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Alvarez XD, Fernando Alcázar C, Hernando Sanz A, Mora Oliver I, Granel L, Barreras JA, Calero A, Carbonell Morote S, Domingo C, Estevan R, Oliver I, López Andujar R, Sabater L, Compañ A, Ramia JM. Solid pseudopapillary neoplasms of the pancreas: Multicenter Vasepa study. Cir Esp 2024:S2173-5077(24)00047-4. [PMID: 38355041 DOI: 10.1016/j.cireng.2024.02.001] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2023] [Accepted: 11/18/2023] [Indexed: 02/16/2024]
Abstract
INTRODUCTION Solid pseudopapillary tumors (SPT) of the pancreas are rare exocrine neoplasms of the pancreas. Correct preoperative diagnosis is not always feasible. The treatment of choice is surgical excision. These tumors have a good prognosis with a high disease-free survival rate. OBJECTIVE To describe the clinicopathological and radiological characteristics as well as short- and long-term follow-up results of patients who have undergone SPT resection. METHODS Multicenter retrospective observational study in patients with SPT who had undergone surgery from January 2000-January 2022. We have studied preoperative, intraoperative, and postoperative variables as well as the follow-up results (mean 28 months). RESULTS 20 patients with histological diagnosis of SPT in the surgical specimen were included. 90% were women; mean age was 33.5 years (13-67); 50% were asymptomatic. CT was the most used diagnostic test (90%). The most frequent location was body-tail (60%). Preoperative biopsy was performed in 13 patients (65%), which was correct in 8 patients. Surgeries performed: 7 distal pancreatectomies, 6 pancreaticoduodenectomies, 4 central pancreatectomies, 2 enucleations, and 1 total pancreatectomy. The R0 rate was 95%. Four patients presented major postoperative complications (Clavien-Dindo > II). Mean tumor size was 81 mm. Only one patient received adjuvant chemotherapy. With a mean follow-up of 28 months, 5-year disease-free survival was 95%. CONCLUSION SPT are large, usually located in the body-tail of the pancreas, and more frequent in women. The R0 rate obtained in our series is very high (95%). The oncological results are excellent.
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Affiliation(s)
- Xiomara Duque Alvarez
- Departamento de Cirugía, Hospital General Universitario Dr. Balmis, Alicante, Spain.
| | | | - Ana Hernando Sanz
- Departamento de Cirugía, Hospital Universitario y Politécnico La Fe, Valencia, Spain
| | - Isabel Mora Oliver
- Departamento de Cirugía, Hospital Clínico Universitario de Valencia, Valencia, Spain
| | - Laura Granel
- Departamento de Cirugía, Hospital General Universitario de Castellón, Castellón, Spain
| | - José A Barreras
- Departamento de Cirugía, Hospital General Universitario de Elche, Elche, Spain
| | - Alicia Calero
- Departamento de Cirugía, Hospital General Universitario de Elche, Elche, Spain
| | | | - Carlos Domingo
- Departamento de Cirugía, Hospital Universitario Doctor Peset, Valencia, Spain
| | - Rafael Estevan
- Departamento de Cirugía, Instituto Valenciano de Oncología, Valencia, Spain
| | - Israel Oliver
- Departamento de Cirugía, Hospital General Marina Baja Villajoyosa. Villajoyosa, Spain
| | - Rafael López Andujar
- Departamento de Cirugía, Hospital Universitario y Politécnico La Fe, Valencia, Spain
| | - Luis Sabater
- Departamento de Cirugía, Hospital Clínico Universitario de Valencia, Valencia, Spain
| | - Antonio Compañ
- Departamento de Cirugía, Hospital General Universitario San Juan, Alicante, Spain; Universidad Miguel Hernández, Campus Sant Joan Alicante, Spain
| | - José M Ramia
- Departamento de Cirugía, Hospital General Universitario Dr. Balmis, Alicante, Spain; Universidad Miguel Hernández, Campus Sant Joan Alicante, Spain
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Baran E, D'Ascenzo MV, Bosia JD, Montaña P. Abdominal ultrasound findings in adult patients with cystic fibrosis. Rev Gastroenterol Mex (Engl Ed) 2024; 89:19-24. [PMID: 35882591 DOI: 10.1016/j.rgmxen.2022.07.002] [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] [Subscribe] [Scholar Register] [Received: 10/10/2021] [Accepted: 05/18/2022] [Indexed: 10/16/2022]
Abstract
INTRODUCTION AND AIMS Cystic fibrosis (CF) is a genetic disease whose gastrointestinal compromise mainly involves the pancreas, bile ducts, and liver. Our aim was to analyze abdominal ultrasound findings. METHODS A retrospective, descriptive study was conducted on adults (patients ≥ 16 years of age) diagnosed with CF, within the time frame of 2006-2019. Clinical and genetic parameters, body mass index, forced expiratory volume in one second, pancreatic insufficiency, CF-related diabetes, cirrhosis secondary to CF, and abdominal ultrasound images were analyzed. RESULTS Seventy patients, 39 of whom were men (55.8%), had a mean age of 27 years and a mean body mass index of 21.3 ± 2.8 kg/m2 (r: 17-30.9). Forty-seven (67.1%) presented with pancreatic insufficiency, 6 (8.5%) with cirrhosis secondary to CF, and 21 (30%) had CF-related diabetes. Median forced expiratory volume in one second was 47% and the F508del mutation was found in 56.1%. Images of the pancreas: no pathologic findings in 49 (70%), increased echogenicity in 18 (25.7%), and cysts in 3 (4.3%). Gallbladder images: microgallbladder in 3 (4.2%), biliary sludge in 2 (2.8%), gallstones in 7 (10%), and a history of cholecystectomy in 4 (5.8%). Liver and spleen images: no pathologic findings in 47 (67.2%), homogeneous hepatomegaly with splenomegaly in 2 (2.8%), a heterogeneous pattern of the parenchyma in 11 (15.8%), increased echogenicity in 4 (5.7%), and heterogeneous echo patterns, lobulated liver contour, and splenomegaly in 6 (8.5%). CONCLUSION Abdominal ultrasound is a safe, low-cost technique that enables the identification of some degree of chronic liver and pancreatic diseases, improving the approach and follow-up decisions in adult patients with CF.
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Affiliation(s)
- E Baran
- Unidad de Adultos con Fibrosis Quística, Servicio de Neumonología, Hospital Rodolfo Rossi, La Plata, Buenos Aires, Argentina.
| | - M V D'Ascenzo
- Unidad de Adultos con Fibrosis Quística, Servicio de Gastroenterología, Hospital Rodolfo Rossi, La Plata, Buenos Aires, Argentina
| | - J D Bosia
- Unidad de Adultos con Fibrosis Quística, Servicio de Gastroenterología, Hospital Rodolfo Rossi, La Plata, Buenos Aires, Argentina
| | - P Montaña
- Servicio de Imágenes, Hospital Rodolfo Rossi, La Plata, Buenos Aires, Argentina
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Nogueira Sixto M, Carracedo Iglesias R, Estévez Fernández S, Rodríguez Pereira C, Sánchez Santos R. Pancreatic PEComa, a not so uncommon neoplasm? Systematic review and therapeutic update. Gastroenterol Hepatol 2024; 47:93-100. [PMID: 37230381 DOI: 10.1016/j.gastrohep.2023.05.009] [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] [Subscribe] [Scholar Register] [Received: 03/29/2023] [Revised: 05/12/2023] [Accepted: 05/18/2023] [Indexed: 05/27/2023]
Abstract
Pancreatic PEComas are extremely rare neoplasms with malignant potential, which mostly affect middle-aged women and are characterized by presenting melanocytic and myogenic markers in immunohistochemical analysis. There are no symptoms or pathognomonic imaging tests, so the diagnosis is established with the analysis of the surgical specimen or the FNA obtained with preoperative endoscopic ultrasound. The mean treatment consists on radical excision, adapting the intervention to the location of the tumor. To date, 34 cases have been described; however, more than 80% of them have been reported in the last decade, which suggests that it is a more frequent pathology than expected. A new case of pancreatic PEComa is reported and a systematic review of the literature is carried out according to the PRISMA guidelines with the aim of divulge this pathology, deepening its knowledge and updating its management.
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Affiliation(s)
- Manuel Nogueira Sixto
- Servicio de Cirugía General y del Aparato Digestivo, Complejo Hospitalario Universitario de Vigo, Vigo, Galicia, España.
| | - Roberto Carracedo Iglesias
- Servicio de Cirugía General y del Aparato Digestivo, Complejo Hospitalario Universitario de Vigo, Vigo, Galicia, España
| | - Sergio Estévez Fernández
- Servicio de Cirugía General y del Aparato Digestivo, Complejo Hospitalario Universitario de Vigo, Vigo, Galicia, España
| | - Carlos Rodríguez Pereira
- Servicio de Anatomía Patológica, Complejo Hospitalario Universitario de Vigo, Vigo, Galicia, España
| | - Raquel Sánchez Santos
- Servicio de Cirugía General y del Aparato Digestivo, Complejo Hospitalario Universitario de Vigo, Vigo, Galicia, España
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Espin Alvarez F, García-Domingo MI, Cremades Pérez M, Pardo Aranda F, Vidal Piñeiro L, Herrero Fonollosa E, Navinés López J, Zárate Pinedo A, Camps-Lasa J, Cugat Andorrà E. Laparoscopic and robotic distal pancreatectomy: the choice and the future. Cir Esp 2023; 101:765-771. [PMID: 37119949 DOI: 10.1016/j.cireng.2023.04.017] [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: 09/29/2022] [Revised: 01/03/2023] [Accepted: 02/21/2023] [Indexed: 05/01/2023]
Abstract
INTRODUCTION Distal pancreatectomy (DP) is currently well established as a minimally invasive surgery (MIS) procedure, using either a laparoscopic (LDP) or robotic (RDP) approach. METHODS Out of 83 DP performed between January 2018 and March 2022, 57 cases (68.7%) were performed using MIS: 35 LDP and 22 RDP (da Vinci Xi). We have assessed the experience with the two techniques and analyzed the value of the robotic approach. Cases of conversion have been examined in detail. RESULTS The mean operative times for LDP and RDP were 201.2 (SD 47.8) and 247.54 (SD 35.8) minutes, respectively (P = NS). No differences were observed in length of hospital stay or conversion rate: 6 (5-34) vs. 5.6 (5-22) days, and 4 (11.4%) vs. 3 (13.6%) cases, respectively (P = NS). The readmission rate was 3/35 patients (11.4%) treated with LDP and 6/22 (27.3%) cases of RDP (P = NS). There were no differences in morbidity (Dindo-Clavien ≥ III) between the two groups. Mortality was one case in the robotic group (a patient with early conversion due to vascular involvement). The rate of R0 resection was greater and statistically significant in the RDP group (77.1% vs. 90.9%) (P = .04). CONCLUSION Minimally invasive distal pancreatectomy (MIDP) is a safe and feasible procedure in selected patients. Surgical planning and stepwise implementation based on prior experience help surgeons successfully perform technically demanding procedures. RDP could be the approach of choice in distal pancreatectomy, and it is not inferior to LDP.
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Affiliation(s)
- Francisco Espin Alvarez
- Unidad de Cirugía de Hepatobiliopancreática, Hospital Universitari Germans Trias i Pujol, Universidad Autónoma de Barcelona, Badalona, Spain.
| | - María Isabel García-Domingo
- Unidad de Cirugía de Hepatobiliopancreática, Hospital Universitari Mútua de Terrassa, Universitat de Barcelona, Terrassa, Spain
| | - Manel Cremades Pérez
- Unidad de Cirugía de Hepatobiliopancreática, Hospital Universitari Germans Trias i Pujol, Universidad Autónoma de Barcelona, Badalona, Spain
| | - Fernando Pardo Aranda
- Unidad de Cirugía de Hepatobiliopancreática, Hospital Universitari Germans Trias i Pujol, Universidad Autónoma de Barcelona, Badalona, Spain
| | - Laura Vidal Piñeiro
- Unidad de Cirugía de Hepatobiliopancreática, Hospital Universitari Germans Trias i Pujol, Universidad Autónoma de Barcelona, Badalona, Spain
| | - Eric Herrero Fonollosa
- Unidad de Cirugía de Hepatobiliopancreática, Hospital Universitari Mútua de Terrassa, Universitat de Barcelona, Terrassa, Spain
| | - Jordi Navinés López
- Unidad de Cirugía de Hepatobiliopancreática, Hospital Universitari Germans Trias i Pujol, Universidad Autónoma de Barcelona, Badalona, Spain
| | - Alba Zárate Pinedo
- Unidad de Cirugía de Hepatobiliopancreática, Hospital Universitari Germans Trias i Pujol, Universidad Autónoma de Barcelona, Badalona, Spain
| | - Judith Camps-Lasa
- Unidad de Cirugía de Hepatobiliopancreática, Hospital Universitari Mútua de Terrassa, Universitat de Barcelona, Terrassa, Spain
| | - Esteban Cugat Andorrà
- Unidad de Cirugía de Hepatobiliopancreática, Hospital Universitari Germans Trias i Pujol, Universidad Autónoma de Barcelona, Badalona, Spain; Unidad de Cirugía de Hepatobiliopancreática, Hospital Universitari Mútua de Terrassa, Universitat de Barcelona, Terrassa, Spain
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Berral Santana AM, Cedrún Sitges I. Groove pancreatitis and how to differentiate it from pancreatic adenocarcinoma. Radiologia (Engl Ed) 2023; 65:81-88. [PMID: 36842788 DOI: 10.1016/j.rxeng.2021.07.005] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2021] [Accepted: 07/23/2021] [Indexed: 02/28/2023]
Abstract
Groove pancreatitis is an uncommon type of chronic pancreatitis that affects the space between the head of the pancreas, the second portion of the duodenum, and the common bile duct. The main trigger is chronic alcohol abuse, which eventually leads to leakage of pancreatic juices into the pancreaticoduodenal groove, causing inflammation and fibrosis. The main differential diagnosis is with pancreatic adenocarcinoma, which is more common than groove pancreatitis. Different imaging techniques make it possible to identify various findings (e.g., duodenal thickening or duodenal and paraduodenal cysts, which are characteristic of groove pancreatitis) that sometimes enable differentiation between groove pancreatitis and other entities, although there are no specific findings for each of them. Sometimes biopsy or surgery is required to establish the definitive diagnosis. The treatment of groove pancreatitis is usually conservative, but in cases in which the symptoms do not improve, interventional procedures (biliary drainage) or surgery (Whipple technique) can be done.
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Gonzales Sejas A, Garcia Garcia M, Bengochea Martínez ML, Ramírez Gasca MT. [Primary pancreatic lymphoma clinically mimicking carcinoma. An important differential diagnostic problem due to the different therapeutic implications]. Rev Esp Patol 2022; 55:274-277. [PMID: 36154736 DOI: 10.1016/j.patol.2020.11.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/07/2020] [Revised: 11/09/2020] [Accepted: 11/14/2020] [Indexed: 06/16/2023]
Abstract
Primary pancreatic lymphoma is very rare; the most commonly described subtype is diffuse large B-cell lymphoma. Although it is morphologically similar to lymphoproliferative lesions found in other locations, clinically it can mimic an epithelial neoplasm. The differential diagnosis is important due to the different therapeutic implications of each entity. We present a case of primary pancreatic lymphoma in a 77-year-old woman and describe its characteristic features.
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Bravo-Taxa M, Luque Vásquez-Vásquez C, Guerrero-Quiroga M, Taxa-Rojas L. [Colloid Carcinoma of the pancreas and synchronous gastrointestinal stromal tumour of stomach. A case report and review of the literature]. Rev Esp Patol 2022; 55:259-266. [PMID: 36154734 DOI: 10.1016/j.patol.2021.02.004] [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] [Subscribe] [Scholar Register] [Received: 12/15/2020] [Revised: 02/07/2021] [Accepted: 02/20/2021] [Indexed: 06/16/2023]
Abstract
Colloid carcinoma (CC) is a rare histological type of adenocarcinoma of the pancreatic duct and is characterized by the presence of large lakes of extracellular mucin containing neoplastic cells. Its 5 year prognosis is more favourable than that of ductal, tubular or not otherwise specified (NOS) adenocarcinomas. We present the case of a 74-year-old woman with a thin walled, multicystic lesion in the tail of the pancreas, radiologically suggestive of a serous cystadenoma as opposed to a mucinous neoplasm. Surgery revealed a 10 x 6 cm lesion invading the splenic hilum and transverse mesocolon. Two nodes on the wall of the gastric fundus were also removed. Histopathology showed the pancreatic tumour to be a colloid carcinoma with a synchronous gastrointestinal stromal tumour of the gastric fundus.
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Affiliation(s)
- Mercedes Bravo-Taxa
- Patología Oncológica, Instituto Nacional de Enfermedades Neoplásicas, Lima, Perú.
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Flórez Rial MDP, Ruz Portero S, Valenzuela González M, Romero Madrid B. [Intrapancreatic bronchogenic cyst. A case report]. Rev Esp Patol 2022; 55:292-296. [PMID: 36154740 DOI: 10.1016/j.patol.2020.11.005] [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] [Subscribe] [Scholar Register] [Received: 10/07/2020] [Accepted: 11/20/2020] [Indexed: 06/16/2023]
Abstract
Bronchogenic cysts arise from abnormalities of the tracheobronchial tree occurring during the early stages of embryonal development. They are most often found in the posterior mediastinum. Retroperitoneal bronchogenic cysts are infrequent and intrapancreatic bronchogenic cysts extremely rare. We present a case of an asymptomatic, intrapancreatic bronchogenic cyst which was an incidental finding during the urological workup of a 61-year-old man.
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Affiliation(s)
| | - Sara Ruz Portero
- Servicio de Anatomía Patológica, Hospital Regional Universitario de Málaga, Málaga, España
| | | | - Beatriz Romero Madrid
- Servicio de Anatomía Patológica, Hospital Regional Universitario de Málaga, Málaga, España
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Pineño-Flores C, Ambrona-Zafra D, Rodríguez-Pino JC, Soldevila-Verdeguer C, Palma-Zamora E, Molina-Romero FX, Morón-Canis JM, González-Argente FX, Morales-Soriano R. Cephalic pancreaticoduodenectomy for ductal adenocarcinoma in the elderly. Can we do it safely? Cir Esp 2022; 100:125-132. [PMID: 35221240 DOI: 10.1016/j.cireng.2022.02.011] [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: 08/29/2020] [Accepted: 01/17/2021] [Indexed: 06/14/2023]
Abstract
INTRODUCTION Surgery and chemotherapy have increased the survival of pancreatic cancer. The decrease in postoperative morbidity and mortality and increase in life expectancy, has expanded the indications por cephalic pancreaticoduodenectomy (PDC), although it remains controversial in the geriatric population. METHODS Retrospective study on a prospective database of patients with ductal adenocarcinoma of pancreas who underwent PDC between 2007-2018. The main objective was to analyse the morbidity-mortality and survival associated with PDC in patients ≥75 years (elderly). RESULTS 79 patients were included, 21 of them older than 75 years (27%); within this group, 23'9% were over 80 years old. The ASA of both groups was similar. Patients ≥75 years required more transfusions. No differences in operating time were observed, although more vascular resection were performed in the elderly (26 vs. 8.7%; P = .037). Morbidity was higher in the elderly (61.9% vs. 46.6%), although without differences. Patients aged ≥75 years had more non-surgical complications (33.3%, P = .050), being pneumonia the most frequent. Postoperative mortality was higher in the ≥75 years (9 vs. 0%; P = .017). The overall survival and disease-free survival did not show significant differences in both groups. CONCLUSIONS Elderly patients had higher postoperative mortality and more non-surgical complications. Survival did not show differences, so with an adequate selection of patients, age should not be considered itself as a contraindication for PDC.
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Affiliation(s)
- Cristina Pineño-Flores
- Servicio de Cirugía General y del Aparato Digestivo, Hospital Universitari Son Espases, Palma de Mallorca, Balearic Islands, Spain; Instituto de Investigación Sanitaria de Islas Baleares (IdISBa), Hospital Universitari Arnau de Villanova, Palma de Mallorca, Balearic Islands, Spain.
| | - David Ambrona-Zafra
- Servicio de Cirugía General y del Aparato Digestivo, Hospital Universitari Arnau de Vilanova, Lleida, Catalonia, Spain
| | - Jose Carlos Rodríguez-Pino
- Servicio de Cirugía General y del Aparato Digestivo, Hospital Universitari Son Espases, Palma de Mallorca, Balearic Islands, Spain
| | - Carla Soldevila-Verdeguer
- Servicio de Cirugía General y del Aparato Digestivo, Hospital Universitari Son Espases, Palma de Mallorca, Balearic Islands, Spain; Instituto de Investigación Sanitaria de Islas Baleares (IdISBa), Hospital Universitari Arnau de Villanova, Palma de Mallorca, Balearic Islands, Spain
| | - Elias Palma-Zamora
- Servicio de Cirugía General y del Aparato Digestivo, Hospital Universitari Son Espases, Palma de Mallorca, Balearic Islands, Spain
| | - Francesc Xavier Molina-Romero
- Servicio de Cirugía General y del Aparato Digestivo, Hospital Universitari Son Espases, Palma de Mallorca, Balearic Islands, Spain; Instituto de Investigación Sanitaria de Islas Baleares (IdISBa), Hospital Universitari Arnau de Villanova, Palma de Mallorca, Balearic Islands, Spain; Facultad de Medicina, Universidad de las Islas Baleares, Palma de Mallorca, Balearic Islands, Spain
| | - Jose Miguel Morón-Canis
- Servicio de Cirugía General y del Aparato Digestivo, Hospital Universitari Son Espases, Palma de Mallorca, Balearic Islands, Spain
| | - Francesc Xavier González-Argente
- Servicio de Cirugía General y del Aparato Digestivo, Hospital Universitari Son Espases, Palma de Mallorca, Balearic Islands, Spain; Instituto de Investigación Sanitaria de Islas Baleares (IdISBa), Hospital Universitari Arnau de Villanova, Palma de Mallorca, Balearic Islands, Spain; Facultad de Medicina, Universidad de las Islas Baleares, Palma de Mallorca, Balearic Islands, Spain
| | - Rafael Morales-Soriano
- Servicio de Cirugía General y del Aparato Digestivo, Hospital Universitari Son Espases, Palma de Mallorca, Balearic Islands, Spain; Instituto de Investigación Sanitaria de Islas Baleares (IdISBa), Hospital Universitari Arnau de Villanova, Palma de Mallorca, Balearic Islands, Spain
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Espin Alvarez F, García Domingo MI, Cremades Pérez M, Herrero Fonollosa E, Navinés López J, Camps Lasa J, Pardo Aranda F, Cugat Andorrá E. Highs and lows in laparoscopic pancreaticoduodenectomy. Cir Esp 2021; 99:593-601. [PMID: 34420909 DOI: 10.1016/j.cireng.2021.08.001] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2020] [Accepted: 07/13/2020] [Indexed: 11/27/2022]
Abstract
INTRODUCTION Laparoscopic pancreaticoduodenectomy (PD) is not widely accepted, and its use is controversial. Only correct patient selection and appropriate training of groups experienced in pancreatic surgery and laparoscopy will be able to establish its role and its hypothetical advantages. METHODS Out of 138 pancreatic surgeries performed in a two-year period (2017-2019), 23 were laparoscopic PD. We evaluate its efficacy and safety compared to 31 open PD. RESULTS There were no cases of B/C pancreatic or biliary fistula, nor any cases of delayed gastric emptying in the laparoscopic group, but hemorrhage required one reoperation. The conversion rate was 21% (five cases): one due to bleeding, and the remainder for non-progression. The converted patients showed no differences compared to those completed by laparoscopy. There were no differences between laparoscopic and open PD in surgical time, postoperative complications, reintervention rate, readmissions or mortality. R0 resection in tumor cases was 85% for laparoscopy and 69% in open surgery without statistical significance. The postoperative hospital stay was shorter in the laparoscopic PD group (eight vs. 15 days). CONCLUSIONS In a selected group, laparoscopic PD can be safely and effectively performed if carried out by groups who are experts in pancreatic surgery and advanced laparoscopy. The technique has the same postoperative results as open surgery and is oncologically adequate, with less hospital stay. Proper patient selection, a step-by-step program and a lax and early conversion prevents serious operating accidents.
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Affiliation(s)
- Francisco Espin Alvarez
- Unidad de Cirugía de Hepatobiliopancreática, Hospital Universitari Germans Trias i Pujol, Universidad Autónoma de Barcelona, Badalona, Spain
| | - María Isabel García Domingo
- Unidad de Cirugía de Hepatobiliopancreática, Hospital Universitari Mútua de Terrassa, Universitat de Barcelona, Terrassa, Spain
| | - Manel Cremades Pérez
- Unidad de Cirugía de Hepatobiliopancreática, Hospital Universitari Germans Trias i Pujol, Universidad Autónoma de Barcelona, Badalona, Spain.
| | - Eric Herrero Fonollosa
- Unidad de Cirugía de Hepatobiliopancreática, Hospital Universitari Mútua de Terrassa, Universitat de Barcelona, Terrassa, Spain
| | - Jordi Navinés López
- Unidad de Cirugía de Hepatobiliopancreática, Hospital Universitari Germans Trias i Pujol, Universidad Autónoma de Barcelona, Badalona, Spain
| | - Judith Camps Lasa
- Unidad de Cirugía de Hepatobiliopancreática, Hospital Universitari Mútua de Terrassa, Universitat de Barcelona, Terrassa, Spain
| | - Fernando Pardo Aranda
- Unidad de Cirugía de Hepatobiliopancreática, Hospital Universitari Germans Trias i Pujol, Universidad Autónoma de Barcelona, Badalona, Spain
| | - Esteban Cugat Andorrá
- Unidad de Cirugía de Hepatobiliopancreática, Hospital Universitari Germans Trias i Pujol, Universidad Autónoma de Barcelona, Badalona, Spain; Unidad de Cirugía de Hepatobiliopancreática, Hospital Universitari Mútua de Terrassa, Universitat de Barcelona, Terrassa, Spain
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11
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Pineño-Flores C, Ambrona-Zafra D, Rodríguez-Pino JC, Soldevila-Verdeguer C, Palma-Zamora E, Molina-Romero FX, Morón-Canis JM, González-Argente FX, Morales-Soriano R. Cephalic pancreaticoduodenectomy for ductal adenocarcinoma in the elderly. Can we do it safely? Cir Esp 2021; 100:S0009-739X(21)00029-4. [PMID: 33714556 DOI: 10.1016/j.ciresp.2021.01.007] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2020] [Revised: 01/03/2021] [Accepted: 01/17/2021] [Indexed: 11/28/2022]
Abstract
INTRODUCTION Surgery and chemotherapy have increased the survival of pancreatic cancer. The decrease in postoperative morbidity and mortality and increase in life expectancy, has expanded the indications por cephalic pancreaticoduodenectomy (PDC), although it remains controversial in the geriatric population. METHODS Retrospective study on a prospective database of patients with ductal adenocarcinoma of pancreas who underwent PDC between 2007-2018.The main objective was to analyse the morbidity-mortality and survival associated with PDC in patients≥75 years (elderly). RESULTS 79 patients were included, 21 of them older than 75 years (27%); within this group, 23.9% were over 80 years old. The ASA of both groups was similar. Patients≥75 years required more transfusions. No differences in operating time were observed, although more vascular resection were performed in the elderly (26 vs. 8.7%; P=.037). Morbidity was higher in the elderly (61.9 vs. 46.6%), although without differences. Patients aged≥75 years had more non-surgical complications (33.3%, P=.050), being pneumonia the most frequent. Postoperative mortality was higher in the≥75 years (9 vs. 0%; P=.017). The overall survival and disease-free survival did not show significant differences in both groups. CONCLUSIONS Elderly patients had higher postoperative mortality and more non-surgical complications. Survival did not show differences, so with an adequate selection of patients, age should not be considered itself as a contraindication for PDC.
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Affiliation(s)
- Cristina Pineño-Flores
- Servicio de Cirugía General y del Aparato Digestivo, Hospital Universitari Son Espases, Palma de Mallorca, Baleares, España; Instituto de Investigación Sanitaria de Islas Baleares (IdISBa), Hospital Universitari Arnau de Villanova, Palma de Mallorca, Baleares, España.
| | - David Ambrona-Zafra
- Servicio de Cirugía General y del Aparato Digestivo, Hospital Universitari Arnau de Vilanova, Lleida, Cataluña, España
| | - Jose Carlos Rodríguez-Pino
- Servicio de Cirugía General y del Aparato Digestivo, Hospital Universitari Son Espases, Palma de Mallorca, Baleares, España
| | - Carla Soldevila-Verdeguer
- Servicio de Cirugía General y del Aparato Digestivo, Hospital Universitari Son Espases, Palma de Mallorca, Baleares, España; Instituto de Investigación Sanitaria de Islas Baleares (IdISBa), Hospital Universitari Arnau de Villanova, Palma de Mallorca, Baleares, España
| | - Elias Palma-Zamora
- Servicio de Cirugía General y del Aparato Digestivo, Hospital Universitari Son Espases, Palma de Mallorca, Baleares, España
| | - Francesc Xavier Molina-Romero
- Servicio de Cirugía General y del Aparato Digestivo, Hospital Universitari Son Espases, Palma de Mallorca, Baleares, España; Instituto de Investigación Sanitaria de Islas Baleares (IdISBa), Hospital Universitari Arnau de Villanova, Palma de Mallorca, Baleares, España; Facultad de Medicina, Universidad de las Islas Baleares, Palma de Mallorca, Baleares, España
| | - Jose Miguel Morón-Canis
- Servicio de Cirugía General y del Aparato Digestivo, Hospital Universitari Son Espases, Palma de Mallorca, Baleares, España
| | - Francesc Xavier González-Argente
- Servicio de Cirugía General y del Aparato Digestivo, Hospital Universitari Son Espases, Palma de Mallorca, Baleares, España; Instituto de Investigación Sanitaria de Islas Baleares (IdISBa), Hospital Universitari Arnau de Villanova, Palma de Mallorca, Baleares, España; Facultad de Medicina, Universidad de las Islas Baleares, Palma de Mallorca, Baleares, España
| | - Rafael Morales-Soriano
- Servicio de Cirugía General y del Aparato Digestivo, Hospital Universitari Son Espases, Palma de Mallorca, Baleares, España; Instituto de Investigación Sanitaria de Islas Baleares (IdISBa), Hospital Universitari Arnau de Villanova, Palma de Mallorca, Baleares, España
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12
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Manuel-Vázquez A, Oliver-Guillén JR, Latorre-Fragua R, Palomares Cano A, Serradilla Martín M, Ramia JM. The top 100. Review of the most cited articles on pancreas and laparoscopy. Cir Esp 2021; 99:124-131. [PMID: 32499052 DOI: 10.1016/j.ciresp.2020.05.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2020] [Revised: 04/27/2020] [Accepted: 05/02/2020] [Indexed: 02/07/2023]
Abstract
INTRODUCTION The number of citations is considered as an indirect indicator of the merit of an article, journal or researcher, although it is not an infallible method to determine scientific quality. Our goal is to determine the characteristics of the articles most cited about pancreas and laparoscopy. METHODS We performed a search of all articles published in any journal about pancreas and laparoscopy until September 2019 and selected the 100 most cited papers. We recorded number of citations, journal, year of publication, quartil, impact factor, institution, country, authors type of paper, type of surgery, topic and area. RESULTS The top 100 citations account 10,970 citations in total. The journal with the most articles is Surgical Endoscopy and 2007 is the year with the highest number of articles in the top 100 citations. The percentage of publications from America and Europe are similar. Case series is the most frequently paper, outcomes/morbidity is the most frequently discussed topic, and distal pancreatectomy is the most frequently type of surgery. CONCLUSIONS This bibliometric study on pancreas and laparoscopy is conditioned by the time factor, since laparoscopy has arrived later at pancreatic surgery, probably due to the morbidity and mortality associated with pancreatic surgery and the need for a high specialization in this field. The literature is recent and scarce. More and better-quality studies are needed in this field.
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Affiliation(s)
- Alba Manuel-Vázquez
- Cirugía General y Digestiva, Hospital Universitario de Guadalajara, Guadalajara, España.
| | | | - Raquel Latorre-Fragua
- Cirugía General y Digestiva, Hospital Universitario de Guadalajara, Guadalajara, España
| | - Ana Palomares Cano
- Cirugía General y Digestiva, Hospital Universitario Miguel Servet, Zaragoza, España
| | | | - José Manuel Ramia
- Cirugía General y Digestiva, Hospital Universitario de Guadalajara, Guadalajara, España
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Espin Alvarez F, García Domingo MI, Cremades Pérez M, Herrero Fonollosa E, Navinés López J, Camps Lasa J, Pardo Aranda F, Cugat Andorrá E. Highs and lows in laparoscopic pancreaticoduodenectomy. Cir Esp 2020; 99:S0009-739X(20)30236-0. [PMID: 32958225 DOI: 10.1016/j.ciresp.2020.07.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2020] [Revised: 06/12/2020] [Accepted: 07/13/2020] [Indexed: 02/07/2023]
Abstract
INTRODUCTION Laparoscopic pancreaticoduodenectomy (PD) is not widely accepted, and its use is controversial. Only correct patient selection and appropriate training of groups experienced in pancreatic surgery and laparoscopy will be able to establish its role and its hypothetical advantages METHODS: Out of 138 pancreatic surgeries performed in a two-year period (2017-2019), 23 were laparoscopic PD. We evaluate its efficacy and safety compared to 31 open PD. RESULTS There were no cases of B/C pancreatic or biliary fistula, nor any cases of delayed gastric emptying in the laparoscopic group, but hemorrhage required one reoperation. The conversion rate was 21% (five cases): one due to bleeding, and the remainder for non-progression. The converted patients showed no differences compared to those completed by laparoscopy. There were no differences between laparoscopic and open PD in surgical time, postoperative complications, reintervention rate, readmissions or mortality. R0 resection in tumor cases was 85% for laparoscopy and 69% in open surgery without statistical significance. The postoperative hospital stay was shorter in the laparoscopic PD group (eight vs. 15 days). CONCLUSIONS In a selected group, laparoscopic PD can be safely and effectively performed if carried out by groups who are experts in pancreatic surgery and advanced laparoscopy. The technique has the same postoperative results as open surgery and is oncologically adequate, with less hospital stay. Proper patient selection, a step-by-step program and a lax and early conversion prevents serious operating accidents.
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Affiliation(s)
- Francisco Espin Alvarez
- Unidad de Cirugía de Hepatobiliopancreática, Hospital Universitari Germans Trias i Pujol, Universidad Autónoma de Barcelona, Badalona, España
| | - María Isabel García Domingo
- Unidad de Cirugía de Hepatobiliopancreática, Hospital Universitari Mútua de Terrassa, Universitat de Barcelona, Terrassa, España
| | - Manel Cremades Pérez
- Unidad de Cirugía de Hepatobiliopancreática, Hospital Universitari Germans Trias i Pujol, Universidad Autónoma de Barcelona, Badalona, España.
| | - Eric Herrero Fonollosa
- Unidad de Cirugía de Hepatobiliopancreática, Hospital Universitari Mútua de Terrassa, Universitat de Barcelona, Terrassa, España
| | - Jordi Navinés López
- Unidad de Cirugía de Hepatobiliopancreática, Hospital Universitari Germans Trias i Pujol, Universidad Autónoma de Barcelona, Badalona, España
| | - Judith Camps Lasa
- Unidad de Cirugía de Hepatobiliopancreática, Hospital Universitari Mútua de Terrassa, Universitat de Barcelona, Terrassa, España
| | - Fernando Pardo Aranda
- Unidad de Cirugía de Hepatobiliopancreática, Hospital Universitari Germans Trias i Pujol, Universidad Autónoma de Barcelona, Badalona, España
| | - Esteban Cugat Andorrá
- Unidad de Cirugía de Hepatobiliopancreática, Hospital Universitari Germans Trias i Pujol, Universidad Autónoma de Barcelona, Badalona, España; Unidad de Cirugía de Hepatobiliopancreática, Hospital Universitari Mútua de Terrassa, Universitat de Barcelona, Terrassa, España
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Del Olmo Martínez ML, Velayos Jiménez B, Almaraz-Gómez A. Hydration with Lactated Ringer's solution combined with rectal diclofenac in the prevention of pancreatitis after endoscopic retrograde cholangiopancreatography. Gastroenterol Hepatol 2020; 44:20-26. [PMID: 32674877 DOI: 10.1016/j.gastrohep.2020.03.014] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/16/2019] [Revised: 02/13/2020] [Accepted: 03/13/2020] [Indexed: 12/17/2022]
Abstract
OBJECTIVE Different measures are recommended to reduce pancreatitis after endoscopic retrograde cholangiopancreatography (ERCP). We conducted a study in patients with ERCP treated with rectal diclofenac or lactated Ringer's solution, or both interventions, to assess whether there is a decrease in the number of cases of post-ERCP pancreatitis. MATERIAL AND METHODS A mixed cohort study involving 1,896 patients from 2009 to 2018. Up to June 2012 without treatment (Group I). Subsequently, 100mg of rectal diclofenac (Group II). Since 2016, lactated Ringer's solution 200ml/hour during the procedure and 4hours after it, in addition to 500ml over 30minutes when the pancreas was cannulated (Group III). Since 2017, lactated Ringer's solution plus Diclofenac (Group IV). There were 725 patients in group I, and 530, 227 and 414 patients in groups II, III and IV, respectively. Factors predisposing to post-ERCP pancreatitis and post-ERCP pancreatitis cases that were defined by consensus criteria have been collected. RESULTS There were 65 cases of post-ERCP pancreatitis (3.4%); 2.9%, 3.4%, 3.1% and 4.3% in groups I, II, III and IV, respectively (P=.640). In group I, there was 4.2% of post-ERCP pancreatitis in naïve papillae and 4%, 4.9% and 6.3% in groups II, III and IV, respectively (P=.585). The severity of post-ERCP pancreatitis and adverse effects were similar in all groups. 38.4% were high-risk patients. There were also no differences in post-ERCP pancreatitis in this group (P=.501). CONCLUSION In this work, no benefit was obtained with diclofenac plus hydration in reducing the number and severity of cases of post-ERCP pancreatitis nor with the other prophylactic measures.
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Affiliation(s)
| | - Benito Velayos Jiménez
- Servicio de Aparato Digestivo, Hospital Clínico Universitario de Valladolid, Valladolid, España
| | - Ana Almaraz-Gómez
- Departamento de Medicina Preventiva y Salud Pública, Facultad de Medicina, Universidad de Valladolid, Valladolid, España
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Salas-Álvarez JM, Campos-Martínez FJ, Moreno-Arciniegas A, Almorza-Gomar D, Pérez-Arana GM, Prada-Oliveira JA, Camacho-Ramírez A. A novel surgical technique focused on the study of the ileum: The preduodenal ileal transposition. CIR CIR 2020; 88:402-409. [PMID: 32567585 DOI: 10.24875/ciru.20001272] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Aims Our main goal is to study the effects on the carbohydrate metabolism. Thus, we designed various experimental surgical models on healthy non-obese Wistar rats to reproduce several conditions. In this sense, we report a new experimental model. It is well known that bariatric surgery has important effects on the control of Type 2 Diabetes Mellitus. The underlying reasons are yet unknown, although the different theories focused in the release of different hormones after the pass of the nutrients through the tract. These released hormones have opposite effects that come together in a balanced glycemic metabolism. Materials and methods After bariatric surgical techniques, the modified anatomy resulted in an imbalance of the secreted hormones. Wistar rats were randomized in two groups Sham and surgical group. Our model consisted on the transposition of the terminal ileum right after the pylorus. Weight gain, food intake, and basal glycemia were measured weekly. Results We did not obtain significant differences between both groups for these functional variables. Conclusions This technique involved an early pass of the bolus through the ileum. The change on the luminal pH, along with the lack of enzymes to absorb the content, or the changes in the release of several hormones must be variables to the study. The mortality rate was assumable considering it was an experimental model on animals.
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Affiliation(s)
| | | | | | - David Almorza-Gomar
- Department of Operative Statistic Universidad de Cádiz. Cadiz, Spain.,Instituto de Investigación e innovación biomédica de Cádiz (INIBICA). Cadiz, Spain
| | | | - J Arturo Prada-Oliveira
- Department of Human Anatomy and Embryology, Faculty of Medicine, Universidad de Cádiz. Cadiz, Spain.,Instituto de Investigación e innovación biomédica de Cádiz (INIBICA). Cadiz, Spain
| | - Alonso Camacho-Ramírez
- Surgery Unit, Puerto Real University Hospital, Universidad de Cádiz. Cadiz, Spain.,Instituto de Investigación e innovación biomédica de Cádiz (INIBICA). Cadiz, Spain.,Surgery Unit, Puerta del Mar University Hospital of Cádiz. Cadiz, Spain
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Vieira J, Amorim J, Martí-Bonmatí L, Alberich-Bayarri Á, França M. Quantifying steatosis in the liver and pancreas with MRI in patient with chronic liver disease. Radiologia (Engl Ed) 2020; 62:222-228. [PMID: 31932016 DOI: 10.1016/j.rx.2019.11.007] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2019] [Revised: 09/08/2019] [Accepted: 11/04/2019] [Indexed: 12/13/2022]
Abstract
AIM To compare pancreatic and hepatic steatosis quantified by proton density fat fraction (PDFF) on magnetic resonance imaging (MRI) in patients with chronic liver disease. MATERIAL AND METHODS This cross-sectional study included 46 adult patients who underwent liver biopsy for chronic viral hepatitis (n=19) or other chronic non-alcoholic liver diseases (NALD) (n=27). Liver biopsy was used as the gold standard for diagnosing and grading hepatic steatosis. All patients underwent clinical evaluation and MRI with a multi-echo chemical shift-encoded (MECSE) gradient-echo sequence for liver and pancreas PDFF quantification. We used Spearman's correlation coefficient to determine the degree of association between hepatic PDFF and steatosis grade, and between pancreatic PDFF and steatosis grade and hepatic PDFF. To compare the chronic viral hepatitis group and the NALD group, we used t-tests for continuous or ordinal variables and chi-square tests for categorical variables. RESULTS Hepatic PDFF measurements correlated with steatosis grades (RS=0.875, p<0.001). Pancreatic PDFF correlated with hepatic steatosis grades (RS=0.573, p<0.001) and hepatic PDFF measurements (RS=0.536, p<0.001). In the subgroup of patients with chronic NALD, the correlations remained significant between pancreatic PDFF and hepatic PDFF (RS=0.632, p<0.001) and between pancreatic PDFF and liver steatosis (RS=0.608, p<0.001); however, in the subgroup of patients with viral hepatitis these correlations were no longer significant. CONCLUSION Pancreatic fat deposition correlates with hepatic steatosis in patients with chronic NALD, but not in those with chronic viral hepatitis.
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Affiliation(s)
- J Vieira
- Instituto de Ciências Biomédicas de Abel Salazar (ICBAS), Universidad de Oporto, Oporto, Portugal.
| | - J Amorim
- Departamento de Diagnóstico por la Imagen, Centro Hospitalar do Porto, Oporto, Portugal; Escola de Medicina, Universidade do Minho, Braga, Portugal; ICVS/3B's, Instituto de Investigación de Ciencias de la Vida y la Salud, Universidade do Minho, Braga, Portugal
| | - L Martí-Bonmatí
- Departamento de Radiología y Grupo de Investigación Biomédica en Imagen GIBI2(30). Hospital Universitario y Politécnico La Fe e Instituto de Investigación Sanitaria La Fe, Valencia, España
| | - Á Alberich-Bayarri
- Departamento de Radiología y Grupo de Investigación Biomédica en Imagen GIBI2(30). Hospital Universitario y Politécnico La Fe e Instituto de Investigación Sanitaria La Fe, Valencia, España; Quantitative Imaging Biomarkers in Medicine (QUIBIM), Valencia, España
| | - M França
- Instituto de Ciências Biomédicas de Abel Salazar (ICBAS), Universidad de Oporto, Oporto, Portugal; Departamento de Diagnóstico por la Imagen, Centro Hospitalar do Porto, Oporto, Portugal; i3S, Instituto de Investigacão e Inovação em Saúde, IBMC, Instituto de Biología Molecular y Celular, Oporto, Portugal
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Ramia JM, Martin-Perez E, Poves I, Fabregat-Prous J, Larrea Y Olea J, Sanchez-Bueno F, Botello-Martinez F, Briceño J, Miyar-de León A, Serradilla M, Moya-Herraiz A. Multicentric study on total pancreatectomies. Cir Esp 2019; 97:377-384. [PMID: 31164217 DOI: 10.1016/j.ciresp.2019.04.004] [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: 07/04/2018] [Revised: 03/11/2019] [Accepted: 04/01/2019] [Indexed: 02/07/2023]
Abstract
INTRODUCTION Total pancreatectomy (TP) is an uncommon operation, with indications that have not been clearly defined and non-standardized postoperative results. We present a national multicentric study on TP and a comparison with the existing literature METHODS: A prospective observational study using data from the national registry of patients after pancreaticoduodenectomy and TP performed for any indication during the study period: January 1 to December 31, 2015 RESULTS: 1016 patients were included from 73 hospitals, 112 of whom had undergone TP. The percentage of TP from the total number of cases was 11%. The mean age was 63.5 years, and 57.2% were males. The most frequently suspected radiological diagnosis was pancreatic cancer (58/112 cases). The most common TP technique was "mesentery artery first" (43/112 cases). Venous resections were performed in 23 patients (20.5%). The percentage of postoperative complications within 90 days was 50%, but major complications (>IIIA) were only 20.7%. The overall 90-day mortality was 8% (9 patients). The average stay was 20.7 days. The 3most frequent definitive histological diagnoses were: adenocarcinoma of the pancreas, intraductal papillary mucinous neoplasm and chronic pancreatitis. The R0 rate was 67.8%. CONCLUSIONS This study shows that the morbidity and mortality results of TP in Spain are similar or superior to previous publications. More precise TP studies are necessary, focused on specific complications such as endocrine insufficiency.
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Affiliation(s)
- Jose M Ramia
- Servicio de Cirugía, Hospital Universitario de Guadalajara, Guadalajara, España.
| | | | - Ignasi Poves
- Servicio de Cirugía, Hospital del Mar, Barcelona, España
| | - Joan Fabregat-Prous
- Servicio de Cirugía, Hospital Universitari Bellvitge, L'Hopitalet de Llobregat, Barcelona, España
| | - Javier Larrea Y Olea
- Servicio de Cirugía, Hospital Universitario Insular de Gran Canaria, Las Palmas de Gran Canaria, Las Palmas, España
| | | | | | - Javier Briceño
- Servicio de Cirugía, Hospital Universitario Reina Sofía, Córdoba, España
| | - Alberto Miyar-de León
- Servicio de Cirugía, Hospital Universitario Central de Asturias, Oviedo, Asturias, España
| | - Mario Serradilla
- Servicio de Cirugía, Hospital Universitario Miguel Servet, Zaragoza, España
| | - Angel Moya-Herraiz
- Servicio de Cirugía, Hospital General de Castelló, Castelló de la Plana, Castellón, España
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Ramia JM, Serrablo A, Gomez Bravo MA. National survey on Pancreatic Surgery Units. Cir Esp 2019; 97:254-260. [PMID: 30981466 DOI: 10.1016/j.ciresp.2019.02.007] [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: 01/13/2019] [Revised: 02/14/2019] [Accepted: 02/19/2019] [Indexed: 02/07/2023]
Abstract
INTRODUCTION The technical, human, scientific and treatment characteristics of the Units that manage complex pathologies have not been studied in depth. METHODS Multi-institutional descriptive study (survey) developed jointly by the Hepatobiliary-Pancreatic Division of the Spanish Association of Surgeons and the Spanish Chapter of the IHPBA (International Hepatopancreatobiliary Association) on the characteristics of the Units where pancreatic surgery is performed in Spain. RESULTS 82 surveys were sent. 69 medical centers responded (84%), belonging to 16 autonomous regions of Spain. The total population of these regions was 23,183,262 (50% of the Spanish population). The average number of beds per hospital was 673. The unit that performs pancreatic surgery is a Hepatobiliary-Pancreatic Surgery Unit or HPB and Liver Transplant Surgery Unit in 56 hospitals (77%). The average number of surgeons is 4.5 per Unit. Fifty-five Units (80%) lack specific anesthetists. The number of pancreatectomies performed during 2017 at the hospitals surveyed was 1,315 pancreaticoduodenectomies (PD), 566 distal pancreatectomies (DP) and 178 total pancreaticoduodenectomies (TPD). The mean per hospital was 19.1 PD, 8.2 DP and 2.6 TPD. PD was usually performed using a classic approach, with pancreatojejunostomy, single-loop technique, antecolic gastrojejunostomy and using two drain tubes. Only 7 Units performed PD laparoscopically and only 13 units did not perform laparoscopic DP. CONCLUSIONS This survey provides updated information about the majority of the Units where pancreatic surgery is performed in Spain and could also serve as a starting point for prospective multicenter studies.
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Affiliation(s)
- José Manuel Ramia
- Unidad de Cirugía Hepatobiliopancreática, Servicio de Cirugía General y Aparato Digestivo, Hospital Universitario de Guadalajara, Universidad de Alcalá, Guadalajara, España.
| | - Alejandro Serrablo
- Unidad de Cirugía Hepatobiliopancreática, Servicio de Cirugía General y Aparato Digestivo, Hospital Miguel Servet, Zaragoza, España; Capítulo Español de la Asociación Internacional Hepatopancreatobiliar (IHPBA)
| | - Miguel Angel Gomez Bravo
- Unidad de Cirugía Hepatobiliopancreática, Servicio de Cirugía General y Aparato Digestivo, Hospital Virgen del Rocío, Sevilla, España; Sección Hepatobiliopancreática (HPB) de la Asociación Española de Cirujanos
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Erráez-Jaramillo PJ, Ortiz-Hidalgo C. [The histological and immunohistochemical diagnosis of solid pseudopapillary neoplasm of the pancreas and its differential diagnosis]. Rev Esp Patol 2019; 52:178-189. [PMID: 31213259 DOI: 10.1016/j.patol.2019.03.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/27/2019] [Revised: 02/23/2019] [Accepted: 03/03/2019] [Indexed: 01/12/2023]
Abstract
Solid pseudopapillary neoplasm of the pancreas is a rare tumor of uncertain histogenesis, described separately by Gruber and Frantz, that accounts for between approximately 1% and 3% of pancreatic neoplasms. It is characterized by a cystic and solid pattern of growth patterns with formation of pseudopapillae. It occurs primarily in young women, although cases in children and older patients and men have been reported. The tumor is of low-grade malignant potential, as the majority of the cases are cured by simple but complete surgical resection. Knowledge of the unique morphologic characteristics of this neoplasm is essential for the correct diagnosis. We review herein the pathologic and immunohistochemical features of this neoplasm and its differential diagnosis with other pancreatic tumors.
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Affiliation(s)
| | - Carlos Ortiz-Hidalgo
- Departamento de Anatomía Patológica, Hospital y Fundación Médica Sur, Ciudad de México, México; Departamento de Biología Celular y Tisular, Escuela de Medicina, Universidad Panamericana, Ciudad de México, México.
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Baleato-González S, García-Figueiras R, Luna A, Domínguez-Robla M, Vilanova JC. Functional imaging in pancreatic disease. Radiologia (Engl Ed) 2018; 60:451-464. [PMID: 30236460 DOI: 10.1016/j.rx.2018.07.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2018] [Revised: 07/19/2018] [Accepted: 07/23/2018] [Indexed: 12/12/2022]
Abstract
In addition to the classical morphological evaluation of pancreatic disease, the constant technological advances in imaging techniques based fundamentally on computed tomography and magnetic resonance imaging have enabled the quantitative functional and molecular evaluation of this organ. In many cases, this imaging-based information results in substantial changes to patient management and can be a fundamental tool for the development of biomarkers. The aim of this article is to review the role of emerging functional and molecular techniques based on computed tomography and magnetic resonance imaging in the evaluation of pancreatic disease.
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Affiliation(s)
- S Baleato-González
- Departamento de Radiología, Complexo Hospitalario Universitario de Santiago de Compostela, Santiago de Compostela, A Coruña, España.
| | - R García-Figueiras
- Departamento de Radiología, Complexo Hospitalario Universitario de Santiago de Compostela, Santiago de Compostela, A Coruña, España
| | - A Luna
- Grupo Health Time. Director - Advanced Medical Imaging, Sercosa (Servicio de Radiología Computerizada), Clínica Las Nieves, Jaén, España
| | - M Domínguez-Robla
- Departamento de Radiología, Complexo Hospitalario Universitario de Santiago de Compostela, Santiago de Compostela, A Coruña, España
| | - J C Vilanova
- Departamento de Radiología, Clínica Girona-Hospital Santa Caterina, Girona, España
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21
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Guerrero García A, González-Huix F, Levy MJ, García de Paredes AG, Vázquez-Sequeiros E. Ablative therapy in pancreatic cystic lesions. Gastroenterol Hepatol 2018; 42:43-50. [PMID: 30131274 DOI: 10.1016/j.gastrohep.2018.07.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/30/2018] [Revised: 06/30/2018] [Accepted: 07/06/2018] [Indexed: 01/04/2023]
Abstract
The growing incidence of cystic pancreatic tumours has become a major problem in daily clinical practice. These patients usually undergo follow-up programmes of questionable clinical efficacy that put significant strain on endoscopy units. Safe and effective alternatives to surgery are desperately needed in these cases. The aim of this study was to critically review the utility of ablative therapies in cystic pancreatic tumours.
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Affiliation(s)
- Antonio Guerrero García
- Unidad de Endoscopia, Servicio de Gastroenterología y Hepatología, Hospital Universitario Ramón y Cajal, IRYCIS, Madrid, España
| | | | - Michael J Levy
- Endoscopic Ultrasound, Endoscopy Unit, Gastroenterology Division, Mayo Clinic Rochester, Minnesota, Estados Unidos
| | - Ana García García de Paredes
- Unidad de Endoscopia, Servicio de Gastroenterología y Hepatología, Hospital Universitario Ramón y Cajal, IRYCIS, Madrid, España
| | - Enrique Vázquez-Sequeiros
- Unidad de Endoscopia, Servicio de Gastroenterología y Hepatología, Hospital Universitario Ramón y Cajal, IRYCIS, Madrid, España.
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22
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Martin-Richard M, Ginès A, Ayuso JR, Sabater L, Fabregat J, Mendez R, Fernández-Esparrach G, Molero X, Vaquero EC, Cuatrecasas M, Ferrández A, Maurel J; Comité multidisciplinar para la actualización de las recomendaciones para el manejo de las lesiones pre-malignas y el adenocarcinoma de páncreas. [Recommendations for the diagnosis, staging and treatment of pre-malignant lesions and pancreatic adenocarcinoma]. Med Clin (Barc) 2016; 147:465.e1-8. [PMID: 27726847 DOI: 10.1016/j.medcli.2016.07.033] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2016] [Revised: 07/02/2016] [Accepted: 07/13/2016] [Indexed: 12/16/2022]
Abstract
BACKGROUND AND OBJECTIVE Clinical management of adenocarcinoma of the pancreas is complex, and requires a multidisciplinary approach. The same applies for the premalignant lesions that are increasingly being diagnosed. The current document is an update on the diagnosis and management of premalignant lesions and adenocarcinoma of the pancreas. PATIENTS AND METHODS A conference to establish the basis of the literature review and manuscript redaction was organized by the Grupo Español Multidisciplinar en Cáncer Digestivo. Experts in the field from different specialties (Gastroenterology, Surgery, Radiology, Pathology, Medical Oncology and Radiation Oncology) met to prepare the present document. RESULTS The current literature was reviewed and discussed, with subsequent deliberation on the evidence. CONCLUSIONS Final recommendations were established in view of all the above.
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23
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Petrone P, Moral Álvarez S, González Pérez M, Ceballos Esparragón J, Marini CP. Pancreatic trauma: Management and literature review. Cir Esp 2016; 95:123-130. [PMID: 27480036 DOI: 10.1016/j.ciresp.2016.05.011] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2016] [Revised: 05/13/2016] [Accepted: 05/22/2016] [Indexed: 12/11/2022]
Abstract
Pancreatic injury is an uncommon event often difficult to diagnose at an early stage. After abdominal trauma, the surgeon must always be aware of the possibility of pancreatic trauma due to the complications associated with missed pancreatic injuries. Due to its retroperitoneal position, asociated organs and vascular injuries are almost always present, which along with frequent extra abdominal injuries explain the high morbidity and mortality. The aim of this study is to present a concise description of the incidence of these injuries, lesional mechanisms, recommended diagnostic methods, therapeutic indications including nonoperative management, endoscopy and surgery, and an analysis of pancreas-specific complications and mortality rates in these patients based on a 60-year review of the literature, encompassing 6,364 patients. Due to pancreatic retroperitoneal position, asociated organs and vascular injuries are almost always present, which along with frequent extraaabdominal injuries explain the high morbidity and mortality of these patients.
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Affiliation(s)
- Patrizio Petrone
- Division of Trauma Surgery, Surgical Critical Care & Acute Care Surgery, Department of Surgery New York Medical College, Westchester Medical Center University Hospital, Valhalla, Nueva York, EE. UU..
| | - Sara Moral Álvarez
- Division of Trauma Surgery, Surgical Critical Care & Acute Care Surgery, Department of Surgery New York Medical College, Westchester Medical Center University Hospital, Valhalla, Nueva York, EE. UU
| | - Marta González Pérez
- Division of Trauma Surgery, Surgical Critical Care & Acute Care Surgery, Department of Surgery New York Medical College, Westchester Medical Center University Hospital, Valhalla, Nueva York, EE. UU
| | - José Ceballos Esparragón
- Division of Trauma Surgery, Surgical Critical Care & Acute Care Surgery, Department of Surgery New York Medical College, Westchester Medical Center University Hospital, Valhalla, Nueva York, EE. UU
| | - Corrado P Marini
- Division of Trauma Surgery, Surgical Critical Care & Acute Care Surgery, Department of Surgery New York Medical College, Westchester Medical Center University Hospital, Valhalla, Nueva York, EE. UU
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24
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Sánchez-Bueno F, Torres Salmerón G, de la Peña Moral J, Ortiz Ruiz E, Fuster Quiñonero M, Gutiérrez Zárate WV, Claver Valderas MA, Parrilla Paricio P. Groove pancreatitis vs. pancreatic adenocarcinoma: A review of 8 cases. Cir Esp 2016; 94:346-52. [PMID: 27048910 DOI: 10.1016/j.ciresp.2016.02.011] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [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: 11/13/2015] [Accepted: 02/11/2016] [Indexed: 01/20/2023]
Abstract
INTRODUCTION Groove pancreatitis (PS) is an uncommon clinical situation and radiologically it can mimic carcinoma of the periampullary area. The aim of this paper is to study a series of 8 patients who underwent surgery with preoperative diagnosis of pancreatic head mass and subsequent pathological diagnosis of PS. METHODS In our series, 6 were men and 2 women, with an average age of 51,9 years. Before surgery, all patients had epigastric abdominal pain requiring analgesia at high doses. The preoperative analytical CEA and Ca 19.9 were normal in all patients. Imaging studies showed intrapancreatic solid lesions in 6 of the 8 patients, and in the remaining 2 one papillary mass of 5 and 6cm, respectively, that caused stenosis in the duodenal luz. EUS neoplastic cells were negative in all patients. RESULTS The immediate postoperative evolution was satisfactory, there are no complications. In our series, no patients have died. The long-term follow-up, in 7 of the 8 patients, has been excellent with disappearance of abdominal pain and improvement of nutritional status. The remaining patient had frequent recurrent episodes of acute pancreatitis, and at 60 months, presented a pseudocyst that has required a Roux-en-Y cystojejunostomy. CONCLUSIONS PS must be included in the differential diagnosis of pancreatic lesions, which may include carcinoma of the periampullary area and other causes of chronic pancreatitis.
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Affiliation(s)
| | - Gloria Torres Salmerón
- Servicio de Cirugía, Hospital Clínico Universitario Virgen de la Arrixaca, Murcia, España
| | - Jesús de la Peña Moral
- Servicio de Anatomía Patológica, Hospital Clínico Universitario Virgen de la Arrixaca, Murcia, España
| | - Eduardo Ortiz Ruiz
- Servicio de Anatomía Patológica, Hospital Clínico Universitario Virgen de la Arrixaca, Murcia, España
| | - Matilde Fuster Quiñonero
- Servicio de Radiodiagnóstico, Hospital Clínico Universitario Virgen de la Arrixaca, Murcia, España
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25
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Sánchez Cabús S, Fernández-Cruz L. [Surgery for pancreatic cancer: Evidence-based surgical strategies]. Cir Esp 2015; 93:423-35. [PMID: 25957457 DOI: 10.1016/j.ciresp.2015.03.009] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2014] [Accepted: 03/27/2015] [Indexed: 11/29/2022]
Abstract
Pancreatic cancer surgery represents a challenge for surgeons due to its technical complexity, the potential complications that may appear, and ultimately because of its poor survival. The aim of this article is to summarize the scientific evidence regarding the surgical treatment of pancreatic cancer in order to help surgeons in the decision making process in the management of these patients .Here we will review such fundamental issues as the need for a biopsy before surgery, the type of pancreatic anastomosis leading to better results, and the need for placement of drains after pancreatic surgery will be discussed.
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Abstract
Autoimmune pancreatitis is a benign fibroinflammatory disease of the pancreas of probable autoimmune origin, which includes 2 different phenotypes: type 1 (lymphoplasmacytic sclerosing pancreatitis) and type 2 (idiopathic duct-centric pancreatitis). Its clinical presentation as obstructive jaundice in patients with a pancreatic mass is common and therefore it must be included in the differential diagnosis of pancreatic neoplasia. Many diagnostic criteria have been described throughout history. The most famous are the HISORT criteria of the Mayo Clinic and the international consensus criteria of 2011. One of the main features of autoimmune pancreatitis is its dramatic response to steroid therapy, without the need for surgical treatment. Knowledge of this disease can dramatically change the management of patients with obstructive jaundice, who would otherwise be subjected to a pancreaticoduodenectomy.
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Affiliation(s)
- Carla Senosiain Lalastra
- Servicio de Aparato Digestivo, Hospital Universitario Príncipe de Asturias, Alcalá de Henares, Madrid, España.
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27
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Navarro S. [A brief history of the anatomy and physiology of a mysterious and hidden gland called the pancreas]. Gastroenterol Hepatol 2014; 37:527-34. [PMID: 25288309 DOI: 10.1016/j.gastrohep.2014.06.007] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/03/2014] [Accepted: 06/27/2014] [Indexed: 11/25/2022]
Abstract
Because of its retrogastric location and appearance, which is similar to mesenteric fat, for centuries the pancreas has been a mysterious, hidden organ that has received little attention. However, its importance was intuited and described by Herophilus, Ruphos of Ephesus and Galen. This gland began to appearin distinct medical treatises from the 16th century. There are two important scientists in the history of the pancreas. The fist, Johann Georg Wirsung, described the main pancreatic duct in 1642, a date considered by many to be the start of Pancreatology. The second, Claude Bernard, described pancreatic exocrine function between 1849 and 1856 and is considered the father of pancreatic physiology. Besides these two outstanding figures, there is a constellation of personalities who contributed to improving knowledge of this enigmatic gland with the results of their studies. The aim of this article is to call attention to some of the most notable findings that have enhanced knowledge of this gland over the years.
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Affiliation(s)
- Salvador Navarro
- Servicio de Gastroenterología, Institut de Malalties Digestives i Metabóliques, Hospital Clínic, Barcelona, España.
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Abstract
Disconnected pancreatic duct syndrome (DPDS) is characterized by disruption of the main pancreatic duct with a loss of continuity between the pancreatic duct and the gastrointestinal tract caused by ductal necrosis after severe acute necrotizing pancreatitis treated medically, by percutaneous drainage, or necrosectomy. There are no clear epidemiological data on the real incidence of DPDS; approximately 10 to 30% of patients with severe acute pancreatitis could develop DPDS. The existing literature is scarce, the terminology is confusing and therapeutic algorithms are not clearly defined. Both endoscopic and surgical management have been described. We have performed a sytematic review of the literature on DPDS.
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Affiliation(s)
- Jose Manuel Ramia
- Unidad de Cirugía Hepatobiliopancreática, Servicio de Cirugía General y Aparato Digestivo, Hospital Universitario de Guadalajara, Guadalajara, España.
| | - Joan Fabregat
- Unidad de Cirugía Hepatobiliopancreática, Servicio de Cirugía General y Aparato Digestivo, Hospital Universitario de Bellvitge, Barcelona, España
| | | | - Joan Figueras
- Unidad de Cirugía Hepatobiliopancreática, Servicio de Cirugía General y Aparato Digestivo, Hospital Josep Trueta, Gerona, España
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