Pancreatic cystic neoplasms have been increasingly recognized recently. Comprising about 16% of all resected pancreatic cystic neoplasms, serous cystic neoplasms are uncommon benign lesions that are usually asymptomat...Pancreatic cystic neoplasms have been increasingly recognized recently. Comprising about 16% of all resected pancreatic cystic neoplasms, serous cystic neoplasms are uncommon benign lesions that are usually asymptomatic and found incidentally. Despite overall low risk of malignancy, these pancreatic cysts still generate anxiety, leading to intensive medical investigations with considerable financial cost to health care systems. This review discusses the general background of serous cystic neoplasms, including epidemiology and clinical characteristics, and provides an updated overview of diagnostic approaches based on clinical features, relevant imaging studies and new findings that are being discovered pertaining to diagnostic evaluation. We also concisely discuss and propose management strategies for better quality of life.展开更多
BACKGROUND Pancreatic fistula is one of the most serious complications after pancreatoduodenectomy for treating any lesions at the pancreatic head. For years, surgeons have tried various methods to reduce its incidenc...BACKGROUND Pancreatic fistula is one of the most serious complications after pancreatoduodenectomy for treating any lesions at the pancreatic head. For years, surgeons have tried various methods to reduce its incidence. AIM To investigate and emphasize the clinical outcomes of Blumgart anastomosis compared with traditional anastomosis in reducing postoperative pancreatic fistula. METHODS In this observational study, a retrospective analysis of 291 patients who underwent pancreatoduodenectomy, including Blumgart anastomosis (201 patients) and traditional embedded pancreaticojejunostomy (90 patients), was performed in our hospital. The preoperative and perioperative courses and longterm follow-up status were analyzed to compare the advantages and disadvantages of the two methods. Moreover, 291 patients were then separated by the severity of postoperative pancreatic fistula, and two methods of pancreaticojejunostomy were compared to detect the features of different anastomosis. Six experienced surgeons were involved and all of them were proficient in both surgical techniques.RESULTS The characteristics of the patients in the two groups showed no significant differences, nor the preoperative information and pathological diagnoses. The operative time was significantly shorter in the Blumgart group (343.5 ± 23.0 vs 450.0 ± 40.1 min, P = 0.028), as well as the duration of pancreaticojejunostomy drainage tube placement and postoperative hospital stay (12.7 ± 0.9 d vs 17.4 ± 1.8 d, P = 0.031;and 21.9 ± 1.3 d vs 28.9 ± 1.3 d, P = 0.020, respectively). The overall complications after surgery were much less in the Blumgart group than in the embedded group (11.9% vs 26.7%, P = 0.002). Patients who underwent Blumgart anastomosis would suffer less from severe pancreatic fistula (71.9% vs 50.0%, P = 0.006), and this pancreaticojejunostomy procedure did not have worse influences on long-term complications and life quality. Thus, Blumgart anastomosis is a feasible pancreaticojejunostomy procedure in pancreatoduodenectomy surgery. It is safe in causing less postoperative complications, especially pancreatic fistula, and thus shortens the hospitalization duration. CONCLUSION Surgical method should be a key factor in reducing pancreatic fistula, and Blumgart anastomosis needs further promotion.展开更多
BACKGROUND Pancreatic cancer with ovarian metastases is rare and easily misdiagnosed.Most patients are first diagnosed with ovarian cancer.We report a rare case of ovarian metastases secondary to pancreatic adenocarci...BACKGROUND Pancreatic cancer with ovarian metastases is rare and easily misdiagnosed.Most patients are first diagnosed with ovarian cancer.We report a rare case of ovarian metastases secondary to pancreatic adenocarcinoma.We also review the literature to analyze the clinical characteristics of,diagnostic methods for,and perioperative management strategies for this rare malignancy.CASE SUMMARY A 48-year-old woman with an abdominal mass presented to our hospital.Computed tomography revealed lesions in the pancreas and lower abdomen.Radiological examination and histological investigation of biopsy specimens revealed either an ovarian metastasis from a pancreatic neoplasm or two primary tumors,with metastasis strongly suspected.The patient simultaneously underwent distal pancreatectomy plus splenectomy by a general surgeon and salpingo-oophorectomy with hysterectomy by a gynecologist.Histological examination of the surgical specimen revealed a pancreatic adenocarcinoma(intermediate differentiation,mucinous)and a metastatic mucinous adenocarcinoma in the ovary.CONCLUSION For this rare tumor,surgical resection is the most effective treatment,and the final diagnosis depends on tumor pathology.展开更多
AIM To investigate the efficacy and safety of isolated hepatic perfusion(IHP) in the management of unresectable liver malignancies.METHODS Studies were identified manually and on-line by using Pub Med and EMBASE datab...AIM To investigate the efficacy and safety of isolated hepatic perfusion(IHP) in the management of unresectable liver malignancies.METHODS Studies were identified manually and on-line by using Pub Med and EMBASE database.We formulate the eligibility criteria according to the PICOS elements,and accessed the quality of studies using the MINORS instrument.Data from all included studies were carefully investigated.We calculated the pooled response rate and incidences of mortality reported from all eligible studies by using the Meta-Analyst software,and we computed a pooled relative risk(RR) and 95%CI by using the Comprehensive Meta-Analysis software.Heterogeneity was quantified evaluated using I^2 statistic.RESULTS Eight studies,including 502 patients,were selected.Of these,six studies performed IHP,while the other two studies performed percutaneous IHP.The results showed that the pooled response rate was 60.8%(95%CI:53.1%-68%),I^2 = 37.1%.The median overall survival was 20 mo(range:12.1 to 25 mo) following IHP or PIHP.The pooled mortality rate was 5.4%(95%CI:2.5%-11.2%),I^2 = 37.5%.Prognostic factors predict the response to IHP or survival,and were reported in six studies.Meta-analysis demonstrated that Gender was not associated with overall survival(RR = 0.877,95%CI:0.564-1.365);however,carcino-embryonic antigen ≤ 30 ng/mL was associated with a significant improvement in survival outcomes with colorectal cancer patients(RR = 2.082,95%CI:1.371-3.163),and there was no significant heterogeneity.CONCLUSION The present systemic review and meta-analysis suggest that IHP and PIHP are potentially efficient and safe techniques for unresectable liver primary and secondary malignancies.展开更多
文摘Pancreatic cystic neoplasms have been increasingly recognized recently. Comprising about 16% of all resected pancreatic cystic neoplasms, serous cystic neoplasms are uncommon benign lesions that are usually asymptomatic and found incidentally. Despite overall low risk of malignancy, these pancreatic cysts still generate anxiety, leading to intensive medical investigations with considerable financial cost to health care systems. This review discusses the general background of serous cystic neoplasms, including epidemiology and clinical characteristics, and provides an updated overview of diagnostic approaches based on clinical features, relevant imaging studies and new findings that are being discovered pertaining to diagnostic evaluation. We also concisely discuss and propose management strategies for better quality of life.
文摘BACKGROUND Pancreatic fistula is one of the most serious complications after pancreatoduodenectomy for treating any lesions at the pancreatic head. For years, surgeons have tried various methods to reduce its incidence. AIM To investigate and emphasize the clinical outcomes of Blumgart anastomosis compared with traditional anastomosis in reducing postoperative pancreatic fistula. METHODS In this observational study, a retrospective analysis of 291 patients who underwent pancreatoduodenectomy, including Blumgart anastomosis (201 patients) and traditional embedded pancreaticojejunostomy (90 patients), was performed in our hospital. The preoperative and perioperative courses and longterm follow-up status were analyzed to compare the advantages and disadvantages of the two methods. Moreover, 291 patients were then separated by the severity of postoperative pancreatic fistula, and two methods of pancreaticojejunostomy were compared to detect the features of different anastomosis. Six experienced surgeons were involved and all of them were proficient in both surgical techniques.RESULTS The characteristics of the patients in the two groups showed no significant differences, nor the preoperative information and pathological diagnoses. The operative time was significantly shorter in the Blumgart group (343.5 ± 23.0 vs 450.0 ± 40.1 min, P = 0.028), as well as the duration of pancreaticojejunostomy drainage tube placement and postoperative hospital stay (12.7 ± 0.9 d vs 17.4 ± 1.8 d, P = 0.031;and 21.9 ± 1.3 d vs 28.9 ± 1.3 d, P = 0.020, respectively). The overall complications after surgery were much less in the Blumgart group than in the embedded group (11.9% vs 26.7%, P = 0.002). Patients who underwent Blumgart anastomosis would suffer less from severe pancreatic fistula (71.9% vs 50.0%, P = 0.006), and this pancreaticojejunostomy procedure did not have worse influences on long-term complications and life quality. Thus, Blumgart anastomosis is a feasible pancreaticojejunostomy procedure in pancreatoduodenectomy surgery. It is safe in causing less postoperative complications, especially pancreatic fistula, and thus shortens the hospitalization duration. CONCLUSION Surgical method should be a key factor in reducing pancreatic fistula, and Blumgart anastomosis needs further promotion.
基金Supported by CAMS Innovation Fund for Medical Sciences,No.2016-I2M-3-005Beijing Municipal Science&Technology Commission,No.Z171100001017017018.
文摘BACKGROUND Pancreatic cancer with ovarian metastases is rare and easily misdiagnosed.Most patients are first diagnosed with ovarian cancer.We report a rare case of ovarian metastases secondary to pancreatic adenocarcinoma.We also review the literature to analyze the clinical characteristics of,diagnostic methods for,and perioperative management strategies for this rare malignancy.CASE SUMMARY A 48-year-old woman with an abdominal mass presented to our hospital.Computed tomography revealed lesions in the pancreas and lower abdomen.Radiological examination and histological investigation of biopsy specimens revealed either an ovarian metastasis from a pancreatic neoplasm or two primary tumors,with metastasis strongly suspected.The patient simultaneously underwent distal pancreatectomy plus splenectomy by a general surgeon and salpingo-oophorectomy with hysterectomy by a gynecologist.Histological examination of the surgical specimen revealed a pancreatic adenocarcinoma(intermediate differentiation,mucinous)and a metastatic mucinous adenocarcinoma in the ovary.CONCLUSION For this rare tumor,surgical resection is the most effective treatment,and the final diagnosis depends on tumor pathology.
文摘AIM To investigate the efficacy and safety of isolated hepatic perfusion(IHP) in the management of unresectable liver malignancies.METHODS Studies were identified manually and on-line by using Pub Med and EMBASE database.We formulate the eligibility criteria according to the PICOS elements,and accessed the quality of studies using the MINORS instrument.Data from all included studies were carefully investigated.We calculated the pooled response rate and incidences of mortality reported from all eligible studies by using the Meta-Analyst software,and we computed a pooled relative risk(RR) and 95%CI by using the Comprehensive Meta-Analysis software.Heterogeneity was quantified evaluated using I^2 statistic.RESULTS Eight studies,including 502 patients,were selected.Of these,six studies performed IHP,while the other two studies performed percutaneous IHP.The results showed that the pooled response rate was 60.8%(95%CI:53.1%-68%),I^2 = 37.1%.The median overall survival was 20 mo(range:12.1 to 25 mo) following IHP or PIHP.The pooled mortality rate was 5.4%(95%CI:2.5%-11.2%),I^2 = 37.5%.Prognostic factors predict the response to IHP or survival,and were reported in six studies.Meta-analysis demonstrated that Gender was not associated with overall survival(RR = 0.877,95%CI:0.564-1.365);however,carcino-embryonic antigen ≤ 30 ng/mL was associated with a significant improvement in survival outcomes with colorectal cancer patients(RR = 2.082,95%CI:1.371-3.163),and there was no significant heterogeneity.CONCLUSION The present systemic review and meta-analysis suggest that IHP and PIHP are potentially efficient and safe techniques for unresectable liver primary and secondary malignancies.
