BACKGROUND Pancreatic ductal adenocarcinoma(PDA)is a malignancy with a high mortality rate and short survival time.The conventional computed tomography(CT)has been worldwide used as a modality for diagnosis of PDA,as ...BACKGROUND Pancreatic ductal adenocarcinoma(PDA)is a malignancy with a high mortality rate and short survival time.The conventional computed tomography(CT)has been worldwide used as a modality for diagnosis of PDA,as CT enhancement pattern has been thought to be related to tumor angiogenesis and pathologic grade of PDA.AIM To evaluate the relationship between the pathologic grade of pancreatic ductal adenocarcinoma and the enhancement parameters of contrast-enhanced CT.METHODS In this retrospective study,42 patients(Age,mean±SD:62.43±11.42 years)with PDA who underwent surgery after preoperative CT were selected.Two radiologists evaluated the CT images and calculated the value of attenuation at the aorta in the arterial phase and the pancreatic phase(VAarterial and VApancreatic)and of the tumor(VTarterial and VTpancreatic)by finding out four regions of interest.Ratio between the tumor and the aorta enhancement on the arterial phase and the pancreatic phase(TARarterial and TARpancreatic)was figured out through dividing VT arterial by VAarterial and VTpancreatic by VApancreatic.Tumor-to-aortic enhancement fraction(TAF)was expressed as the ratio of the difference between attenuation of the tumor on arterial and parenchymal images to that between attenuation of the aorta on arterial and pancreatic images.The Kruskal-Wallis analysis of variance and Mann-Whitney U test for statistical analysis were used.RESULTS Forty-two PDAs(23 men and 19 women)were divided into three groups:Welldifferentiated(n=13),moderately differentiated(n=21),and poorly differentiated(n=8).TAF differed significantly between the three groups(P=0.034)but TARarterial(P=0.164)and TARpancreatic(P=0.339)did not.The median value of TAF for poorly differentiated PDAs(0.1011;95%CI:0.01100-0.1796)was significantly higher than that for well-differentiated PDAs(0.1941;95%CI:0.1463-0.3194).CONCLUSION Calculation of TAF might be useful in predicting the pathologic grade of PDA.展开更多
BACKGROUND Sarcomatoid carcinoma of the pancreas(SCP)is a rare type of pancreatic neoplasm,and only a few cases have been described in the literature.Histologically,it is composed mostly of atypical spindle cells with...BACKGROUND Sarcomatoid carcinoma of the pancreas(SCP)is a rare type of pancreatic neoplasm,and only a few cases have been described in the literature.Histologically,it is composed mostly of atypical spindle cells with apparent sarcomatous features.CASE SUMMARY This is a report of a 61-year-old Chilean woman who underwent medical investigation for acute abdominal pain.Computed tomography identified a solid tumor in the tail of the pancreas with features suspicious of malignancy.En-bloc distal pancreatectomy and splenectomy were performed to excise the tumor.Histopathology and immunohistochemistry were confirmatory of sarcomatoid carcinoma with lymphovascular invasion.After surgery,the patient did not receive chemotherapy.Previous studies indicate a poor prognosis for this type of malignancy.However,our patient has survived for 35 mo with no recurrence to date.CONCLUSION The case presented herein is a patient with an SCP with a rare presentation and long-term survival after surgery despite not receiving adjuvant chemotherapy.展开更多
Surgery plays a central role in the treatment of benign and malignant pancreatic diseases.Artificial intelligence(AI)is an important upcoming technology to support surgeons in pre-,intra-,and postoperative diagnosis,d...Surgery plays a central role in the treatment of benign and malignant pancreatic diseases.Artificial intelligence(AI)is an important upcoming technology to support surgeons in pre-,intra-,and postoperative diagnosis,decision-making and training toward an optimized patient care.Current AI applications show a promising role in the evaluation of preoperative images for prediction of malignancy and resectability,intraoperative decision support,surgical training as well as a postoperative risk stratification to per-sonalize the management of complications.This scoping review summarizes the most up to date developments of AI in pancreatic surgery with the highest available level of evidence.展开更多
文摘BACKGROUND Pancreatic ductal adenocarcinoma(PDA)is a malignancy with a high mortality rate and short survival time.The conventional computed tomography(CT)has been worldwide used as a modality for diagnosis of PDA,as CT enhancement pattern has been thought to be related to tumor angiogenesis and pathologic grade of PDA.AIM To evaluate the relationship between the pathologic grade of pancreatic ductal adenocarcinoma and the enhancement parameters of contrast-enhanced CT.METHODS In this retrospective study,42 patients(Age,mean±SD:62.43±11.42 years)with PDA who underwent surgery after preoperative CT were selected.Two radiologists evaluated the CT images and calculated the value of attenuation at the aorta in the arterial phase and the pancreatic phase(VAarterial and VApancreatic)and of the tumor(VTarterial and VTpancreatic)by finding out four regions of interest.Ratio between the tumor and the aorta enhancement on the arterial phase and the pancreatic phase(TARarterial and TARpancreatic)was figured out through dividing VT arterial by VAarterial and VTpancreatic by VApancreatic.Tumor-to-aortic enhancement fraction(TAF)was expressed as the ratio of the difference between attenuation of the tumor on arterial and parenchymal images to that between attenuation of the aorta on arterial and pancreatic images.The Kruskal-Wallis analysis of variance and Mann-Whitney U test for statistical analysis were used.RESULTS Forty-two PDAs(23 men and 19 women)were divided into three groups:Welldifferentiated(n=13),moderately differentiated(n=21),and poorly differentiated(n=8).TAF differed significantly between the three groups(P=0.034)but TARarterial(P=0.164)and TARpancreatic(P=0.339)did not.The median value of TAF for poorly differentiated PDAs(0.1011;95%CI:0.01100-0.1796)was significantly higher than that for well-differentiated PDAs(0.1941;95%CI:0.1463-0.3194).CONCLUSION Calculation of TAF might be useful in predicting the pathologic grade of PDA.
文摘BACKGROUND Sarcomatoid carcinoma of the pancreas(SCP)is a rare type of pancreatic neoplasm,and only a few cases have been described in the literature.Histologically,it is composed mostly of atypical spindle cells with apparent sarcomatous features.CASE SUMMARY This is a report of a 61-year-old Chilean woman who underwent medical investigation for acute abdominal pain.Computed tomography identified a solid tumor in the tail of the pancreas with features suspicious of malignancy.En-bloc distal pancreatectomy and splenectomy were performed to excise the tumor.Histopathology and immunohistochemistry were confirmatory of sarcomatoid carcinoma with lymphovascular invasion.After surgery,the patient did not receive chemotherapy.Previous studies indicate a poor prognosis for this type of malignancy.However,our patient has survived for 35 mo with no recurrence to date.CONCLUSION The case presented herein is a patient with an SCP with a rare presentation and long-term survival after surgery despite not receiving adjuvant chemotherapy.
文摘Surgery plays a central role in the treatment of benign and malignant pancreatic diseases.Artificial intelligence(AI)is an important upcoming technology to support surgeons in pre-,intra-,and postoperative diagnosis,decision-making and training toward an optimized patient care.Current AI applications show a promising role in the evaluation of preoperative images for prediction of malignancy and resectability,intraoperative decision support,surgical training as well as a postoperative risk stratification to per-sonalize the management of complications.This scoping review summarizes the most up to date developments of AI in pancreatic surgery with the highest available level of evidence.
