Pancreatic metastases from other primary malignancies are a rare entity. By far, the most common primary cancer site resulting in an isolated pancreatic metastasis is the kidney, followed by colorectal cancer, melanom...Pancreatic metastases from other primary malignancies are a rare entity. By far, the most common primary cancer site resulting in an isolated pancreatic metastasis is the kidney, followed by colorectal cancer, melanoma, breast cancer, lung carcinoma and sarcoma. Only few data on the surgical outcome of pancreatic resections performed for metastases from other primary tumor have been published, and there are no guidelines to address the surgical treatment for these patients. In this study, we performed a review of the published literature, focusing on the early and long-term results of surgery for the most frequent primary tumors metastasizing to the pancreas. Results for the Literature's analysis show that in last years an increasing number of surgical resections have been performed in selected patients with limited pancreatic disease. Pancreatic resection for metastatic disease can be performed with acceptable mortality and morbidity rates. The usefulness of pancreatic resection is mainly linked to the biology of the primary tumor metastasizing to the pancreas. The benefit of metastasectomy in terms of patient survival has been observed for metastases from renal cell cancer, while for other primary tumors, such as lung and breast cancers, the role of surgery is mainly palliative.展开更多
Pancreatic metastases,although uncommon,have been observed with increasing frequency recently,especially by high-volume pancreatic surgery centers.They are often asymptomatic and detected incidentally or during follow...Pancreatic metastases,although uncommon,have been observed with increasing frequency recently,especially by high-volume pancreatic surgery centers.They are often asymptomatic and detected incidentally or during follow-up investigations even several years after the re-moval of the primary tumor.Renal cell cancer represents the most common primary tumor by far,followed by colorectal cancer,melanoma,sarcoma and lung cancer.Pancreatic metastasectomy is indicated for an isolated and resectable metastasis in a patient fit to tolerate pancreatectomy.Both standard and atypical pancreatic resection can be performed:a resection strategy providing adequate resection margins and maximal tissue preservation of the pancreas should be pursued.The effectiveness of resection for pancreatic metastases is mainly dependent on the tumor biology of the primary cancer;renal cell cancer is associated with the best outcome with a 5-year survival rate greater than 70%.展开更多
Like in most other malignancies the lymph node status is of outstanding prognostic relevance and an important tool for the determination of adjuvant strategies for urological tumor entities, too. Even in the era of PE...Like in most other malignancies the lymph node status is of outstanding prognostic relevance and an important tool for the determination of adjuvant strategies for urological tumor entities, too. Even in the era of PET/CT and MRI with iron oxid nano-particles the radiological imaging technology is strongly limited in cases of metastases smaller than 5 mm. Therefore only the operative lymph node exploration is suitable for an exact lymph node staging. The dilemma, however, is that the extended lymphadenectomy techniques feature a high morbidity and that any limitation of the dissection area results in a reduced detection rate of metastases in penile and prostate cancer. In contrast the sentinel- guided lymphadenectomy (SLND) offers a short operation time and a low morbidity without the risk of a significantly reduced detection of lymph node positive patients. As a consequence of many published papers dealing with a few thousands of patients the European Association of Urology (EAU) guidelines recommend the SLND in penile cancer (tumor stages ≥ T1G2) and as an option in prostate cancer. The latest studies of bladder, renal cell and testicular cancer promise the feasibility for these tumor entities, too. Up to which extend these thera- peutic concepts are able to replace or at least complement the default therapeutic procedures has to be shown in further studies.展开更多
目的:探究肾周脂肪CT参数对肾癌诊断和预后的临床意义和预测价值。方法:收集蚌埠医学院第一附属医院泌尿外科肾癌患者91例,同时收集50例肾囊肿患者作为对照。记录2组患者一般临床资料、MAP评分、肾周脂肪CT值、厚度和面积等资料,寻找对...目的:探究肾周脂肪CT参数对肾癌诊断和预后的临床意义和预测价值。方法:收集蚌埠医学院第一附属医院泌尿外科肾癌患者91例,同时收集50例肾囊肿患者作为对照。记录2组患者一般临床资料、MAP评分、肾周脂肪CT值、厚度和面积等资料,寻找对肾癌诊断具有临床意义的指标并分析其与肾癌患者预后的相关性。结果:2组患者的患侧肾周脂肪面积及手术时间比较差异有统计学意义(P<0.05)。回归分析结果显示,患侧肾周脂肪面积与肾癌相关(P<0.05),且为肾癌发生的独立危险因素。ROC曲线分析结果显示,在肾癌组与肾囊肿组中,最佳临界值为14.575,灵敏度为63.7%,特异度为64.0%,约登指数为0.277,ROC曲线下面积为0.634。在肾癌复发组与未复发组中,最佳临界值为21.485,灵敏度为100.0%,特异度为65.5%,约登指数为0.655,ROC曲线下面积为0.731。免疫组化结果表明高面积组解偶连蛋白1(uncoupling protein 1,UCP-1)表达显著高于低面积组。结论:本研究证实患侧肾周脂肪面积在肾癌诊断及预后判断方面具有一定的临床价值,值得关注并推广。展开更多
目的:应用R.E.N.A.L.肾功能评分系统进行配对分析,比较腹膜后腹腔镜肾部分切除术(Laparoscopic Partial Nephrectomy,LPN)与机器人肾部分切除术(Robot-assisted Partial Nephrectomy,RPN)的围手术期疗效。方法:对2016年1月—2020年3月54...目的:应用R.E.N.A.L.肾功能评分系统进行配对分析,比较腹膜后腹腔镜肾部分切除术(Laparoscopic Partial Nephrectomy,LPN)与机器人肾部分切除术(Robot-assisted Partial Nephrectomy,RPN)的围手术期疗效。方法:对2016年1月—2020年3月543例于浙江大学医学院附属第一医院泌尿外科行腹腔镜及机器人辅助肾部分切除术患者的相关临床资料进行分析。根据R.E.N.A.L.肾功能评分、性别和年龄进行1∶1配对(112对配对),通过统计分析对围手术期结果进行比较。结果:LPN组和RPN组在年龄、性别、体重指数(Body Mass Index,BMI)、肿瘤大小、美国麻醉学家协会(American Society of Anesthesiologists,ASA)评分和术前估算肾小球滤过率(Estimated Glomerular Filtration Rate,eGFR)方面均无显著差异。接受LPN的患者左侧肿瘤所占比例略高(51.7%Vs42.9%,P=0.032)。两组在手术时间、术中出血量、术后住院时间(Length of Stay,LOS)、术后eGFR、输血量和/或术后并发症等方面均无显著差异。RPN组热缺血时间(Warm Ischemia Time,WIT)明显比LPN组短(18.9 min Vs22.6 min,P=0.032)。以复杂性为特点的亚集分析显示,复杂肿瘤RPN的WIT显著短于LPN(21.1 min Vs 26.3 min,P=0.012),而单纯性肿瘤RPN与LPN的WIT差异无统计学意义(16.4 min Vs 18.3 min,P=0.085)。结论:经腹膜后RPN手术时间较经腹膜后LPN短,但二者围手术期效果基本相同。在有限的腹膜后工作空间内进行复杂的肿瘤切除和修补,机器人辅助手术可能比传统的腹腔镜术更具优势。展开更多
A 62-year-old woman with a history of curatively treated mucinous ovarian cancer, presented with dyspnea, anorexia and right-upper-quadrant pain at consultation with her general practitioner. A CT scan revealed severa...A 62-year-old woman with a history of curatively treated mucinous ovarian cancer, presented with dyspnea, anorexia and right-upper-quadrant pain at consultation with her general practitioner. A CT scan revealed several lymph node metastases in lungs and abdomen as well as a tumor in Morrison’s pouch and biopsy revealed renal cell carcinoma. Therefore, she was referred to Department of Urology. The multidisciplinary team could not immediately reject that there could be an exophytic tumor in the right kidney but discrepancy between histology and imaging, led to several biopsies including laparoscopic procedure. Re-examination of the primary ovarian cancer showed that one percent was classified as clear cell carcinoma. The final diagnose was metastatic clear cell ovarian carcinoma. The patient was terminal and suffered of cachexia and pleural effusion. The patient deceased four months after first consultation.展开更多
文摘Pancreatic metastases from other primary malignancies are a rare entity. By far, the most common primary cancer site resulting in an isolated pancreatic metastasis is the kidney, followed by colorectal cancer, melanoma, breast cancer, lung carcinoma and sarcoma. Only few data on the surgical outcome of pancreatic resections performed for metastases from other primary tumor have been published, and there are no guidelines to address the surgical treatment for these patients. In this study, we performed a review of the published literature, focusing on the early and long-term results of surgery for the most frequent primary tumors metastasizing to the pancreas. Results for the Literature's analysis show that in last years an increasing number of surgical resections have been performed in selected patients with limited pancreatic disease. Pancreatic resection for metastatic disease can be performed with acceptable mortality and morbidity rates. The usefulness of pancreatic resection is mainly linked to the biology of the primary tumor metastasizing to the pancreas. The benefit of metastasectomy in terms of patient survival has been observed for metastases from renal cell cancer, while for other primary tumors, such as lung and breast cancers, the role of surgery is mainly palliative.
文摘Pancreatic metastases,although uncommon,have been observed with increasing frequency recently,especially by high-volume pancreatic surgery centers.They are often asymptomatic and detected incidentally or during follow-up investigations even several years after the re-moval of the primary tumor.Renal cell cancer represents the most common primary tumor by far,followed by colorectal cancer,melanoma,sarcoma and lung cancer.Pancreatic metastasectomy is indicated for an isolated and resectable metastasis in a patient fit to tolerate pancreatectomy.Both standard and atypical pancreatic resection can be performed:a resection strategy providing adequate resection margins and maximal tissue preservation of the pancreas should be pursued.The effectiveness of resection for pancreatic metastases is mainly dependent on the tumor biology of the primary cancer;renal cell cancer is associated with the best outcome with a 5-year survival rate greater than 70%.
文摘Like in most other malignancies the lymph node status is of outstanding prognostic relevance and an important tool for the determination of adjuvant strategies for urological tumor entities, too. Even in the era of PET/CT and MRI with iron oxid nano-particles the radiological imaging technology is strongly limited in cases of metastases smaller than 5 mm. Therefore only the operative lymph node exploration is suitable for an exact lymph node staging. The dilemma, however, is that the extended lymphadenectomy techniques feature a high morbidity and that any limitation of the dissection area results in a reduced detection rate of metastases in penile and prostate cancer. In contrast the sentinel- guided lymphadenectomy (SLND) offers a short operation time and a low morbidity without the risk of a significantly reduced detection of lymph node positive patients. As a consequence of many published papers dealing with a few thousands of patients the European Association of Urology (EAU) guidelines recommend the SLND in penile cancer (tumor stages ≥ T1G2) and as an option in prostate cancer. The latest studies of bladder, renal cell and testicular cancer promise the feasibility for these tumor entities, too. Up to which extend these thera- peutic concepts are able to replace or at least complement the default therapeutic procedures has to be shown in further studies.
文摘目的:探究肾周脂肪CT参数对肾癌诊断和预后的临床意义和预测价值。方法:收集蚌埠医学院第一附属医院泌尿外科肾癌患者91例,同时收集50例肾囊肿患者作为对照。记录2组患者一般临床资料、MAP评分、肾周脂肪CT值、厚度和面积等资料,寻找对肾癌诊断具有临床意义的指标并分析其与肾癌患者预后的相关性。结果:2组患者的患侧肾周脂肪面积及手术时间比较差异有统计学意义(P<0.05)。回归分析结果显示,患侧肾周脂肪面积与肾癌相关(P<0.05),且为肾癌发生的独立危险因素。ROC曲线分析结果显示,在肾癌组与肾囊肿组中,最佳临界值为14.575,灵敏度为63.7%,特异度为64.0%,约登指数为0.277,ROC曲线下面积为0.634。在肾癌复发组与未复发组中,最佳临界值为21.485,灵敏度为100.0%,特异度为65.5%,约登指数为0.655,ROC曲线下面积为0.731。免疫组化结果表明高面积组解偶连蛋白1(uncoupling protein 1,UCP-1)表达显著高于低面积组。结论:本研究证实患侧肾周脂肪面积在肾癌诊断及预后判断方面具有一定的临床价值,值得关注并推广。
文摘目的:应用R.E.N.A.L.肾功能评分系统进行配对分析,比较腹膜后腹腔镜肾部分切除术(Laparoscopic Partial Nephrectomy,LPN)与机器人肾部分切除术(Robot-assisted Partial Nephrectomy,RPN)的围手术期疗效。方法:对2016年1月—2020年3月543例于浙江大学医学院附属第一医院泌尿外科行腹腔镜及机器人辅助肾部分切除术患者的相关临床资料进行分析。根据R.E.N.A.L.肾功能评分、性别和年龄进行1∶1配对(112对配对),通过统计分析对围手术期结果进行比较。结果:LPN组和RPN组在年龄、性别、体重指数(Body Mass Index,BMI)、肿瘤大小、美国麻醉学家协会(American Society of Anesthesiologists,ASA)评分和术前估算肾小球滤过率(Estimated Glomerular Filtration Rate,eGFR)方面均无显著差异。接受LPN的患者左侧肿瘤所占比例略高(51.7%Vs42.9%,P=0.032)。两组在手术时间、术中出血量、术后住院时间(Length of Stay,LOS)、术后eGFR、输血量和/或术后并发症等方面均无显著差异。RPN组热缺血时间(Warm Ischemia Time,WIT)明显比LPN组短(18.9 min Vs22.6 min,P=0.032)。以复杂性为特点的亚集分析显示,复杂肿瘤RPN的WIT显著短于LPN(21.1 min Vs 26.3 min,P=0.012),而单纯性肿瘤RPN与LPN的WIT差异无统计学意义(16.4 min Vs 18.3 min,P=0.085)。结论:经腹膜后RPN手术时间较经腹膜后LPN短,但二者围手术期效果基本相同。在有限的腹膜后工作空间内进行复杂的肿瘤切除和修补,机器人辅助手术可能比传统的腹腔镜术更具优势。
文摘A 62-year-old woman with a history of curatively treated mucinous ovarian cancer, presented with dyspnea, anorexia and right-upper-quadrant pain at consultation with her general practitioner. A CT scan revealed several lymph node metastases in lungs and abdomen as well as a tumor in Morrison’s pouch and biopsy revealed renal cell carcinoma. Therefore, she was referred to Department of Urology. The multidisciplinary team could not immediately reject that there could be an exophytic tumor in the right kidney but discrepancy between histology and imaging, led to several biopsies including laparoscopic procedure. Re-examination of the primary ovarian cancer showed that one percent was classified as clear cell carcinoma. The final diagnose was metastatic clear cell ovarian carcinoma. The patient was terminal and suffered of cachexia and pleural effusion. The patient deceased four months after first consultation.
