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Prete AM, Gonda TA. Endoscopic Ultrasound-Guided Local Ablative Therapies for the Treatment of Pancreatic Neuroendocrine Tumors and Cystic Lesions: A Review of the Current Literature. J Clin Med 2023; 12:jcm12093325. [PMID: 37176764 PMCID: PMC10179349 DOI: 10.3390/jcm12093325] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2023] [Revised: 05/02/2023] [Accepted: 05/05/2023] [Indexed: 05/15/2023] Open
Abstract
Since its emergence as a diagnostic modality in the 1980s, endoscopic ultrasound (EUS) has provided the clinician profound access to gastrointestinal organs to aid in the direct visualization, sampling, and subsequent identification of pancreatic pathology. In recent years, advancements in EUS as an interventional technique have promoted the use of local ablative therapies as a minimally invasive alternative to the surgical management of pancreatic neuroendocrine tumors (pNETs) and pancreatic cystic neoplasms (PCNs), especially for those deemed to be poor operative candidates. EUS-guided local therapies have demonstrated promising efficacy in addressing a spectrum of pancreatic neoplasms, while also balancing local adverse effects on healthy parenchyma. This article serves as a review of the current literature detailing the mechanisms, outcomes, complications, and limitations of EUS-guided local ablative therapies such as chemical ablation and radiofrequency ablation (RFA) for the treatment of pNETs and PCNs, as well as a discussion of future applications of EUS-guided techniques to address a broader scope of pancreatic pathology.
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Affiliation(s)
- Alexander M Prete
- Department of Medicine, New York University (NYU) Grossman School of Medicine, New York, NY 10016, USA
| | - Tamas A Gonda
- Division of Gastroenterology and Hepatology, New York University (NYU) Langone Health, New York, NY 10016, USA
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Ugonabo O, Mohamed T, Kheetan M, Sherif A. Failure to Thrive in a Middle-Aged Female: A Case of Congenital Incomplete Pancreas From a Rare Genetic Defect. J Investig Med High Impact Case Rep 2023; 11:23247096231165742. [PMID: 37052076 PMCID: PMC10102923 DOI: 10.1177/23247096231165742] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/14/2023] Open
Abstract
Hepatocyte nuclear factor-1 beta (HNF1B) gene is predominantly expressed in the liver, kidney, lung, genitourinary tract, and pancreas. It is an important transcription factor that regulates pancreas development. Mutation or absence of this gene is rare and can cause incomplete pancreatic development known as the agenesis of the dorsal pancreas. This rare genetic abnormality is associated with other disorders like maturity-onset diabetes of the young, abnormal liver function tests, genitourinary tract malformation, pancreatitis, and renal cysts. Diagnosing this genetic abnormality is difficult, especially in patients presenting with symptoms specific to only one system. Management is based on disease manifestation and involves a multidisciplinary approach. Our case describes a 51-year-old female with poorly controlled diabetes mellitus and Mullerian duct anomalies who presented with abdominal pain, fatigue, dizziness, and electrolyte derangement. Contrast-enhanced computed tomography (CECT) of the abdomen showed a multicystic kidney and a pancreatic head with a missing body and tail. Further workup revealed an HNF1B mutation.
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Agenesis of Dorsal Pancreas With Chronic Calcific Pancreatitis: The Head Without a Body. Pancreas 2022; 51:e80-e82. [PMID: 35973021 DOI: 10.1097/mpa.0000000000002045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]
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Zhou L, Wang J, Zhang XX, Lyu SC, Pan LC, Du GS, Lang R, He Q. Prognostic Value of Preoperative NLR and Vascular Reconstructive Technology in Patients With Pancreatic Cancer of Portal System Invasion: A Real World Study. Front Oncol 2021; 11:682928. [PMID: 34604028 PMCID: PMC8484969 DOI: 10.3389/fonc.2021.682928] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2021] [Accepted: 08/30/2021] [Indexed: 01/05/2023] Open
Abstract
The purpose was aimed to establish a simple computational model to predict tumor prognosis by combining neutrophil to lymphocyte Ratio (NLR) and biomarkers of oncological characteristics in patients undergoing vascular reconstructive radical resection of PDAC. The enrolled patients was divided into high or low NLR group with the cutoff value determined by the receiver operator characteristic (ROC) curve. Different vascular anastomoses were selected according to the Chaoyang classification of PDAC. Survival rates were calculated using the Kaplan-Meier and evaluated with the log-rank test. Cox risk regression model was used to analyze the independent risk factors for prognostic survival. The optimal cut-off value of NRL was correlated with the differentiation, tumor size, TNM stage and distant metastasis of advanced PDAC. A curative resection with vascular reconstructive of advanced PDAC according to Chaoyang classification can obviously improve the survival benefits. Cox proportional hazards demonstrated higher evaluated NLR, incisal margin R1 and lymphatic metastasis were the independent risk predictor for prognosis with the HR > 2, meanwhile, age beyond 55, TNM stage of III-IV or Tumor size > 4cm were also the obvious independent risk predictor for prognosis with the HR ≤ 2. The advanced PADC patients marked of RS group (3 < RS ≤ 6) showed no more than 24 months of survival time according to RS model based on the six independent risk predictors. Vascular reconstruction in radical resection of advanced PDAC improved survival, higher elevated NLR (>2.90) was a negative predictor of DFS and OS in those patients accompanying portal system invasion.
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Affiliation(s)
- Lin Zhou
- Department of Hepatobiliary and Pancreaticosplenic Surgery, Beijing ChaoYang Hospital, Capital Medical University, Beijing, China
| | - Jing Wang
- Department of Hepatobiliary and Pancreaticosplenic Surgery, Beijing ChaoYang Hospital, Capital Medical University, Beijing, China
| | - Xin-xue Zhang
- Department of Hepatobiliary and Pancreaticosplenic Surgery, Beijing ChaoYang Hospital, Capital Medical University, Beijing, China
| | - Shao-cheng Lyu
- Department of Hepatobiliary and Pancreaticosplenic Surgery, Beijing ChaoYang Hospital, Capital Medical University, Beijing, China
| | - Li-chao Pan
- Faculty of Hepato-Pancreato-Biliary Surgery, Chinese People’s Liberation Army (PLA) General Hospital, Beijing, China
| | - Guo-sheng Du
- Faculty of Hepato-Pancreato-Biliary Surgery, Chinese People’s Liberation Army (PLA) General Hospital, Beijing, China
| | - Ren Lang
- Department of Hepatobiliary and Pancreaticosplenic Surgery, Beijing ChaoYang Hospital, Capital Medical University, Beijing, China
| | - Qiang He
- Department of Hepatobiliary and Pancreaticosplenic Surgery, Beijing ChaoYang Hospital, Capital Medical University, Beijing, China
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Wang J, Lyu SC, Zhou L, Wang H, Pan F, Jiang T, Lang R, He Q. Prognostic analysis of pancreatic carcinoma with portal system invasion following curative resection. Gland Surg 2021; 10:35-49. [PMID: 33633960 PMCID: PMC7882355 DOI: 10.21037/gs-20-495] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2020] [Accepted: 09/18/2020] [Indexed: 01/08/2023]
Abstract
BACKGROUND To analyze the related factors affecting the prognosis of pancreatic carcinoma with portal system invasion. METHODS We retrospectively analyzed the clinical data of 118 patients with portal venous system invasion in Beijing Chaoyang Hospital between January 2011 and December 2018. Only patients with borderline resectable pancreatic cancer were included in this study. Borderline pancreatic cancer was defined according to NCCN (The National Comprehensive Cancer Network) guidelines. All patients underwent surgical treatment combined with vascular resection and reconstruction. The prognosis was evaluated according to the follow-up results, and the related risk factors for prognosis were analyzed. The survival curve was drawn by Kaplan-Meier method, and the survival rate was compared by log-rank test. Multivariate Cox regression was used to analyze the prognostic factors. RESULTS In our research, all of 126 patients were successfully completed the operations. Complications occurred in 29.7% of patients and perioperative death in 4.0%. A total of 118 patients were followed up and the followed-up rate was 97.5% (118/121). The overall 1-year, 2-year and 3-year survival rates were 49.2%, 27.1% and 19.8%, And the median survival time was 20 months. Multivariate analysis showed that preoperative CA19-9 (RR 1.449, 95% CI: 1.053-1.994), N status (RR 2.533, 95% CI: 1.337-4.798), degree of tumor differentiation (RR 1.592, 95% CI: 1.064-2.381) and venous invasion depth (RR 2.03, 95% CI: 1.504-2.758) were independent risk factors for the prognosis. CONCLUSIONS The long-term prognosis of pancreatic carcinoma patients with portal system invasion is poor. The venous invasion depth is an independent risk factor for the prognosis of pancreatic carcinoma with portal system invasion, the deeper of venous invasion, the worse the prognosis, and poorly differentiated tumors have the worst prognosis. Other independent risk factors included N status and the preoperative CA19-9. Those may help with patients' selection for different treatment protocols.
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Affiliation(s)
- Jing Wang
- Department of Hepatobiliary and Pancreatic Splenic Surgery, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China
| | - Shao-Cheng Lyu
- Department of Hepatobiliary and Pancreatic Splenic Surgery, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China
| | - Lin Zhou
- Department of Hepatobiliary and Pancreatic Splenic Surgery, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China
| | - Han Wang
- Department of Hepatobiliary and Pancreatic Splenic Surgery, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China
| | - Fei Pan
- Department of Hepatobiliary and Pancreatic Splenic Surgery, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China
| | - Tao Jiang
- Department of Hepatobiliary and Pancreatic Splenic Surgery, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China
| | - Ren Lang
- Department of Hepatobiliary and Pancreatic Splenic Surgery, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China
| | - Qiang He
- Department of Hepatobiliary and Pancreatic Splenic Surgery, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China
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Robert AP, Iqbal S, John M. Complete agenesis of the dorsal pancreas: A rare clinical entity. Int J Appl Basic Med Res 2016; 6:290-292. [PMID: 27857901 PMCID: PMC5108110 DOI: 10.4103/2229-516x.192599] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2015] [Accepted: 04/07/2016] [Indexed: 11/06/2022] Open
Abstract
Complete agenesis of the dorsal pancreas (ADP) is an exceedingly rare congenital anomaly, compatible with life. The first case was reported in 1911 and so far around 100 cases have been reported in the world literature. Majority of the patients with this anomaly are asymptomatic or associated with abdominal pain, hyperglycemia, diabetes mellitus, and acute or chronic pancreatitis. We present a case report of a 34-year-old male with ADP, diagnosed incidentally during radiological evaluation for abdominal pain. Magnetic resonance cholangiopancreatography confirmed the absence of neck, body, and tail of the pancreas along with duct of Santorini and the minor duodenal papilla. Because of its rarity of occurrence, clinical awareness of the ADP can expand the differential diagnosis and improve patient management in pertinent light of the world literature.
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Affiliation(s)
- Ambooken P Robert
- Department of Radiodiagnosis, Amala Institute of Medical Sciences, Thrissur, Kerala, India
| | - Showkathali Iqbal
- Department of Anatomy, Amala Institute of Medical Sciences, Thrissur, Kerala, India
| | - Mathew John
- Department of Radiodiagnosis, Amala Institute of Medical Sciences, Thrissur, Kerala, India
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Kumar R, Vyas K, Agrahari N, Kundu J, Jaiswal G. Complete agenesis of the dorsal pancreas: Case report with imaging findings and review of the literature. Malawi Med J 2016; 27:73-4. [PMID: 26405517 DOI: 10.4314/mmj.v27i2.9] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Affiliation(s)
- R Kumar
- Department of Radiodiagnosis, Geetanjali Medical College & Hospital, Geetanjali University, Udaipur, India
| | - K Vyas
- Department of Radiodiagnosis, Geetanjali Medical College & Hospital, Geetanjali University, Udaipur, India
| | - N Agrahari
- Department of Radiodiagnosis, Geetanjali Medical College & Hospital, Geetanjali University, Udaipur, India
| | - J Kundu
- Department of Radiodiagnosis, Geetanjali Medical College & Hospital, Geetanjali University, Udaipur, India
| | - G Jaiswal
- Department of Radiodiagnosis, Geetanjali Medical College & Hospital, Geetanjali University, Udaipur, India
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Matsumoto K, Katanuma A, Maguchi H, Takahashi K, Osanai M, Yane K, Kin T, Takaki R, Matsumori T, Gon K, Tomonari A, Nojima M. Performance of novel tissue harmonic echo imaging using endoscopic ultrasound for pancreatic diseases. Endosc Int Open 2016; 4:E42-50. [PMID: 26793784 PMCID: PMC4713188 DOI: 10.1055/s-0034-1393367] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND AND STUDY AIMS Recently, tissue harmonic echo (THE) imaging has advanced with the development of a new endoscopic ultrasound (EUS) monitor/processing unit. With this new technology, penetration (THE-P) and resolution (THE-R) images can be obtained. The aim of this study was to investigate the performance of this novel THE imaging using a new processing unit for pancreatic diseases. PATIENTS AND METHODS Fifty patients with pancreatic lesions (38 cystic, 12 solid) were retrospectively analyzed. At each examination, 3 EUS images of the same pancreatic lesion were obtained using B-mode, THE-P mode, and THE-R mode imaging. Each set of EUS images was randomly arranged and evaluated independently by 4 physicians blinded to the imaging technique. Images were compared using a Likert scale 5-point grading system for each parameter. RESULTS For cystic lesions, THE-P mode images were significantly superior to conventional B-mode images for visualizing the boundary, septum, nodules, and total image quality (P < 0.05). THE-R mode images were significantly superior to conventional B-mode images for visualizing the boundary, septum, and total image quality (P < 0.05). However, for solid lesions, there was no significant difference in all the evaluation points between THE-P and conventional B-mode images. THE-R mode images were inferior to conventional B-mode images for visualizing the boundary, internal structure, and total image quality (P < 0.05). CONCLUSIONS For pancreatic cystic lesions, THE mode images provided better lesion characterization than conventional B-mode images. Further research is required to determine if this improvement will result in improved EUS diagnostics.
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Affiliation(s)
| | - Akio Katanuma
- Center for Gastroenterology, Teine-Keijinkai Hospital, Hokkaido, Japan
| | - Hiroyuki Maguchi
- Center for Gastroenterology, Teine-Keijinkai Hospital, Hokkaido, Japan
| | | | - Manabu Osanai
- Center for Gastroenterology, Teine-Keijinkai Hospital, Hokkaido, Japan
| | - Kei Yane
- Center for Gastroenterology, Teine-Keijinkai Hospital, Hokkaido, Japan
| | - Toshifumi Kin
- Center for Gastroenterology, Teine-Keijinkai Hospital, Hokkaido, Japan
| | - Ryo Takaki
- Center for Gastroenterology, Teine-Keijinkai Hospital, Hokkaido, Japan
| | - Tomoaki Matsumori
- Center for Gastroenterology, Teine-Keijinkai Hospital, Hokkaido, Japan
| | - Katsushige Gon
- Center for Gastroenterology, Teine-Keijinkai Hospital, Hokkaido, Japan
| | - Akiko Tomonari
- Center for Gastroenterology, Teine-Keijinkai Hospital, Hokkaido, Japan
| | - Masanori Nojima
- Center for Translational Research, The Institute of Medical Science, The University of Tokyo, Tokyo, Japan
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Polistina F, Natale GD, Bonciarelli G, Ambrosino G, Frego M. Neoadjuvant strategies for pancreatic cancer. World J Gastroenterol 2014; 20:9374-83. [PMID: 25071332 PMCID: PMC4110569 DOI: 10.3748/wjg.v20.i28.9374] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2013] [Revised: 01/03/2014] [Accepted: 02/17/2014] [Indexed: 02/06/2023] Open
Abstract
Pancreatic cancer (PC) is the fourth cause of cancer death in Western countries, the only chance for long term survival is an R0 surgical resection that is feasible in about 10%-20% of all cases. Five years cumulative survival is less than 5% and rises to 25% for radically resected patients. About 40% has locally advanced in PC either borderline resectable (BRPC) or unresectable locally advanced (LAPC). Since LAPC and BRPC have been recognized as a particular form of PC neoadjuvant therapy (NT) has increasingly became a valid treatment option. The aim of NT is to reach local control of disease but, also, it is recognized to convert about 40% of LAPC patients to R0 resectability, thus providing a significant improvement of prognosis for responding patients. Once R0 resection is achieved, survival is comparable to that of early stage PCs treated by upfront surgery. Thus it is crucial to look for a proper patient selection. Neoadjuvant strategies are multiples and include neoadjuvant chemotherapy (nCT), and the association of nCT with radiotherapy (nCRT) given as either a combination of a radio sensitizing drug as gemcitabine or capecitabine or and concomitant irradiation or as upfront nCT followed by nRT associated to a radio sensitizing drug. This latter seem to be most promising as it may select patients who do not go on disease progression during initial treatment and seem to have a better prognosis. The clinical relevance of nCRT may be enhanced by the application of higher active protocols as FOLFIRINOX.
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Vicente E, Quijano Y, Ielpo B, Duran H, Diaz E, Fabra I, Oliva C, Olivares S, Caruso R, Ferri V, Ceron R, Moreno A. Is arterial infiltration still a criterion for unresectability in pancreatic adenocarcinoma? Cir Esp 2014; 92:305-15. [PMID: 24636076 DOI: 10.1016/j.ciresp.2013.11.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2013] [Accepted: 11/04/2013] [Indexed: 12/20/2022]
Abstract
As surgical resection remains the only hope for cure in pancreatic cancer (PC), more aggressive surgical approaches have been advocated to increase resection rates. Venous resection demonstrated to be a feasible technique in experienced centers, increasing survival. In contrast, arterial resection is still an issue of debate, continuing to be considered a general contraindication to resection. In the last years there have been significant advances in surgical techniques and postoperative management which have dramatically reduced mortality and morbidity of major pancreatic resections. Furthermore, advances in multimodal neo-adjuvant and adjuvant treatments, as well as the better understanding of tumor biology and new diagnostic options have increased overall survival. In this article we highlight some of the important points that a modern pancreatic surgeon should take into account in the management of PC with arterial involvement in light of the recent advances.
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Affiliation(s)
- Emilio Vicente
- Hospital Universitario Madrid Sanchinarro, Centro Integral Oncológico Clara Campal, Facultad de Medicina, Universidad CEU San Pablo, Madrid, España.
| | - Yolanda Quijano
- Hospital Universitario Madrid Sanchinarro, Centro Integral Oncológico Clara Campal, Facultad de Medicina, Universidad CEU San Pablo, Madrid, España
| | - Benedetto Ielpo
- Hospital Universitario Madrid Sanchinarro, Centro Integral Oncológico Clara Campal, Facultad de Medicina, Universidad CEU San Pablo, Madrid, España
| | - Hipolito Duran
- Hospital Universitario Madrid Sanchinarro, Centro Integral Oncológico Clara Campal, Facultad de Medicina, Universidad CEU San Pablo, Madrid, España
| | - Eduardo Diaz
- Hospital Universitario Madrid Sanchinarro, Centro Integral Oncológico Clara Campal, Facultad de Medicina, Universidad CEU San Pablo, Madrid, España
| | - Isabel Fabra
- Hospital Universitario Madrid Sanchinarro, Centro Integral Oncológico Clara Campal, Facultad de Medicina, Universidad CEU San Pablo, Madrid, España
| | - Catalina Oliva
- Hospital Universitario Madrid Sanchinarro, Centro Integral Oncológico Clara Campal, Facultad de Medicina, Universidad CEU San Pablo, Madrid, España
| | - Sergio Olivares
- Hospital Universitario Madrid Sanchinarro, Centro Integral Oncológico Clara Campal, Facultad de Medicina, Universidad CEU San Pablo, Madrid, España
| | - Riccardo Caruso
- Hospital Universitario Madrid Sanchinarro, Centro Integral Oncológico Clara Campal, Facultad de Medicina, Universidad CEU San Pablo, Madrid, España
| | - Valentina Ferri
- Hospital Universitario Madrid Sanchinarro, Centro Integral Oncológico Clara Campal, Facultad de Medicina, Universidad CEU San Pablo, Madrid, España
| | - Ricardo Ceron
- Hospital Universitario Madrid Sanchinarro, Centro Integral Oncológico Clara Campal, Facultad de Medicina, Universidad CEU San Pablo, Madrid, España
| | - Almudena Moreno
- Hospital Universitario Madrid Sanchinarro, Centro Integral Oncológico Clara Campal, Facultad de Medicina, Universidad CEU San Pablo, Madrid, España
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Wang W, Shpaner A, Krishna SG, Ross WA, Bhutani MS, Tamm EP, Raju GS, Xiao L, Wolff RA, Fleming JB, Lee JH. Use of EUS-FNA in diagnosing pancreatic neoplasm without a definitive mass on CT. Gastrointest Endosc 2013; 78:73-80. [PMID: 23523302 DOI: 10.1016/j.gie.2013.01.040] [Citation(s) in RCA: 75] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2012] [Accepted: 01/29/2013] [Indexed: 02/08/2023]
Abstract
BACKGROUND Diagnosis of pancreatic neoplasm is challenging in patients with inconclusive findings on pancreatic multidetector row CT (MDCT). OBJECTIVE To determine the diagnostic accuracy and to identify predictors of pancreatic neoplasm by EUS with FNA in this setting. DESIGN Retrospective chart review during the study period of January 2002 to December 2010. SETTING Tertiary referral center. PATIENTS Of the 1046 patients who underwent pancreatic EUS, 116 patients were selected because their clinical presentation was suspicious for pancreatic malignancy, but their MDCT findings were inconclusive. INTERVENTION EUS with FNA. MAIN OUTCOME MEASUREMENTS Diagnostic yield of malignancy and significance of clinical variables. RESULTS When surgical pathology or subsequent clinical course was used as the criterion standard, EUS with FNA had a sensitivity, specificity, positive predictive value, and accuracy of 87.3%, 98.3%, 98.5%, and 92.1%, respectively, in diagnosing a pancreatic neoplasm that was indeterminate on MDCT. Factors significantly associated with EUS detection of pancreatic ductal adenocarcinoma were total bilirubin level greater than 2 mg/dL (P < .001), CT finding of pancreatic duct dilation (P < .001), bile duct stricture (P < .001), and tumor size 1.5 cm or larger detected by EUS (P = .004). Among them, pancreatic duct dilation on CT (odds ratio 4.10; 95% confidence interval, 1.52-11.05), and tumor size 1.5 cm or larger detected by EUS (odds ratio 8.46; 95% confidence interval, 2.02-35.45) were independent risk factors. LIMITATIONS Retrospective design and patient referral bias. CONCLUSIONS When MDCT is indeterminate, EUS is a highly sensitive and accurate modality for the detection of pancreatic neoplasm, especially when the tumor is smaller than 2.0 cm.
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Affiliation(s)
- Wei Wang
- Department of Gastroenterology, Hepatology, and Nutrition, MD Anderson Cancer Center, Houston, TX 77030, USA
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12
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Cavallini A, Butturini G, Malleo G, Bertuzzo F, Angelini G, Abu Hilal M, Pederzoli P, Bassi C. Endoscopic transmural drainage of pseudocysts associated with pancreatic resections or pancreatitis: a comparative study. Surg Endosc 2010; 25:1518-25. [PMID: 20976483 DOI: 10.1007/s00464-010-1428-9] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2010] [Accepted: 09/30/2010] [Indexed: 01/11/2023]
Abstract
BACKGROUND Endoscopy has been regarded as an effective modality for draining pancreatic collections, pseudocysts, and abscesses. This study analyzes our experience with endoscopic transmural drainage of pancreatic pseudocysts and compares the outcomes in patients with postsurgical and pancreatitis-associated ones. METHODS Patients who underwent endoscopic drainage of a pancreatic pseudocyst from January 1999 through June 2008 were included in this retrospective analysis. The specific indication for attempting the procedure was the presence of direct contact between the pseudocyst and the gastric wall. All the drainages were carried out via a transgastric approach, and one or two straight plastic stents (10 or 11.5 French) were positioned. A comparative analysis of short- and long-term results was made between patients with postoperative pseudocysts (group A) and patients with pancreatitis-associated pseudocysts (group B). RESULTS Fifty-five patients were included in the study, 25 in group A and 30 in group B. Overall, a single stent was inserted in 84.0% of patients, while two stents were needed in the remaining 16.0%. The technical success rate was 78.2%, whereas procedure-related complications were 16.4%. Complications included pseudocyst superinfection and major bleeding and were managed mainly by surgery. Mortality rate was 1.8% (1 patient). There were no significant differences in the technical success rate and procedure-related complications between the two groups (p=0.532 and 0.159, respectively) Recurrences were 13.9% and significantly more common in group B (p=0.021). In such cases, a second endoscopic drainage was successfully performed. CONCLUSION Transmural endoscopic treatment of pancreatic pseudocysts is feasible and has a technical success rate of 78.2%, without differences related to the pseudocyst etiology. Recurrences, on the other hand, are more common in patients with pancreatitis. Given the severe complications that may occur after the procedure, we recommend that endoscopic drainage be performed in a tertiary-care center with specific expertise in pancreatic surgery.
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Affiliation(s)
- Alvise Cavallini
- Department of Surgery-General Surgery B, G.B. Rossi Hospital, University of Verona, Piazzale L.A. Scuro 10, 37134, Verona, Italy
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Kwok KH, Rizk J, Coleman M, Fenton-Lee D. Pancreaticoduodenectomy - outcomes from an Australian institution. ANZ J Surg 2010; 80:605-8. [DOI: 10.1111/j.1445-2197.2010.05348.x] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
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14
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Buchs NC, Chilcott M, Poletti PA, Buhler LH, Morel P. Vascular invasion in pancreatic cancer: Imaging modalities, preoperative diagnosis and surgical management. World J Gastroenterol 2010; 16:818-31. [PMID: 20143460 PMCID: PMC2825328 DOI: 10.3748/wjg.v16.i7.818] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Pancreatic cancer is associated with a poor prognosis, and surgical resection remains the only chance for curative therapy. In the absence of metastatic disease, which would preclude resection, assessment of vascular invasion is an important parameter for determining resectability of pancreatic cancer. A frequent error is to misdiagnose an involved major vessel. Obviously, surgical exploration with pathological examination remains the “gold standard” in terms of evaluation of resectability, especially from the point of view of vascular involvement. However, current imaging modalities have improved and allow detection of vascular invasion with more accuracy. A venous resection in pancreatic cancer is a feasible technique and relatively reliable. Nevertheless, a survival benefit is not achieved by curative resection in patients with pancreatic cancer and vascular invasion. Although the discovery of an arterial invasion during the operation might require an aggressive management, discovery before the operation should be considered as a contraindication. Detection of vascular invasion remains one of the most important challenges in pancreatic surgery. The aim of this article is to provide a complete review of the different imaging modalities in the detection of vascular invasion in pancreatic cancer.
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Abstract
OBJECTIVES We report the incidence rates of pancreatic cancer in Denmark during 61 years of data registration, from 1943 to 2003. METHODS On the basis of reports in the nationwide, population-based Danish Cancer Registry, we calculated age-standardized, period-specific incidence rates of pancreatic cancer. RESULTS A total of 32,654 incident cases of pancreatic cancer were evaluated (male-female ratio, 1.4). The age-standardized incidence rate of pancreatic cancer increased steadily in the beginning of the study period from 3.75/100,000 person-years in 1943 to 1947 to the maximum of 9.96/100,000 person-years in 1968 to 1972 among men and from 2.95 in 1943 to 1947 to the maximum of 7.04 in 1978 to 1982 among women. The incidence rates declined between 1968 to 1972 and 1988 to 1992 for men and between 1978 to 1982 and 2003 for women. Most tumors were located in the exocrine pancreas, and most were adenocarcinomas. More than 40% were located in the head of the pancreas; 14% were localized, 21% were regionally spread, and 36% were metastatic at the time of diagnosis. During the period 1978 to 2003, the percentages of histologically or cytologically verified adenocarcinomas remained relatively steady, approximately 30%. CONCLUSIONS The incidence rate of pancreatic cancer increased at the beginning of the 61 years of registration and declined slightly thereafter.
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Controversies in the management of borderline resectable proximal pancreatic adenocarcinoma with vascular involvement. HPB SURGERY : A WORLD JOURNAL OF HEPATIC, PANCREATIC AND BILIARY SURGERY 2009; 2008:839503. [PMID: 19283083 PMCID: PMC2654339 DOI: 10.1155/2008/839503] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 11/06/2007] [Revised: 07/28/2008] [Accepted: 12/18/2008] [Indexed: 12/26/2022]
Abstract
Synchronous major vessel resection during pancreaticoduodenectomy
(PD) for borderline resectable pancreatic adenocarcinoma remains controversial.
In the 1970s, regional pancreatectomy advocated by Fortner was associated with
unacceptably high morbidity and mortality rates, with no impact on long-term survival.
With the establishment of a multidisciplinary approach, improvements in preoperative
staging techniques, surgical expertise, and perioperative care reduced mortality
rates and improved 5-year-survival rates are now achieved following resection in
high-volume centres. Perioperative morbidity and mortality following PD with portal
vein resection are comparable to standard PD, with reported 5-year-survival rates
of up to 17%. Segmental resection and reconstruction of the common hepatic
artery/proper hepatic artery (CHA/PHA) can be performed to achieve an R0 resection in
selected patients with limited involvement of the CHA/PHA at the origin of the gastroduodenal artery (GDA).
PD with concomitant major vessel resection for borderline resectable tumours should be
performed when a margin-negative resection is anticipated at high-volume centres
with expertise in complex pancreatic surgery. Where an incomplete (R1 or R2) resection
is likely neoadjuvant treatment with systemic chemotherapy followed by chemoradiation
as part of a clinical trial should be offered to all patients.
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Mansfield SD, Scott J, Oppong K, Richardson DL, Sen G, Jaques BC, Manas DM, Charnley RM. Comparison of multislice computed tomography and endoscopic ultrasonography with operative and histological findings in suspected pancreatic and periampullary malignancy. Br J Surg 2008; 95:1512-20. [PMID: 18942059 DOI: 10.1002/bjs.6330] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
BACKGROUND This study compared multislice computed tomography (MSCT) with endoscopic ultrasonography (EUS) in the diagnosis and staging of pancreatic and periampullary malignancy. METHODS Data were collected prospectively on patients having MSCT and EUS for suspected pancreatic and periampullary malignancy. RESULTS Eighty-four patients had MSCT and EUS, of whom 35 underwent operative assessment (29 resections). In assessing malignancy, there was no significant difference between MSCT and EUS, and agreement was good (82 per cent, kappa = 0.49); the sensitivity and specificity of MSCT were 97 and 87 per cent, compared with 95 and 52 per cent respectively for EUS (P = 0.264). For portal vein/superior mesenteric vein invasion, MSCT was superior (P = 0.017) and agreement was moderate (72 per cent, kappa = 0.42); the sensitivity and specificity were 88 and 92 per cent for MSCT, and 50 and 83 per cent for EUS. For resectability, there was no significant difference and agreement was good (78 per cent, kappa = 0.51). EUS had an impact on the management of 14 patients in whom MSCT suggested benign disease or equivocal resectability. CONCLUSION MSCT is the imaging method of choice for pancreatic and periampullary tumours. Routine EUS should be reserved for those with borderline resectability on MSCT.
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Affiliation(s)
- S D Mansfield
- Hepato-Pancreato-Biliary Unit, Freeman Hospital, Newcastle upon Tyne, UK
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18
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Blondet JJ, Carlson AM, Kobayashi T, Jie T, Bellin M, Hering BJ, Freeman ML, Beilman GJ, Sutherland DER. The role of total pancreatectomy and islet autotransplantation for chronic pancreatitis. Surg Clin North Am 2008; 87:1477-501, x. [PMID: 18053843 DOI: 10.1016/j.suc.2007.08.014] [Citation(s) in RCA: 109] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Total pancreatectomy and islet autotransplantation are done for chronic pancreatitis with intractable pain when other treatment measures have failed, allowing insulin secretory capacity to be preserved, minimizing or preventing diabetes, while at the same time removing the root cause of the pain. Since the first case in 1977, several series have been published. Pain relief is obtained in most patients, and insulin independence preserved long term in about a third, with another third having sufficient beta cell function so that the surgical diabetes is mild. Islet autotransplantation has been done with partial or total pancreatectomy for benign and premalignant conditions. Islet autotransplantation should be used more widely to preserve beta cell mass in major pancreatic resections.
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Affiliation(s)
- Juan J Blondet
- Division of Surgical Critical Care/Trauma, Department of Surgery, University of Minnesota, MMC 11, 420 Delaware Street Southeast, Minneapolis, MN 55455, USA
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Talbot JN, Montravers F, Gutman F, Kerrou K, Huchet V, Grahek D, Andre T, Houry S, Touboul E, Rosmorduc O, Poupon R, Ruszniewski P, Rougier P, Grange JD. Tomographie par émission de positons et cancers digestifs. Presse Med 2008; 37:e1-e24. [DOI: 10.1016/j.lpm.2007.03.048] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2007] [Accepted: 03/08/2007] [Indexed: 02/08/2023] Open
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Abstract
The close proximity of the endoscopic ultrasound probe to the pancreas results in superior spatial resolution compared to CT scan and MRI. In addition, endoscopic ultrasound (EUS) is a minimally invasive procedure that does not share the relatively high complication rate of ERCP. Due to these advantages, EUS has evolved into an important technique to assess pancreatobiliary disease. This review will discuss the role of EUS in patients with pancreatitis. The indications can be divided into acute pancreatitis and chronic pancreatitis. In acute pancreatitis, EUS is used to determine the etiology; in suspected chronic pancreatitis it is helpful to establish the diagnosis. Lastly, this review will discuss biliary pancreatitis with suspicion for persistent choledocholithiasis.
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Montravers F, Grahek D, Kerrou K, Gutman F, Talbot JN. [Positron emission tomography (PET) in gastrointestinal cancer]. ACTA ACUST UNITED AC 2006; 30:737-41. [PMID: 16801895 DOI: 10.1016/s0399-8320(06)73306-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
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22
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Bardales RH, Stelow EB, Mallery S, Lai R, Stanley MW. Review of endoscopic ultrasound-guided fine-needle aspiration cytology. Diagn Cytopathol 2006; 34:140-75. [PMID: 16511852 DOI: 10.1002/dc.20300] [Citation(s) in RCA: 69] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
This review, based on the Hennepin County Medical Center experience and review of the literature, vastly covers the up-to-date role of endoscopic ultrasonography (EUS) and EUS-guided fine-needle aspiration (FNA) in evaluating tumorous lesions of the gastrointestinal tract and adjacent organs. Emphasis is given to the tumoral and nodal staging of esophageal, pulmonary, and pancreatic cancer. This review also discusses technical, pathological, and gastroenterologic aspects and the role of the pathologist and endosonographer in the evaluation of these lesions, as well as the corresponding FNA cytology and differential diagnosis.
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Affiliation(s)
- Ricardo H Bardales
- Department of Pathology, Hennepin County Medical Center, Minneapolis, Minnesota 55415, USA.
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23
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Klapman JB, Chang KJ, Lee JG, Nguyen P. Negative predictive value of endoscopic ultrasound in a large series of patients with a clinical suspicion of pancreatic cancer. Am J Gastroenterol 2005; 100:2658-2661. [PMID: 16393216 DOI: 10.1111/j.1572-0241.2005.00315.x] [Citation(s) in RCA: 109] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
OBJECTIVES Endoscopic ultrasound (EUS) has been shown to be very accurate in the diagnosis and staging of pancreatic cancer. The accuracy of EUS in predicting the absence of pancreatic cancer in a large series of patients with a clinical suspicion of pancreatic cancer is not well documented. Our aim was to determine the negative predictive value (NPV) of EUS in patients with a suspicion of pancreatic cancer. METHODS We retrospectively reviewed, from our EUS database (between January 1999 and March 2003), 693 patients who were suspected of having pancreatic cancer and had EUS examinations. A total of 155 patients were found by EUS to have a completely normal pancreas. Indications for EUS in these patients included: weight loss/abdominal pain; and/or pancreatic enlargement/fullness on computed tomography (CT); and/or bile duct/pancreatic duct narrowing on endoscopic retrograde cholangiopancreatography; and/or an elevated CA 19-9. Follow-up information was obtained in 135/155 (87%) patients from patient phone calls and/or physician visits and/or CT scan. The mean follow-up period was 25 months (range 8-48 months). RESULTS No patients developed pancreatic cancer during the follow-up period. Following the EUS examination, no work-up was required in 119/135 (88%) of patients. CT scan was performed in 16 patients at 6 months post-procedure, none of which showed a pancreatic mass. The NPV of EUS in excluding pancreatic cancer in those patients with follow-up was 100%. CONCLUSION EUS is highly specific in the diagnosis of pancreatic cancer with a NPV of 100% and obviates the need for further diagnostic testing. In patients with a clinical suspicion of pancreatic cancer, EUS should be considered as the initial diagnostic modality.
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Affiliation(s)
- Jason B Klapman
- Division of Gastrointestinal Tumors, Section of Endoscopic Oncology, H. Lee Moffitt Center & Research Institute, Tampa, Florida 33612, USA
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Chen F, Li ZS, Li SD, Wang LW, Xu GM. Etiology, diagnosis and treatment of chronic pancreatitis: an analysis of 294 cases. Shijie Huaren Xiaohua Zazhi 2004; 12:2829-2832. [DOI: 10.11569/wcjd.v12.i12.2829] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
AIM: To investigate the associated factors, diagnosis and treatment of chronic pancreatitis in Shanghai, China.
METHODS: Two hundred and ninety four patients with confirmed chronic pancreatitis in Changhai Hospital were retrospectively studied, including investigation of their associated etiological factors, diagnostic and therapeutic methods.
RESULTS: Of all the 294 patients, there were 89 with biliary chronic pancreatitis (30.3%) and 84 with alcoholic pancreatitis (28.6%). The rest included idiopathic chronic pancreatitis, abnormity of pancreatic duct, hereditary pancreatitis and autoimmune pancreatitis. The most common symptom of chronic pancreatitis was abdominal pain. A few patients were accompanied by steatorrhoea and decrease body weight. Forty-nine patients were diagnosed by histopathology. Others were diagnosed by imaging procedures. The positive rate for imaging diagnosis was 88.0% on average. Most patients suffered less after non-operation therapies.
CONCLUSION: Biliary diseases are still the most common etiological factors of chronic pancreatitis, but its rate has significantly decreased in Shanghai. Meanwhile, the rate of alcoholic chronic pancreatitis is increasing gradually. Imaging procedures play the most important role in diagnosis, and non-operation therapies are the main methods to treat chronic pancreatitis.
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Affiliation(s)
- Fu Chen
- Department of Gastroenterology, Changhai Hospital, Second Millitary Medical University, Shanghai 200433, China
| | - Zhao-Shen Li
- Department of Gastroenterology, Changhai Hospital, Second Millitary Medical University, Shanghai 200433, China
| | - Shu-De Li
- Department of Gastroenterology, Changhai Hospital, Second Millitary Medical University, Shanghai 200433, China
| | - Luo-Wei Wang
- Department of Gastroenterology, Changhai Hospital, Second Millitary Medical University, Shanghai 200433, China
| | - Guo-Ming Xu
- Department of Gastroenterology, Changhai Hospital, Second Millitary Medical University, Shanghai 200433, China
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