1/11. Arterial and vena caval resections combined with pancreaticoduodenectomy in highly selected patients with periampullary malignancies.BACKGROUND/AIMS: To obtain a margin-negative resection and increase the indication for resection of periampullary malignancies, pancreaticoduodenectomy with a SM-PVR (superior mesenterico-portal vein resection) has been performed. However, an arterial resection, other vascular resections except SM-PVR (e.g., an inferior vena caval resection), or a metastatic tumor resection combined with pancreaticoduodenectomy has yet to be fully elucidated because of the high risk of postoperative complications and extremely poor long-term survival in patients undergoing these exceptional procedures. The present report focused on highly selected patients undergoing an arterial resection or a vena caval resection associated with pancreaticoduodenectomy. METHODOLOGY: Besides 31 patients with periampullary tumors undergoing pancreaticoduodenectomy associated with SM-PVR in our department, a group of 4 patients underwent arterial resections and another patient underwent pancreaticoduodenectomy combined with a resection of liver metastasis together with an inferior vena caval resection. These five patients were reported in the present study. RESULTS: A 27 year-old-woman presented pancreatic ductal adenocarcinoma of the pancreatic head and a liver metastasis in which involvements of the superior mesenterico-portal vein and the inferior vena cava were shown. pancreaticoduodenectomy was performed with SM-PVR associated with a left hemihepatectomy combined with a segment 1 resection and an inferior vena caval resection. The patient did not present severe postoperative complications and experienced a good quality of life during 16 months after surgery. Four other patients underwent arterial resections. These arterial resections were performed only when a margin-negative resection was feasible. The superior mesenteric artery was resected and reconstructed with a Goretex graft in one patient. The right hepatic artery was resected and reconstructed with a saphenous graft in two patients. The other patient underwent a resection of the common hepatic artery and reconstruction was performed with the splenic artery. Three of the four patients presented postoperative complications but were conservatively treated. Two patients are still alive 25 months and 8 months after surgery. One patient died of sepsis 5 months after surgery, and the other died of cancer progression 19 months after surgery. CONCLUSIONS: The indication for retropancreatic arterial resection associated with pancreaticoduodenectomy should be carefully evaluated only when a margin-negative resection can be achieved. An appropriate bypass method of arterial reconstruction should be selected because a direct end-to-end anastomosis is not always feasible. hepatectomy for metastases of pancreatic ductal carcinoma should be also regarded as an exceptional procedure.- - - - - - - - - - ranking = 1keywords = carcinoma, adenocarcinoma (Clic here for more details about this article) |
2/11. Metastatic cancer to the renal pelvis: a novel approach to management.We describe a novel application of percutaneous renal surgery for the management of an unusual and challenging urologic problem. Two patients with symptomatic, metastatic adenocarcinoma in the renal pelvis were treated with percutaneous resection. The lesion was in a solitary kidney in 1 patient, and was bilateral in the second. Percutaneous resection resulted in complete relief of symptoms and obstruction. Although both patients ultimately died of their primary disease, their quality of life was significantly improved in the interim. Percutaneous resection of renal pelvic tumors is accepted management for select patients with upper tract transitional cell carcinoma. These 2 cases demonstrated both an unusual presentation for metastatic adenocarcinoma and an expanded application for percutaneous renal surgery.- - - - - - - - - - ranking = 1.5166654242425keywords = carcinoma, adenocarcinoma (Clic here for more details about this article) |
3/11. Laparoscopic surgery for the management of obstruction of the gastric outlet and small bowel following previous laparotomy for major upper gastrointestinal resection or cancer palliation: a new concept.BACKGROUND: Surgical relief of gastric outlet obstruction (GOO) or small bowel obstruction in patients who had undergone major resection or palliative bypass surgery for malignancy is conventionally achieved at a laparotomy. The potential role of minimally invasive surgery in the management of these complications has not been previously explored. methods: Between 2003 and 2004, 4 consecutive patients, age range 37 to 72 years, where admitted with gastric outlet or proximal small bowel obstruction following previous open surgery for suspected intra-abdominal malignancy, under the care of one surgeon. The respective past histories of these patients were recurrent GOO and concomitant distal biliary obstruction following a previous open gastric bypass elsewhere for metastatic pancreatic head cancer; persistent adhesive small bowel obstruction following radical gastrectomy for gastric cancer; GOO secondary to intra-abdominal recurrence 6 months after hepatobiliary resection for hilar cholangiocarcinoma; and GOO following previous pancreatico-duodenectomy for suspected pancreatic head cancer. Their respective surgical management consisted of a laparoscopic re-do gastric bypass and concomitant cholecystojejunostomy; adhesiolysis and revision of the Roux-en-Y enteric anastomosis; a Devine exclusion gastroenterostomy; and resection and refashioning of the gastroenterostomy. RESULTS: There were no conversions to open surgery and no postoperative complications. The median operating time was 240 minutes (range, 145 to 300 minutes). Oral free fluid intake was resumed on postoperative day (POD) 1, while diet was resumed between POD 2 and 4. The median postoperative hospital stay was 15.5 days (range, 14 to 25 days). CONCLUSION: Previous laparotomy and major resection or palliation of malignancy do not preclude the application of the laparoscopic approach for the management of upper gastrointestinal obstruction. Laparoscopic adhesiolysis and revision of enteroenteric and gastroenteric anastomoses are feasible management options in the hands of those experienced with complex laparoscopic surgery.- - - - - - - - - - ranking = 0.48333457575745keywords = carcinoma (Clic here for more details about this article) |
4/11. Multiple effects of somatostatin analogs verified in three cases of metastasized neuroendocrine tumors of the gastroenteropancreatic system.AIMS AND BACKGROUND: In neuroendocrine tumors of the gastroenteropancreatic (GEP) system, radiolabeled analogs of somatostatin (SST) are useful to the surgeon in different phases of treatment: preoperatively, to identify the lesion with somato-statin receptor scintigraphy (SRS), intraoperatively for localization using a hand-held gamma probe, and postoperatively acting directly to eliminate any residual tumor cells. Additional features of these analogs that are of value in treating such GEP tumors include their antiproliferative potential, which is in the process of being verified, and, above all, their anti-secretory action, so effective in symptom control. In this study the authors, based on their own experience, evaluate the effectiveness of SST analogs in treating GEP endocrine tumors. methods: Three patients with malignant GEP apudomas were studied. In case 1, an insulinoma, the patient underwent four surgical procedures for ablation of the pancreatic tumor and of hepatic and lymph node metastases in addition to local radiofrequency treatment and radiometabolic therapy. Case 2 was a carcinoid tumor of the small intestine with hepatic metastases, managed by ileal resection, local radiofrequency treatment and receptor-mediated radionuclide therapy. In case 3, a non-functioning pancreatic carcinoma with liver and lymph node metastases, the patient underwent four surgical procedures, hepatic chemoembolization, antiproliferative treatment using octreotide (OCT) and metabolic radionuclide therapy. RESULTS: In all three cases SRS proved highly sensitive in the early detection of even the smallest recurrences. There was uncertainty, however, regarding the effectiveness of therapy with radiolabeled SST analogs. Hepatic metastases from the carcinoid were completely unresponsive, but in the case of the insulinoma, the hepatic metastases showed necrosis following treatment, while lymph node metastases were unaffected. In the case of the non-functioning carcinoma, there was a correlation between treatment and a marked improvement in the patient's clinical condition, although the appearance of the lesions themselves remained unchanged. The antiproliferative effect of OCT in this case was nil. CONCLUSIONS: SRS proved highly accurate in detecting recurrences during follow-up. The merits of radiometabolic therapy, on the other hand, were unclear, a finding reported elsewhere in the literature, and in the only case treated by prolonged OCT treatment, no antiproliferative action was observed. The diagnostic usefulness of SRS was thus confirmed and it appears likely that radiolabeled analogs used intraoperatively for tumor localization will prove equally of value. The effectiveness of receptor-mediated radionuclide therapy is still in the process of being verified. Based on the expectation of analogs with an universal affinity for SST receptors (sst), it is reasonable to look forward to a significant increase in the efficacy of this type of therapy.- - - - - - - - - - ranking = 0.9666691515149keywords = carcinoma (Clic here for more details about this article) |
5/11. role of computed tomography and endoscopy in the management of alimentary tract lipomas.Four cases of alimentary tract lipomas are described. While conventional radiology is unable to differentiate these tumours from the much commoner carcinomas, computed tomography and endoscopic examination may allow a definitive diagnosis thus sparing the patient major surgery. In selected cases endoscopic polypectomy is feasible and safe.- - - - - - - - - - ranking = 0.48333457575745keywords = carcinoma (Clic here for more details about this article) |
6/11. Endoprosthetic insertion for malignant obstructive jaundice: a retrospective review.We reviewed 13 cases of biliary endoprosthetic insertion for malignant obstructive jaundice from August 1983 to May 1987, and recorded (1) location and etiology of the obstruction, (2) length of time the endoprosthesis remained functional, and (3) complications related to the endoprosthesis, its insertion, or its long-term function. Of the 13 patients, 3 had pancreatic carcinoma, 3 had cholangiocarcinoma, and 3 had metastatic disease to the porta hepatis. The underlying malignancy was not histologically proved in four patients despite evidence of neoplasm by percutaneous cholangiography and computerized tomography. These four patients were not considered good surgical risks and were referred for percutaneous therapy. The longest endoprosthetic patency was 3.5 years. Three patients experienced obstruction of the endoprosthesis at 3, 4, and 9 months after insertion, respectively. Two of the endoprostheses were subsequently removed endoscopically, while the third was extracted through a new percutaneous tract with use of a balloon angioplasty catheter. Complications related to endoprosthetic insertion included bilous hydro pneumothorax (1 patient), subcutaneous and subcapsular liver abscess (1 patient), postinsertion cholangitis (4 patients), and reflex ileus (1 patient).- - - - - - - - - - ranking = 0.9666691515149keywords = carcinoma (Clic here for more details about this article) |
7/11. Peutz-Jeghers polyposis associated with carcinoma of the digestive organs. Report of three cases and review of the literature.Three cases of Peutz-Jeghers polyposis with carcinoma of the digestive organs are studied. Although mucocutaneous pigmentation was not present in two of the three patients, the features of intestinal polyposis are consistent with those of peutz-jeghers syndrome. One patient had a carcinoma of the pancreas and the other two had carcinomas with colonic Peutz-Jeghers polyps. Previous reports on carcinomas associated with peutz-jeghers syndrome are reviewed. An unusual location in the gastrointestinal tract, together with occurrence at an early age, characterize the carcinoma in peutz-jeghers syndrome. In Japanese patients, the large bowel is the site of the greatest number of carcinomas. On the other hand, Western patients showed a relatively even distribution. A possible surveillance protocol for early detection of gastrointestinal carcinoma in patients with peutz-jeghers syndrome is discussed.- - - - - - - - - - ranking = 5.316680333332keywords = carcinoma (Clic here for more details about this article) |
8/11. Carcinoma arising in the wall of congenital bile duct cysts.The incidence of carcinoma arising in the wall of the congenital bile duct cysts is much higher than previously assumed. The authors report 4 such cases of primary and secondary carcinomas and review their clinical features through the similar 59 cases in the literature. Of the 63 cases, the average age was much younger, at least several decades, compared with cases of extra-hepatic carcinoma without bile duct cysts. The female-male ratio was 2.5:1. Racial preponderance was also observed, namely, the majority were Japanese. Additionally, many patients previously received various internal drainage procedures, especially choledochocystoduodenostomy. As the treatment, primary excision of the extrahepatic bile duct cyst seems to give the best results because it can avoid ascending cholangitis and prevent development of carcinoma. However, carcinoma still can arise in the intrahepatic bile duct cyst, which cannot be removed at the present time.- - - - - - - - - - ranking = 2.4166728787873keywords = carcinoma (Clic here for more details about this article) |
9/11. Fine needle aspiration under percutaneous transhepatic cholangiographic guidance.Fine needle aspiration (FNA) is a rapid diagnostic technique accompanied by minimal patient morbidity and providing access to deep visceral lesions. We report three cases of obstructive jaundice secondary to malignancy in which FNA was performed at the time of percutaneous transhepatic cholangiogram. After the cholangiogram was performed and the obstructive lesion identified, a drainage catheter was inserted for decompression of the biliary tree. Using the drainage tube as a guide, multiple FNAs of the area of obstruction were done. In case 1 an area adjacent to the common bile duct was aspirated and diagnosed as adenocarcinoma of undetermined origin. FNA of a liver mass in case 2 revealed poorly differentiated squamous carcinoma consistent with a previous uterine cervix biopsy. Both of these patients were discharged for outpatient treatment following the procedure. In case 3 FNA diagnostic of adenocarcinoma was obtained from an intra- and extrahepatic mass. This patient underwent exploratory laparotomy for possible resection; adenocarcinoma of the head of the pancreas was found. For patients with advanced malignancies, minimizing inpatient hospital time is an important goal. In cases of obstructive jaundice secondary to malignancy, the combined techniques of percutaneous cholangiogram, biliary tree compression and FNA provide both diagnosis and palliation, with minimal morbidity and inpatient care.- - - - - - - - - - ranking = 2.0333308484851keywords = carcinoma, adenocarcinoma (Clic here for more details about this article) |
10/11. Bouveret's syndrome: a rare consequence of malignant cholecystoduodenal fistula.We report a case of duodenal gallstone obstruction, resulting from cholecystoduodenal fistula. Fistulization was associated with a repeat chronic inflammation and metastatic carcinomatous infiltration. The diagnosis was confirmed by ultrasonography, barium meal examination, and gastroscopy. An attempt at endoscopic extraction was unsuccessful and the patient was referred for operative therapy. We present a graphic algorithm for decision-making in Bouveret's syndrome.- - - - - - - - - - ranking = 0.48333457575745keywords = carcinoma (Clic here for more details about this article) |
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