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1.
BMC Surg ; 21(1): 91, 2021 Feb 18.
Artigo em Inglês | MEDLINE | ID: mdl-33602183

RESUMO

BACKGROUND: The treatment of chronic pancreatitis requires a surgical approach in patients who are refractory to medical therapy. During surgical treatment, ductal decompression is required, but a pancreatectomy is necessary for some patients, such as those with severe stenosis of the pancreatic duct. Indeed, suboptimal procedures lead to recurrent pancreatitis. We used a laparoscopic hybrid approach for patients with severe stenosis of the pancreatic duct. In this report, we present the feasibility and outcomes of our approach. METHODS: We selected a laparoscopic approach for the distal pancreatectomy, which is relatively safe and the effect of reducing the length of the wound is substantial. We selected an open approach for the Frey procedure because complete ductal compression has a high risk for injury to the vessels posterior to the pancreas. We recorded the operative outcomes, postoperative complications, and recurrence of pancreatitis. RESULTS: We performed the laparoscopic hybrid approach on 3patients between January and December 2018. There were no major intraoperative complications (Clavien-Dindo classification IIIa or more) and the postoperative course was uneventful in all patients. There were no recurrences of pancreatitis and no postoperative pain in all patients in > 2 years of follow-up. CONCLUSION: Our hybrid method with a focus on complete ductal compression with safety and minimal invasiveness might be the optimal approach for the surgical treatment of chronic pancreatitis that requires a pancreatectomy with the Frey procedure.


Assuntos
Laparoscopia , Pancreatectomia , Pancreatite Crônica , Humanos , Laparoscopia/métodos , Pancreatectomia/métodos , Pancreatite Crônica/cirurgia
2.
BMC Surg ; 21(1): 78, 2021 Feb 10.
Artigo em Inglês | MEDLINE | ID: mdl-33568109

RESUMO

BACKGROUND: The radical antegrade modular pancreatosplenectomy (RAMPS) which is a reasonable surgical approach for left-sided pancreatic cancer is emphasis on the complete resection of regional lymph nodes and tumor-free margin resection. Laparoscopic radical antegrade modular pancreatosplenectomy (LRAMPS) has been rarely performed, with only 49 cases indexed on PubMed. In this study, we present our experience of LRAMPS. METHODS: From December 2018 to February 2020, 10 patients underwent LRAMPS for pancreatic cancer at our department. The data of the patient demographics, intraoperative variables, postoperative hospital stay, morbidity, mortality, pathologic findings and follow-up were collected. RESULTS: LRAMPS was performed successfully in all the patients. The median operative time was 235 min (range 212-270 min), with an EBL of 120 ml (range 100-200 ml). Postoperative complications occurred in 5 (50.0%) patients. Three patients developed a grade B pancreatic fistula. There was no postoperative 30-day mortality and reoperation. The median postoperative hospital stay was 14 days (range 9-24 days).The median count of retrieved lymph nodes was 15 (range 13-21), and four patients (40%) had malignant-positive lymph nodes. All cases achieved a negative tangential margin and R0 resection. Median follow-up time was 11 months (range 3-14 m). Two patients developed disease recurrence (pancreatic bed recurrence and liver metastasis) 9 months, 10 months after surgery, respectively. Others survived without tumor recurrence or metastasis. CONCLUSIONS: LRAMPS is technically safe and feasible procedure in well-selected patients with pancreatic cancer in the distal pancreas. The oncologically outcomes need to be further validated based on additional large-volume studies.


Assuntos
Laparoscopia , Pancreatectomia , Neoplasias Pancreáticas , Esplenectomia , Humanos , Recidiva Local de Neoplasia , Pancreatectomia/métodos , Neoplasias Pancreáticas/cirurgia , Estudos Retrospectivos , Esplenectomia/métodos , Resultado do Tratamento
3.
Int J Clin Oncol ; 26(3): 450-460, 2021 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-33386555

RESUMO

It is well known that surgery is the mainstay treatment for duodenal adenocarcinoma. However, the optimal extent of surgery is still under debate. We aimed to systematically review and perform a meta-analysis of limited resection (LR) and pancreatoduodenectomy for patients with duodenal adenocarcinoma. A systematic electronic database search of the literature was performed using PubMed and the Cochrane Library. All studies comparing LR and pancreatoduodenectomy for patients with duodenal adenocarcinoma were selected. Long-term overall survival was considered as the primary outcome, and perioperative morbidity and mortality as the secondary outcomes. Fifteen studies with a total of 3166 patients were analyzed; 995 and 1498 patients were treated with limited resection and pancreatoduodenectomy, respectively. Eight and 7 studies scored a low and intermediate risk of publication bias, respectively. The LR group had a more favorable result than the pancreatoduodenectomy group in overall morbidity (odd ratio [OR]: 0.33, 95% confidence interval [CI] 0.17-0.65) and postoperative pancreatic fistula (OR: 0.13, 95% CI 0.04-0.43). Mortality (OR: 0.96, 95% CI 0.70-1.33) and overall survival (OR: 0.61, 95% CI 0.33-1.13) were not significantly different between the two groups, although comparison of the two groups stratified by prognostic factors, such as T categories, was not possible due to a lack of detailed data. LR showed long-term outcomes equivalent to those of pancreatoduodenectomy, while the perioperative morbidity rates were lower. LR could be an option for selected duodenal adenocarcinoma patients with appropriate location or depth of invasion, although further studies are required.


Assuntos
Adenocarcinoma , Neoplasias Duodenais , Neoplasias Pancreáticas , Adenocarcinoma/cirurgia , Anastomose Cirúrgica , Neoplasias Duodenais/cirurgia , Humanos , Pancreatectomia , Neoplasias Pancreáticas/cirurgia , Pancreaticoduodenectomia
4.
BMC Surg ; 21(1): 54, 2021 Jan 22.
Artigo em Inglês | MEDLINE | ID: mdl-33482805

RESUMO

BACKGROUND: Surgeons are likely to get progressively fatigued during the course of a normal workday. The objective of this study was to evaluate the impact of surgeon work duration prior to performing distal pancreatectomy (DP) on the perioperative outcome, especially frequency of grade II or higher grade postoperative complications. METHODS: Patients undergoing DP for all causes were divided into two groups according to surgeon work hours prior to performing DP: group A (less than 5 h) and group B (5-10 h). Propensity score matching (PSM) analysis (1:1) were performed to balance the baseline characteristics between the two groups. Intraoperative complications were compared between the two groups. Postoperative complications and their severity were followed up for 60 days and mortality for 90 days. The study was powdered to identify a 15% difference in the incidence of grade II or higher grade complications. RESULTS: By using PSM analysis, the patients in group A (N = 202) and group B (N = 202) were well matched regarding demographics, comorbidities, operative technique, pancreatic texture and pathology. There was no significant difference in the incidence of grade II or higher grade complications between the two groups. There was no difference in clinically relevant postoperative pancreatic fistula, percutaneous drainage, readmission, reoperation, or morality. Group B was associated with a higher incidence of intraoperative organ injury, which could be managed successfully during the operation. CONCLUSION: The retrospective study demonstrated that the surgeon work duration did not significantly affect the clinical outcome of DP.


Assuntos
Fadiga/complicações , Pancreatectomia/efeitos adversos , Neoplasias Pancreáticas , Cirurgiões , Desempenho Profissional/normas , Idoso , Feminino , Humanos , Complicações Intraoperatórias/etiologia , Masculino , Pessoa de Meia-Idade , Duração da Cirurgia , Pancreatectomia/normas , Pancreatopatias/cirurgia , Neoplasias Pancreáticas/cirurgia , Complicações Pós-Operatórias/etiologia , Pontuação de Propensão , Estudos Retrospectivos , Cirurgiões/normas , Fatores de Tempo , Resultado do Tratamento , Carga de Trabalho
5.
Anticancer Res ; 41(1): 403-408, 2021 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-33419837

RESUMO

BACKGROUND/AIM: Drains are frequently placed at the time of distal pancreatectomy (DP) to evacuate pancreatic juice and intra-abdominal exudate and obtain information on abdominal cavity status. However, the timing of drain removal remains debatable. Meanwhile, prolonged drain placement might increase the risk of postoperative pancreatic fistula (POPF), with a prevalence of 5-40%. Therefore, we examined the effect of removing the drain within postoperative day (POD) 3 on the risk of POPF development. PATIENTS AND METHODS: A total of 108 consecutive patients who underwent DP between April 2015 and March 2020 were examined and divided into two groups according to the day of drain removal; hence, for some patients, the drain was removed on POD 1 (POD 1 group) and for others on POD 3 (POD 3 group). Furthermore, risk factors, including drain fluid amylase (DFA) levels, for developing POPF were investigated. RESULTS: The overall rate of clinically relevant POPF was 4.6% and did not significantly differ between the POD 1 and POD 3 groups [4.5% and 4.9%, respectively (p=0.924)]. DFA levels on POD 1 did not significantly differ between patients with and without POPF. On POD 3 and POD 5, C-reactive protein (CRP) levels were significantly higher in patients with POPF than in those without (p=0.03 and p<0.001, respectively). CONCLUSION: Early drain removal regardless of DFA level may reduce the risk of developing POPF. CRP measured on POD 3 and POD 5 appeared to be a useful predictor of clinically relevant POPF.


Assuntos
Amilases/metabolismo , Remoção de Dispositivo , Drenagem , Fístula Pancreática/etiologia , Fístula Pancreática/prevenção & controle , Complicações Pós-Operatórias , Biomarcadores , Gerenciamento Clínico , Drenagem/instrumentação , Drenagem/métodos , Humanos , Incidência , Pancreatectomia/efeitos adversos , Pancreatectomia/métodos , Fístula Pancreática/diagnóstico , Fístula Pancreática/terapia , Cuidados Pós-Operatórios , Complicações Pós-Operatórias/prevenção & controle , Curva ROC , Fatores de Risco , Fatores de Tempo
6.
Khirurgiia (Mosk) ; (1): 47-54, 2021.
Artigo em Russo | MEDLINE | ID: mdl-33395512

RESUMO

OBJECTIVE: To analyze the effect of timing of surgery, quality of resection and removal of MPD-stones on long-term results of duodenum-preserving pancreatic head resection (DPPHR). MATERIAL AND METHODS: The study included 110 patients with chronic pancreatitis (CP) who underwent DPPHR in 2014-2019. Evaluation of long-term outcomes included pain syndrome severity, exocrine and endocrine insufficiency and quality of life (QoL). Patients were stratified depending on duration of disease (within 36 months, >36 months after manifestation), volume of resected pancreatic head tissue according to CT data, removal of MPD-stones. RESULTS: Surgical treatment within 36 months after clinical manifestation was followed by less pain syndrome (VAS score 1.16±1.76 vs. 2.03±1.87, p=0.02), exocrine insufficiency (69.8% vs. 98.5%, p<0.001). Resection of more than 50% of the pancreatic head and removal of MPD-stones were accompanied by pain relief, improved pancreatic secretory function and quality of life. CONCLUSION: Pancreatic head resection in patients with chronic pancreatitis should be performed within 3 years after clinical manifestation. Resection of more than 50% of the pancreatic head with extraction of MPD-stones ensures pain relief, better endocrine and exocrine function, as well as higher QoL in long-term follow-up period.


Assuntos
Pâncreas/cirurgia , Pancreatite Crônica , Qualidade de Vida , Cálculos/complicações , Cálculos/cirurgia , Humanos , Pâncreas/diagnóstico por imagem , Pancreatectomia/efeitos adversos , Pancreatectomia/métodos , Ductos Pancreáticos/diagnóstico por imagem , Ductos Pancreáticos/cirurgia , Pancreatite Crônica/complicações , Pancreatite Crônica/diagnóstico por imagem , Pancreatite Crônica/cirurgia , Fatores de Tempo , Resultado do Tratamento
7.
Khirurgiia (Mosk) ; (1): 77-82, 2021.
Artigo em Russo | MEDLINE | ID: mdl-33395516

RESUMO

Surgical treatment of pancreatic diseases is always associated with a large number of complications. Postoperative hemorrhage is a specific complication of pancreatic surgery requiring a clear classification and surgical strategy. According to literature data, postoperative hemorrhage occurs in 3-30% of cases. Incidence of hemorrhages depends on intraoperative, anamnestic, histological and postoperative factors. Early postoperative hemorrhage (within 24 hours after surgery) is usually a consequence of technical errors in intraoperative hemostasis, perioperative coagulation disorders. The mechanism of delayed bleeding is more complex and often associated with various arrosive factors: pancreatic fistula, biliary fistula, abscess. Currently, there is no a single treatment algorithm for patients with postpancreatectomy hemorrhage. According to various researchers, contrast-enhanced CT is preferred for diagnosis. In recent years, the role of endovascular hemostasis has significantly increased. This problem requires further study and development of a single treatment and diagnostic algorithm that will reduce mortality in these patients.


Assuntos
Pancreatectomia , Pancreatopatias , Hemorragia Pós-Operatória , Humanos , Incidência , Pancreatectomia/efeitos adversos , Pancreatopatias/cirurgia , Fístula Pancreática , Pancreaticoduodenectomia , Hemorragia Pós-Operatória/classificação , Hemorragia Pós-Operatória/diagnóstico , Hemorragia Pós-Operatória/etiologia , Hemorragia Pós-Operatória/terapia
8.
J Surg Res ; 257: 605-615, 2021 01.
Artigo em Inglês | MEDLINE | ID: mdl-32947122

RESUMO

BACKGROUND: The clinicopathologic factors associated with the survival of patients with pancreatic ductal adenocarcinoma (PDAC) during the different phases of neoadjuvant treatment (NT)-at diagnosis, restaging, or postoperatively-remain unclear. METHODS: Data of patients with PDAC who underwent pancreatic resection after NT between 2008 and 2018 were retrospectively collected. Clinicopathologic characteristics and outcomes were compared stratified by resection margin status. Three multivariable regression models (at diagnosis, restaging, and postoperatively) were constructed to assess the temporal impact of different prognostic factors on all-cause survival (ACS) and disease-free survival (DFS). RESULTS: All patients were diagnosed with a nonmetastatic PDAC and were appropriate candidates for NT according to the current National Comprehensive Cancer Network guidelines. From a total of 83 patients, 57 (68.7%) had a negative resection margin >1 mm (R0), whereas 26 patients (31.3%) had a positive resection margin (R1). At diagnosis, planned procedure (P = 0.017) and CA19-9 >100 U/mL (P = 0.047) were independent prognostic factors of decreased ACS. At restaging, planned procedure (P = 0.017), FOLFIRINOX (P = 0.026), and tumor size >30 mm (P = 0.030) were independent prognostic factors for increased and decreased ACS, respectively. Postoperatively, R0 was an independent prognostic factor for improved ACS (P = 0.005) and DFS (P = 0.002), whereas adjuvant therapy (P = 0.006) was associated with increased ACS. Lymph node involvement (P = 0.019) was associated with decreased DFS. CONCLUSIONS: At diagnosis, restaging, and postoperatively, different, relevant clinicopathologic factors significantly impact the survival of patients with nonmetastatic PDAC undergoing NT. An R0 resection remains the most important prognostic factor and therefore should be the primary goal of surgical treatment in the neoadjuvant setting.


Assuntos
Carcinoma Ductal Pancreático/mortalidade , Terapia Neoadjuvante , Pancreatectomia , Neoplasias Pancreáticas/mortalidade , Idoso , Boston/epidemiologia , Carcinoma Ductal Pancreático/patologia , Carcinoma Ductal Pancreático/terapia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Pâncreas/patologia , Neoplasias Pancreáticas/patologia , Neoplasias Pancreáticas/terapia , Prognóstico , Modelos de Riscos Proporcionais , Estudos Retrospectivos
9.
Lancet Gastroenterol Hepatol ; 6(2): 128-138, 2021 02.
Artigo em Inglês | MEDLINE | ID: mdl-33338442

RESUMO

BACKGROUND: The optimal preoperative treatment for locally advanced pancreatic cancer is unknown. We aimed to compare the efficacy and safety of nab-paclitaxel plus gemcitabine with nab-paclitaxel plus gemcitabine followed by fluorouracil, leucovorin, irinotecan, and oxaliplatin (FOLFIRINOX) as multidrug induction chemotherapy regimens in locally advanced pancreatic cancer. METHODS: In this open-label, multicentre, randomised phase 2 study, done at 28 centres in Germany, eligible patients were adults (aged 18-75 years) with an Eastern Cooperative Oncology Group performance status of 0 or 1 and histologically or cytologically confirmed, treatment-naive locally advanced pancreatic adenocarcinoma, as determined by local multidisciplinary team review. After two cycles of nab-paclitaxel 125 mg/m2 plus gemcitabine 1000 mg/m2 (administered intravenously on days 1, 8, and 15 of each 28-day cycle), patients without progressive disease or unacceptable adverse events were randomly assigned (1:1) to receive either two additional cycles of nab-paclitaxel plus gemcitabine (nab-paclitaxel plus gemcitabine group) or four cycles of sequential FOLFIRINOX (oxaliplatin 85 mg/m2, leucovorin 400 mg/m2, irinotecan 180 mg/m2, fluorouracil 400 mg/m2 by intravenous bolus followed by a continuous intravenous infusion of 2400 mg/m2 for 46 h on day 1 of each 14-day cycle; sequential FOLFIRINOX group). Randomisation was done by the clinical research organisation on request of the trial centre using a permuted block design (block size 2 and 4). Patients, investigators, and study team members were not masked to treatment allocation. The primary endpoint was surgical conversion rate (complete macroscopic tumour resection) in the randomised population by intention-to-treat analysis, which was assessed by surgical exploration in all patients with at least stable disease after completion of induction chemotherapy. This trial is registered with ClinicalTrials.gov, NCT02125136. FINDINGS: Between Nov 18, 2014, and April 27, 2018, 168 patients were registered and 130 were randomly assigned to either the nab-paclitaxel plus gemcitabine group (64 patients) or the sequential FOLFIRINOX group (66 patients). Surgical exploration after completed induction chemotherapy was done in 40 (63%) of 64 patients in the nab-paclitaxel plus gemcitabine group and 42 (64%) of 66 patients in the sequential FOLFIRINOX group. 23 patients in the nab-paclitaxel plus gemcitabine group and 29 in the sequential FOLFIRINOX group had complete macroscopic tumour resection, yielding a surgical conversion rate of 35·9% (95% CI 24·3-48·9) in the nab-paclitaxel plus gemcitabine group and 43·9% (31·7-56·7) in the sequential FOLFIRINOX group (odds ratio 0·72 [95% CI 0·35-1·45]; p=0·38). At a median follow-up of 24·9 months (95% CI 21·8-27·6), median overall survival was 18·5 months (95% CI 14·4-21·5) in the nab-paclitaxel plus gemcitabine group and 20·7 months (13·9-28·7) in the sequential FOLFIRINOX group (hazard ratio 0·86 [95% CI 0·55-1·36]; p=0·53). All other secondary efficacy endpoints, such as investigator-assessed progression-free survival, radiographic response rate, CA 19-9 response rate, and R0 resection rate, were not significantly different between the two treatment groups except for improved histopathological downstaging in evaluable resection specimens from the sequential FOLFIRINOX group (ypT1/2 stage: 20 [69%] of 29 patients in the sequential FOLFIRINOX group vs four [17%] of 23 patients in the nab-paclitaxel plus gemcitabine group, p=0·0003; ypN0 stage: 15 [52%] of 29 patients in the sequential FOLFIRINOX group vs four [17%] of 23 patients in the nab-paclitaxel plus gemcitabine group, p=0·02). Grade 3 or higher treatment-emergent adverse events during induction chemotherapy occurred in 35 (55%) of 64 patients in nab-paclitaxel plus gemcitabine group and in 35 (53%) of 66 patients in the sequential FOLFIRINOX group. The most common of which were neutropenia (18 [28%] in nab-paclitaxel plus gemcitabine group, 16 [24%] in the sequential FOLFIRINOX group), nausea and vomiting (two [3%] in nab-paclitaxel plus gemcitabine group, eight [12%] in the sequential FOLFIRINOX group), and bile duct obstruction with cholangitis (six [9%] in nab-paclitaxel plus gemcitabine group, seven [11%] in the sequential FOLFIRINOX group). No deaths were caused by treatment-related adverse events during the induction chemotherapy phase. INTERPRETATION: Our findings suggest that nab-paclitaxel plus gemcitabine is similarly active and safe as nab-paclitaxel plus gemcitabine followed by FOLFIRINOX as multidrug induction chemotherapy regimens for locally advanced pancreatic cancer. Although conversion to resectability was achieved in about a third of patients, additional evidence is required to determine whether this translates into improved overall survival. FUNDING: Celgene.


Assuntos
Adenocarcinoma/tratamento farmacológico , Albuminas/uso terapêutico , Antineoplásicos/uso terapêutico , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , Desoxicitidina/análogos & derivados , Paclitaxel/uso terapêutico , Neoplasias Pancreáticas/tratamento farmacológico , Adenocarcinoma/patologia , Adenocarcinoma/cirurgia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Desoxicitidina/uso terapêutico , Esquema de Medicação , Feminino , Fluoruracila/uso terapêutico , Seguimentos , Humanos , Quimioterapia de Indução , Irinotecano/uso terapêutico , Leucovorina/uso terapêutico , Masculino , Pessoa de Meia-Idade , Terapia Neoadjuvante , Estadiamento de Neoplasias , Oxaliplatina/uso terapêutico , Pancreatectomia , Neoplasias Pancreáticas/patologia , Neoplasias Pancreáticas/cirurgia , Resultado do Tratamento , Adulto Jovem
10.
Chirurgia (Bucur) ; 115(6): 735-746, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-33378632

RESUMO

Introduction: We present our department experience in pancreatic surgery over the last 6 years. From its inception the number of pancreatic resections has been continuously growing each year. Method: We performed a retrospective analysis of a prospectively maintained database where we included all the patients with pancreatic resections over the last 6 years. We present the main indication and the different types of pancreatic resections, postoperative morbidity, intrahospital and 90-day mortality and an analysis of survival for the patients with pancreatic ductal adenocarcinoma. Results: We analyzed 198 patients, 193 with pancreatic resections and 5 patients with open surgery microwave ablation. There were 145 pancreaticoduodenectomies, 37 distal pancreatectomies, one total pancreatectomy, 3 distal pancreatectomies with celiac axis resection and 7 surgical interventions for chronic pancreatitis. Conclusion: We presented our center's experience in pancreatic surgery with good overall results, however, there is still room for continuous improvement and refinements to achieve better shortterm outcomes, regarding postoperative morbidity and mortality.


Assuntos
Carcinoma Ductal Pancreático , Pancreatectomia , Neoplasias Pancreáticas , Pancreaticoduodenectomia , Técnicas de Ablação , Carcinoma Ductal Pancreático/cirurgia , Humanos , Micro-Ondas/uso terapêutico , Neoplasias Pancreáticas/cirurgia , Pancreatite Crônica/cirurgia , Estudos Retrospectivos , Resultado do Tratamento
11.
BMC Surg ; 20(1): 331, 2020 Dec 14.
Artigo em Inglês | MEDLINE | ID: mdl-33317505

RESUMO

BACKGROUND: Serous cysto-adenoma (SCA) is a rare benign neoplasm of the pancreas. SCA can mimic other pancreatic lesions, such as neuroendocrine tumours. 68Gallium-DOTA-peptide Positron Emission Tomography (PET) is able to image in vivo the over-expression of the somatostatin receptors, playing an important role for the identification of neuroendocrine neoplasms. CASE PRESENTATION: We reported a case of 63-year-old man, with a solid lesion of 7 cm of diameter of the body-tail of the pancreas. Two fine-needle-aspirations (FNA) were inconclusive. A 68Ga-DOTA-peptide PET-CT revealed a pathological uptake of the pancreatic lesion. The diagnosis of a pancreatic neuroendocrine neoplasm was established and a laparoscopic distal splenopancreatectomy and cholecystectomy was performed. Final histopathological report revealed the presence of a micro-cystic SCA. CONCLUSIONS: The current case firstly reports a pancreatic SCA showing increased radiopharmaceutical uptake at 68Ga-DOTA-peptide PET-CT images. This unexpected finding should be taken into account during the diagnostic algorithm of a pancreatic lesion, in order to minimize the risk of misdiagnosis and overtreatment of SCA.


Assuntos
Acetatos/administração & dosagem , Cistadenoma Seroso/diagnóstico por imagem , Radioisótopos de Gálio/administração & dosagem , Compostos Organometálicos/metabolismo , Pâncreas/metabolismo , Neoplasias Pancreáticas/diagnóstico por imagem , Peptídeos Cíclicos/administração & dosagem , Tomografia Computadorizada com Tomografia por Emissão de Pósitrons/métodos , Cistadenoma Seroso/patologia , Cistadenoma Seroso/cirurgia , Humanos , Masculino , Pessoa de Meia-Idade , Tumores Neuroendócrinos/diagnóstico por imagem , Pâncreas/diagnóstico por imagem , Pâncreas/patologia , Pancreatectomia , Neoplasias Pancreáticas/patologia , Neoplasias Pancreáticas/cirurgia
12.
Zhonghua Zhong Liu Za Zhi ; 42(12): 1020-1024, 2020 Dec 23.
Artigo em Chinês | MEDLINE | ID: mdl-33342158

RESUMO

Objective: To explore the learning curve of central pancreatectomy (CP) and provide an excellent reference for surgeons to get the point of this operation. Methods: Clinical data of 73 patients who underwent CP in the same operation team from January 2006 to January 2018 were collected and retrospectively analyzed by the moving average method (MAM) and the cumulative sum method (CUSUM). Data was analyzed by statistical package for social science (SPSS) software. Results: According to the MAM and CUSUM curves, the learning process of CP could be divided into two stages. At the first stage (n=1-11), the median operation time was 340 minutes and the median intraoperative hemorrhage was 400 ml. In the second stage (n=12-73), the median operation time was 213 minutes and the median intraoperative hemorrhage was 100 ml. The difference was statistically significant (P<0.001). There were no significant differences between the two stages of patients in terms of other aspects (P>0.05). Conclusions: CP can be mastered after 11 cases of exercises. In the first 11 operations, surgeons should get familiar with the operation process, respond actively to emergencies and accumulate experience to gain this surgical technique fast.


Assuntos
Curva de Aprendizado , Pancreatectomia , Cirurgiões , Perda Sanguínea Cirúrgica/estatística & dados numéricos , Humanos , Duração da Cirurgia , Estudos Retrospectivos , Cirurgiões/psicologia
13.
Medicine (Baltimore) ; 99(44): e22896, 2020 Oct 30.
Artigo em Inglês | MEDLINE | ID: mdl-33126342

RESUMO

Many patients with chronic pancreatitis (CP) undergo a step-up approach with interventional procedures as first-line treatment and resection reserved for later stages. The aim of this study was to identify predictive factors for a significant clinical improvement (SCI) after surgical treatment.All patients operated for CP between September 2012 and June 2017 at our center was retrospectively reviewed. A prospective patient survey was conducted to measure patients postoperative outcome. The primary endpoint SCI was defined as stable health status, positive weight development and complete pain relief without routine pain medication. Additionally, risk factors for relaparotomy were analyzed.A total of 89 patients with a median follow-up of 38 months were included. In most cases, a duodenum-preserving pancreatic head resection (n = 48) or pancreatoduodenectomy (n = 28) was performed. SCI was achieved in 65.3% (n = 47) of the patients after the final medium follow-up of 15.0 months (IQR: 7.0-35.0 months), respectively. Patients with a longer mean delay (7.7 vs 4 years) between diagnosis and surgical resection were less likely to achieve SCI (P = .02; OR .88; 95%CI .80-98). An endocrine insufficiency was a negative prognostic factor for SCI (P = .01; OR .15; 95%CI .04-68). In total, 96.2% of the patients had a complete or major postoperative relief with a mean pain intensity reduction from 8.1 to 1.9 on the visual analogue scale.The results support that surgical resection for CP should be considered at early stages. Resection can effectively reduce postoperative pain intensity and improve long-term success.


Assuntos
Pancreatectomia , Pancreatite Crônica , Complicações Pós-Operatórias , Tempo para o Tratamento/estatística & dados numéricos , Manutenção do Peso Corporal , Tratamento Conservador/métodos , Insuficiência Pancreática Exócrina/epidemiologia , Insuficiência Pancreática Exócrina/etiologia , Feminino , Alemanha/epidemiologia , Humanos , Masculino , Pessoa de Meia-Idade , Medição da Dor/métodos , Pancreatectomia/efeitos adversos , Pancreatectomia/métodos , Pancreatite Crônica/enzimologia , Pancreatite Crônica/epidemiologia , Pancreatite Crônica/fisiopatologia , Pancreatite Crônica/terapia , Complicações Pós-Operatórias/diagnóstico , Complicações Pós-Operatórias/epidemiologia , Complicações Pós-Operatórias/cirurgia , Prognóstico , Reoperação/métodos , Reoperação/estatística & dados numéricos , Estudos Retrospectivos , Fatores de Risco , Resultado do Tratamento
14.
Dtsch Arztebl Int ; 117(31-32): 521-527, 2020 Aug 03.
Artigo em Inglês | MEDLINE | ID: mdl-33087240

RESUMO

BACKGROUND: A number of studies have revealed higher postoperative mortality after operations that were performed toward the end of the week. It is not yet known whether a day-of-the-week effect exists after visceral surgical procedures for cancer in Germany. METHODS: Data on resections of carcinomas of the colon, rectum (2010-2017), and head of the pancreas (2014-2017) (n = 19 703) that had been prospectively acquired by the Study, Documentation, and Quality Center of the German Society for General and Visceral Surgery were analyzed in relation to the day of the week on which the operation was performed. The primary endpoint was postoperative 30-day mortality; the secondary endpoints were complications, length of hospital stay, and MTL30 (a combined outcome criterion that is positive if the patient has died, is still in the hospital, or has been transferred to another acute care hospital 30 days after the index procedure). RESULTS: Resections of colon carcinomas that were performed on Mondays were associated with more advanced tumor stages (T4: 18.4% vs. 15.7%, p <0.001), higher 30-day mortality (3.5% vs. 2.3%, p = 0.004), and a more frequently positive MTL30 (10.5% vs. 8.5%, p = 0.004). Among patients who underwent pancreatic head resections, those whose procedures were on Tuesday had higher mortality (6.2% vs. 3.8%; p = 0.021). Among those who underwent surgery for rectal carcinoma, the day of the week on which the procedure was performed had no effect on postoperative morality. Multivariate analysis revealed that the independent risk factors for postoperative mortality were colonic resection on a Monday (odds ratio [OR]: 1.45; 95% confidence interval [1.11; 1.92], p = 0.008) and pancreatic head resection on a Tuesday (OR: 1.88 [1.18; 2.91], p = 0.006). CONCLUSION: Elective surgery for carcinoma of the colon or pancreatic head is associated with slightly higher mortality if per - formed toward the beginning of the week. On the other hand, the day of the week has no effect on the outcome of surgery for rectal carcinoma.


Assuntos
Procedimentos Cirúrgicos do Sistema Digestório , Procedimentos Cirúrgicos Eletivos , Neoplasias Colorretais/cirurgia , Procedimentos Cirúrgicos do Sistema Digestório/mortalidade , Procedimentos Cirúrgicos Eletivos/mortalidade , Alemanha/epidemiologia , Humanos , Tempo de Internação , Pancreatectomia , Complicações Pós-Operatórias , Neoplasias Retais , Fatores de Tempo
15.
Zhonghua Wai Ke Za Zhi ; 58(11): 858-863, 2020 Nov 01.
Artigo em Chinês | MEDLINE | ID: mdl-33120449

RESUMO

Objective: To examine the effect of the "four-steps" treatment on infectious pancreatic necrosis(IPN). Methods: The data of 207 patients who were diagnosed with IPN from January 2013 to December 2017 at Department of Pancreaticobiliary Surgery, the First Affiliated Hospital of Harbin Medical University were analyzed retrospectively. Among 207 patients, 132(63.8%) were males and 75(36.2%) were females. The median age was 45 years old (range: 19 to 80 years old). One hundred and fifty-eight patients(76.3%) suffered severe acute pancreatitis and 49 patients(23.7%) suffered moderately severe acute pancreatitis. Percutaneous catheter drainage(PCD) was performed on all the patients(Step 1). Patients received "four-steps" minimally invasive treatment strategy in step-up group(173 patients). The following steps after PCD were mini-incision access pancreatic necrosectomy(MIAPN) (Step 2), sinus tract endoscopic debridement and(or) PCD for residual infections(Step 3) and finally conventional open pancreatic necrosectomy(OPN) (Step 4). Patients(34 cases) received conventional open pancreatic necrosectomy after invalided PCD in OPN group. The perioperative parameters and prognosis were compared between Step-up group and OPN group. Normally distributed quantitative variables were analyzed by t-test, non-normally distributed quantitative variables were analyzed by Wilcoxon chi-square test and categorical variables were analyzed by χ(2) test or Fisher exact test, respectively. Results: The basic characteristics of the two groups of patients were similar, but the referral rate of patients and the rate of preoperative 3 days organ failure in the OPN group were significantly higher than those of step-up group patients(47.1% vs. 28.9%, χ(2)=4.313, P=0.038; 26.5% vs. 9.2%, χ(2)=2.819, P=0.011). The frequency of PCD and the number of PCD tube (root) were less than those in the step-up group(1(1) vs. 2(1), Z=-3.373, P=0.018; 2(1) vs. 3(2), Z=-2.208, P=0.027). Compared with the OPN group, the interval time from onset to surgery and the MIAPN operation time were significantly shorter in the step-up group(29(15) days vs. 36(17)days, Z=-0.567, P=0.008; 58(27)minutes vs. 90(56)minutes, Z=-3.908, P<0.01); postoperative mortality was lower(5.8% vs.17.6%, χ(2)=4.070, P=0.044); the overall incidence of postoperative complications was reduced(23.1% vs. 55.9%, χ(2)=14.960, P<0.01) and the incidence of new-onset organ failure was decreased after operation in the step-up group(37.5% vs.47.4%, χ(2)=7.133, P=0.007). The incidence of local abdominal complications (pancreatic fistula, intra-abdominal hemorrhage, gastrointestinal fistula) showed no significant difference between the two groups (P>0.05). Fewer patients required ICU treatment after operation in the step-up group compared with OPN group(22.0% vs. 44.1%, χ(2)=6.204, P=0.013). Patients in the Step-up group has shorter hospital stay than patients in OPN group (46(13) days vs. 52(13)days, Z=-1.993, P=0.046). Conclusions: The clinical effects of "four-steps" exhibited the superiority of minimally invasive treatment of IPN.And MIAPN is a simple, safe and effective procedure to remove pancreatic necrotic tissue and decrease complications.


Assuntos
Infecções Intra-Abdominais , Pancreatite Necrosante Aguda , Doença Aguda , Adulto , Idoso , Idoso de 80 Anos ou mais , Desbridamento , Drenagem , Feminino , Humanos , Infecções Intra-Abdominais/etiologia , Infecções Intra-Abdominais/cirurgia , Masculino , Pessoa de Meia-Idade , Procedimentos Cirúrgicos Minimamente Invasivos/métodos , Pancreatectomia , Pancreatite Necrosante Aguda/complicações , Pancreatite Necrosante Aguda/cirurgia , Estudos Retrospectivos , Resultado do Tratamento , Adulto Jovem
16.
Nihon Shokakibyo Gakkai Zasshi ; 117(10): 919-924, 2020.
Artigo em Japonês | MEDLINE | ID: mdl-33041304

RESUMO

A 75-year-old male patient has been followed-up for mixed-type intraductal papillary mucinous neoplasm (IPMN) in the tail of the pancreas for about 20 years. Upon close examination, he was diagnosed of high-risk stigmata due to a nodule having a contrast effect of 5mm or more in the tumor. Based on this, a distal pancreatectomy was performed. Histopathological analysis revealed concomitant IPMN (low-grade) and pancreatic neuroendocrine neoplasm (PNEN) (G1). This prompted us to report a very rare case of coexisting PNEN and IPMN with an interesting pathological finding that might suggest its pathogenic mechanism.


Assuntos
Carcinoma Ductal Pancreático , Neoplasias Gastrointestinais , Neoplasias Pancreáticas , Idoso , Carcinoma Ductal Pancreático/diagnóstico por imagem , Carcinoma Ductal Pancreático/cirurgia , Humanos , Masculino , Pâncreas/cirurgia , Pancreatectomia , Neoplasias Pancreáticas/diagnóstico por imagem , Neoplasias Pancreáticas/cirurgia
17.
Intern Med ; 59(19): 2383-2389, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32999265

RESUMO

Follow-up computed tomography revealed a 40-mm pancreatic tail cyst in a 59-year-old man with type 1 diabetes mellitus. An intraductal papillary mucinous neoplasm was suspected; mucinous cystic neoplasm (MCN) was not considered because the patient was a man. During follow-up, cyst infection occurred but was improved by conservative treatment. At the 24-month follow up examination, cyst nodules had developed, corresponding to an increase in the carbohydrate antigen 19-9 level. Mucinous cystadenocarcinoma (MCC) was diagnosed pathologically based on distal pancreatectomy. A diagnosis of male MCN/MCC is often delayed, which may lead to a poor prognosis. MCN infection is also rare and poorly recognized. We observed an atypical male case of MCN/MCC.


Assuntos
Cistadenocarcinoma Mucinoso/patologia , Cisto Pancreático/patologia , Neoplasias Pancreáticas/patologia , Antígeno CA-19-9/sangue , Cistadenocarcinoma Mucinoso/diagnóstico , Cistadenocarcinoma Mucinoso/cirurgia , Humanos , Masculino , Pessoa de Meia-Idade , Pâncreas/patologia , Pancreatectomia , Neoplasias Pancreáticas/diagnóstico , Tomografia Computadorizada por Raios X
18.
Medicine (Baltimore) ; 99(35): e21829, 2020 Aug 28.
Artigo em Inglês | MEDLINE | ID: mdl-32871906

RESUMO

Imaging parameters including metabolic or textural parameters during F-18 fluorodeoxyglucose (FDG) positron emission tomography/computed tomography (PET/CT) are being used for evaluation of malignancy. However, their utility for prognosis prediction has not been thoroughly investigated. Here, we evaluated the prognosis prediction ability of imaging parameters from preoperative FDGPET/CT in operable pancreatic cancer patients.Sixty pancreatic cancer patients (male:female = 36:24, age = 67.2 ±â€Š10.5 years) who had undergone FDGPET/CT before the curative intent surgery were enrolled. Clinico-pathologic parameters, metabolic parameters from FDGPET/CT; maximal standard uptake value (SUVmax), glucose-incorporated SUVmax (GI-SUVmax), metabolic tumor volume, total-lesion glycolysis, and 53 textural parameters derived from imaging analysis software (MaZda version 4.6) were compared with overall survival.All the patients underwent curative resection. Mean and standard deviation of overall follow-up duration was 16.12 ±â€Š9.81months. Among them, 39 patients had died at 13.46 ±â€Š8.82 months after operation, whereas 21 patients survived with the follow-up duration of 18.56 ±â€Š9.97 months. In the univariate analysis, Tumor diameter ≥4 cm (P = .003), Preoperative Carbohydrate antigen 19-9 ≥37 U/mL (P = .034), number of metastatic lymph node (P = .048) and GI-SUVmax (P = .004) were significant parameters for decreased overall survival. Among the textural parameters, kurtosis3D (P = .052), and skewness3D (P = .064) were potentially significant predictors in the univariate analysis. However, in multivariate analysis only GI-SUVmax (P = .026) and combined operation (P = .001) were significant independent predictors of overall survival.The current research result indicates that metabolic parameter (GI-SUVmax) from FDGPET/CT, and combined operation could predict the overall survival of surgically resected pancreatic cancer patients. Other metabolic or textural imaging parameters were not significant predictors for overall survival of localized pancreatic cancer.


Assuntos
Neoplasias Pancreáticas/diagnóstico por imagem , Neoplasias Pancreáticas/mortalidade , Tomografia Computadorizada com Tomografia por Emissão de Pósitrons , Idoso , Antígenos Glicosídicos Associados a Tumores/análise , Feminino , Fluordesoxiglucose F18 , Seguimentos , Humanos , Masculino , Pancreatectomia , Neoplasias Pancreáticas/cirurgia , Pancreaticoduodenectomia , Cuidados Pré-Operatórios , Prognóstico , Compostos Radiofarmacêuticos , Estudos Retrospectivos
19.
Chirurgia (Bucur) ; 115(4): 520-525, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32876026

RESUMO

We present the case of a 42-year-old woman diagnosed with a cystic pancreatic lesion, suggestive of a serous cystadenoma of 27/13 mm. The diagnosis was established by the examination of abdominal CT and eco-endoscopy. The patient was referred to the surgery department for treatment. The benign etiology suggested by imaging and the desire to preserve the spleen along with as much of the pancreatic parenchyma, indicated a laparoscopic central pancreatectomy with a anastomosis between the distal pancreatic stump and the stomach. The authors reviewed the national and international publications related to the indications of this minimally invasive surgery.


Assuntos
Cistadenoma Seroso/cirurgia , Pâncreas/cirurgia , Pancreatectomia/métodos , Neoplasias Pancreáticas/cirurgia , Estômago/cirurgia , Adulto , Anastomose Cirúrgica , Cistadenoma Seroso/diagnóstico por imagem , Feminino , Humanos , Laparoscopia , Neoplasias Pancreáticas/diagnóstico por imagem , Resultado do Tratamento
20.
Am J Clin Oncol ; 43(9): 648-653, 2020 09.
Artigo em Inglês | MEDLINE | ID: mdl-32889835

RESUMO

OBJECTIVES: Optimal radiation target volumes for neoadjuvant therapy in patients with borderline resectable pancreatic cancer (BRPCa) are undefined. Most local recurrences are near the celiac axis and superior mesenteric artery. Methods for generating radiation target volumes include symmetric expansion around the tumor or a customized vascular based approach. We investigated 3 current prospective trials' coverage of vascular regions at increased risk of recurrence by comparing them to 2 reference standards. MATERIALS AND METHODS: Fourteen computed tomography simulation scans from an institutional prospective trial on BRPCa were used to replicate distinct volumes corresponding to each of 3 contemporary BRPCa trials. Trial volumes were compared with 2 reference volumes (vascular planning target volume and Hopkins planning target volume), which were both based on vascular regions at increased risk of recurrence. Boolean operators and DICE analyses were performed to evaluate trial volume coverage of reference standards. RESULTS: A total of 42 target volumes and 28 reference volumes were created using the 14-patient data set. DICE coefficients were highly variable ranging from 0.11 to 0.99. Mean % coverage of reference volumes ranged from 5.8% to 98.6%. CONCLUSIONS: The wide range of DICE coefficients and coverage indicate heterogeneity in high risk vascular target coverage using symmetric Boolean expansions from the primary tumor. This approach may inadequately cover regions at high risk of local recurrence in BRPCa. A customized clinical target volume that specifically includes the superior mesenteric artery and celiac axis will improve coverage to this region and will account for individual and tumor variability.


Assuntos
Artéria Celíaca , Artéria Mesentérica Superior , Neoplasias Pancreáticas/radioterapia , Ensaios Clínicos como Assunto , Simulação por Computador , Humanos , Terapia Neoadjuvante , Pancreatectomia , Neoplasias Pancreáticas/diagnóstico por imagem , Neoplasias Pancreáticas/patologia , Neoplasias Pancreáticas/cirurgia , Dosagem Radioterapêutica , Planejamento da Radioterapia Assistida por Computador , Radioterapia Adjuvante/métodos , Tomografia Computadorizada por Raios X , Carga Tumoral
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