评估内镜超声引导下细针抽吸术(endoscopic ultrasound-guided fine needle aspiration,EUS-FNA)诊断继发性胰腺肿瘤的有效性。回顾性分析2015年1月—2020年11月在复旦大学附属中山医院内镜中心因胰腺占位性病变行EUS-FNA,且病理证实为...评估内镜超声引导下细针抽吸术(endoscopic ultrasound-guided fine needle aspiration,EUS-FNA)诊断继发性胰腺肿瘤的有效性。回顾性分析2015年1月—2020年11月在复旦大学附属中山医院内镜中心因胰腺占位性病变行EUS-FNA,且病理证实为继发性胰腺肿瘤的患者资料。统计患者的临床特征,肿瘤EUS表现,病理类型和分布,以及后续治疗及随访情况。11例患者经EUS-FNA最终诊断为继发性胰腺肿瘤,其中肾脏来源4例,肺来源4例,结肠、乳腺、膀胱来源各1例。EUS主要呈均匀低回声表现(10/11),周围边界不清晰(6/11)。近半数患者(5/11)可在转移灶附近发现淋巴结肿大。转移灶诊断与原发肿瘤发现的时间跨度从6 d至27年不等。EUS-FNA可有效诊断继发性胰腺肿瘤。展开更多
卵巢恶性肿瘤按组织来源分为上皮性肿瘤、生殖细胞肿瘤、性索-间质肿瘤及转移性肿瘤,后者是指原发于其他器官的肿瘤转移至卵巢,也称卵巢继发性肿瘤(secondary tumors of the ovary,STOs)。STOs占卵巢恶性肿瘤的10%~25%^([1-2]),肿瘤原...卵巢恶性肿瘤按组织来源分为上皮性肿瘤、生殖细胞肿瘤、性索-间质肿瘤及转移性肿瘤,后者是指原发于其他器官的肿瘤转移至卵巢,也称卵巢继发性肿瘤(secondary tumors of the ovary,STOs)。STOs占卵巢恶性肿瘤的10%~25%^([1-2]),肿瘤原发部位多来源于乳腺、消化系统、卵巢以外的生殖道、泌尿系统等,消化道恶性肿瘤为STOs的常见原发肿瘤,其中以胃癌及结直肠癌最为常见。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
Background: During the last decades, deceased-donor liver transplantation (DDLT) has gained a place in the therapeutic algorithm of well-selected patients harbouring non-resectable secondary liver tumors. Living-donor...Background: During the last decades, deceased-donor liver transplantation (DDLT) has gained a place in the therapeutic algorithm of well-selected patients harbouring non-resectable secondary liver tumors. Living-donor LT (LDLT) might represent a valuable means to further expand this indication for LT. Methods: Between 1985 and 2016, twenty-two adults were transplanted because of neuroendocrine ( n = 18, 82%) and colorectal metastases ( n = 4, 18%);50% received DDLT and 50% LDLT. In LDLT, 4 (36%) right and 7 (64%) left grafts were used;the median graft-to-recipient-weight ratios (GRWR) were 1.03%(IQR 0.86%- 1.30%) and 0.59%(IQR 0.51%- 0.91%), respectively. Median post-LT follow-up was 64 months (IQR 17–107) in the DDLT group and 40 months (IQR 35–116) in the LDLT group. DDLT and LDLT recipients were compared in terms of overall survival, graft survival, postoperative complications and recurrence. Results: The 1- and 5-year actuarial patient survivals were 82% and 55% after DDLT, 100% and 100% after LDLT, respectively ( P < 0.01). One- and 5-year actuarial graft survivals were 73% and 36% after DDLT, 91% and 91% after LDLT ( P < 0.01). The outcomes of right or left LDLT were comparable. Donor hepatectomy proved safe, and one donor experienced a Clavien IIIb complication. Bilirubin peak was significantly lower after left hepatectomy compared with that after right hepatectomy [1.3 (IQR 1.2–2.2) vs. 3.3 (IQR 2.3–5.2) mg/dL;P = 0.02]. Conclusions: The more recent LDLT series compared favorably to our DDLT series in the treatment of secondary liver malignancies. The absence of portal hypertension and the use of smaller left grafts make recipient and donor surgeries safe. The safety of the procedures and lack of interference with the scarce allograft pool are expected to lead to a more frequent use of LDLT in the field of transplant oncology.展开更多
文摘卵巢恶性肿瘤按组织来源分为上皮性肿瘤、生殖细胞肿瘤、性索-间质肿瘤及转移性肿瘤,后者是指原发于其他器官的肿瘤转移至卵巢,也称卵巢继发性肿瘤(secondary tumors of the ovary,STOs)。STOs占卵巢恶性肿瘤的10%~25%^([1-2]),肿瘤原发部位多来源于乳腺、消化系统、卵巢以外的生殖道、泌尿系统等,消化道恶性肿瘤为STOs的常见原发肿瘤,其中以胃癌及结直肠癌最为常见。
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Background: During the last decades, deceased-donor liver transplantation (DDLT) has gained a place in the therapeutic algorithm of well-selected patients harbouring non-resectable secondary liver tumors. Living-donor LT (LDLT) might represent a valuable means to further expand this indication for LT. Methods: Between 1985 and 2016, twenty-two adults were transplanted because of neuroendocrine ( n = 18, 82%) and colorectal metastases ( n = 4, 18%);50% received DDLT and 50% LDLT. In LDLT, 4 (36%) right and 7 (64%) left grafts were used;the median graft-to-recipient-weight ratios (GRWR) were 1.03%(IQR 0.86%- 1.30%) and 0.59%(IQR 0.51%- 0.91%), respectively. Median post-LT follow-up was 64 months (IQR 17–107) in the DDLT group and 40 months (IQR 35–116) in the LDLT group. DDLT and LDLT recipients were compared in terms of overall survival, graft survival, postoperative complications and recurrence. Results: The 1- and 5-year actuarial patient survivals were 82% and 55% after DDLT, 100% and 100% after LDLT, respectively ( P < 0.01). One- and 5-year actuarial graft survivals were 73% and 36% after DDLT, 91% and 91% after LDLT ( P < 0.01). The outcomes of right or left LDLT were comparable. Donor hepatectomy proved safe, and one donor experienced a Clavien IIIb complication. Bilirubin peak was significantly lower after left hepatectomy compared with that after right hepatectomy [1.3 (IQR 1.2–2.2) vs. 3.3 (IQR 2.3–5.2) mg/dL;P = 0.02]. Conclusions: The more recent LDLT series compared favorably to our DDLT series in the treatment of secondary liver malignancies. The absence of portal hypertension and the use of smaller left grafts make recipient and donor surgeries safe. The safety of the procedures and lack of interference with the scarce allograft pool are expected to lead to a more frequent use of LDLT in the field of transplant oncology.
