1,721,137 research outputs found
Alteration of hypothalamus-pituitary-adrenal glands axis in colorectal cancer patients. Preliminary report
No full textGlobal genomic analysis of intraductal papillary mucinous neoplasms of the pancreas reveals significant molecular differences compared to ductal adenocarcinoma
No full textA grading system can predict clinical and economic outcomes of pancreatic fistula after pancreaticoduodenectomy: results in 755 consecutive patients.
No full textTHE VALUE OF (18)FLUOR-DEOXYGLUCOSE POSITRON EMISSION TOMOGRAPHY/COMPUTED TOMOGRAPHY (18FDG-PET/CT) IN RESECTABLE PANCREATIC CANCER: A PROSPECTIVE STUDY
Full text linkIntroduzione e obiettivi : La PET/TC con 18-fluoro-desossiglucosio - (18)FDG-PET/CT - si è affermata come una promettente tecnica diagnostica in diverse neoplasie. L’utilità della (18)FDG-PET/CT nel carcinoma pancreatico resecabile è dibattuto. Obiettivo di questo studio è di valutare in maniera prospettica il ruolo della (18)FDG-PET/CT in aggiunta all’imaging convenzionale per lo staging di pazienti candidati a resezione pancreatica per carcinoma. Obiettivo secondario è valutare una possibile correlazione tra (18)FDG-PET/CT e ricorrenza di malattia dopo resezione.
Materiali e metodi : (18)FDG-PET/CT è stata effettuata in 72 pazienti con adenocarcinoma pancreatico considerate resecabile all’imaging ad alta risoluzione. La terapia neoadiuvante è stata effettuata nel 14% dei casi. Il maximum standardized uptake value (SUVmax) è stato valutato 60 minuti dopo la somministrazione di FDG. La PET/TC è considerata "positiva" per carcinoma se SUV > 3.
Risultati : 8/72 (11%) pazienti non sono stati sottoposti a intervento chirurgico per l’evidenza di malattia metastatica (n=7) e di un carcinoma polmonare avanzato sincrono (n=1) alla (18)FDG-PET/CT. Il valore mediano di Ca 19.9 è stato di 48.8 U/mL per l’intera coorte e di 292 U/mL per i pazienti metastatici (p=0.112). In altri due pazienti la (18)FDG-PET/CT ha identificato un carcinoma colico e un neurinoma mediastinico. 15/72 (21%) pazienti avevano un SUVmax<3, e il 60% di questi pazienti era stato sottoposto a terapia neoadiuvante (p=0.0001). 3/64 (5%) pazienti non sono stati resecati per malattia avanzata alla laparotomia. Il 77% dei 61 pazienti resecati presentava metastasi linfonodali. Nel 13% dei casi la (18)FDG-PET/CT ha identificato metastasi linfonodali che hanno richiesto una estensione della linfoadenectomia. Sensibilità e specificità della PET/CT per malattia metastatica sono state del 78%e 100%. Il follow-up mediano dei pazienti resecati è stato di 10 mesi e il 55% di essi ha sviluppato una recidiva. Non è stata identificata alcuna correlazione significativa tra SUVmax e sopravvivenza libera da malattia.
Conclusioni : La PET/CT ha determinate un cambiamento nella strategia terapeutica del 25% dei pazienti, migliorando lo staging preoperatorio dei pazienti con carcinoma pancreatico candidati alla resezione chirurgica. Il trattamento neoadiuvante si associa ad una riduzione significativa dei valori di SUV, limitando pertanto il ruolo della PET/CT in questi pazienti.Background and aim : Whole-body (18)fluor-deoxyglucose positron emission tomography/computed tomography (PET/CT) has emerged as a promising diagnostic modality in different tumors. The role and the utility of (18)FDG-PET/CT in resectable pancreatic cancer is debated. Aim of the present work was to assess prospectively the value of (18)FDG-PET/CT in addition to conventional imaging as a staging modality in candidates for resection of resectable pancreatic cancer. Secondary aim is to correlate (18)FDG-PET/CT results with tumor-recurrence after resection.
Material and methods : Whole-body (18)FDG-PET/CT was performed in 72 patients with pancreatic ductal adenocarcinoma who were judged resectable at high-resolution imaging. Neoadjuvant therapy was performed in the 14% of cases. Maximum standardized uptake value (SUVmax) was evaluated 60 minutes after FDG injection. PET/TC was considered "positive" for pancreatic cancer when SUV > 3.
Results : 8/72 (11%) patients were spared unwarranted resection since (18)FDG-PET/CT detected synchronous advanced lung cancer (n=1) or metastatic disease (n=7). Median CA 19.9 was 48.8 U/mL for the entire cohort and 292 U/mL for seven patients with metastases (p=0.112). In other two patients (18)FDG-PET/CT identified one colon carcinoma and a thoracic neurinoma. 15/72 (21%) patients had low metabolic activity (SUVmax<3), and 60% of these patients had undergone neoadjuvant treatment (p=0.0001). At laparotomy 3/64 (5%) patients did not undergo resection because of locally-advanced (n=1) or metastatic disease (n=2). 61 patients underwent pancreatic resections with curative intent. N1 rate was 77%, with a median of 33 resected nodes. In 8/61 (13%) patients (18)FDG-PET/CT identified metastatic lymph nodes that required an extension of lymphadenectomy. Sensitivity and specificity of (18)FDG-PET/CT for the detection of metastatic disease were 78% and 100%, respectively. Median follow-up for resected patients was 10 months and 53% of them developed recurrence. No significant correlation between SUVmax values and disease-free survival was found.
Conclusions : (18)FDG-PET/CT findings resulted in changes of therapeutic management/operative procedures in one third of patients. (18)FDG-PET/CT improves staging of patients with resectable pancreatic cancer. Neoadjuvant treatment is significantly associated with low metabolic activity limiting the value of (18)FDG-PET/CT in this setting
Perioperative and long-term outcomes after left pancreatectomy: a single-institution, non-randomized, comparative study between open and laparoscopic approach
No full textPancreatic cystic tumours: when to resect, when to observe
No full textBackground and Objectives: In recent years there has been an increase in the diagnosis of cystic tumors of the pancreas. In this setting, difficult diagnostic problems and different therapeutic management can be proposed. Material and Methods: A review of the literature and authors experience were undertaken. Results: Cystic tumors of the pancreas include different neoplasms with a different biological behaviour. While most serous cystadenomas (SCAs) can be managed nonoperatively, patients with mucinous cystic neoplasms (MCNs), solid pseudopapillary tumors (SPTs), main-duct intraductal papillary mucinous neoplasms (IPMNs) should undergo surgical resection. Branch-duct IPMNs can be observed with radiological and clinical follow-up when asymptomatic, < 3 cm in size and without radiologic features of malignancy (i.e. nodules). Conclusions: Cystic tumors of the pancreas are common. Differential diagnosis among the different tumor-types is of paramount importance for appropriate management. Nonoperative management seems appropriate for most SCAs and for well-selected branch-duct IPMNs
Intraductal papillary mucinous neoplasms of the biliary and pancreatic ducts-A shape shifting outlook into an increasingly recognized disease.
No full textShape shifting, transformations and metamorphoses are common
and fascinating themes in mythology, literature and folklore
of different times. Among numerous examples of shape shifting, as
physicians it is apt to mention The Strange Case of Dr. Jekyll and Mr.
Hyde, by Robert Louis Stevenson, where the good Dr. Jekyll metamorphoses
into the evil Mr. Hyde. Dr. Jekyll and Mr. Hyde: same
character, two bodies with different morphology and with different
biological behaviours.
Those of us participating in the diagnosis and treatment of biliary
and pancreatic tumours may find a similar scenario when
considering the “strange case” of intraductal papillary mucinous
neoplasms (IPMNs). IPMNs of the pancreas (IPMNs-P) and of the biliary tract (IPMNs-B) were initially described in Japan in the 1980s with the name of “mucin-secreting cancer of the pancreas” and “mucin-hypersecreting intrahepatic biliary neoplasms”, respectively. However, while IPMNs-P are widely recognized since
the late 1990s, the term IPMN-B was used for the first time only in
200
Intraductal papillary mucinous neoplasms (IPMNs): is it time to (sometimes) spare the knife?
No full textASO Author Reflections: Recurrence Following Post-neoadjuvant Pancreatectomy: How Can We Do Better?
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