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1.
World J Gastroenterol ; 25(46): 6752-6766, 2019 Dec 14.
Artigo em Inglês | MEDLINE | ID: mdl-31857777

RESUMO

BACKGROUND: The 8th edition of the American Joint Committee on Cancer (AJCC) staging system for pancreatic ductal adenocarcinoma (PDAC) excludes extrapancreatic extension from the assessment of T stage and restages tumors with mesenterico-portal vein (MPV) invasion into T1-3 diseases according to tumor size. However, MPV invasion is believed to be correlated with a poor prognosis. AIM: To analyze whether the inclusion of MPV invasion can further improve the 8th edition of the AJCC staging system for PDAC. METHODS: This study retrospectively included 8th edition AJCC T1-3N0-2M0 patients undergoing pancreaticoduodenectomy/total pancreatectomy from two cohorts and analyzed survival outcomes. In the first cohort, a total of 7539 patients in the surveillance, epidemiology, and end results database was included, and in the second cohort, 689 patients from the West China Hospital database were enrolled. RESULTS: Cox regression analysis showed that MPV invasion is an independent prognostic factor in both databases. In the MPV- group, all pairwise comparisons between the survival functions of patients with different stages were significant except for the comparison between patients with stage IIA and those with stage IIB. However, in the MPV+ group, pairwise comparisons between the survival functions of patients with stage IA, stage IB, stage IIA, stage IIB, and stage III were not significant. T1-3N0 patients in the MPV+ group were compared with the T1N0, T2N0, and T3N0 subgroups of the MPV- group; only the survival of MPV-T3N0 and MPV+T1-3N0 patients had no significant difference. Further comparisons of patients with stage IIA and subgroups of stage IIB showed (1) no significant difference between the survival of T2N1 and T3N0 patients; (2) a longer survival of T1N1 patients that was shorter than the survival of T2N0 patients; and (3) and a shorter survival of T3N1 patients that was similar to that of T1-3N2 patients. CONCLUSION: The modified 8th edition of the AJCC staging system for PDAC proposed in this study, which includes the factor of MPV invasion, provides improvements in predicting prognosis, especially in MPV+ patients.


Assuntos
Carcinoma Ductal Pancreático/patologia , Veias Mesentéricas/patologia , Neoplasias Pancreáticas/patologia , Veia Porta/patologia , Idoso , Carcinoma Ductal Pancreático/diagnóstico , Carcinoma Ductal Pancreático/mortalidade , China/epidemiologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estadiamento de Neoplasias , Neoplasias Pancreáticas/diagnóstico , Neoplasias Pancreáticas/mortalidade , Prognóstico , Estudos Retrospectivos , Programa de SEER , Estados Unidos/epidemiologia
2.
BMJ Case Rep ; 12(9)2019 Sep 24.
Artigo em Inglês | MEDLINE | ID: mdl-31551317

RESUMO

Mesenteric ischaemia represents an uncommon complication of splanchnic vein thrombosis which requires a high level of suspicion to diagnose in a timely manner. This report discusses a case of portal, splenic and superior mesenteric vein thrombosis leading to mesenteric ischaemia and infarct in a 79-year-old man. The diagnosis of acute mesenteric ischaemia and splanchnic vein thrombosis remains difficult due to the non-specific symptoms of these conditions. As diagnosis does continue to improve, treatment of acute mesenteric ischaemia using medical management has become increasingly possible before ischaemia advances to the point at which surgical resection is required.


Assuntos
Isquemia Mesentérica/etiologia , Veias Mesentéricas/patologia , Veia Porta/patologia , Veia Esplênica/patologia , Trombose Venosa/complicações , Dor Abdominal , Idoso , Diagnóstico Diferencial , Humanos , Jejuno/cirurgia , Masculino , Isquemia Mesentérica/diagnóstico por imagem , Isquemia Mesentérica/cirurgia , Veias Mesentéricas/diagnóstico por imagem , Veia Porta/diagnóstico por imagem , Veia Esplênica/diagnóstico por imagem , Tomógrafos Computadorizados , Trombose Venosa/diagnóstico por imagem
3.
Ann Surg Oncol ; 26(11): 3709-3710, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31407182

RESUMO

BACKGROUND: Solid pseudopapillary tumors (SPPTs) are low malignant potential entities found mainly in young females.1,2 Pancreatectomy without tumor rupture is the treatment of choice, and the laparoscopic approach is indicated.3,4 Limited pancreatectomy is possible due to the low risk of malignancy (< 10%) based on the low risk of lymph node invasion or true vascular invasion.1,2 Centrally located large SPPTs can be treated by extended central pancreatectomy with or without vascular resection to avoid pancreatoduodenectomy or distal pancreatectomy. METHODS: A 24-year-old woman was admitted with abdominal pain. A 6-cm SPPT was discovered at the neck-body junction in close contact with the anterior aspect of the mesentericoportal vein (MPV) and the splenic vessels, with signs of segmental portal hypertension. To avoid an extended pancreatectomy for this young patient, an extended central pancreatectomy was performed, with resection of the splenic vessels, and the MPV was freed from the tumor under clamping for 10 min, with no need for vascular reconstruction. The duration of the surgery was 260 min, with 200 ml of blood loss and no transfusion. RESULTS: The woman's postoperative course was uneventful, with a hospital stay of 16 days. Histology confirmed the diagnosis of a 6-cm SPPT tumor (R0 and N0). The patient was asymptomatic 1 year later, with no tumor recurrence and no pancreatic insufficiency. Between 2011 and 2018 the authors performed 72 laparoscopic central pancreatectomies, with SPPT performed for 13 patients (18%). Laparoscopic central pancreatectomy was extended (n = 5) or standard (n = 8) with no conversion, no recurrence, and no pancreatic insufficiency. CONCLUSION: An SPPT tumor is a good indication for the laparoscopic approach because this entity is found in young patients with a low risk of malignancy. Large centrally located tumors can be treated by extended central pancreatectomy to avoid a large pancreatectomy with greater early and long-term disadvantages.


Assuntos
Carcinoma Papilar/cirurgia , Laparoscopia/métodos , Veias Mesentéricas/cirurgia , Neoplasias Pancreáticas/cirurgia , Veia Porta/cirurgia , Baço/cirurgia , Adulto , Carcinoma Papilar/patologia , Feminino , Humanos , Veias Mesentéricas/patologia , Neoplasias Pancreáticas/patologia , Veia Porta/patologia , Prognóstico , Baço/patologia , Instrumentos Cirúrgicos , Adulto Jovem
5.
BMC Surg ; 19(1): 84, 2019 Jul 08.
Artigo em Inglês | MEDLINE | ID: mdl-31286916

RESUMO

BACKGROUND: Although pancreaticoduodenectomy with vein resection (PDVR) is widely performed in selected patients with indications, its benefits remain controversial. In this meta-analysis, we evaluate the safety and efficacy of PDVR in comparison to standard pancreaticoduodenectomy (PD). METHODS: We searched PubMed, Embase, and Cochrane as well as the Chinese National Knowledge Infrastructure, Weipu, and Wanfang databases for studies that evaluate the value of PVDR. The data of the patients who underwent PD or PDVR were analyzed using Review Manager and STATA software. RESULTS: In comparison with the PD group, the PDVR group had a lower R0 resection rate and higher rates of complications such as biliary fistula, reoperation rate, delayed gastric emptying, cardiopulmonary abnormalities, hemorrhage, in-hospital mortality, 30-day mortality. The blood loss, duration of operation, total hospital stay is higher in PDVR group. CONCLUSIONS: Compared to standard PD, PDVR was associated with a greater risk of some specific complications and increase the mortality rate, total hospital stay time, combine with vein resection have a lower R0 resection rate. Therefore, combine with vascular resection for pancreatic cancer needs to be carefully selected by the surgeon.


Assuntos
Carcinoma Ductal Pancreático/cirurgia , Veias Mesentéricas/cirurgia , Neoplasias Pancreáticas/cirurgia , Pancreaticoduodenectomia/métodos , Veia Porta/cirurgia , Neoplasias Vasculares/cirurgia , Procedimentos Cirúrgicos Vasculares/métodos , Carcinoma Ductal Pancreático/patologia , Humanos , Veias Mesentéricas/patologia , Invasividade Neoplásica , Neoplasias Pancreáticas/patologia , Pancreaticoduodenectomia/efeitos adversos , Pancreaticoduodenectomia/mortalidade , Veia Porta/patologia , Resultado do Tratamento , Neoplasias Vasculares/secundário , Procedimentos Cirúrgicos Vasculares/efeitos adversos , Procedimentos Cirúrgicos Vasculares/mortalidade
6.
Cells ; 8(7)2019 06 29.
Artigo em Inglês | MEDLINE | ID: mdl-31261968

RESUMO

Portal hypertension is a common complication of liver disease, either acute or chronic. Consequently, in chronic liver disease, such as the hypertensive mesenteric venous pathology, the coexisting inflammatory response is classically characterized by the splanchnic blood circulation. However, a vascular lymphatic pathology is produced simultaneously with the splanchnic arterio-venous impairments. The pathological increase of the mesenteric venous pressure, by mechanotransduction of the venous endothelium hyperpressure, causes an inflammatory response involving the subendothelial mast cells and the lymphatic endothelium of the intestinal villi lacteal. In portal hypertension, the intestinal lymphatic inflammatory response through the development of mesenteric-systemic lymphatic collateral vessels favors the systemic diffusion of substances with a molecular pattern associated with damage and pathogens of intestinal origin. When the chronic hepatic insufficiency worsens the portal hypertensive inflammatory response, the splanchnic lymphatic system transports the hyperplasied intestinal mast cells to the mesenteric lymphatic complex. Then, an acquired immune response regulating a new hepato-intestinal metabolic scenario is activated. Therefore, reduction of the hepatic metabolism would reduce its key centralized functions, such as the metabolic, detoxifying and antioxidant functions which would try to be substituted by their peroxisome activity, among other functions of the mast cells.


Assuntos
Hipertensão Portal/imunologia , Inflamação/imunologia , Vasos Linfáticos/citologia , Mastócitos/imunologia , Circulação Esplâncnica/imunologia , Humanos , Hipertensão Portal/patologia , Inflamação/patologia , Mucosa Intestinal/imunologia , Vasos Linfáticos/imunologia , Vasos Linfáticos/patologia , Mecanotransdução Celular/imunologia , Veias Mesentéricas/imunologia , Veias Mesentéricas/patologia , Mesentério/irrigação sanguínea
7.
Hepatobiliary Pancreat Dis Int ; 18(4): 389-394, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31230959

RESUMO

BACKGROUND: Borderline resectable pancreatic cancer may require extended resections in order to achieve tumor-free margins, especially in the case of up-front resections, but it is important to know the limits of surgical therapy in this disease. This study aimed to investigate the impact of extent of pancreatic and venous resection on short- and long-term outcomes in patients with pancreatic adenocarcinoma (PDAC). METHODS: This was a retrospective study from a prospectively maintained database of pancreatic resections for PDAC. Short- and long-term outcomes were analyzed in patients having borderline resectable PDAC submitted to up-front total pancreatectomy (TP) or pancreaticoduodenectomy (PD) with simultaneous portal vein (PV) and/or superior mesenteric vein (SMV) resection. Venous resections were carried out as tangential venous resection (TVR) or segmental venous resection (SVR). Patients were divided into 4 groups: (1) PD + TVR, (2) PD + SVR, (3) TP + TVR, (4) TP + SVR. Uni- and multivariate Cox regression analysis were performed to identify factors associated with survival. RESULTS: Ninety-nine patients were submitted to simultaneous pancreatic and venous resection for PDAC. Among them, 25 were submitted to PD + TVR (25.3%), 12 to PD + SVR (12.1%), 23 to TP + TVR (23.2%), and 39 to TP + SVR (39.4%). Overall, major morbidity (Clavien-Dindo grade ≥ IIIA) was 26.3%. Thirty- and 90-day mortality were 3% and 11.1%, respectively. There were no significant differences among groups in terms of short-term outcomes. Median overall survival of patients submitted to PD + TVR was significantly higher than those to TP+SVR (29.5 vs 7.9 months, P = 0.001). Multivariate analysis identified TP (HR = 2.11; 95% CI: 1.31-3.44; P = 0.002) and SVR (HR = 2.01; 95% CI: 1.27-3.15; P = 0.003) as the only independent prognostic factors for overall survival. CONCLUSIONS: Up-front TP associated to SVR was predictive of worse survival in borderline resectable PDAC. Perioperative treatments in high-risk surgical groups may improve such poor outcomes.


Assuntos
Carcinoma Ductal Pancreático/cirurgia , Veias Mesentéricas/cirurgia , Pancreatectomia , Neoplasias Pancreáticas/cirurgia , Pancreaticoduodenectomia , Veia Porta/cirurgia , Idoso , Carcinoma Ductal Pancreático/mortalidade , Carcinoma Ductal Pancreático/patologia , Bases de Dados Factuais , Feminino , Humanos , Masculino , Margens de Excisão , Veias Mesentéricas/patologia , Pessoa de Meia-Idade , Pancreatectomia/efeitos adversos , Pancreatectomia/mortalidade , Neoplasias Pancreáticas/mortalidade , Neoplasias Pancreáticas/patologia , Pancreaticoduodenectomia/efeitos adversos , Pancreaticoduodenectomia/mortalidade , Veia Porta/patologia , Estudos Retrospectivos , Medição de Risco , Fatores de Risco , Fatores de Tempo , Resultado do Tratamento
9.
Cardiovasc Pathol ; 40: 68-71, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30928813

RESUMO

Enterocolic lymphocytic phlebitis (ELP) is a rare enteropathy characterized by lymphocytic phlebitis of the mesenteric veins without arteritis. Idiopathic myointimal hyperplasia of mesenteric veins (IMHMV) is a rare disease similar to ELP, characterized by myointimal hyperplasia that constricts the lumen of veins, causing mucosal injury. A 62-year-old man with chief complaint of abdominal pain was treated by partial resection of the ileum after 3 months of conservative therapy. The pathologic diagnosis was ELP with prominent myointimal hyperplasia. Histologically, the lesion consisted of lymphocytic infiltration into the vein accompanied by prominent myointimal hyperplasia and perivenous concentric fibrosis, which are characteristics shared by ELP and IMHMV. The observations in this case suggest that some of ELP and IMHMV may belong to the same disease spectrum. Furthermore, perivascular concentric fibrosis was a remarkable observation that may contribute to differential diagnosis between ELP and "true" IMHMV.


Assuntos
Linfócitos T CD4-Positivos/patologia , Enteropatias/patologia , Veias Mesentéricas/patologia , Flebite/patologia , Túnica Íntima/patologia , Biópsia , Angiografia por Tomografia Computadorizada , Diagnóstico Diferencial , Fibrose , Humanos , Hiperplasia , Imuno-Histoquímica , Enteropatias/diagnóstico por imagem , Enteropatias/cirurgia , Masculino , Veias Mesentéricas/diagnóstico por imagem , Veias Mesentéricas/cirurgia , Pessoa de Meia-Idade , Flebite/diagnóstico por imagem , Flebite/cirurgia , Flebografia/métodos , Valor Preditivo dos Testes , Resultado do Tratamento , Túnica Íntima/diagnóstico por imagem , Túnica Íntima/cirurgia
10.
Ann Surg Oncol ; 26(8): 2516, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-30927197

RESUMO

BACKGROUND: Laparoscopic complete mesocolic excision (CME) for hepatic or splenic flexural colon cancer is considered technically demanding. The double (hepatic and splenic) flexural colon cancers are rare, and the laparoscopic CME procedure for such disease is not standardized. METHODS: This video presents laparoscopic CME for double (hepatic and splenic) flexural colon cancers using a medial and cranial approach. RESULTS: The patient was a 60-year-old woman with the diagnosis of splenic flexure cancer (cT4N1M0) and hepatic flexure cancer (cT3N0M0). Laparoscopic subtotal colectomy was performed. First, the left colic artery was divided at its origin, and the inferior mesenteric vein also was divided at the same level. The descending mesocolon was widely separated from the retroperitoneal tissues using a medial approach. Then, lymph node dissection along the surgical trunk was performed using a cranial approach. Finally, the transverse mesocolon was divided at the inferior border of the pancreas, and CME was achieved. The specimen was extracted through a small incision at the umbilicus, and side-to-side ileo-sigmoid anastomosis was performed extracorporeally. CONCLUSIONS: The approach presented in the video might be useful for standardization of laparoscopic CME for double flexural colon cancers.


Assuntos
Colectomia/métodos , Colo Transverso/cirurgia , Neoplasias do Colo/cirurgia , Laparoscopia/métodos , Excisão de Linfonodo/métodos , Veias Mesentéricas/cirurgia , Mesocolo/cirurgia , Colo Transverso/patologia , Neoplasias do Colo/patologia , Feminino , Humanos , Veias Mesentéricas/patologia , Mesocolo/patologia , Pessoa de Meia-Idade , Prognóstico , Gravação em Vídeo
11.
BMC Gastroenterol ; 19(1): 37, 2019 Feb 28.
Artigo em Inglês | MEDLINE | ID: mdl-30819091

RESUMO

BACKGROUND: Endoscopic injection sclerotherapy (EIS) is a life-saving procedure for pediatric patients with bleeding gastric varices (GV) associated with advanced liver cirrhosis and severe portal hypertension. Because of the lack of an endoscopic banding ligation device for pediatric patients, EIS is usually performed for bleeding esophageal varices (EV) in infants with congenital biliary atresia. CASE PRESENTATION: We present a case of a 15-month-old female infant with type I biliary atresia with jaundice (total serum bilirubin, 22.2 mg/dL), hypoalbuminemia (serum albumin level, 2.58 g/dL), coagulopathy (prothrombin time > 20 s compared with that of a normal control), ascites, splenomegaly, portal hypertension (portal vein velocity, 3.9-5.6 cm/sec of hepatopetal flow), and repeated bleeding of the varices after receiving three doses of intravascularly administered Histoacryl 1 ampoule mixed with Lipiodol UF 8 mL in the EV. Prominent GV and EV were occluded by EIS. The sclerosing agent was also present in the main portal vein, splenic mesenteric junction, and splenic vein, causing an engorged inferior mesenteric vein. The patient underwent total hepatectomy and living donor liver transplantation (LDLT) by left lateral segment graft (segments 2, 3, and 4 of the middle hepatic vein trunk) and left portal vein graft to the recipient inferior mesenteric vein anastomosis. Portal vein stent placement via segment 4 of the portal vein stump was performed from the inferior mesenteric vein to the umbilical portion of the left portal vein. The patient is still alive and doing well after the LDLT. CONCLUSIONS: EIS is a life-saving procedure in cases involving bleeding EV complicated by gastric, main portal vein, splenic mesenteric junction, and splenic vein occlusions; hence, it should be kept in mind as a treatment for EV complications in pediatric patients.


Assuntos
Endoscopia Gastrointestinal , Varizes Esofágicas e Gástricas/complicações , Varizes Esofágicas e Gástricas/terapia , Hemorragia Gastrointestinal/complicações , Hemorragia Gastrointestinal/terapia , Técnicas Hemostáticas , Escleroterapia/métodos , Insuficiência Venosa/etiologia , Atresia Biliar/complicações , Feminino , Humanos , Lactente , Oclusão Vascular Mesentérica/etiologia , Veias Mesentéricas/patologia , Veia Porta/patologia , Veia Esplênica/patologia , Estômago/irrigação sanguínea , Veias/patologia
12.
Langenbecks Arch Surg ; 404(2): 191-201, 2019 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-30631907

RESUMO

PURPOSE: Many studies report that pancreatoduodenectomy (PD) with portal-superior mesenteric vein resection and reconstruction (PVR) is not a contraindication to extended tumor resection for pancreatic ductal adenocarcinoma. However, the clinical benefit of an interposition graft for PVR still remains controversial. METHODS: Between January 2001 and December 2017, 199 patients with pancreatic cancer underwent PD either with or without PVR, and their medical records were reviewed retrospectively, paying specific attention to the PVR methods and the long-term outcome. RESULTS: Among the 122 patients with PVR, 97 (79.5%) underwent end-to-end anastomosis and 25 (20.5%) had an interposition graft using the right external iliac vein (REIV). The 2-year and 5-year survival rates of the no-PVR group (54.2% and 30.8%, respectively) were longer than both the end-to-end anastomosis group (24.5% and 13.7%) and the interposition graft group (32% and 10.0%) (p < 0.001). However, there was no significant difference in the survival between the end-to-end anastomosis group and the interposition graft group (p = 0.963). A multivariate analysis indicated that the level of preoperative serum albumin < 3.5 g/dL (risk ratio (RR) 2.08, 95% confidence interval (CI) 1.26 to 3.43; p = 0.004), and postoperative adjuvant chemotherapy (RR 1.82, 95% CI 1.19 to 2.79; p = 0.006) were independently associated with overall survival after PVR. CONCLUSIONS: An interposition graft using the REIV for PVR following PD is safe and effective. There was no significant prognostic difference between PD with end-to-end anastomosis and with an interposition graft in patients with pancreatic ductal adenocarcinoma.


Assuntos
Carcinoma Ductal Pancreático/patologia , Carcinoma Ductal Pancreático/cirurgia , Pancreaticoduodenectomia/métodos , Veia Porta/cirurgia , Procedimentos Cirúrgicos Reconstrutivos/métodos , Procedimentos Cirúrgicos Vasculares/métodos , Adenocarcinoma/mortalidade , Adenocarcinoma/patologia , Adenocarcinoma/cirurgia , Adulto , Idoso , Anastomose Cirúrgica , Carcinoma Ductal Pancreático/mortalidade , Estudos de Coortes , Terapia Combinada , Feminino , Sobrevivência de Enxerto , Humanos , Estimativa de Kaplan-Meier , Masculino , Veias Mesentéricas/patologia , Veias Mesentéricas/cirurgia , Pessoa de Meia-Idade , Invasividade Neoplásica/patologia , Estadiamento de Neoplasias , Pancreaticoduodenectomia/mortalidade , Veia Porta/patologia , Prognóstico , Modelos de Riscos Proporcionais , Estudos Retrospectivos , Estatísticas não Paramétricas , Análise de Sobrevida , Transplante de Tecidos/métodos , Resultado do Tratamento
13.
Eur J Haematol ; 102(1): 53-62, 2019 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-30267448

RESUMO

Thrombosis of unusual venous sites encompasses a large part of consultative hematology and is encountered routinely by practicing hematologists. Contrary to the more commonly encountered lower extremity venous thrombosis and common cardiovascular disorders, the various thromboses outlined in this review have unique presentations, pathophysiology, workup, and treatments that all hematologists should be aware of. This review attempts to outline the most up to date literature on cerebral, retinal, upper extremity, hepatic, portal, splenic, mesenteric, and renal vein thrombosis, focusing on the incidence, pathophysiology, provoking factors, and current recommended treatments for each type of unusual thrombosis to provide a useful and practical review for the hematologist.


Assuntos
Trombose Venosa/diagnóstico , Trombose Venosa/terapia , Síndrome de Budd-Chiari/diagnóstico , Síndrome de Budd-Chiari/etiologia , Síndrome de Budd-Chiari/terapia , Veias Cerebrais/patologia , Gerenciamento Clínico , Humanos , Veias Mesentéricas/patologia , Veia Porta/patologia , Veias Renais/patologia , Veia Retiniana/patologia , Veia Esplênica/patologia , Extremidade Superior/patologia , Trombose Venosa/etiologia
14.
J Gastrointest Surg ; 23(1): 112-121, 2019 01.
Artigo em Inglês | MEDLINE | ID: mdl-30242644

RESUMO

INTRODUCTION: Approximately, 20% of patients with pancreatic ductal adenocarcinoma have resectable disease at diagnosis. Given improvements in locoregional and systemic therapies, some patients with borderline resectable pancreatic cancer (BRPC) can now undergo successful resection. The outcomes of patients with BRPC after neoadjuvant therapy remain unclear. METHODS: A prospectively maintained single-institution database was utilized to identify patients with BRPC who were managed at the Johns Hopkins Pancreas Multidisciplinary Clinic (PMDC) between 2013 and 2016. BRPC was defined as any tumor that presented with radiographic evidence of the involvement of the portal vein (PV) or superior mesenteric vein (SMV) that was deemed to be technically resectable (with or without the need for reconstruction), or the abutment (< 180° involvement) of the common hepatic artery (CHA) or superior mesenteric artery (SMA), in the absence of involvement of the celiac axis (CA). We collected data on treatment, the course of the disease, resection rate, and survival. RESULTS: Of the 866 patients evaluated at the PMDC during the study period, 151 (17.5%) were staged as BRPC. Ninety-six patients (63.6%) underwent resection. Neoadjuvant chemotherapy was administered to 142 patients (94.0%), while 78 patients (51.7%) received radiation therapy in the neoadjuvant setting. The median overall survival from the date of diagnosis, of resected BRPC patients, was 28.8 months compared to 14.5 months in those who did not (p < 0.001). Factors associated with increased chance of surgical resection included lower ECOG performance status (p = 0.011) and neck location of the tumor (p = 0.001). Forty-seven patients with BRPC (31.1%) demonstrated progression of disease; surgical resection was attempted and aborted in 12 patients (7.9%). Eight patients (5.3%) were unable to tolerate chemotherapy; six had disease progression and two did not want to pursue surgery. Lastly, four patients (3.3%) were conditionally unresectable due to medical comorbidities at the time of diagnosis due to comorbidities and failed to improve their status and subsequently had progression of the disease. CONCLUSION: After initial management, 31.1% of patients with BRPC have progression of disease, while 63.6% of all patients successfully undergo resection, which was associated with improved survival. Factors associated with increased likelihood of surgical resection include lower ECOG performance status and tumor location in the neck.


Assuntos
Antineoplásicos/uso terapêutico , Carcinoma Ductal Pancreático/tratamento farmacológico , Carcinoma Ductal Pancreático/cirurgia , Terapia Neoadjuvante , Neoplasias Pancreáticas/tratamento farmacológico , Neoplasias Pancreáticas/cirurgia , Idoso , Carcinoma Ductal Pancreático/patologia , Quimioterapia Adjuvante , Progressão da Doença , Feminino , Nível de Saúde , Hepatectomia , Artéria Hepática/patologia , Humanos , Masculino , Artéria Mesentérica Superior/patologia , Veias Mesentéricas/patologia , Pessoa de Meia-Idade , Neoplasias Pancreáticas/patologia , Veia Porta/patologia , Radioterapia Adjuvante , Estudos Retrospectivos , Taxa de Sobrevida
15.
Ann Surg Oncol ; 26(2): 652, 2019 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-30539487

RESUMO

INTRODUCTION: Patients with locally advanced pancreatic cancer (LAPC) represent a challenging group to treat, given the involvement of major vascular structures. In selected patients with favorable biology, temporary mesocaval shunt can facilitate the resection and allow for a safer procedure with enhanced exposure to the superior mesenteric vessels. METHODS: We present a video of a pancreaticoduodenectomy (PD) with temporary mesocaval shunt with left internal jugular (LIJ) vein conduit. RESULTS: A 65-year-old woman presented with LAPC in the uncinate, causing total occlusion of the superior mesenteric vein (SMV) and encasement of the first jejunal artery. After neoadjuvant therapy and evidence of disease stability, a decision was made to perform a PD with a temporary mesocaval shunt to divert mesenteric flow to reduce blood loss and prevent bowel ischemia. During the procedure, the main mesenteric collateral (ileocolic vein) was divided to create the shunt to the inferior vena cava (IVC) with LIJ interposition. The remaining mesenteric tributaries involved by the tumor were divided. The uncinate dissection was performed using a superior mesenteric artery-first approach. Once the resection was completed, the shunt was stapled from the IVC and the graft transposed to the upper SMV. Standard reconstruction was performed. Total operative time was 536 min, and estimated blood loss was 250 cc without transfusions. No perioperative complications occurred. CONCLUSION: In selected patients with LAPC, PD with temporary mesocaval shunt can facilitate resection and venous reconstruction in patients with complete portal vein/SMV occlusion.


Assuntos
Adenocarcinoma/cirurgia , Veias Mesentéricas/cirurgia , Neoplasias Pancreáticas/cirurgia , Pancreaticoduodenectomia , Procedimentos Cirúrgicos Vasculares , Veia Cava Inferior/cirurgia , Adenocarcinoma/patologia , Idoso , Anastomose Cirúrgica , Feminino , Humanos , Veias Mesentéricas/patologia , Neoplasias Pancreáticas/patologia , Prognóstico , Veia Cava Inferior/patologia
17.
J Microbiol Immunol Infect ; 52(4): 672-673, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-30042036

RESUMO

Pylephlebitis is a condition with thrombophlebitis of the portal mesenteric venous system. Herein, we report a patient suggesting odontogenic bacteremia as a risk factor of pylephlebitis. He was diagnosed as superior mesenteric vein thrombophlebitis, and blood cultures grew Gemella sanguinis and Streptococcus gordonii.


Assuntos
Bacteriemia/complicações , Bacteriemia/microbiologia , Gemella/patogenicidade , Veias Mesentéricas/patologia , Streptococcus gordonii/patogenicidade , Tromboflebite/complicações , Antibacterianos/uso terapêutico , Implantes Dentários/efeitos adversos , Humanos , Masculino , Veias Mesentéricas/diagnóstico por imagem , Pessoa de Meia-Idade , Boca/microbiologia , Veia Porta , Fatores de Risco , Tromboflebite/diagnóstico por imagem , Tromboflebite/patologia , Extração Dentária/efeitos adversos
18.
Obes Surg ; 29(1): 350-352, 2019 01.
Artigo em Inglês | MEDLINE | ID: mdl-30382462

RESUMO

Sleeve gastrectomy (SG) is currently the most popular bariatric procedure. Portomesenteric venous thrombosis (PVT) is a feared and increasingly reported complication. Herein, we describe the history of a patient who developed a post-operative PVT after SG, aggravated with refractory ascites, and finally required orthotopic liver transplantation (LT). Acquired thrombophilia-anti-cardiolipin syndrome was present. As SG expands worldwide, this first case of LT for PVT following SG may warrant a systematic screening for prothrombotic condition and information on the possible consequences of PVT prior to bariatric surgery.


Assuntos
Gastrectomia/efeitos adversos , Falência Hepática Aguda/diagnóstico , Obesidade Mórbida/cirurgia , Complicações Pós-Operatórias/diagnóstico , Trombose Venosa/diagnóstico , Adulto , Anticorpos Anticardiolipina/sangue , Gastrectomia/métodos , Humanos , Laparoscopia/efeitos adversos , Laparoscopia/métodos , Falência Hepática Aguda/sangue , Falência Hepática Aguda/etiologia , Falência Hepática Aguda/terapia , Transplante de Fígado , Veias Mesentéricas/patologia , Obesidade Mórbida/patologia , Veia Porta/patologia , Complicações Pós-Operatórias/etiologia , Complicações Pós-Operatórias/terapia , Síndrome , Trombofilia/sangue , Trombofilia/complicações , Trombofilia/etiologia , Trombose Venosa/etiologia , Trombose Venosa/terapia
19.
J Gastrointest Cancer ; 50(3): 660-664, 2019 09.
Artigo em Inglês | MEDLINE | ID: mdl-29663116
20.
Khirurgiia (Mosk) ; (12): 21-29, 2018.
Artigo em Russo | MEDLINE | ID: mdl-30560841

RESUMO

AIM: To evaluate the outcomes of pancreaticoduodenectomy with mesenteric-portal vein resection for pancreatic head cancer. MATERIAL AND METHODS: Retrospective analysis included 124 patients with pancreatic head cancer for the period 2010-2017. Mesenteric-portal vein (MPV) invasion was diagnosed in 37 (29.8%) patients, tumor contact with superior mesenteric artery as a borderline resectable state was noted in 11 cases. All patients underwent pancreaticoduodenectomy with mesenteric-portal vein resection. RESULTS: Vein invasion was histologically confirmed in 19 (51.3%) out of 37 patients. At the same time, arterial invasion was absent in 11 patients with a borderline resectable tumor. CT-associated overdiagnosis of venous wall invasion was 6.4%, intraoperative overdiagnosis - 87.5%. R0-resection was achieved in 88.5% after conventional pancreaticoduodenectomy and in 78.4% after pancreaticoduodenectomy followed by MPV resection. Median survival was 17 months, 2-year survival - 41%. Among 11 patients with a borderline resectable tumor median survival was 11 months. Pancreaticoduodenectomy without vein resection was followed by 2-year survival near 68.1%. Differences were significant (p=0.02). CONCLUSION: Pancreaticoduodenectomy followed by MPV resection as the first stage of combined treatment of pancreatic head cancer is absolutely justified if circumferential involvement of the vein and contact with superior mesenteric artery or celiac trunk do not exceed 50%. Vein resection can provide R0-surgery in these cases.


Assuntos
Veias Mesentéricas/cirurgia , Neoplasias Pancreáticas/diagnóstico , Neoplasias Pancreáticas/cirurgia , Pancreaticoduodenectomia , Veia Porta/cirurgia , Humanos , Artérias Mesentéricas/diagnóstico por imagem , Artérias Mesentéricas/patologia , Artérias Mesentéricas/cirurgia , Veias Mesentéricas/diagnóstico por imagem , Veias Mesentéricas/patologia , Invasividade Neoplásica , Neoplasias Pancreáticas/mortalidade , Pancreaticoduodenectomia/métodos , Veia Porta/diagnóstico por imagem , Veia Porta/patologia , Estudos Retrospectivos , Análise de Sobrevida
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