2,879 research outputs found
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
OBSERVATIONAL STUDY OF NATURAL HISTORY OF SMALL SPORADIC NONFUNCTIONING PANCREATIC NEUROENDOCRINE TUMORS
No full textIntroduzione: I tumori pancreatici neuroendocrini non funzionanti (NF-PNET) asintomatici ben differenziati sono un’entità sempre più spesso diagnosticata e la loro gestione è controversa vista la loro buona prognosi seppur eterogenea.
Scopo: Scopo dello studio è stato quello di valutare la storia naturale dei NF-PNET sporadici asintomatici con diametro < 2 cm valutando il rapporto rischio-beneficio di una gestione conservativa.
Metodi: Tra Gennaio 2000 e Giugno 2011, 46 pazienti con una diagnosi di NF-PNET < 2 cm sono stati inseriti in un programma di follow-up di almeno 18 mesi con imaging seriale in due centri di riferimento
Risultati: I pazienti sono stati prevalentemente di sesso femminile (65%) con un’età mediana di 60 anni. I tumori erano principalmente localizzati a livello della testa del pancreas (52%) con un diametro mediano di 13 mm (9-15 mm). Dopo un follow-up mediano di 34 mesi (24-52 mesi) e una media di 4 imaging seriali (3-6), non si sono osservate metastasi a distanza o linfonodali. In 6 pazienti (13%) è stato osservato un aumento dimensionale del 20%. La crescita mediana complessiva tumorale è stata di 0.12 mm all’anno e non è stato identificato nessun fattore correlate al paziente o al tumore predittivo di crescita tumorale. Complessivamente, 8 pazienti (17%) sono stati sottoposti a intervento chirurgico dopo un tempo mediano di 41 mesi (27-58 mesi). Tutte le lesioni sottoposte a resezione sono state classificate come stadio I (n=7) o 2 (n=1) di grado 1, con assenza di metastasi linfonodali e invasione vascolare.
Conclusioni: In pazienti selezionati una gestione conservativa di NF-PNET sporadici asintomatici < 2 cm è sicura. Necessitiamo di studi prospettici per validare questa politica di “wait and see”.Introduction: Asymptomatic sporadic non-functioning well-differentiated
pancreatic neuroendocrine tumors (NF-PNET) are increasingly diagnosed, and their
management is controversial because of their overall good but heterogeneous
prognosis.
Objective: To assess the natural history of asymptomatic sporadic NF-PNETs
smaller than 2 cm in size and the risk-benefit balance of non-operative management.
Methods: From January 2000 to June 2011, 46 patients with proven AS-NF-PNET
smaller than 2 cm in size were followed-up for at least 18 months with serial imaging
in tertiary referral centers.
Results: Patients were mainly female (65%), with a median age of 60 years. Tumors
were mainly located in the pancreatic head (52%), with a median lesion size of 13
mm (9 –15). After a median follow-up of 34 months (24 –52) and an average of 4
(3– 6) serial imaging sessions, distant or nodal metastases appeared on the imaging
in none of the patients. In 6 (13%) patients, a 20% increase in size was observed.
Overall median tumor growth was 0.12 mm per year and neither patients nor tumor
characteristics were found to be significant predictors of tumor growth. Overall, 8
patients (17%) underwent surgery after a median time from initial evaluation of 41
months (27–58); all resected lesions were ENETS T stage 1 (n=7) or 2 (n=1), grade
1, node negative, with neither vascular nor peripancreatic fat invasion.
Conclusions: In selected patients, non-operative management of asymptomatic
sporadic NF-PNET smaller than 2 cm in size is safe. Larger and prospective
multicentric studies with long-term follow-up are now needed to validate this “wait
and see” policy
Extent of surgical resections for intraductal papillary mucinous neoplasms
No full textIntraductal papillary mucinous neoplasms (IPMNs) can involve the main pancreatic duct (MD-IPMNs) or its secondary branches (BD-IPMNs) in a segmental of multifocal/diffuse fashion. Growing evidence indicates that BD-IPMNs are less likely to harbour cancer and in selected cases these lesions can be managed non operatively. For surgery, clarification is required on: (1) when to resect an IPMN; (2) which type of resection should be performed; and (3) how much pancreas should be resected. In recent years parenchyma-sparing resections as well as laparoscopic procedures have being performed more frequently by pancreatic surgeons in order to decrease the rate of postoperative pancreatic insufficiency and to minimize the surgical impact of these operations. However, oncological radicality is of paramount importance, and extended resections up to total pancreatectomy may be necessary in the setting of IPMNs. In this article the type and extension of surgical resections in patients with MD-IPMNs and BD-IPMNs are analyzed, evaluating perioperative and long-term outcomes. The role of standard and parenchyma-sparing resections is discussed as well as different strategies in the case of multifocal neoplasms
Rectal indomethacin to prevent post-ERCP pancreatitis.
No full textIn their article on the prevention of pancreatitis after endoscopic retrograde cholangiopancreatography (ERCP), Elmunzer et al. (April 12 issue)1 underemphasized the fact that prophylactic pancreatic stents were placed in more than 80% of the study patients, among whom clinical suspicion of sphincter of Oddi dysfunction was predominant. Pancreatic stents significantly reduce rates of pancreatitis in high-risk patients,2,3 and the average rate reduction is larger than that in the current trial. In addition, the diameter of the stents influences rates of pancreatitis4,5; the diameter of the stents used by Elmunzer et al. was not reported
Parenchyma-sparing resections for pancreatic neoplasms.
No full textIn recent years there has been an increase in the indications for pancreatic resection of benign or low-grade malignant lesions, especially in young patients with long life expectancy. In this setting, patients may benefit from parenchyma-sparing resections in order to decrease the risk of development of exocrine/endocrine insufficiency.A review of the literature and authors experience was undertaken.Parenchyma-sparing resections of the pancreas including enucleation, middle pancreatectomy (MP) and middle-preserving pancreatectomy are described. Short and long-term outcomes after surgery are analyzed with special regard to postoperative morbidity/mortality, and oncological and functional long-term results.Parenchyma-sparing resections are safe and effective procedures for treatment of benign and low-grade malignant neoplasms. Despite a significant postoperative morbidity they are associated with good long-term functional and oncological results. Enucleation should preferentially be performed laparoscopically whenever possible
Implications of the new histological classification (WHO 2010) for pancreatic neuroendocrine neoplasms.
No full textPancreatic neuroendocrine tumors (PanNETs) are rare
neoplasms with a more favorable prognosis than pancreatic
adenocarcinoma. However, up to 60% of patients with
PanNETs present with advanced disease or will recur after
surgical resection, requiring multimodal therapy to improve
clinical outcomes. In 2011, two phase 3, randomized, placebo-controlled trials provided optimism regarding the treatment of malignant PanNETs. The tyrosine kinase inhibitor sunitinib and
the mTOR inhibitor everolimus were effective in improving
progression-free survival in advanced PanNETs. These
two trials involved patients with well-differentiated or
intermediate/low-grade PanNETs as defined by previous
histological classifications including the World Health
Organization (WHO) 2000 system. Patients with poorly
differentiated endocrine carcinomas (PDECs) were excluded
from these trials, as PDECs are highly malignant tumors
commonly treated with cisplatin and etoposide
Indications to total pancreatectomy for positive neck margin after partial pancreatectomy: a review of a slippery ground
No full textThe extension of a partial pancreatectomy up to total pancreatectomy because of positive neck margin examined at intraoperative frozen section (IFS) analysis is an accepted procedure in modern pancreatic surgery with good accuracy. The goal of this practice is to improve the rate of radical (R0) resection in malignant tumors, mainly pancreatic ductal adenocarcinoma (PDAC), and to completely resect pre-invasive neoplasms such as intraductal papillary mucinous neoplasms (IPMNs). In the setting of IPMNs there is a consensus for pancreatic re-resection when high-grade dysplasia and invasive cancer are present at the neck margin. The presence of denudation is another indication for further resection in IPMNs. The role of IFS analysis in the management of pancreatic cancer is more debated. The presence of a positive intraoperative transection margin can be considered the surrogate of a biologically aggressive disease associated with a poorer prognosis. There are conflicting data regarding possible advantages of pancreatic re-resection up to total pancreatectomy, and the lack of randomized trials comparing different strategies does not offer a definitive answer. The goal of this review is to provide an up-to-date overview of the role IFS analysis of pancreatic margin and of pancreatic re-resection up to total pancreatectomy considering different pancreatic tumors
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