1,720,985 research outputs found
Laparoscopic subtotal pancreatectomy: the right edge of the distal resection
No full textCase
We report a case of an obese (BMI 30.) 48 year-old male patient who presented with recurrent upper abdominal pain. He was found to have a symptomatic cystic mass in the neck of the pancreas.. US demonstrated a 5 cm hypoechoic cystic mass of the pancreatic isthmus. Serum CA 19-9 was slightly elevated. CT and MRI findings were consistent with a mucinous cystoadenoma/cystoadenocarcinoma. EUS-FNAB diagnostic of a cystic lesion with no evidence of malignant cells. A 6-month follow up MRI scan demonstrated the lesion had increased in size, strengthening the suspicion for mucinous cystoadenocarcinoma. The patient underwent a laparoscopic subtotal pancreatectomy and splenectomy. The pancreatic transection was extended to the left side of the gastroduodenal artery. The surgical procedure was technically demanding due to the patient’s visceral obesity and the anatomical location of the lesion. The postoperative course was complicated by a grade B pancreatic leak, managed conservatively. The pathology report demonstrated a pancreatic lympho-epithelial cyst which was resected with a clear surgical margin.
Conclusions
Laparoscopic distal pancreatectomy and splenectomy for a pancreatic neck lesion can be extended to the left side of the gastroduodenal artery in order to obtain a clear resection margin. Even if obesity increased the techinical difficulty, it should not be considered a contraindication to laparoscopic approach
Another Dimension in Magnetic Resonance Cholangiopancreatography: Comparison of 2-and 3-Dimensional Magnetic Resonance Cholangiopancreatography for the Evaluation of Intraductal Papillary Mucinous Neoplasm of the Pancreas
No full textPurpose: The purpose of this study was to compare 2-dimensional (2D) and 3D magnetic resonance cholangiopancreatography (MRCP) for image quality and diagnostic performance in the evaluation of pathologically verified intraductal papillary mucinous neoplasm (IPMN) of the pancreas. Materials and Methods: In this institutional review board-approved retrospective review, 21 patients (14 women and 7 men; mean age, 69 years; range, 43-93 years) who underwent 2D and 3D MRCPs oil a 1.5-T system for pathologically confirmed IPMN were studied. Two-dimensional MRCP protocol included multiplanar thin- and thick-slab single-shot fast spin-echo imaging, coronal single-shot fast spin-echo, and transverse T2-weighted fast spin-echo imaging. Three-dimensional MRCP was performed using a fast-recovery fast spin-echo sequence with single-volume acquisition and maximum intensity projection reconstructions. Using a 5-point scale, 2 readers independently evaluated MRCPs for (1) image quality, (2) visualization of the pancreatic duct (PD), and (3) Visualization of the cystic lesions. Intraductal papillary mucinous neoplasm's morphological features (septa, mural nodules, and duct communication) were also graded similarly to predict benignity or malignancy. Surgical and pathological data served as reference standard. A pancreatic surgeon reviewed the 21 MRCPs to determine the usefulness of 3D MRCP compared with that of 2D MRCP for Surgical planning. Results: Of the 21 IPMNs, 11 were side-branch IPMNs and 10 were main-duct-lesions IPMNs with side-branch involvement. A statistically significant improvement in image quality and Visualization of the PD and cystic lesion was demonstrated with 3D MRCP in comparison with that demonstrated with 2D MRCP (P <= 0.002). The morphological details of IPMN were also identified, with higher confidence with 3D MRCP in comparison with that using 2D MRCP Two-dimensional and 3D MRCPs performed similarly for predicting benign and malignant lesions, with sensitivity ranging from 50.0% to 66.7% and specificity ranging from 86.7% to 93.3%. The pancreatic surgeon preferred 3D to 2D MRCP for surgical evaluation and planning in 14 of 21 cases. Conclusion: Compared with 2D MRCP, 3D MRCP provides better image quality, offers superior evaluation of the PD and morphological details of IPMN, and is preferred for surgical planning
Vascular and biliary variants in the liver: Implications for liver surgery
No full textAccurate preoperative assessment of the hepatic vascular and biliary anatomy is essential to ensure safe and successful hepatic surgery. Such surgical procedures range from the more complex, like tumor resection and partial hepatectomy for living donor liver transplantation, to others performed more routinely, like laparoscopic cholecystectomy. Modern noninvasive diagnostic imaging techniques, such as multidetector computed tomography (CT) and magnetic resonance (MR) imaging performed with liver-specific contrast agents with biliary excretion, have replaced conventional angiography and endoscopic cholangiography for evaluation of the hepatic vascular and biliary anatomy. These techniques help determine the best hepatectomy plane and help identify patients in whom additional surgical steps will be required. Preoperative knowledge of hepatic vascular and biliary anatomic variants is mandatory for surgical planning and to help reduce postoperative complications. Multidetector CT and MR imaging, with the added value of allow accurate identification of areas at risk for image postprocessing, venous congestion or devascularization. This information may influence surgical planning with regard to the extent of hepatic resection or the need for vascular reconstruction. (c) RSNA, 2008
Oncocytic-Type Intraductal Papillary Mucinous Neoplasms: A Unique Malignant Pancreatic Tumor with Good Long-Term Prognosis
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Major Complications Independently Increase Long-Term Mortality After Pancreatoduodenectomy for Cancer
No full textBackground: Postoperative major morbidity has been associated with worse survival gastrointestinal tumors. This association remains controversial in pancreatic cancer (PC). We analyzed whether major complications after surgical resection affect long-term survival. Methods: Records of all PC patients resected from 2007 to 2015 were reviewed. Major morbidity was defined as any grade-3 or higher 30-day complications, per the Clavien-Dindo Classification. Patients who died within 90 days after surgery were excluded from survival analysis. Results: Of 616 patients, 81.7% underwent pancreatoduodenectomy (PD) and 18.3% distal pancreatectomy (DP). Major complications occurred in 19.1% after PD and 15.9% after DP. In patients who survived > 90 days, the likelihood of receiving adjuvant treatment was 43.9% if major complications had occurred, vs. 68.5% if not (p < 0.001), and those who received it started the treatment median 10 days later compared with uncomplicated patients (median 60 days (50–72) vs. 50 days (41–61), p = 0.001). By univariate analysis, in addition to the conventional pathology-related prognostic determinants and the receipt of adjuvant treatment, major complications worsened long-term survival after PD (median OS 26 months vs. 15, p = 0.008). A difference was also seen after DP, but it did not reach statistical significance, likely related to the small sample size (median OS 33 months vs. 18, p = 0.189). At multivariate analysis for PD, major postoperative complications remained independently associated with worse survival [HR 1.37, 95%CI (1.01–1.86)]. Conclusions: Major surgical complications after pancreaticoduodenectomy are associated with worse long-term survival in pancreatic cancer. This effect is independent of the receipt of adjuvant treatment. © 2018, The Society for Surgery of the Alimentary Tract
LYMPHOEPITHELIAL CYSTS OF THE PANCREAS: REPORT OF A SINGLE INSTITUTION EXPERIENCE OF 8 CASES
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Going Beyond Counting First Authors in Author Co-citation Analysis
Full text linkThe present study examines one of the fundamental aspects of author co-citation analysis (ACA) - the way co-citation
counts are defined. Co-citation counting provides the data on which all subsequent statistical analyses and mappings
are based, and we compare ACA results based on two different types of co-citation counting - the traditional type that
only counts the first one among a cited work's authors on the one hand and a non-traditional type that takes into
account the first 5 authors of a cited work on the other hand. Results indicate that the picture produced through this non-traditional author co-citation counting contains more coherent author groups and is therefore considerably clearer. However, this picture represents fewer specialties in the research field being studied than that produced through the traditional first-author co-citation counting when the same number of top-ranked authors is selected and analyzed. Reasons for these effects are discussed
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