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Revoredo Rego F, Reaño Paredes G, de Vinatea de Cárdenas J, Herrera Chávez G, Kometter Barrios F, Arenas Gamio J. Intraductal papillary mucinous neoplasm of pancreas: Clinicopathological features and long-term survival after surgical resection. Cir Esp 2023; 101:736-745. [PMID: 36716959 DOI: 10.1016/j.cireng.2023.01.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2022] [Revised: 10/04/2022] [Accepted: 10/30/2022] [Indexed: 02/01/2023]
Abstract
INTRODUCTION Intraductal papillary mucinous neoplasm (IPMN) of the pancreas can progress from low-grade dysplasia to high-grade dysplasia and invasive carcinoma. METHODS In this single-center retrospective series, we analyze the clinicopathological features and long-term follow up of patients who underwent pancreatic resection for IPMN, from January 2009 to December 2019. RESULTS 31 patients were diagnosed with IPMN: 9 males and 22 females. Mean age was 67 years. Twenty-seven patients (87%) were symptomatic. Seven patients had main duct IPMN, 11 branch-type IPMN and 13 mixed-type IPMN. High-risk stigmata were found in 20 patients (64.5%) and worrisome features in 10 patients (32.2%). Thirteen patients (41.9%) had an associated invasive carcinoma, 4 (12.9%) high-grade dysplasia and 14 (45.2%) low-grade dysplasia. The follow-up was from 2 to 12 years. Median survival for patients with IPMN and associated invasive carcinoma was 45.8 months, and disease-free survival was 40.8 months. CONCLUSIONS IPMN had a higher prevalence in females, mostly symptomatic and high incidence of associated invasive carcinoma with branch type. The 5-year survival was good even with associated invasive carcinoma.
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Affiliation(s)
- Fernando Revoredo Rego
- Servicio de Cirugía de Páncreas, Bazo y Retroperitoneo, Hospital Nacional Guillermo Almenara Irigoyen, Lima, Peru.
| | - Gustavo Reaño Paredes
- Servicio de Cirugía de Páncreas, Bazo y Retroperitoneo, Hospital Nacional Guillermo Almenara Irigoyen, Lima, Peru
| | - José de Vinatea de Cárdenas
- Servicio de Cirugía de Páncreas, Bazo y Retroperitoneo, Hospital Nacional Guillermo Almenara Irigoyen, Lima, Peru
| | - Guillermo Herrera Chávez
- Servicio de Cirugía de Páncreas, Bazo y Retroperitoneo, Hospital Nacional Guillermo Almenara Irigoyen, Lima, Peru
| | - Fritz Kometter Barrios
- Servicio de Cirugía de Páncreas, Bazo y Retroperitoneo, Hospital Nacional Guillermo Almenara Irigoyen, Lima, Peru
| | - José Arenas Gamio
- Servicio de Anatomía Patológica, Hospital Nacional Guillermo Almenara Irigoyen, Lima, Peru
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Revoredo Rego F, Reaño Paredes G, de Vinatea de Cárdenas J, Herrera Chávez G, Kometter Barrios F, Arenas Gamio J. Neoplasia mucinosa papilar intraductal del páncreas: características clínico-patológicas y supervivencia a largo plazo de pacientes sometidos a pancreatectomía. Cir Esp 2023. [DOI: 10.1016/j.ciresp.2022.10.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/16/2023]
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Revoredo Rego F, Reaño Paredes G, De Vinatea De Árdenas J, Kometter Barrios F, Alfaro Ita S, Vereau Robles J. [Infected necrotizing pancreatitis. Video-assisted retroperitoneal debridement]. Medicina (B Aires) 2021; 81:115-118. [PMID: 33611255] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/12/2023] Open
Abstract
The step-up approach for infected necrotizing pancreatitis, consisting of broad-spectrum antibiotics, drainage followed, if necessary, by minimally invasive necrosectomy, has replaced open surgery as the standard of management. Video-assisted retroperitoneal debridement (VARD) is a surgical minimally invasive necrosectomy. This is a 5 cases series (2 female and 3 males) with severe acute pancreatitis and infected pancreatic necrosis who underwent step up approach and VARD. The age ranged from 27 to 60 years old. Al patients had biliary pancreatitis. APACHE II ranged from 16 to 20. The time to percutaneous lumbar drainage ranged from 4 to 7 weeks. There was one complication associated with percutaneous drainage (duodenal fistula) with nonoperative management. All necrotizing pancreatitis had positive cultures. The time to perform VARD ranged from 6 to 10 weeks. One patient required two procedures. There were two type B pancreatic fistulas associated with VARD, managed nonoperatively. There was no mortality. During long-term follow-up two patients were diagnosed with exocrine and endocrine pancreatic insufficiency. We conclude that VARD is a safe and effective procedure in patients with infected necrotizing pancreatitis requiring debridement, and with good long-term outcomes.
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Affiliation(s)
- Fernando Revoredo Rego
- Servicio de Cirugía de Páncreas, Bazo y Retroperitoneo, Hospital Nacional Guillermo Almenara Irigoyen, Lima, Perú. E-mail:
| | - Gustavo Reaño Paredes
- Servicio de Cirugía de Páncreas, Bazo y Retroperitoneo, Hospital Nacional Guillermo Almenara Irigoyen, Lima, Perú
| | - José De Vinatea De Árdenas
- Servicio de Cirugía de Páncreas, Bazo y Retroperitoneo, Hospital Nacional Guillermo Almenara Irigoyen, Lima, Perú
| | - Fritz Kometter Barrios
- Servicio de Cirugía de Páncreas, Bazo y Retroperitoneo, Hospital Nacional Guillermo Almenara Irigoyen, Lima, Perú
| | - Sheyla Alfaro Ita
- Servicio de Radiología Intervencionista, Hospital Nacional Guillermo Almenara Irigoyen, Lima, Perú
| | - José Vereau Robles
- Servicio de Cuidados Intensivos, Hospital Nacional Guillermo Almenara Irigoyen, Lima, Perú
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Revoredo Rego F, De Vinatea De Cárdenas J, Reaño Paredes G, Villanueva Alegre L, Kometter Barrios F, Tang Sing J, Uribe León M, Italo Aliaga L, Arenas Gamio J. [Hydatid cysts in pancreas: laparoscopic approach]. Rev Gastroenterol Peru 2016; 36:264-268. [PMID: 27716766] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
UNLABELLED Hydatid disease is a parasitic infestation caused by Echinococcus and is endemic in many areas of the world. Hydatid cysts are commonly located in the liver and lung. Pancreas affection is very rare even in endemic areas. CASE REPORT 36-year-old female with the suspicion of hydatid disease of the pancreas 5 years before her admission. The patient gave history of epigastric pain and weight lose. CT scan and MRI showed a cystic lesion of the tail of the pancreas and the diagnosis of hydatid disease was confirmed with ELIZA and Western Blot. The patient underwent a laparoscopic distal spleno pancreatectomy. The recovery was uneventful. CONCLUSION Hydatid disease must be considered in the differential diagnosis of the cystic lesions of the pancreas, especially in patients who come from endemic areas.
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Affiliation(s)
- Fernando Revoredo Rego
- Servicio de Cirugía de Páncreas, Bazo y Retroperitoneo, Hospital Nacional Guillermo Almenara Irigoyen. Lima, Perú
| | - José De Vinatea De Cárdenas
- Servicio de Cirugía de Páncreas, Bazo y Retroperitoneo, Hospital Nacional Guillermo Almenara Irigoyen. Lima, Perú
| | - Gustavo Reaño Paredes
- Servicio de Cirugía de Páncreas, Bazo y Retroperitoneo, Hospital Nacional Guillermo Almenara Irigoyen. Lima, Perú
| | - Luis Villanueva Alegre
- Servicio de Cirugía de Páncreas, Bazo y Retroperitoneo, Hospital Nacional Guillermo Almenara Irigoyen. Lima, Perú
| | - Fritz Kometter Barrios
- Servicio de Cirugía de Páncreas, Bazo y Retroperitoneo, Hospital Nacional Guillermo Almenara Irigoyen. Lima, Perú
| | - Jorge Tang Sing
- Servicio de Cirugía de Páncreas, Bazo y Retroperitoneo, Hospital Nacional Guillermo Almenara Irigoyen. Lima, Perú
| | - Mónica Uribe León
- Servicio de Cirugía de Páncreas, Bazo y Retroperitoneo, Hospital Nacional Guillermo Almenara Irigoyen. Lima, Perú
| | - Landeo Italo Aliaga
- Servicio de Gastroenterología, Hospital Nacional Guillermo Almenara Irigoyen. Lima, Perú
| | - José Arenas Gamio
- Servicio de Anatomía Patológica, Hospital Nacional Guillermo Almenara Irigoyen. Lima, Perú
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Revoredo Rego F, De Vinatea de Cárdenas J, Reaño Paredes G, Villanueva Alegre L, Kometter Barrios F, Tang Sing J, Uribe León M, Arenas Gamio J. Insulinoma pancreático gigante. An Fac med 2016. [DOI: 10.15381/anales.v77i1.11555] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
Los insulinomas son los tumores neuroendocrinos pancreáticos más frecuentes y típicamente son benignos y pequeños. Los insulinomas gigantes de páncreas son tumores raros. Reportamos el caso de un paciente varón de 67 años, quien presentaba síntomas y signos de hipoglicemia. Subsecuentes estudios de laboratorio y radiológicos establecieron el diagnóstico de un insulinoma de 13,5 cm. Fue sometido a pancreaticoduodenectomía. A pesar del tamaño, en la evaluación patológica no se identificó invasión local ni metástasis. Además de la descripción de la presentación clínica y los hallazgos operatorios, se realiza una revisión de las opciones para la localización y manejo de los insulinomas.
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Revoredo Rego F, Reaño Paredes G, Kometter Barrios F, Villanueva Alegre L, Arenas Gamio J, de Vinatea de Cárdenas J. [Intraductal papillary mucinous neoplasms of the pancreas in Hospital Nacional Guillermo Almenara Irigoyen, Lima, Peru]. Rev Gastroenterol Peru 2014; 34:195-201. [PMID: 25293987] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
OBJECTIVE To analyze retrospectively the clinical, radiologic and pathologic features as well as the surgical results of the patients with diagnosis of intraductal papillary mucinous neoplasms of the pancreas (IPMN). MATERIALS AND METHODS Patients with diagnosis of IPMN who underwent pancreatectomy were identified from January 2006 to September 2013, using the prospective data base of the Pancreas, Spleen and retroperitoneum HNGAI service. RESULTS A total of 11 patients were found (9 females and 2 males). The mean age was 67.36 years. 2 were main duct type IPMN, 3 branch type and 6 mixed type. All patients had symptoms. The pain was the most frequent symptom, 27% had pancreatitis. For the diagnosis 100% had CT scan, 90% MRI. 10 patients underwent pancreaticoduodenectomy and 1 distal pancreatectomy. 2 patients had type C pancreatic fistula. 2 patients underwent reoperation and 1 died. 5 patients had low grade dysplasia, 2 moderate dysplasia, 1 high grade dysplasia and 3 invasive carcinoma. CONCLUSIONS This entity is present in our country being more common in women. The mixed type IPMN is the most frequent type. Complication with the highest incidence is the pancreatic fistula and the mortality rate is low. The IPMN´s malignancy potential founded was high.
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Affiliation(s)
- Fernando Revoredo Rego
- Servicio de Cirugía de Páncreas, Bazo y Retroperitoneo. Hospital Nacional Guillermo Almenara Irigoyen. Lima, Perú
| | - Gustavo Reaño Paredes
- Servicio de Cirugía de Páncreas, Bazo y Retroperitoneo. Hospital Nacional Guillermo Almenara Irigoyen. Lima, Perú
| | - Fritz Kometter Barrios
- Servicio de Cirugía de Páncreas, Bazo y Retroperitoneo. Hospital Nacional Guillermo Almenara Irigoyen. Lima, Perú
| | - Luis Villanueva Alegre
- Servicio de Cirugía de Páncreas, Bazo y Retroperitoneo. Hospital Nacional Guillermo Almenara Irigoyen. Lima, Perú
| | - José Arenas Gamio
- Servicio de Anatomía Patológica. Hospital Nacional Guillermo Almenara Irigoyen. Lima, Perú
| | - José de Vinatea de Cárdenas
- Servicio de Cirugía de Páncreas, Bazo y Retroperitoneo. Hospital Nacional Guillermo Almenara Irigoyen. Lima, Perú
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Reaño Paredes G, De Vinatea De Cárdenas J, Revoredo Rego F, Kometter Barrios F, Villanueva Alegre L, Arenas Gamio J, Uribe León M. [Pancreatoduodenectomy for ampullary adenocarcinoma and and re-intervention for ganglinonar recurrency]. Rev Gastroenterol Peru 2014; 34:247-253. [PMID: 25293995] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
A 30 years old woman in the 13 week of her second pregnancy who had severe anemia, upper gastrointestinal bleeding and weight loss. She was given the endoscopic diagnosis of a well differentiated ampullary adenocarcinoma. She underwent a pancreato duodenectomy during the 16 week of pregnancy without complications. After 4 months of follow up we identified a ganglionar local recurrence so that's why she underwent a cesarean in the 34 week of pregnancy. The product was a healthy 2500 gr. newborn. We decided a reoperation for the resection of the recurrence and it was carried out successfully. Currently the patient has 36 months of follow up without evidence of recurrence and her baby has a normal grow up.
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Affiliation(s)
- Gustavo Reaño Paredes
- Servicio de Cirugía de Páncreas, Bazo y Retroperitoneo, Departamento de Cirugía General, Hospital Nacional Guillermo Almenara Irigoyen, EsSalud. Lima, Perú
| | - José De Vinatea De Cárdenas
- Servicio de Cirugía de Páncreas, Bazo y Retroperitoneo, Departamento de Cirugía General, Hospital Nacional Guillermo Almenara Irigoyen, EsSalud. Lima, Perú
| | - Fernando Revoredo Rego
- Servicio de Cirugía de Páncreas, Bazo y Retroperitoneo, Departamento de Cirugía General, Hospital Nacional Guillermo Almenara Irigoyen, EsSalud. Lima, Perú
| | - Fritz Kometter Barrios
- Servicio de Cirugía de Páncreas, Bazo y Retroperitoneo, Departamento de Cirugía General, Hospital Nacional Guillermo Almenara Irigoyen, EsSalud. Lima, Perú
| | - Luis Villanueva Alegre
- Servicio de Cirugía de Páncreas, Bazo y Retroperitoneo, Departamento de Cirugía General, Hospital Nacional Guillermo Almenara Irigoyen, EsSalud. Lima, Perú
| | - José Arenas Gamio
- Servicio de Anatomía Patológica, Hospital Nacional Guillermo Almenara Irigoyen, EsSalud. Lima, Perú
| | - Mónica Uribe León
- Servicio de Cirugía de Páncreas, Bazo y Retroperitoneo, Departamento de Cirugía General, Hospital Nacional Guillermo Almenara Irigoyen, EsSalud. Lima, Perú
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