inglês | MEDLINE | ID: mdl-26625759

RESUMO

AIM: To report the histologic findings on Whipple resection specimens and thus determine the extent and spread of carcinomas of ampullary region and head of pancreas in our population. SETTING: Section of Histopathology, Department of Pathology, Aga Khan University Hospital (AKUH), Karachi, Pakistan. MATERIALS AND METHODS: A case series of 311 consecutive Whipple resection specimens received between January 1,2003 and December 31, 2014. Specimens processed for histologic sections and representative sections submitted and histologically examined as per established and standard protocols. All relevant tumor parameters including histologic type, histologic grade, pathologic T and N stage and tumor size were assessed. Epidemiologic data were also recorded. All findings were analysed using SPSS 19.0 software. RESULTS: Ampullary (periampullary) carcinomas were much more common than carcinomas of the head of the pancreas, especially in males, with an average age of 53 years. Mean tumor size was 2.5 cms, over 54% were well differentiated. A large majority were pT2 or pT3 and N0. Carcinomas of pancreatic head were also more common in males, mean age was 55 years, mean tumor size was 3.5 cms, and over 65% were moderately differentiated. The majority were T2 or T3 and pN1. Prognostically, significant statistical correlation was seen with tumor grade and pathologic T and N stage (p values statistically significant). However, tumor size was not statistically significant. CONCLUSIONS: Ampullary carcinomas are more common compared to pancreatic carcinomas. Majority of ampullary carcinomas were well differentiated while majority of pancreatic carcinomas were moderately differentiated. Large majority of both types of cases were pT2 or T3. Histologic tumor grade and pathologic T and N stage are significantly related to prognosis in Pakistani patients with ampullary and pancreatic cancers.


Assuntos
Ampola Hepatopancreática/patologia , Neoplasias do Ducto Colédoco/epidemiologia , Pâncreas/patologia , Neoplasias Pancreáticas/epidemiologia , Adulto , Idoso , Ampola Hepatopancreática/cirurgia , Neoplasias do Ducto Colédoco/patologia , Neoplasias do Ducto Colédoco/cirurgia , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Gradação de Tumores , Estadiamento de Neoplasias , Paquistão/epidemiologia , Pâncreas/cirurgia , Neoplasias Pancreáticas/patologia , Neoplasias Pancreáticas/cirurgia , Adulto Jovem
7.
Pancreas ; 44(6): 967-70, 2015 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-26087354

RESUMO

OBJECTIVES: Double-duct sign (combined dilatation of the common bile duct and pancreatic duct) is an infrequently encountered finding in cross-sectional radiological imaging of the pancreatobiliary system. This sign is commonly deemed to signify on ominous pathology and suggests the presence of pancreatic or biliary malignancy. METHODS: We aim to correlate double-duct sign discovered on magnetic resonance cholangiopancreatogram (MRCP) in the clinical context. We retrospectively analyzed MRCP database over a period of 4 years, January 2010 to December 2013. Follow-up information was available for a median of 27 months (range, 12-42 months) RESULTS: The commonest cause of double-duct sign was choledocholithiasis followed closely by pancreatobiliary malignancy. Patients with jaundice in the context of double-duct sign had a higher incidence of malignancy (48%). None of the anicteric patients were found to have malignancy (P = 0.002). CONCLUSIONS: In patients with MRCP evidence of double-duct sign, the absence of jaundice makes a malignant etiology unlikely. Conversely, in jaundiced patients, a malignant cause is much more likely. Figures from larger series are needed to support this conclusion.


Assuntos
Coledocolitíase/patologia , Neoplasias do Ducto Colédoco/patologia , Ducto Colédoco/patologia , Pancreatopatias/patologia , Ductos Pancreáticos/patologia , Neoplasias Pancreáticas/patologia , Idoso , Idoso de 80 Anos ou mais , Bilirrubina/sangue , Biomarcadores/sangue , Colangiopancreatografia por Ressonância Magnética , Coledocolitíase/sangue , Coledocolitíase/epidemiologia , Neoplasias do Ducto Colédoco/sangue , Neoplasias do Ducto Colédoco/epidemiologia , Dilatação Patológica , Inglaterra/epidemiologia , Feminino , Humanos , Incidência , Icterícia/sangue , Icterícia/epidemiologia , Icterícia/patologia , Masculino , Pessoa de Meia-Idade , Neoplasias Pancreáticas/sangue , Neoplasias Pancreáticas/epidemiologia , Valor Preditivo dos Testes , Prognóstico , Estudos Retrospectivos , Fatores de Risco , Fatores de Tempo
9.
Ann Hepatol ; 13(6): 819-26, 2014.
Artigo em Inglês | MEDLINE | ID: mdl-25332269

RESUMO

BACKGROUND: Choledochal cysts are most common in Asian populations. In addition, the incidence of biliary tract malignancies from choledochal cysts is increasing, but the risk of carcinogenesis is still unclear. MATERIAL AND METHODS: Clinical data from 214 congenital choledochal cyst cases from 1968 to 2013 were retrospectively analyzed. RESULTS: Todani type I was more common (139, 65.0%) than type IVa (53, 24.8%) or type V (17, 7.9%) in these choledochal cyst patients. Biliary tract malignant tumors occurred in the gallbladder (2, 13.3%), common bile duct (10, 66.7%), and intrahepatic bile duct (3, 20%) in 15 patients (7.0%), including one patient in whom malignant transformation occurred in the intrahepatic bile duct in a type IVa patient 15 years after extrahepatic cyst resection. An age at symptom onset ≥ 60 years was a risk factor (p < 0.001), while an initial complete surgery was a protective factor for carcinogenesis (p = 0.001). CONCLUSIONS: Choledochal cysts should be removed once diagnosed because of an increased risk of malignant transformation with increasing age. Complete cyst removal is necessary for the first surgical treatment. Additional hepatectomy should be considered for type IVa choledochal cysts because cholangiocarcinoma can arise from the intrahepatic bile duct years after the extrahepatic cyst excision.


Assuntos
Adenocarcinoma/epidemiologia , Ductos Biliares Intra-Hepáticos , Carcinogênese , Cisto do Colédoco/epidemiologia , Neoplasias do Ducto Colédoco/epidemiologia , Neoplasias da Vesícula Biliar/epidemiologia , Adenocarcinoma Mucinoso/epidemiologia , Adulto , Idade de Início , Idoso , Neoplasias dos Ductos Biliares/epidemiologia , Colangiocarcinoma/epidemiologia , Cisto do Colédoco/cirurgia , Estudos de Coortes , Cistadenocarcinoma/epidemiologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Fatores de Risco
10.
World J Gastroenterol ; 20(29): 10144-50, 2014 Aug 07.
Artigo em Inglês | MEDLINE | ID: mdl-25110442

RESUMO

AIM: To provide trends in incidence, management and survival of cancer of the ampulla of Vater in a well-defined French population. METHODS: Data were obtained from the population-based digestive cancer registry of Burgundy over a 34-year period. Age-standardized incidence rates were computed using the world standard population. Average annual variations in incidence rates were estimated using a poisson regression. A univariate and multivariate relative survival analysis was performed. RESULTS: Age-standardized incidence rates were 0.46 and 0.30 per 100000 inhabitants for men and women, respectively. Incidence rate increased from 0.26 (1976-1984) to 0.58 (2003-2009) for men and remained stable for women. Resection for cure was performed in 48.3% of cases. This proportion was stable over the study period. Among cases with curative resection, pancreatico-duodenectomy was performed in 94.0% of cases and ampullectomy in 6.0% of cases. A total of 50.8% of cancers of the ampulla of Vater were diagnosed at an advanced stage. Their proportion remained stable throughout the study period. The overall 1- and 5-year relative survival rates were 60.2% and 27.7%, respectively. Relative survival did not vary over time. Treatment and stage at diagnosis were the most important determinants of survival. The 5-year relative survival rate was 41.5% after resection for cure, 9.5% after palliative surgery and 6.7% after symptomatic treatment. In multivariate analysis, only stage at diagnosis significantly influenced the risk of death. CONCLUSION: Cancer of the ampulla of Vater is still uncommon, but its incidence increased for men in Burgundy. Diagnosis is often made at an advanced stage, dramatically worsening the prognosis.


Assuntos
Ampola Hepatopancreática/cirurgia , Procedimentos Cirúrgicos do Sistema Biliar/tendências , Neoplasias do Ducto Colédoco/epidemiologia , Neoplasias do Ducto Colédoco/terapia , Cuidados Paliativos/tendências , Pancreaticoduodenectomia/tendências , Adolescente , Adulto , Distribuição por Idade , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Ampola Hepatopancreática/patologia , Procedimentos Cirúrgicos do Sistema Biliar/efeitos adversos , Procedimentos Cirúrgicos do Sistema Biliar/mortalidade , Distribuição de Qui-Quadrado , Criança , Pré-Escolar , Neoplasias do Ducto Colédoco/diagnóstico , Neoplasias do Ducto Colédoco/mortalidade , Feminino , França/epidemiologia , Humanos , Incidência , Lactente , Recém-Nascido , Masculino , Pessoa de Meia-Idade , Análise Multivariada , Estadiamento de Neoplasias , Pancreaticoduodenectomia/efeitos adversos , Pancreaticoduodenectomia/mortalidade , Modelos de Riscos Proporcionais , Estudos Prospectivos , Sistema de Registros , Fatores de Risco , Distribuição por Sexo , Fatores Sexuais , Fatores de Tempo , Resultado do Tratamento , Adulto Jovem
11.
World J Gastroenterol ; 20(28): 9541-8, 2014 Jul 28.
Artigo em Inglês | MEDLINE | ID: mdl-25071350

RESUMO

AIM: To evaluate the risk factors for ampullary adenoma and ampullary cancer. METHODS: This case-control study included ampullary tumor patients referred to Peking Union Medical College Hospital. Controls were randomly selected from an existing database of healthy individuals at the Health Screening Center of the same hospital. Data on metabolic syndromes, medical conditions, and family history were collected by retrospective review of the patients' records and health examination reports, or by interview. RESULTS: A total of 181 patients and 905 age- and sex-matched controls were enrolled. We found that a history of diabetes, cholecystolithiasis, low-density lipoprotein, and apolipoprotein A were significantly related to ampullary adenomas. Diabetes, cholecystolithiasis, chronic pancreatitis, total cholesterol, high-density lipoprotein, and apolipoprotein A were also significantly related to ampullary cancer. CONCLUSION: Some metabolic syndrome components and medical conditions are potential risk factors for the development of ampullary tumors. Cholelithiasis, diabetes, and apolipoprotein A may contribute to the malignant transformation of benign ampullary adenomas into ampullary cancer.


Assuntos
Adenoma/epidemiologia , Carcinoma/epidemiologia , Neoplasias do Ducto Colédoco/epidemiologia , Síndrome Metabólica/epidemiologia , Adenoma/sangue , Adenoma/diagnóstico , Idoso , Biomarcadores/sangue , Carcinoma/sangue , Carcinoma/diagnóstico , China/epidemiologia , Neoplasias do Ducto Colédoco/sangue , Neoplasias do Ducto Colédoco/diagnóstico , Comorbidade , Feminino , Humanos , Masculino , Síndrome Metabólica/sangue , Síndrome Metabólica/diagnóstico , Pessoa de Meia-Idade , Estudos Retrospectivos , Fatores de Risco
12.
Acta Oncol ; 52(3): 498-505, 2013 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-23477361

RESUMO

BACKGROUND: To review treatment toxicity for patients with pancreatic and ampullary cancer treated with proton therapy at our institution. MATERIAL AND METHODS: From March 2009 through April 2012, 22 patients were treated with proton therapy and concomitant capecitabine (1000 mg PO twice daily) for resected (n = 5); marginally resectable (n = 5); and unresectable/inoperable (n = 12) biopsy-proven pancreatic and ampullary adenocarcinoma. Two patients with unresectable disease were excluded from the analysis for reasons unrelated to treatment. Proton doses ranged from 50.40 cobalt gray equivalent (CGE) to 59.40 CGE. RESULTS: Median follow-up for all patients was 11 (range 5-36) months. No patient demonstrated any grade 3 toxicity during treatment or during the follow-up period. Grade 2 gastrointestinal toxicities occurred in three patients, consisting of vomiting (n = 3); and diarrhea (n = 2). Median weight loss during treatment was 1.3 kg (1.75% of body weight). Chemotherapy was well-tolerated with a median 99% of the prescribed doses delivered. Percentage weight loss was reduced (p = 0.0390) and grade 2 gastrointestinal toxicity was eliminated (p = 0.0009) in patients treated with plans that avoided anterior and left lateral fields which were associated with reduced small bowel and gastric exposure. DISCUSSION: Proton therapy may allow for significant sparing of the small bowel and stomach and is associated with a low rate of gastrointestinal toxicity. Although long-term follow-up will be needed to assess efficacy, we believe that the favorable toxicity profile associated with proton therapy may allow for radiotherapy dose escalation, chemotherapy intensification, and possibly increased acceptance of preoperative radiotherapy for patients with resectable or marginally resectable disease.


Assuntos
Adenocarcinoma/terapia , Ampola Hepatopancreática , Quimiorradioterapia/efeitos adversos , Neoplasias do Ducto Colédoco/terapia , Desoxicitidina/análogos & derivados , Fluoruracila/análogos & derivados , Gastroenteropatias/epidemiologia , Neoplasias Pancreáticas/terapia , Terapia com Prótons/efeitos adversos , Adenocarcinoma/epidemiologia , Adenocarcinoma/patologia , Administração Oral , Idoso , Ampola Hepatopancreática/efeitos dos fármacos , Ampola Hepatopancreática/patologia , Ampola Hepatopancreática/efeitos da radiação , Capecitabina , Neoplasias do Ducto Colédoco/epidemiologia , Neoplasias do Ducto Colédoco/patologia , Desoxicitidina/administração & dosagem , Desoxicitidina/efeitos adversos , Esquema de Medicação , Efeitos Colaterais e Reações Adversas Relacionados a Medicamentos/epidemiologia , Feminino , Fluoruracila/administração & dosagem , Fluoruracila/efeitos adversos , Gastroenteropatias/etiologia , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Neoplasias Pancreáticas/epidemiologia , Neoplasias Pancreáticas/patologia , Terapia com Prótons/métodos , Lesões por Radiação/epidemiologia , Dosagem Radioterapêutica , Estudos Retrospectivos
13.
Int J Cancer ; 133(7): 1664-71, 2013 Oct 01.
Artigo em Inglês | MEDLINE | ID: mdl-23504585

RESUMO

We evaluated incidence patterns of biliary tract cancers (gallbladder, extrahepatic bile duct, ampulla of Vater and not otherwise specified) to provide potential insight into the etiology of these cancers. Data were obtained from the population-based Surveillance, Epidemiology and End Results program. Rates for cases diagnosed during 1992-2009 were calculated by racial/ethnic, gender and age groups. Temporal trends during 1974-2009 and annual percentage changes (APC) during 1992-2009 were estimated. Age-adjusted rates by site were higher among American Indian/Alaska Natives, Hispanics (white) and Asian/Pacific Islanders (Asian/PI) and lower among whites and blacks. Gallbladder cancer was more common among women in all ethnic groups (female-to-male incidence rate ratio [IRR] ranged from 1.24 to 2.86), but bile duct and ampulla of Vater cancers were more common among men (female-to-male IRR 0.57 to 0.82). Gallbladder cancer rates declined among all racial/ethnic and gender groups except blacks (APC -0.4% to -3.9%). In contrast, extrahepatic bile duct cancer rates rose significantly in most female racial/ethnic groups; the APCs among whites were 0.8 among females and 1.3 among males, both significant. Rates for ampulla of Vater cancer decreased among Asian/PI females (APC -2.7%) but remained stable for the other groups. In addition to confirming that biliary tract cancer incidence patterns differ by gender and site and that the gallbladder cancer incidence rates have been declining, our study provides novel evidence that extrahepatic bile duct cancer rates are rising. These observations may help guide future etiologic studies.


Assuntos
Neoplasias do Sistema Biliar/epidemiologia , Ampola Hepatopancreática , Neoplasias dos Ductos Biliares/epidemiologia , Neoplasias do Ducto Colédoco/epidemiologia , Grupos de Populações Continentais/estatística & dados numéricos , Demografia , Grupos Étnicos/estatística & dados numéricos , Feminino , Neoplasias da Vesícula Biliar/epidemiologia , Humanos , Incidência , Masculino , Programa de SEER , Estados Unidos/epidemiologia
14.
Gastrointest Endosc Clin N Am ; 23(1): 95-109, 2013 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-23168121

RESUMO

Most (>95%) ampullary lesions are adenomas or adenocarcinomas. Side viewing endoscopy, endoscopic ultrasound, and endoscopic retrograde cholangiopancreatography are complementary procedures that have an important role in the diagnosis, staging, and treatment of ampullary lesions. Here the authors review their epidemiology and discuss the evidence for endoscopic modalities, with an emphasis on techniques for endoscopic resection. Although endoscopic papillectomy represents one of the highest-risk endoscopic interventions, it has largely replaced surgical modalities for the treatment of adenomatous lesions. Appropriate patient selection and use of preventive maneuvers will minimize the likelihood of persistent or recurrent lesions and postprocedure complications.


Assuntos
Ampola Hepatopancreática/cirurgia , Neoplasias do Ducto Colédoco/diagnóstico , Neoplasias do Ducto Colédoco/cirurgia , Endoscopia Gastrointestinal/métodos , Adenocarcinoma/complicações , Adenocarcinoma/diagnóstico , Adenocarcinoma/epidemiologia , Adenocarcinoma/cirurgia , Adenoma/complicações , Adenoma/diagnóstico , Adenoma/epidemiologia , Adenoma/cirurgia , Ampola Hepatopancreática/patologia , Neoplasias do Ducto Colédoco/complicações , Neoplasias do Ducto Colédoco/epidemiologia , Humanos
15.
World J Gastroenterol ; 18(31): 4175-81, 2012 Aug 21.
Artigo em Inglês | MEDLINE | ID: mdl-22919251

RESUMO

AIM: To evaluate the impact of surgical volume on nationwide hospital mortality after pancreaticoduodenectomy (PD) for periampullary tumors in South Korea. METHODS: Periampullary cancer patients who underwent PD between 2005 and 2008 were analyzed from the database of the Health Insurance Review and Assessment Service of South Korea. A total of 126 hospitals were divided into 5 categories, each similar in terms of surgical volume for each category. We used hospital mortality as a quality indicator, which was defined as death during the hospital stay for PD, and calculated adjusted mortality through multivariate logistic models using several confounder variables. RESULTS: A total of eligible 4975 patients were enrolled in this study. Average annual surgical volume of hospitals was markedly varied, ranging from 215 PDs in the very-high-volume hospital to < 10 PDs in the very-low-volume hospitals. Admission route, type of medical security, and type of operation were significantly different by surgical volume. The overall hospital mortality was 2.1% and the observed hospital mortality by surgical volume showed statistical difference. Surgical volume, age, and type of operation were independent risk factors for hospital death, and adjusted hospital mortality showed a similar difference between hospitals with observed mortality. The result of the Hosmer-Lemeshow test was 5.76 (P = 0.674), indicating an acceptable appropriateness of our regression model. CONCLUSION: The higher-volume hospitals showed lower hospital mortality than the lower-volume hospitals after PD in South Korea, which were clarified through the nationwide database.


Assuntos
Ampola Hepatopancreática/cirurgia , Neoplasias do Ducto Colédoco/cirurgia , Mortalidade Hospitalar/tendências , Hospitais com Alto Volume de Atendimentos , Hospitais com Baixo Volume de Atendimentos , Pancreaticoduodenectomia/mortalidade , Idoso , Neoplasias do Ducto Colédoco/epidemiologia , Feminino , Humanos , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Reprodutibilidade dos Testes , República da Coreia , Estudos Retrospectivos , Resultado do Tratamento
16.
Clin Gastroenterol Hepatol ; 10(5): 555-8, 2012 May.
Artigo em Inglês | MEDLINE | ID: mdl-22210438

RESUMO

BACKGROUND & AIMS: The incidence of intraductal papillary mucinous neoplasm (IPMN) is believed to be increasing; we investigated whether this is the result of increasing burden of disease or more diagnostic scrutiny. METHODS: In a retrospective cohort study, we calculated a trend in reported incidence of IPMN using data collected from Olmsted County, Minnesota, from 1985 to 2005. Total IPMN cases from the Olmsted database were identified through a keyword and International Classification of Diseases, 9th revision, search using a database from the Rochester Epidemiology Project, with all cases verified by subsequent chart review. The subsequent rate of IPMN-related carcinoma was calculated using data from the national Surveillance Epidemiology and End Results-9 database, reflecting trends from 1982 to 2007. Cases of IPMN-related carcinoma were identified in the Surveillance Epidemiology and End Results-9 database by limiting the search to histology codes for noninvasive and invasive IPMN. RESULTS: Between 1985 and 2005, there was a 14-fold increase in the age- and sex-adjusted incidence of IPMN, from 0.31 to 4.35 per 100,000 persons. From 2000 to 2001, the rate of reported carcinoma increased from 0.008 to 0.032 per 100,000 persons, but stabilized afterward, with a rate of 0.06 per 100,000 persons in 2007. Mortality from all causes of pancreatic cancer was stable between 1975 and 2007 (approximately 11 deaths per 100,000 individuals). CONCLUSIONS: The incidence of IPMN has increased in the absence of an increase in IPMN-related or overall pancreatic cancer-related mortality, so it likely results from an increase in diagnostic scrutiny, rather than greater numbers of patients with clinically relevant disease.


Assuntos
Neoplasias do Ducto Colédoco/diagnóstico , Neoplasias do Ducto Colédoco/epidemiologia , Neoplasias Císticas, Mucinosas e Serosas/diagnóstico , Neoplasias Císticas, Mucinosas e Serosas/epidemiologia , Estudos de Coortes , Neoplasias do Ducto Colédoco/patologia , Feminino , Humanos , Incidência , Masculino , Minnesota/epidemiologia , Neoplasias Císticas, Mucinosas e Serosas/patologia , Estudos Retrospectivos
17.
Arch Pathol Lab Med ; 134(11): 1692-6, 2010 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-21043824

RESUMO

CONTEXT: Neuroendocrine tumors of the ampulla of Vater constitute a heterogeneous group of neoplasms clinically and morphologically. Because they are rare, little is known about their demographics and biologic behavior. OBJECTIVE: To analyze the demographics and the 5- and 10-year relative survival rates of 139 patients with carcinoid tumors and high-grade neuroendocrine carcinomas of the ampulla. DESIGN: Using data from National Cancer Institute's Surveillance, Epidemiology, and End Results (SEER) Program from 1973 to 2006, we analyzed the demographics, morphology, and survival of patients with carcinoids and neuroendocrine carcinomas of the ampulla. RESULTS: SEER recorded 6081 cases of malignant neoplasms of the ampulla, of which 82 were carcinoid tumors and 57 were high-grade neuroendocrine carcinomas. Of these 57, 42 were neuroendocrine carcinomas, not otherwise specified; 9 were small cell carcinomas; and 6 were large cell neuroendocrine carcinomas. The incidence was higher in men than in women. Patients with carcinoid tumors were younger (mean age, 61.6 years) than those with high-grade neuroendocrine carcinomas (mean age, 67.5 years). Carcinoid tumors were smaller than high-grade neuroendocrine carcinomas. The frequency of lymph node metastasis was 28.5% for carcinoid tumors and 62% for high-grade neuroendocrine carcinomas. The 5- and 10-year relative survival rates of patients with carcinoid tumors were 82% and 71%, respectively. The 5- and 10-year relative survival rate of patients with high-grade neuroendocrine carcinomas was 15.7%. CONCLUSIONS: Carcinoids of the ampulla of Vater are relatively rare. Carcinoids and high-grade neuroendocrine carcinomas of the ampulla are biologically and clinically similar to these tumors arising in other sites. Carcinoids were smaller and metastasized less frequently than high-grade neuroendocrine carcinomas.


Assuntos
Ampola Hepatopancreática/patologia , Tumor Carcinoide/epidemiologia , Carcinoma Neuroendócrino/epidemiologia , Neoplasias do Ducto Colédoco/epidemiologia , Adulto , Fatores Etários , Idoso , Tumor Carcinoide/patologia , Carcinoma Neuroendócrino/patologia , Neoplasias do Ducto Colédoco/patologia , Feminino , Humanos , Incidência , Metástase Linfática/patologia , Masculino , Pessoa de Meia-Idade , Programa de SEER , Fatores Sexuais , Taxa de Sobrevida
18.
Surg Obes Relat Dis ; 6(6): 670-5, 2010.
Artigo em Inglês | MEDLINE | ID: mdl-20627707

RESUMO

BACKGROUND: The diagnosis and treatment of gastric and pancreatoduodenal neoplasms after previous gastric bypass has been limited. Experience should increase in the future owing to the number of bariatric procedures being performed. The diagnosis and resection of these neoplasms and restoration of biliopancreatic intestinal continuity pose challenges. We present a 2-institutional experience of diagnosis and reconstruction after resection of gastric and pancreatoduodenal neoplasms and discuss the technical options for reconstruction. METHODS: The medical records were reviewed retrospectively from 2003 to 2009 for patients with previous gastric bypass who developed a gastric or pancreatoduodenal neoplasm. RESULTS: Of the available patients, 7 were identified with 2 remnant gastric cancers (2 signet ring cell adenocarcinomas), 4 pancreatic neoplasms (2 adenocarcinomas and 2 neuroendocrine cancers), and 1 ampullary cancer. The gastric neoplasms required complete remnant gastrectomy but did not require additional gastrointestinal reconstruction. The pancreatic and duodenal neoplasms required pancreatoduodenectomy, with 4 of 5 patients also undergoing remnant gastrectomy. The patients after pancreatoduodenectomy required biliary and pancreatic reconstruction with the pancreaticobiliary limb, Roux limb, or proximal common channel, depending on the limb length. Operative mortality was nil, and the morbidity rate was 28%. CONCLUSION: Gastric and pancreatoduodenal neoplasms after previous gastric bypass, although rare, will most likely increase as the number of bariatric operations increases. A high index of suspicion and focused diagnostic testing are key in identifying these lesions. Resection is feasible and safe but could require complex gastric and pancreatobiliary reconstruction.


Assuntos
Procedimentos Cirúrgicos do Sistema Digestório/métodos , Neoplasias Duodenais/cirurgia , Gastrectomia/métodos , Derivação Gástrica , Neoplasias Pancreáticas/cirurgia , Pancreaticoduodenectomia/métodos , Neoplasias Gástricas/cirurgia , Adenoma de Células das Ilhotas Pancreáticas/diagnóstico , Adenoma de Células das Ilhotas Pancreáticas/epidemiologia , Adenoma de Células das Ilhotas Pancreáticas/cirurgia , Idoso , Carcinoma Neuroendócrino/diagnóstico , Carcinoma Neuroendócrino/epidemiologia , Carcinoma Neuroendócrino/cirurgia , Neoplasias do Ducto Colédoco/diagnóstico , Neoplasias do Ducto Colédoco/epidemiologia , Neoplasias do Ducto Colédoco/cirurgia , Neoplasias Duodenais/diagnóstico , Neoplasias Duodenais/epidemiologia , Feminino , Derivação Gástrica/estatística & dados numéricos , Humanos , Masculino , Pessoa de Meia-Idade , Neoplasias Pancreáticas/diagnóstico , Estudos Retrospectivos , Neoplasias Gástricas/diagnóstico , Neoplasias Gástricas/epidemiologia
19.
Arch Pathol Lab Med ; 133(1): 67-71, 2009 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-19123739

RESUMO

CONTEXT: Carcinomas co-occur in the pancreas, extrahepatic bile ducts, and ampulla of Vater. We investigated whether cancers originating in these sites represent a field effect similar to that observed in the lung and upper aerodigestive tract. OBJECTIVE: To determine whether a field effect for carcinogenesis exists in the ampulla of Vater, extrahepatic bile ducts, gallbladder, and pancreas. DESIGN: Data were obtained from National Cancer Institute's Surveillance Epidemiology and End Results Program from 1973 through 2005. Cases were compared by age frequency density plots, age-specific incidence rates, and logarithmic plots of the age-specific incidence rates and age of diagnosis. RESULTS: Incidence rates were 11.71, 1.43, 0.88, and 0.49 per 100,000 persons at risk for pancreatic, gallbladder, extrahepatic bile ducts, and ampullary carcinomas, respectively. Age frequency density plots were congruent for cancers originating in all 4 sites. Logarithmic plots of the age-specific incidence rates with age of diagnosis produced parallel linear rate patterns for the 4 sites indicative of similar populations for tumor development. However, density and logarithmic plots of pancreatic endocrine carcinomas, a tumor of different cellular differentiation and carcinogenic pathway, served as a comparison. The endocrine carcinomas showed a different age distribution and nonparallel rate patterns with ductal carcinomas. CONCLUSIONS: Carcinomas of the pancreas, gallbladder, extrahepatic bile ducts, and ampulla have a common embryonic cellular ancestry, differentiation pathways, mucosal histologic patterns, and population-related tumor development indicating a field effect in carcinogenesis. Parallel linear rate patterns indicate (1) the rate of cancer development is similar in all 4 sites even though the absolute incidence rates vary and (2) regardless of location, the ductal epithelium is equally susceptible to malignant transformation. If carcinogenic pathways to cancer are similar, then the different incidence rates seen clinically may depend on the relative surface area of the ductal system in these sites. Pancreatic cancers are most common because the surface area of the pancreas' ductal system is greater than that of the gallbladder, extrahepatic bile ducts, and ampulla.


Assuntos
Adenocarcinoma/patologia , Neoplasias dos Ductos Biliares/patologia , Neoplasias do Ducto Colédoco/patologia , Neoplasias da Vesícula Biliar/patologia , Neoplasias Pancreáticas/patologia , Adenocarcinoma/epidemiologia , Idoso , Ampola Hepatopancreática/patologia , Neoplasias dos Ductos Biliares/epidemiologia , Ductos Biliares Extra-Hepáticos/patologia , Neoplasias do Ducto Colédoco/epidemiologia , Neoplasias da Vesícula Biliar/epidemiologia , Humanos , Incidência , Neoplasias Primárias Múltiplas , Neoplasias Pancreáticas/epidemiologia , Vigilância da População , Estados Unidos/epidemiologia
20.
Surg Today ; 38(12): 1152-4, 2008.
Artigo em Inglês | MEDLINE | ID: mdl-19039646

RESUMO

This report describes three patients who underwent a pylorus-preserving pancreaticoduodenectomy (PpPD) and received maintenance hemodialysis due to chronic renal failure. The three cases were diagnosed to have bile duct cancer, intraductal papillary mucinous neoplasm, and carcinoma of the ampulla of Vater, respectively. They underwent chronic hemodialysis for 7.7 years. They all underwent a PpPD with lymph node dissection. The mean operation time was 373 min and mean blood loss was 647 ml. During the postoperative courses, hemodialysis was restarted on postoperative day 1 in all three cases. In the three patients, only minor complications were experienced and these were treated conservatively. The mean postoperative hospital stay was 48 days. Two patients are still alive 135 and 21 months after the operation, respectively, but the other patient died of another disease 21 months after the PpPD. A PpPD may therefore be safe and feasible even in patients receiving chronic hemodialysis.


Assuntos
Pancreaticoduodenectomia/métodos , Diálise Renal , Idoso , Ampola Hepatopancreática , Carcinoma Ductal Pancreático/epidemiologia , Carcinoma Ductal Pancreático/cirurgia , Neoplasias do Ducto Colédoco/epidemiologia , Neoplasias do Ducto Colédoco/cirurgia , Comorbidade , Contraindicações , Humanos , Falência Renal Crônica/epidemiologia , Falência Renal Crônica/terapia , Tempo de Internação , Masculino , Pessoa de Meia-Idade
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