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Liu C, Tian X, Xie X, Gao H, Zhuang Y, Yang Y. Comparison of Uncinate Process Cancer and Non-Uncinate Process Pancreatic Head Cancer. J Cancer 2016; 7:1242-9. [PMID: 27390599 PMCID: PMC4934032 DOI: 10.7150/jca.15062] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2016] [Accepted: 05/01/2016] [Indexed: 12/20/2022] Open
Abstract
The special anatomical position accounts for unusual clinicopathological features of uncinate process cancer. This study aimed to compare clinicopathological features of patients with uncinate process cancer to patients with non-uncinate process pancreatic head cancer. Total 160 patients with pancreatic head cancer were enrolled and classified into two groups: uncinate process cancer and non-uncinate process pancreatic head cancer. We found that the ratio of vascular invasion was significantly higher in patients with uncinate process cancer than in patients with non-uncinate process pancreatic head cancer. In addition, the rate of R1 resection was significantly higher in patients with uncinate process cancer. Furthermore, the median disease-free survival (11 months vs. 15 months, p=0.043) and overall survival (15 months vs. 19 months, p=0.036) after R0 resection were lower for uncinate process cancer. Locoregional recurrence was more frequent (p=0.017) and earlier (12 months vs. 36 months; p=0.002) in patients with uncinate process cancer than in patients with non-uncinate process pancreatic head cancer. In conclusion, uncinate process cancer is more likely to invade blood vessel and has worse prognosis due to the earlier and more frequent locoregional recurrence.
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Affiliation(s)
- Chang Liu
- Department of General Surgery, Peking University First hospital, 8th Xishiku Street, Beijing 100034, People's Republic of China
| | - Xiaodong Tian
- Department of General Surgery, Peking University First hospital, 8th Xishiku Street, Beijing 100034, People's Republic of China
| | - Xuehai Xie
- Department of General Surgery, Peking University First hospital, 8th Xishiku Street, Beijing 100034, People's Republic of China
| | - Hongqiao Gao
- Department of General Surgery, Peking University First hospital, 8th Xishiku Street, Beijing 100034, People's Republic of China
| | - Yan Zhuang
- Department of General Surgery, Peking University First hospital, 8th Xishiku Street, Beijing 100034, People's Republic of China
| | - Yinmo Yang
- Department of General Surgery, Peking University First hospital, 8th Xishiku Street, Beijing 100034, People's Republic of China
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Beak-Like Extension of the Pancreatic Uncinate Process on MDCT: Is It Hyperplasia or Movement? J Comput Assist Tomogr 2016; 40:683-91. [PMID: 27224221 DOI: 10.1097/rct.0000000000000418] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE We aimed to evaluate the pancreatic uncinate process with a beak-like extension (BLE) beyond the left border of the superior mesenteric artery, to define the cause of BLE, and to differentiate BLE from hyperplasia. METHODS We retrospectively reviewed 1042 triple-phase contrast-enhanced multidetector-row computed tomography (3P-CE-MDCT) examinations of 500 patients. Finally, 38 patients (28 men, 10 women; mean age, 66 years) with 140 3P-CE-MDCT images showing BLE were studied regarding BLE size, contour, and cause. The superior mesenteric artery position was also evaluated. RESULTS Beak-like extensions were found in 7.6% of patients. Most were caused by movement of the small bowel mesentery (n = 21, 55%), with deviation of mesenteric vessels or mass effect from expanded adjacent organs (n = 3, 8%). Seven patients (18.5%) had true hyperplasia. CONCLUSIONS Beak-like extension is caused by movement of the small bowel mesentery with deviation of mesenteric vessels or by adjacent organ expansion. Beak-like extension closely mimics other pathology on nonenhanced MDCT.
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Pancreatic neck cancer has specific and oncologic characteristics regarding portal vein invasion and lymph node metastasis. Surgery 2016; 159:426-40. [DOI: 10.1016/j.surg.2015.07.001] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2015] [Revised: 06/23/2015] [Accepted: 07/01/2015] [Indexed: 01/08/2023]
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Roshdy S, Hussein O, Abdallah A, Abdel-Wahab K, Senbel A. Surgical management of adenocarcinoma of the pancreatic uncinate process in a cancer hospital in egypt. CLINICAL MEDICINE INSIGHTS. GASTROENTEROLOGY 2015; 8:1-6. [PMID: 25635169 PMCID: PMC4295910 DOI: 10.4137/cgast.s20650] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/30/2014] [Revised: 11/27/2014] [Accepted: 11/29/2014] [Indexed: 12/05/2022]
Abstract
INTRODUCTION Pancreatic carcinoma affecting the uncinate process is a challenging surgical condition. Several considerations affect the management plan, including the need for vascular resection and the ability to achieve a clear margin. METHODS The data of 19 patients who had curative resection for pancreatic adenocarcinoma of the uncinate process were reviewed. Operative mortality and morbidity, and disease-free survival (DFS) were calculated. RESULTS The study population included 13 male and 6 female patients with a mean age of 55 years. Nine patients (47.4%) had stage I disease, seven patients (36.8%) had stage II disease, and three patients (15.8%) had stage III disease. A total of 12 patients had Whipple procedure and 7 patients had total pancreatectomy. In total, there were 9 R0 and 10 R1 resections. Operative mortality rate was 10.5% (2/19), postoperative leakage rate was 21.1% (4/19), and wound sepsis rate was 21.1%. Median DFS was 19.2 months. Survival was superior in the Whipple procedure group than in the total pancreatectomy group (median survival 19 months vs 4 months, respectively). Vascular resection and retroperitoneal safety margin status did not affect disease relapse. CONCLUSION Non-metastatic pancreatic adenocarcinoma of the uncinate process should be offered R0 or R1 resection whenever technically feasible.
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Affiliation(s)
- Sameh Roshdy
- Surgical Oncology Department, Mansoura University Cancer Center, Mansoura, Egypt
| | - Osama Hussein
- Surgical Oncology Department, Mansoura University Cancer Center, Mansoura, Egypt
| | - Ahmed Abdallah
- Surgical Oncology Department, Mansoura University Cancer Center, Mansoura, Egypt
| | - Khaled Abdel-Wahab
- Surgical Oncology Department, Mansoura University Cancer Center, Mansoura, Egypt
| | - Ahmed Senbel
- Surgical Oncology Department, Mansoura University Cancer Center, Mansoura, Egypt
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Costa A, Yamashita ET, Takahashi W, Perosa M, Genzini T. Malignant duodenal obstruction: palliative endoscopic treatment using self-expanding metal prosthesis. Rev Assoc Med Bras (1992) 2012; 58:636-7. [PMID: 23250087 DOI: 10.1590/s0104-42302012000600003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/27/2023] Open
Affiliation(s)
- Adriana Costa
- Center for Advanced Therapeutic Diagnostic Endoscopy-Hospital Santa Helena, São Paulo, SP, Brazil
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Costa A, Tomohissa Yamashita E, Takahashi W, Perosa M, Genzini T. Obstrução duodenal maligna: tratamento endoscópico paliativo utilizando prótese metálica autoexpansível. Rev Assoc Med Bras (1992) 2012. [DOI: 10.1016/s0104-4230(12)70262-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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He JJ, Ding KF, Zheng L, Xu JH, Li J, Wu YL, Sun LF, Zhou DE, Zheng S. Adenosquamous carcinoma of the uncinate process of the pancreas with synchronous gastrointestinal stromal tumor of the stomach: Case report and review of the literature. Oncol Lett 2012. [PMID: 23197997 DOI: 10.3892/ol.2012.902] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
Recently, the coexistence of gastrointestinal stromal tumors (GISTs) with other neoplasms has been studied with increasing frequency. Coexistence of pancreatic cancer with GISTs remains a rarity; however, here, we report a very rare case of adenosquamous carcinoma (ASC) of the uncinate process of the pancreas with synchronous GISTs of the stomach in a 62-year-old female. The patient presented with epigastric discomfort and vomiting. Radiographic imaging revealed two masses; one located at the body of the stomach and the other located at the uncinate process of the pancreas. Intraoperatively, a fine needle aspiration biopsy was conducted in the uncinate process of the pancreas, which revealed the malignancy of the masses. A pancreaticoduodenectomy and partial gastrectomy were then conducted, and subsequent pathological examinations identified an ASC of the pancreas and a GIST of the stomach. In our case, contrary to the majority of previous cases of synchronous GISTs and other malignancies, GIST was not an incidental finding. The initial suspicion on the GIST as the underlying cause of clinical symptoms led to the discovery of the ASC of the uncinate process of the pancreas.
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Affiliation(s)
- Jin-Jie He
- Department of Surgical Oncology, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang 310009, P.R. China
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Abstract
OBJECTIVE The objective of the study was to delineate surgical outcomes of pancreatoduodenectomy following neoadjuvant concurrent chemoradiation therapy (CCRT) in uncinate process pancreatic cancer (UPC). METHODS We reviewed 97 patients with resected usual pancreatic head cancer (PHC) and UPC and analyzed clinicopathologic characteristics and survival outcomes of PHC and UPC with a review of the reported literature regarding UPC. RESULTS Twenty-five patients (27.8%) had UPC, and 72 patients had PHC. Pylorus-preserving pancreatoduodenectomy was performed in 67 patients (69.1%) and conventional pancreatoduodenectomy in 28 patients (28.9%), and 2 patients needed total pancreatectomies. When comparing UPCs with PHCs, less frequent jaundice (P = 0.009) and more advanced stages of cancers at the time of diagnosis (linear-to-linear association, P = 0.03) were found in UPCs, and CCRT was administered more frequently in UPCs (P = 0.013). Survival outcomes between PHC and UPC were similar, with median survival rates of 25.9 and 30.5 months, respectively (P = 0.702). In addition, disease-free survival was similar between the 2 groups (15.6 and 15.2 months, respectively; P = 0.4503). Our oncologic outcome of pancreatectomy for UPC is likely to be more acceptable compared with those previously reported in the literature. CONCLUSIONS Although UPCs are found in relatively advanced clinical stages, favorable oncologic outcomes may be obtained by pancreatectomy following preoperative CCRT.
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Padilla-Thornton AE, Willmann JK, Jeffrey RB. Adenocarcinoma of the uncinate process of the pancreas: MDCT patterns of local invasion and clinical features at presentation. Eur Radiol 2011; 22:1067-74. [DOI: 10.1007/s00330-011-2339-4] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2011] [Revised: 10/26/2011] [Accepted: 10/29/2011] [Indexed: 11/25/2022]
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Alvarado-Bachmann R, Choi J, Gananadha S, Hugh T, Samra J. The infracolic approach to pancreatoduodenectomy for large pancreatic head tumours invading the colon. Eur J Surg Oncol 2010; 36:1220-4. [DOI: 10.1016/j.ejso.2010.08.132] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2009] [Revised: 08/12/2010] [Accepted: 08/19/2010] [Indexed: 01/14/2023] Open
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Kang MJ, Jang JY, Lee SE, Lim CS, Lee KU, Kim SW. Comparison of the long-term outcomes of uncinate process cancer and non-uncinate process pancreas head cancer: poor prognosis accompanied by early locoregional recurrence. Langenbecks Arch Surg 2010; 395:697-706. [PMID: 20652784 DOI: 10.1007/s00423-010-0593-6] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2009] [Accepted: 01/07/2010] [Indexed: 12/22/2022]
Abstract
PURPOSE The embryologic and anatomic peculiarity of the uncinate process may result in distinct clinical features, but few studies have addressed the uncinate process cancer. The purpose of this study was to compare the clinicopathologic characteristics and identify the prognostic factors that affect the survival and recurrence of pancreatic head cancer by tumor location. METHODS Between January 2002 and December 2008, 453 patients (161 with uncinate and 292 with non-uncinate process cancer) were treated for pancreatic head cancer. Clinicopathologic variables were analyzed by tumor location. RESULTS Invasion into the superior mesenteric artery (SMA) occurred more frequently (p < 0.001), and overall resectability (p = 0.003), curative resection (p < 0.001), and R0 resection rates (22.3% vs 35.6%; p = 0.003) were lower for uncinate process cancer. Furthermore, overall survival after R0 resection was lower for uncinate process cancer (median 21 vs 26 months; p = 0.018), and this was accompanied by more frequent (p = 0.038) and earlier (median 13 vs 52 months; p < 0.001) locoregional recurrence. Concurrent chemoradiation increased overall (median, 26 vs 13 months; p < 0.001) and disease-free survival (median, 15 vs 6 months; p < 0.001) of uncinate and non-uncinate process cancer, respectively, after curative-intended resection. CONCLUSION In uncinate process cancer, frequent invasion into the SMA led to lower resectability. Furthermore, lower survival after R0 resection was accompanied with frequent and early locoregional recurrence. Strategies to improve surgical and perioperative locoregional control are required for uncinate process cancer.
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Affiliation(s)
- Mee Joo Kang
- Department of Surgery, Seoul National University College of Medicine, 28 Yongon-dong, Chongno-gu, Seoul, 110-744, South Korea
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Shanmugarajah K, Hui E, Vergis N, Schelvan C, Robinson S. Carcinoma of the uncinate process of the pancreas presenting with deep vein thrombosis: a case report. CASES JOURNAL 2009; 2:8780. [PMID: 20184696 DOI: 10.1186/1757-1626-0002-0000008780] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Subscribe] [Scholar Register] [Received: 07/26/2009] [Accepted: 08/21/2009] [Indexed: 11/10/2022]
Abstract
The uncinate process is a hook-like projection of the inferior aspect of the head of the pancreas. Carcinoma of the uncinate process of the pancreas is considered to be rare, difficult to diagnose and particularly devastating. The current method of detection is computed tomography. We report a case of carcinoma of the uncinate process of the pancreas in a patient who initially presented with deep vein thrombosis. The diagnosis of carcinoma of the uncinate process of the pancreas should be considered in patients who present with primary thromboembolic disease and other nonspecific signs.
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Affiliation(s)
- Kumaran Shanmugarajah
- Department of Endocrinology and Metabolic Medicine, The Mint Wing, Imperial College Healthcare NHS Trust, St Mary's Hospital,London, W2 1NY, UK. kumaran.shanmugarajah
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Bittner R, Büchler MW. The surgical school of Hans G. Beger in Ulm. Am J Surg 2007. [DOI: 10.1016/j.amjsurg.2007.05.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Ide Y, Miyoshi E, Nakagawa T, Gu J, Tanemura M, Nishida T, Ito T, Yamamoto H, Kozutsumi Y, Taniguchi N. Aberrant expression of N-acetylglucosaminyltransferase-IVa and IVb (GnT-IVa and b) in pancreatic cancer. Biochem Biophys Res Commun 2006; 341:478-82. [PMID: 16434023 DOI: 10.1016/j.bbrc.2005.12.208] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2005] [Accepted: 12/29/2005] [Indexed: 12/17/2022]
Abstract
The goal of this study was to identify glycosyltransferases that are specifically expressed in pancreatic cancer. To investigate the gene expression of glycosyltransferases between pancreatic cancer and normal pancreatic tissues, we performed DNA-microarray (involving about 1000 oligosaccharide-related genes) using RNA mixtures of pancreatic cancer cells and normal pancreatic tissues. Eighty-six genes were up-regulated and thirty-two were down-regulated in pancreatic cancer, compared to normal pancreatic tissue. Among these changes, it is noteworthy that the expression of GnT-IVa was decreased and the expression of GnT-IVb was increased in pancreatic cancer, compared to normal pancreatic tissues. Although GnT-IVa and -IVb are involved in the same reaction as a glycosyltransferase, their chromosomal localization is different. When 5 cases of pancreatic cancer tissues were examined using the real-time RT-PCR method, the expression of GnT-IVb was dominant in tumor tissues and the expression of GnT-IVa was dominant in the surrounding normal tissues. The expression of GnT-IVa was increased in all 3 cell lines that had been treated with 5-aza-C and butyrate. These results suggest that the down-regulation of GnT-IVa in pancreatic cancer cells is due to an epigenetic abnormality in the gene.
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Affiliation(s)
- Yoshihito Ide
- Department of Biochemistry, Osaka University Graduate School of Medicine, Suita, Osaka 565-0871, Japan
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Beger HG, Rau B, Gansauge F, Poch B, Link KH. Treatment of pancreatic cancer: challenge of the facts. World J Surg 2003; 27:1075-84. [PMID: 12925907 DOI: 10.1007/s00268-003-7165-7] [Citation(s) in RCA: 137] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Adenocarcinoma of the pancreas is associated with the worst survival of any form of gastrointestinal malignancy. In spite of the progress in surgical treatment, resulting in increasing resection rates and a decrease in treatment-related morbidity and mortality, the true figures of cure are even today below 3%. The dissemination of pancreatic cancer behind the local tissue compartments restricts the short-term (< 3 years) and long-term outcome for patients who have undergone resection. By histological evaluation, less than 15% of the patients undergoing R(0) resection have a pN(0) status, more than 60% suffer from lymph angiosis carcinomatosa, and more than 50% suffer extrapancreatic nerve plexus infiltration. Hematoxylin and eosin-negative lymph nodes were found to be cancer positive when reverse transcriptase polymerase chain reaction (RT- PCR) or immunostaining was applied to the HE-negative lymph nodes. Cancer of the uncinate process has a very poor prognosis because there are no early symptoms; vessel wall involvement occurs early and frequently; a high association of liver metastasis exists as well. Surgery offers a low success rate, but it provides the only chance of cure. Ductal pancreatic cancer is diagnosed in more than 95% of the cases in an advanced stage; potentially curative resection can be performed only in about 10%-15% of these patients. Major contributions of surgery to improved treatment results are the reduction of surgical morbidity--e.g., early postoperative local and systemic complications--and a decrease of hospital mortality below 3%-5%. In most recently published prospective trials, R(0) resection has been reported to result in an increase in short-term survival beyond that recorded for patients with residual tumor. However, R(0) resection fails to improve long-term survival. In many published R(0) series, standard tissue resection of pancreatic head cancer with the Kausch-Whipple procedure failed to include remote cancer cell-positive tissues in the operative specimen; e.g., N(2)-lymph nodes, nerve plexus, and perivascular extrapancreatic and retropancreatic tissues were not excised. Cancer recurrence after so-called R(0) resection with curative intent is frequently the consequence of cancer left behind. Thus, long-term survival (> 5 years) is observed in a very small group of patients, contradicting the published 5-year actuarial survival rates of 20%-45% for resected patients. The assessment of clinical benefit from surgical or medical cancer treatment should therefore be based on several end points, not only on actuarial survival. Publication of actuarial survival figures must include the number of observed (actual) survivals, the definition of the subset of patients followed after resection, and the total number of patients in the study group; anything less is misleading. In reporting pancreatic cancer treatment trial results after oncological resections, more convincing primary end points to evaluate treatment efficacy are median survival (in months), actual survival at 1-5 years, and progression-free survival (in months). In series with multimodality treatment, clinical benefit response as well as quality of life measurements using the EORTC Quality of Life index C30 (QLQ-C30) are of importance in evaluating survival data. Adjuvant treatment improves survival after oncological resection; however, the short-term and long-term benefit after adjuvant chemotherapy in R(0) as well as in R(1)-(2) resected patients has not yet been underscored by data from controlled clinical trials. The survival benefit (median survival time) of adjuvant chemotherapy or radiochemotherapy has been demonstrated to be 6-10 months. Therefore, after oncological resection of pancreatic cancer each patient should be offered adjuvant treatment. A neoadjuvant treatment protocol for pancreatic cancer, however, has not been established.
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