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Pancreatic surgery

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162 papers 0 to 25 followers
Markus K Diener, Christina Fitzmaurice, Guido Schwarzer, Christoph M Seiler, Felix J Hüttner, Gerd Antes, Hanns-Peter Knaebel, Markus W Büchler
Background Pancreatic cancer is the fourth leading cause of cancer death for men and the fifth for women. The standard treatment for resectable tumours consists of a classic Whipple (CW) operation or a pylorus-preserving pancreaticoduodenectomy (PPW). It is unclear which of these procedures is more favourable in terms of survival, mortality, complications and quality of life.Objectives The objective of this systematic review is to compare the effectiveness of CW and PPW techniques for surgical treatment of cancer of the pancreatic head and the periampullary region...
November 11, 2014: Cochrane Database of Systematic Reviews
Dionissios D Karavias, Dimitrios D Karavias, Ioannis G Chaveles, Stavros K Kakkos, Nicolaos A Katsiakis, Ioannis C Maroulis
BACKGROUND: Postoperative pancreatic fistula (POPF) due to anastomotic leak is often associated with significant morbidity and mortality. The aim of this study was to present an improved anastomotic technique for Whipple operation, which we call "true" duct-to-mucosa anastomosis (DMA)-pancreaticojejunostomy. METHODS: A novel enteric mucosal eversion at the point of the jejunostomy is constructed prior to the anastomosis with the pancreatic duct in order to enhance sealing...
March 2015: Journal of Gastrointestinal Surgery: Official Journal of the Society for Surgery of the Alimentary Tract
Benjamin L Bick, Felicity T Enders, Michael J Levy, Lizhi Zhang, Michael R Henry, Barham K Abu Dayyeh, Suresh T Chari, Jonathan E Clain, Michael B Farnell, Ferga C Gleeson, Michael L Kendrick, Randall K Pearson, Bret T Petersen, Elizabeth Rajan, Santhi Swaroop Vege, Mark Topazian
BACKGROUND AND STUDY AIMS: Pancreas cyst fluid analysis does not provide optimal discrimination between mucinous and nonmucinous cysts. The aim of this study was to assess the performance characteristics of the "string sign" - a test performed at the time of endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA), for the diagnosis of mucinous pancreatic cysts (branch duct intraductal papillary mucinous neoplasms [bIPMN] and mucinous cystic neoplasms). PATIENTS AND METHODS: Patients undergoing EUS-FNA of pancreatic cystic lesions at one referral center between 2003 and 2012 were included...
July 2015: Endoscopy
Gang Pan, Mei Hua Wan, Kun-Lin Xie, Wei Li, Wei-Ming Hu, Xu-Bao Liu, Wen-Fu Tang, Hong Wu
This article aims to elucidate the classification of and optimal treatment for pancreatic pseudocysts. Various approaches, including endoscopic drainage, percutaneous drainage, and open surgery, have been employed for the management of pancreatic pseudocysts. However, no scientific classification of pancreatic pseudocysts has been devised, which could assist in the selection of optimal therapy. We evaluated the treatment modalities used in 893 patients diagnosed with pancreatic pseudocysts according to the revision of the Atlanta classification in our department between 2001 and 2010...
June 2015: Medicine (Baltimore)
Maximilian Weniger, Jan G D'Haese, Martin K Angele, Axel Kleespies, Jens Werner, Werner Hartwig
BACKGROUND: Chylous leakage is a relevant clinical problem after major abdominal surgery leading to an increased length of stay. DATA SOURCES: A systematic search of MEDLINE/PubMed and the Cochrane Library was performed according to the PRISMA statement. The search for the MeSH terms "chylous ascites" and/or "lymphatic fistula" retrieved a total of 2,348 articles, of which 36 full-text articles were reviewed by 2 independent investigators. RESULTS: Chylous ascites is described with an incidence of up to 11%, especially after pancreatic surgery...
January 2016: American Journal of Surgery
Daniel E Abbott, Jeffrey M Sutton, Peter L Jernigan, Alex Chang, Patrick Frye, Shimul A Shah, Daniel P Schauer, Mark H Eckman, Syed A Ahmad, Jeffrey J Sussman
INTRODUCTION: Pasireotide was recently shown to decrease leak rates after pancreatic resection, though the significant cost of the drug may be prohibitive. We conducted a cost-effectiveness analysis to determine whether prophylactic pasireotide possesses a reasonable cost profile by improving outcomes. METHODS: A cost-effectiveness model was constructed to compare pasireotide administration after pancreatic resection versus usual care, populated by probabilities of clinical outcomes from a recent randomized trial and hospital costs (2013 US$) from a university pancreatic disease center...
November 26, 2015: Annals of Surgery
Zhi Ven Fong, Matthew T McMillan, Giovanni Marchegiani, Klaus Sahora, Giuseppe Malleo, Matteo De Pastena, Andrew P Loehrer, Grace C Lee, Cristina R Ferrone, David C Chang, Matthew M Hutter, Jeffrey A Drebin, Claudio Bassi, Keith D Lillemoe, Charles M Vollmer, Carlos Fernández-Del Castillo
IMPORTANCE: Wound infections after pancreaticoduodenectomy (PD) are common. The standard antibiotic prophylaxis given to prevent the infections is often a cephalosporin. However, this decision is rarely guided by microbiology data pertinent to PD, particularly in patients with biliary stents. OBJECTIVE: To analyze the microbiology of post-PD wound infection cultures and the effectiveness of institution-based perioperative antibiotic protocols. DESIGN, SETTING, AND PARTICIPANTS: The pancreatic resection databases of 3 institutions (designated as institutions A, B, or C) were queried on patients undergoing PD from June 1, 2008, to June 1, 2013, and a total of 1623 patients were identified...
May 1, 2016: JAMA Surgery
Luis Sabater, Fabio Ausania, Olaf J Bakker, Jaume Boadas, J Enrique Domínguez-Muñoz, Massimo Falconi, Laureano Fernández-Cruz, Luca Frulloni, Víctor González-Sánchez, José Lariño-Noia, Björn Lindkvist, Félix Lluís, Francisco Morera-Ocón, Elena Martín-Pérez, Carlos Marra-López, Ángel Moya-Herraiz, John P Neoptolemos, Isabel Pascual, Ángeles Pérez-Aisa, Raffaele Pezzilli, José M Ramia, Belinda Sánchez, Xavier Molero, Inmaculada Ruiz-Montesinos, Eva C Vaquero, Enrique de-Madaria
OBJECTIVE: To provide evidence-based recommendations for the management of exocrine pancreatic insufficiency (EPI) after pancreatic surgery. BACKGROUND: EPI is a common complication after pancreatic surgery but there is certain confusion about its frequency, optimal methods of diagnosis, and when and how to treat these patients. METHODS: Eighteen multidisciplinary reviewers performed a systematic review on 10 predefined questions following the GRADE methodology...
December 2016: Annals of Surgery
Zhi Ven Fong, Donna Marie L Alvino, Carlos Fernández-Del Castillo, Winta T Mehtsun, Ilaria Pergolini, Andrew L Warshaw, David C Chang, Keith D Lillemoe, Cristina R Ferrone
BACKGROUND: Recent advances in imaging and the increasing use of neoadjuvant therapy puts the contemporary utility of staging laparoscopy for patients with pancreatic adenocarcinoma (PDAC) into question. This study aimed to develop a prognostic score to optimize prevention of an unnecessary laparotomy and minimize the rate for unnecessary laparoscopy. METHODS: Clinicopathologic data were evaluated for all patients undergoing surgical intervention for PDAC between 2001 and 2015, who were stratified into group 1 (2001-2008) and group 2 (2009-2014)...
October 2017: Annals of Surgical Oncology
John P Neoptolemos, Daniel H Palmer, Paula Ghaneh, Eftychia E Psarelli, Juan W Valle, Christopher M Halloran, Olusola Faluyi, Derek A O'Reilly, David Cunningham, Jonathan Wadsley, Suzanne Darby, Tim Meyer, Roopinder Gillmore, Alan Anthoney, Pehr Lind, Bengt Glimelius, Stephen Falk, Jakob R Izbicki, Gary William Middleton, Sebastian Cummins, Paul J Ross, Harpreet Wasan, Alec McDonald, Tom Crosby, Yuk Ting Ma, Kinnari Patel, David Sherriff, Rubin Soomal, David Borg, Sharmila Sothi, Pascal Hammel, Thilo Hackert, Richard Jackson, Markus W Büchler
BACKGROUND: The ESPAC-3 trial showed that adjuvant gemcitabine is the standard of care based on similar survival to and less toxicity than adjuvant 5-fluorouracil/folinic acid in patients with resected pancreatic cancer. Other clinical trials have shown better survival and tumour response with gemcitabine and capecitabine than with gemcitabine alone in advanced or metastatic pancreatic cancer. We aimed to determine the efficacy and safety of gemcitabine and capecitabine compared with gemcitabine monotherapy for resected pancreatic cancer...
March 11, 2017: Lancet
Giovanni Marchegiani, Mari Mino-Kenudson, Cristina R Ferrone, Vicente Morales-Oyarvide, Andrew L Warshaw, Keith D Lillemoe, Carlos Fernández-Del Castillo
OBJECTIVE: To describe the patterns of recurrence after resection of intraductal papillary mucinous neoplasms (IPMN) of the pancreas. BACKGROUND: IPMNs represent an increasing indication for pancreatic resection, but little is known about the actual incidence and the patterns of recurrence after surgical excision. METHODS: Retrospective review of 412 resected IPMNs from 1990 to 2013 who have had near-complete follow-up. RESULTS: Median age of the cohort was 68 years, 56% had branch duct (BD)-IPMN and 21% had invasive cancers...
December 2015: Annals of Surgery
Matthäus Felsenstein, Michaël Noë, David L Masica, Waki Hosoda, Peter Chianchiano, Catherine G Fischer, Gemma Lionheart, Lodewijk A A Brosens, Antonio Pea, Jun Yu, Georgios Gemenetzis, Vincent P Groot, Martin A Makary, Jin He, Matthew J Weiss, John L Cameron, Christopher L Wolfgang, Ralph H Hruban, Nicholas J Roberts, Rachel Karchin, Michael G Goggins, Laura D Wood
OBJECTIVE: Intraductal papillary mucinous neoplasms (IPMNs) are precursor lesions that can give rise to invasive pancreatic carcinoma. Although approximately 8% of patients with resected pancreatic ductal adenocarcinoma have a co-occurring IPMN, the precise genetic relationship between these two lesions has not been systematically investigated. DESIGN: We analysed all available patients with co-occurring IPMN and invasive intrapancreatic carcinoma over a 10-year period at a single institution...
September 2018: Gut
Gabriele Capurso, Stefania Boccia, Roberto Salvia, Marco Del Chiaro, Luca Frulloni, Paolo Giorgio Arcidiacono, Alessandro Zerbi, Raffaele Manta, Carlo Fabbri, Maurizio Ventrucci, Ilaria Tarantino, Matteo Piciucchi, Antonella Carnuccio, Ugo Boggi, Emanuele Leoncini, Guido Costamagna, Gianfranco Delle Fave, Raffaele Pezzilli, Claudio Bassi, Alberto Larghi
OBJECTIVES: To investigate environmental, personal, and hereditary risk factors associated with the occurrence of intraductal papillary mucinous neoplasms of the pancreas (IPMNs). METHODS: Multicentre case-control study. Risk factors were identified from a questionnaire collecting data on family and medical history, and environmental factors. Cases were prevalent IPMNs seen at the participating units within an 18-month timeframe. Matched controls were enrolled alongside patients seen at outpatient clinics...
June 2013: American Journal of Gastroenterology
Marta Chiaravalli, Michele Reni, Eileen M O'Reilly
Pancreatic ductal adenocarcinoma (PDAC) is a fatal malignancy with an overall 5-year survival of 8% for all stages combined. The majority of patients present with stage IV disease at diagnosis and these patients have an overall 5-year survival of 3%. Currently, the standard of care for metastatic pancreas adenocarcinoma is combination cytotoxic therapy, namely FOLFIRINOX or gemcitabine plus nab-paclitaxel for good performance status patients. Given the challenges and the rising incidence of PDAC expected to become the second leading cause of cancer-related death by 2030, there is a major unmet need to develop more effective therapies...
November 2017: Cancer Treatment Reviews
Mahmoud M Al-Hawary, Isaac R Francis, Suresh T Chari, Elliot K Fishman, David M Hough, David S Lu, Michael Macari, Alec J Megibow, Frank H Miller, Koenraad J Mortele, Nipun B Merchant, Rebecca M Minter, Eric P Tamm, Dushyant V Sahani, Diane M Simeone
Pancreatic ductal adenocarcinoma is an aggressive malignancy with a high mortality rate. Proper determination of the extent of disease on imaging studies at the time of staging is one of the most important steps in optimal patient management. Given the variability in expertise and definition of disease extent among different practitioners as well as frequent lack of complete reporting of pertinent imaging findings at radiologic examinations, adoption of a standardized template for radiology reporting, using universally accepted and agreed on terminology for solid pancreatic neoplasms, is needed...
January 2014: Radiology
Nao Shimada, Shiro Miwa, Takuma Arai, Noriyuki Kitagawa, Shingo Akita, Nobuyoshi Iinuma, Keiko Ishii
INTRODUCTION: Pancreatic mixed adenoneuroendocrine carcinoma (MANEC) is a rare tumor. We report herein a case of pancreatic MANEC with cystic features. PRESENTATION OF CASE: A 67-year-old woman presented with jaundice. A CT scan revealed an 18-mm mass at the pancreatic head that obstructed the common bile duct and another 35-mm cystic lesion containing a mural nodule in the pancreatic body, which was suspected to be an intraductal papillary mucinous carcinoma. A biopsy of the head mass led to the diagnosis of adenocarcinoma...
2018: International Journal of Surgery Case Reports
Saila Kauhanen, Irina Rinta-Kiikka, Jukka Kemppainen, Juha Grönroos, Sami Kajander, Marko Seppänen, Kalle Alanen, Risto Gullichsen, Pirjo Nuutila, Jari Ovaska
UNLABELLED: Accurate diagnosis of the nature of pancreatic cysts is challenging but more important than ever, in part because of the increasing number of incidental cystic findings in the pancreas. Preliminary data suggest that (18)F-FDG PET/CT may have a significant influence on clinical decision making, although its role is still evolving. Our aim was to prospectively compare the accuracy of combined (18)F-FDG PET and contrast-enhanced CT ((18)F-FDG PET/CT), multidetector CT (MDCT), and MR imaging in differentiating malignant from benign pancreatic cysts...
August 2015: Journal of Nuclear Medicine: Official Publication, Society of Nuclear Medicine
Thomas Zikos, Kimberly Pham, Raffick Bowen, Ann M Chen, Subhas Banerjee, Shai Friedland, Monica M Dua, Jeffrey A Norton, George A Poultsides, Brendan C Visser, Walter G Park
OBJECTIVES: Better diagnostic tools are needed to differentiate pancreatic cyst subtypes. A previous metabolomic study showed cyst fluid glucose as a potential marker to differentiate mucinous from non-mucinous pancreatic cysts. This study seeks to validate these earlier findings using a standard laboratory glucose assay, a glucometer, and a glucose reagent strip. METHODS: Using an IRB-approved prospectively collected bio-repository, 65 pancreatic cyst fluid samples (42 mucinous and 23 non-mucinous) with histological correlation were analyzed...
June 2015: American Journal of Gastroenterology
Philipp Horvath, Stefan Beckert, Florian Struller, Alfred Königsrainer, Marc André Reymond
Data on the effectivness of PIPAC in patients with peritoneal metastases of pancreaticobiliary origin is scarce. We here present further proof of treatment efficacy in this subset of patients. Repetitive PIPAC treatment with low-dose cisplatin 7.5 mg/m2 and doxorubicin 1.5 mg/m2 body surface area every 6 weeks and prospective data collection. Documentation included microscopic histological regression, median overall survival and treatment-related adverse events. Twelve patients with a median age of 57 years (range 43-78 years) were included...
October 2018: Clinical & Experimental Metastasis
Vikrom K Dhar, Nipun B Merchant, Sameer H Patel, Michael J Edwards, Koffi Wima, Joseph Imbus, Daniel E Abbott, Sharon M Weber, Raphael Louie, Hong J Kim, Robert C G Martin, Charles R Scoggins, David J Bentrem, Michael T LeCompte, Kamran Idrees, Alexandra G Lopez-Aguiar, Shishir K Maithel, David A Kooby, Daniel A Franco, Danny Yakoub, Syed A Ahmad
OBJECTIVE: The relevance of margin positivity on recurrence after resection of intraductal papillary mucinous neoplasms (IPMNs) is poorly defined and represents one reason controversy remains regarding optimal surveillance recommendations. METHODS: Patients undergoing surgery for noninvasive IPMN at 8 academic medical centers from the Central Pancreas Consortium were analyzed. A positive margin was defined as presence of IPMN or pancreatic intraepithelial neoplasia...
September 2018: Annals of Surgery
2018-08-18 10:43:52
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