Necessity and guidance of preoperative pathological diagnosis of space-occupying lesions of the head of pancreas / 中华消化外科杂志

The need of pathological diagnosis of spaceoccupying lesions of the head of pancreas before pancreaticoduodenectomy is a hot issue in the pancreatic surgery.According to the present guidelines and consensus,pathological diagnosis is not required if the patient with clinically resectable space-occupying lesions of the head of pancreas.However,confirmation of tumor malignancy is mandatory for patients with borderline resectable disease to be treated by neoadjuvant therapy,for patients with unresectable tumors to be treated by chemoradiotherapy,and for patients with unresectable tumors to be treated with a palliative bypass procedure during the surgical exploration.When making a clinical decision,surgeons should fully communicate with the patients and their relatives,under the direction of a multidisciplinary team,and have a correct and dialectical knowledge of the guidelines and consensus.This would be helpful for the improvements of the diagnosis and treatment of space-occupying lesions of the head of pancreas.

Diagnosis and treatment of space-occupying lesions of the head of pancreas / 中华消化外科杂志

Objective To investigate the experiences in the diagnosis and treatment of space-occupying lesions of the head of pancreas.Methods The clinical data of 247 patients with space-occupying lesions of the head of pancreas who were admitted to the First Affiliated Hospital of Chinese Medical University from January 2011 to April 2014 were retrospectively analyzed.All the patients received enhanced computed tomnography and (or) magnetic resonance imaging of the pancreas.The levels of alpha-fetal protein (AFP),CA19-9,CA125 and carcinoembryonic antigen (CEA) were detected,and the serum level of IgG4 was detected in patients who were suspected of autoimmune pancreatitis.Intraoperative pathological examination was applied to patients who were diagnosed as with cancer of the head of pancreas.Pancreaticoduodenectomy,extended pancreaticoduodenectomy or bilio-jejunostomy or (and) gastrointestinal anastomosis were applied to patients according to the stage and infiltration of the tumor.Duodenum-preserving pancreatic head resection or pancreaticoduodenectomy could be selected after informed consent.The adjacent tissues and organs should be preserved on the premise of complete tumor resection for patients with benign and low-grade malignancy.Results A total of 194 patients had solid spaceoccupying lesions of the head of pancreas,including 125 with pancreatic head cancer,45 with mnass in the head of pancreas,9 with chronic pancreatitis with mass in the head of pancreas,11 with autoimmune pancreatitis,4 with insulinoma.Fifty-three patients were with cystic space-occupying lesions,including 12 with mucinous cystadenoma,8 with serous cystadenoma,17 with pancreatic cyst,12 with solid-pseudopapillary tumor of pancreas and 4 with intraductal papillary mucinous neoplasm.The positive rates of AFP,CA19-9,CA125 and CEA of the 71 patients who were confirmed as with pancreatic cancer by pathological examination were 7.0％ (5/71),94.4％ (67/71),42.3％ (30/71) and 0,respectively.The positive rates of AFP,CA19-9,CA125 and CEA of the 12 patients with chronic pancreatitis with mass in the head of pancreas were 1/12,4/12,1/12 and 0,respectively.Seventynine patients with pancreatic head cancer,mass in the head of pancreas and chronic pancreatitis with mass in the head of pancreas received intraoperative pathological examination.A total of 119 patients received operation,including 71 with pancreatic head cancer,7 with chronic pancreatitis with mass in the head of pancreas,4 with insulinoma,1 with pancreatic tuberculosis,8 with mucinous cystadenoma,4 with serous cystadenoma,6 with pancreatic pseudocyst,1 with huge lymphangioma,1 with lymphoepithelial cyst,12 with solid-pseudopapillary tumor of pancreas and 4 with intraductal papillary mucinous neoplasm.Of the 247 patients with space-occupying lesions of the head of pancreas,61 received pancreaticoduodenectomy,4 received duodenum-preserving pancreatic head resection,4 received pancreatic head and neck resection,2 received partial resection of the uncinate process of the pancreas,9 received enucleation of the tumor,38 received bilio-jejunostomy or (and) gastrointestinal anastomosis,22 received endoscopic retrograde cholangio-pancreatography + stent installation,18 received percutaneous transhepatic cholangial drainage + stent installation,1 received exploratory lapartomy and the other 88 patients were untreated.Conclusions The diagnosis and differential diagnosis of the space-occupying lesions of the head of pancreas depend on the clinical presentation,medical history,laboratory examination,sonography,computed tomography or magnetic resonance imaging.Individualized treatment plan based on the feature of the tumor and kinds of the lesions combined with intraoperative pathological examination is helpful for selecting the surgical procedures.

Evaluation of LFT and serum iron in obstructive jaundice due to choledocholithiasis and carcinoma head of pancreas.

BACKGROUND: Obstructive jaundice is caused due to obstruction to the biliary flow via the biliary system. The most common benign condition causing this obstruction is Choledocholithiasis and the most common malignant cause is Carcinoma head of pancreas. MATERIALS AND METHODS: 40 cases of Choledocholithiasis and 40 cases of Carcinoma head of pancreas were included in this study. Liver function tests and serum iron and its related parameters were estimated in both the groups and were statistically compared. RESULTS: A statistically significant increase in Total bilirubin, Direct bilirubin, Alkaline phosphatase and 5’Nucleotidase was seen among Group 2 cases when compared to Group 1 cases. Serum iron levels showed a statistically significant decrease among Group 2 cases when compared to Group 1 cases. DISCUSSION: Early evaluation of obstructive jaundice to establish the etiology is crucial to avoid secondary pathological changes. Liver function tests provide a simple and non-invasive means of diagnosis. In this study it is observed that the magnitude of alteration of LFT is higher in Carcinoma head of pancreas when compared to Choledocholithiasis thus differentiating the two. Serum iron levels are elevated in hepatocellular injury and as there is hepatocellular injury in obstructive jaundice, serum iron levels were estimated in both the groups of patients. However serum iron levels were within the normal range but the mean value was lower in the group 2 compared to group 1 which demands further study in this field.

Efficacies of extended and standard radical pancreatoduodenectomy / 中华消化外科杂志

Objective To compare the efficacies of extended and standard radical pancreatoduodenectomy (RPD) for the treatment of pancreatic cancer in head of pancreas.Methods The clinical data of 96 patients with pancreatic cancer in head of pancreas who were admitted to the West China Hospital of Sichuan University from 2001 to 2011 were retrospectively analyzed.Forty-one patients who received extended RPD were in the extended group and 55 patients who received standard RPD were in the standard group.Blood loss,operation time,hospital stay,surgical complications,severity of complication,1-,3-,5-year survival rate,median survival time,time and location of tumor recurrence and 1-year quality of life of the patients in the 2 groups were compared.All data were analyzed by using rank sum test and analysis of variance.The survival rate was calculated by Kaplan-Meier method and was analyzed by Log-rank test.Results There were no significant differences in the age,diameter and differentiation of the tumor,and number of metastatic lymph nodes between the 2 groups.The operation time,operative blood loss,postoperative hospital stay were 364 minutes (310-650 minutes),680 ml (0-1800 ml) and 13.5 days (10-76 days) in the extended group,which were significantly higher than 315 minutes (260-306 minutes),305 ml (0-1000 ml) and 9.2 days (7-30 days) in the standard group (F=7.15,4.22,3.82,P＜0.05).The incidences of complications in grade 1 and 2 were 5％ (2/41) and 20％ (8/41) in the extended group,which were significantly lower than 25％ ( 14/55 ) and 49％ (27/55) in the standard group ( x2 =5.76,8.87,P ＜ 0.05).The incidence of complications in grade 3a was 41％ ( 17/41 ) in the extended group,which was significantly higher than 7％ (4/55) in the standard group ( x2 =14.10,P ＜ 0.05 ).There were no significant differences in the incidence of complications in grade 3b and 4a between the 2 groups ( x2 =1.44,0.88,P ＞ 0.05 ).There were no significant difference in the 1-,3-,5-year survival rate,median survival time,postoperative quality of life and time of tumor recurrence between the 2 groups ( x2 =0,0.13,0; F =0.49,1.03,t =0.32,P ＞ 0.05 ).Conclusion Standard RPD is optimal for patients with ordinary pancreatic cancer in head of pancreas.Extended RPD could be applied for patients with enlargement of group 16 lymph nodes and could receive R0 resection.

Surgical Treatment of Chronic Pancreatitis with Mass in Head / 上海第二医科大学学报

Objective To summarize and discuss the diagnostic and treating experiences of chronic pancreatitis with mass in the head. Methods Eight patients of chronic pancreatitis with mass in the head who were misdiagnosised as carcinoma of head of pancreas were analyzed retrospectively in the past 10 years. Results All the patients exhibited abdominal pain,5 of whom were with jaundice and 3 with anorexia. All the patients were misdiagnosised as carcinoma of head of pancreas before the operation,but the pathology after operation indicated chronic pancreatitis. The pancreaticoduodenectomy was performed in 5 patients,the choledochojejunostomy in 2 patients,while the exploratory laparotomy in 1 patient. After the operations,the abdominal pain was relieved in 7 patients, while 2 patients who accepted pancreatoduodenectomy suffered from pancreatic fistula,1 of whom died in the end. Conclusion It’s hard to differentiate the chronic pancreatitis with mass in the head from the carcinoma of head of pancreas before operation. If the carcinoma of head of pancreas can’t be excluded during the operation,the pancreatoduodenectomy should be performed,while the duodenum-preserving total resection of the head of the pancreas or any intra-drainage operations should be done if chronic inflammation is found in the whole pancreas with a negative result of the biopsy of the pancreas through the needle aspiration.

A Case of Solid and Papillary Epithelial Neoplasm in Head of Pancreas in a 11-year-old Female / 대한소아소화기영양학회지

Solid and Papillary epithelial neoplasm of pancreas is a rare and low grade malignant tumor. It develops in 2nd or 3rd decades of young female and located in tail of pancreas predominantly. Prognosis is good despite its various histologic features, which suggest a malignant appearance. We report one case of solid and papillary epithelial neoplasm in head of pancreas in a 11-year-old girl who had been suffered from vomiting and right upper abdominal pain for 3 weeks.

Therapeutic effect analysis of surgical treatment for carcinoma of the head of pancreas in 97 cases / 重庆医科大学学报

Objective:To analyze therapeutic effect of surgical treatment for carcinoma of the head of pancreas and study the operative indication and model of carcinoma of the head of pancreas.Methods:The clinical data of 97 patients with carcinoma of the head of pancreas were analyzed retrospectively from 2000 to 2004.Results:41 patients underwent pancreatoduodenectomy,13 patients underwent pancreatoduodenectomy with PV/SMV resection,palliative hepaticojejunostomy was performed to the rest.All the patients who underwent palliative resection were died in lyear after the operation,the 1,3-year survival rate of patients undergoing PD was 58.5% and 26.8% respectively,the 1,3-year survival rate of patients undergoing PD with vascular resection was 53.8% and 23.1% respectively.Conclusion:PD is the only way to cure.carcinoma of the head of pancreas,PD with vascular resection can increase the resection rate and the survival on the condition of strict indication.