AIM: To evaluate the results of segmental duodenectomy (SD) and pancreaticoduodenectomy (PD) for duodenal gastrointestinal stromal tumor (GIST) and help clinicians with surgical management. METHODS: All patients who u...AIM: To evaluate the results of segmental duodenectomy (SD) and pancreaticoduodenectomy (PD) for duodenal gastrointestinal stromal tumor (GIST) and help clinicians with surgical management. METHODS: All patients who underwent surgery for non-metastatic GIST of the duodenum in a single institution since 2000 were prospectively followed up. Seven patients (median age 51 years, range: 41-73 years) were enrolled: five underwent SD and two underwent PD. RESULTS: All the patients had a complete resection (R0), with no postoperative morbidity and mortality. Among the SD group, GIST was classified as low risk in two patients, intermediate risk in two, and high risk in one, according to the Fletcher scale, (vs two high risk patients in the PD group). With a median followup of 41 (18-85) mo, disease-free survival (DFS) rateswere 100% after SD and 0% after PD (P < 0.05). The median DFS was 13 mo in the PD group. CONCLUSION: Whenever associated with clear surgical margins, SD is a reliable and curative option for most duodenal GISTs, and is compatible with longterm DFS.展开更多
Recent advances in localization techniques,such as the selective arterial secretagogue injection test(SASI test) and somatostatin receptor scintigraphy have promoted curative resection surgery for patients with pancre...Recent advances in localization techniques,such as the selective arterial secretagogue injection test(SASI test) and somatostatin receptor scintigraphy have promoted curative resection surgery for patients with pancreatic neuroendocrine tumors(PNET).For patients with sporadic functioning PNET,curative resection surgery has been established by localization with the SASI test using secretin or calcium.For curative resection of functioning PNET associated with multiple endocrine neoplasia type 1(MEN 1) which are usually multiple and sometimes numerous,resection surgery of the pancreas and/or the duodenum has to be performed based on localization by the SASI test.As resection surgery of PNET has increased,several important pathological features of PNET have been revealed.For example,in patients with Zollinger-Ellison syndrome(ZES),duodenal gastrinoma has been detected more frequently than pancreatic gastrinoma,and in patients with MEN 1 and ZES,gastrinomas have been located mostly in the duodenum,and pancreatic gastrinoma has been found to co-exist in 13% of patients.Nonfunctioning PNET in patients with MEN 1 becomes metastatic to the liver when it is more than 1 cm in diameter and should be resected after careful observation.The most important prognos-tic factor in patients with PNET is the development of hepatic metastases.The treatment strategy for hepatic metastases of PNET has not been established and aggressive resection with chemotherapy and trans-arterial chemoembolization have been performed with significant benefit.The usefulness of octreotide treatment and other molecular targeting agents are currently being assessed.展开更多
To investigate the range of pathologies treated by pancreas preserving distal duodenectomy (PPDD) and present the outcome of follow-up.METHODSNeoplastic lesions of the duodenum are treated conventionally by pancreatic...To investigate the range of pathologies treated by pancreas preserving distal duodenectomy (PPDD) and present the outcome of follow-up.METHODSNeoplastic lesions of the duodenum are treated conventionally by pancreaticoduodenectomy. Lesions distal to the major papilla may be suitable for a pancreas-preserving distal duodenectomy, potentially reducing morbidity and mortality. We present our experience with this procedure. Selective intraoperative duodenoscopy assessed the relationship of the papilla to the lesion. After duodenal mobilisation and confirmation of the site of the lesion, the duodenum was transected distal to the papilla and beyond the duodenojejunal flexure and a side-to-side duodeno-jejunal anastomosis was formed. Patients were identified from a prospectively maintained database and outcomes determined from digital health records with a dataset including demographics, co-morbidities, mode of presentation, preoperative imaging and assessment, nutritional support needs, technical operative details, blood transfusion requirements, length of stay, pathology including lymph node yield and lymph node involvement, length of follow-up, complications and outcomes. Related published literature was also reviewed.RESULTSTwenty-four patients had surgery with the intent of performing PPDD from 2003 to 2016. Nineteen underwent PPDD successfully. Two patients planned for PPDD proceeded to formal pancreaticoduodenectomy (PD) while three had unresectable disease. Median post-operative follow-up was 32 mo. Pathologies resected included duodenal adenocarcinoma (n = 6), adenomas (n = 5), gastrointestinal stromal tumours (n = 4) and lipoma, bleeding duodenal diverticulum, locally advanced colonic adenocarcinoma and extrinsic compression (n = 1 each). Median postoperative length of stay (LOS) was 8 d and morbidity was low [pain and nausea/vomiting (n = 2), anastomotic stricture (n = 1), pneumonia (n = 1), and overwhelming post-splenectomy sepsis (n = 1, asplenic patient)]. PPDD was associated with a significantly shorter L展开更多
Major duodenal papilla cancer(MDPC) represents the primary type of duodenal cancer, and is typically considered a periampullary carcinoma as most tumors arise in this region. This report describes an extremely rare ca...Major duodenal papilla cancer(MDPC) represents the primary type of duodenal cancer, and is typically considered a periampullary carcinoma as most tumors arise in this region. This report describes an extremely rare case involving a patient with rapidly and extensively recurrent MDPC following pancreaticoduodenectomy, who achieved complete response by concurrent image-guided radiation and intravenous oxaliplatin plus oral capecitabine therapies. The patient was a 50-year-old female who was admitted to our hospital 6 wk after resection for MDPC for evaluation of a nontender and enlarged node in the left side of her neck. After clinical work-up, the patient was diagnosed with postoperatively recurrent MDPC with widespread lymph node metastases at the bilateral cervix, mediastinum, abdominal cavity, and retroperitoneal area. She was administered whole field image-guided radiation therapy along with four cycles of the intravenous oxaliplatin plus oral capecitabine regimen. A complete response by positron emission tomography with 18-fluorodeoxyglucose was observed 4 months after treatment. The patient continues to be disease-free 2 years after the diagnosis of recurrence.展开更多
BACKGROUND The management of cystic dystrophy of the duodenal wall(CDDW),or groove pancreatitis(GP),remains controversial.Although pancreatoduodenectomy(PD)is considered the most suitable operation for CDDW,pancreas-p...BACKGROUND The management of cystic dystrophy of the duodenal wall(CDDW),or groove pancreatitis(GP),remains controversial.Although pancreatoduodenectomy(PD)is considered the most suitable operation for CDDW,pancreas-preserving duodenal resection(PPDR)has also been suggested as an alternative for the pure form of GP(isolated CDDW).There are no studies comparing PD and PPDR for this disease.AIM To compare the safety,efficacy,and short-and long-term results of PD and PPDR in patients with CDDW.METHODS A retrospective analysis of the clinical,radiologic,pathologic,and intra-and postoperative data of 84 patients with CDDW(2004-2020)and a comparison of the safety and efficacy of PD and PPDR.RESULTS Symptoms included abdominal pain(100%),weight loss(76%),vomiting(30%)and jaundice(18%)and data from computed tomography,magnetic resonance imaging,and endoUS led to the correct preoperative diagnosis in 98.8%of cases.Twelve patients were treated conservatively with pancreaticoenterostomy(n=8),duodenum-preserving pancreatic head resection(n=6),PD(n=44)and PPDR(n=15)without mortality.Weight gain was significantly higher after PD and PPDR and complete pain control was achieved significantly more often after PPDR(93%)and PD(84%)compared to the other treatment modalities(18%).New onset diabetes mellitus and severe exocrine insufficiency occurred after PD(31%and 14%),but not after PPDR.CONCLUSION PPDR has similar safety and better efficacy than PD in patients with CDDW and may be the optimal procedure for the isolated form of CDDW.The pure form of GP is a duodenal disease and PD may be an overtreatment for this disease.Early detection of CDDW provides an opportunity for pancreas-preserving surgery.展开更多
BACKGROUND Duodenal papillary tumor is a rare tumor of the digestive tract,accounting for about 0.2%of gastrointestinal tumors and 7%of periampullary tumors.The clinical manifestations of biliary obstruction are most ...BACKGROUND Duodenal papillary tumor is a rare tumor of the digestive tract,accounting for about 0.2%of gastrointestinal tumors and 7%of periampullary tumors.The clinical manifestations of biliary obstruction are most common.Some benign tumors or small malignant tumors are often not easily found because they have no obvious symptoms in the early stage.Surgical resection is the only treatment for duodenal papillary tumors.At present,the methods of operation for duodenal papillary tumors include pancreatoduodenectomy,duodenectomy,ampullectomy,and endoscopic resection.CASE SUMMARY A 47-year-old man was admitted to because of a duodenal mass that had been discovered 2 mo previously.Electronic gastroscopy at another hospital revealed a duodenal papillary mass that had been considered to be a high-grade intraepithelial neoplasia.Therefore,we conducted a multidisciplinary group discussion and decided to perform a pancreas-preserving duodenectomy and a R0 resection was successfully performed.After surgery,the patient underwent a follow-up period of 5 yr.No recurrence or metastasis occurred.CONCLUSION According to our experience with a duodenal papillary tumor,compared with pancreaticoduodenectomy,the use of pancreas-preserving duodenectomy can preserve pancreatic function,maintain gastrointestinal structure and function,reduce tissue damage and complications,and render the postoperative recovery faster.Pancreas-preserving duodenectomy for treatment of a duodenal papillary tumor is feasible under strict control of surgical indications.展开更多
Background:There are no clearly defined indications for pancreas-preserving duodenectomy.The present study aimed to analyze postoperative morbidity and the outcomes of patients undergoing pancreaspreserving duodenecto...Background:There are no clearly defined indications for pancreas-preserving duodenectomy.The present study aimed to analyze postoperative morbidity and the outcomes of patients undergoing pancreaspreserving duodenectomy.Methods:Patients undergoing pancreas-preserving duodenectomy from April 2008 to May 2020 were included.We divided the series according to indication:scenario 1,primary duodenal tumors;scenario 2,tumors of another origin with duodenal involvement;and scenario 3,emergency duodenectomy.Results:We included 35 patients.Total duodenectomy was performed in 1 patient of adenomatous duodenal polyposis,limited duodenectomy in 7,and third+fourth duodenal portion resection in 27.The indications for scenario 1 were gastrointestinal stromal tumor(n=13),adenocarcinoma(n=4),neuroendocrine tumor(n=3),duodenal adenoma(n=1),and adenomatous duodenal polyposis(n=1);scenario 2:retroperitoneal desmoid tumor(n=2),recurrence of liposarcoma(n=2),retroperitoneal paraganglioma(n=1),neuroendocrine tumor in pancreatic uncinate process(n=1),and duodenal infiltration due to metastatic adenopathies of a germinal tumor with digestive hemorrhage(n=1);and scenario 3:aortoenteric fistula(n=3),duodenal trauma(n=1),erosive duodenitis(n=1),and biliopancreatic limb ischemia(n=1).Severe complications(Clavien-Dindo≥IIIb)developed in 14%(5/35),and postoperative mortality was 3%(1/35).Conclusions:Pancreas-preserving duodenectomy is useful in the management of primary duodenal tumors,and is a technical option for some tumors with duodenal infiltration or in emergency interventions.展开更多
BACKGROUND:With the improvement of perioperative management over the years,pancreatico-duodenectomy has become a safe operation despite its technical complexity.The presence of concomitant visceral artery occlusion un...BACKGROUND:With the improvement of perioperative management over the years,pancreatico-duodenectomy has become a safe operation despite its technical complexity.The presence of concomitant visceral artery occlusion unrelated to the underlying malignancy and concomitant major venous infiltration by tumor poses additional hazards to resection which could compromise the postoperative outcome.DATA SOURCES:A MEDLINE database search was performed to identify relevant articles using the key ords 'median arcuate ligament syndrome','superior mesenteric artery','replaced right hepatic artery',and 'portal vein resection'.Additional papers and book chapters were identified by a manual search of the references from the key articles.RESULTS:Computed tomography with 3-dimensional reconstruction of the vascular anatomy provides most key information on the potential vascular problems encountered during surgery.A trial clamping of the gastroduodenal artery provides a simple intraoperative assessment for the presence of any significant visceral arterial occlusion.Depending on the timing of diagnosis,division of the median arcuate ligament,bypass or endovascular stenting should be considered.Portal and superior mesenteric vein resection had been used with increasing frequency and safety.The steps and methods taken to reconstruct the venous continuity vary with individual surgeons,and the anatomical variations encountered.With segmental loss of the portal vein,opinions differs with regard to the preservation of the splenic vein,and when divided,the necessity of restoring its continuity;source of the autologous vein graft when needed and whether the use of synthetic graft is a safe alternative.CONCLUSIONS:During a pancreatico-duodenectomy,images of computed tomography must be carefully studied to appreciate the changes and variation of vascular anatomy.Adequate preoperative preparation,acute awareness of the probable arterial and venous anatomical variation and the availability of expertise,especially micro-vascular surgery,for vascul展开更多
文摘AIM: To evaluate the results of segmental duodenectomy (SD) and pancreaticoduodenectomy (PD) for duodenal gastrointestinal stromal tumor (GIST) and help clinicians with surgical management. METHODS: All patients who underwent surgery for non-metastatic GIST of the duodenum in a single institution since 2000 were prospectively followed up. Seven patients (median age 51 years, range: 41-73 years) were enrolled: five underwent SD and two underwent PD. RESULTS: All the patients had a complete resection (R0), with no postoperative morbidity and mortality. Among the SD group, GIST was classified as low risk in two patients, intermediate risk in two, and high risk in one, according to the Fletcher scale, (vs two high risk patients in the PD group). With a median followup of 41 (18-85) mo, disease-free survival (DFS) rateswere 100% after SD and 0% after PD (P < 0.05). The median DFS was 13 mo in the PD group. CONCLUSION: Whenever associated with clear surgical margins, SD is a reliable and curative option for most duodenal GISTs, and is compatible with longterm DFS.
文摘Recent advances in localization techniques,such as the selective arterial secretagogue injection test(SASI test) and somatostatin receptor scintigraphy have promoted curative resection surgery for patients with pancreatic neuroendocrine tumors(PNET).For patients with sporadic functioning PNET,curative resection surgery has been established by localization with the SASI test using secretin or calcium.For curative resection of functioning PNET associated with multiple endocrine neoplasia type 1(MEN 1) which are usually multiple and sometimes numerous,resection surgery of the pancreas and/or the duodenum has to be performed based on localization by the SASI test.As resection surgery of PNET has increased,several important pathological features of PNET have been revealed.For example,in patients with Zollinger-Ellison syndrome(ZES),duodenal gastrinoma has been detected more frequently than pancreatic gastrinoma,and in patients with MEN 1 and ZES,gastrinomas have been located mostly in the duodenum,and pancreatic gastrinoma has been found to co-exist in 13% of patients.Nonfunctioning PNET in patients with MEN 1 becomes metastatic to the liver when it is more than 1 cm in diameter and should be resected after careful observation.The most important prognos-tic factor in patients with PNET is the development of hepatic metastases.The treatment strategy for hepatic metastases of PNET has not been established and aggressive resection with chemotherapy and trans-arterial chemoembolization have been performed with significant benefit.The usefulness of octreotide treatment and other molecular targeting agents are currently being assessed.
文摘To investigate the range of pathologies treated by pancreas preserving distal duodenectomy (PPDD) and present the outcome of follow-up.METHODSNeoplastic lesions of the duodenum are treated conventionally by pancreaticoduodenectomy. Lesions distal to the major papilla may be suitable for a pancreas-preserving distal duodenectomy, potentially reducing morbidity and mortality. We present our experience with this procedure. Selective intraoperative duodenoscopy assessed the relationship of the papilla to the lesion. After duodenal mobilisation and confirmation of the site of the lesion, the duodenum was transected distal to the papilla and beyond the duodenojejunal flexure and a side-to-side duodeno-jejunal anastomosis was formed. Patients were identified from a prospectively maintained database and outcomes determined from digital health records with a dataset including demographics, co-morbidities, mode of presentation, preoperative imaging and assessment, nutritional support needs, technical operative details, blood transfusion requirements, length of stay, pathology including lymph node yield and lymph node involvement, length of follow-up, complications and outcomes. Related published literature was also reviewed.RESULTSTwenty-four patients had surgery with the intent of performing PPDD from 2003 to 2016. Nineteen underwent PPDD successfully. Two patients planned for PPDD proceeded to formal pancreaticoduodenectomy (PD) while three had unresectable disease. Median post-operative follow-up was 32 mo. Pathologies resected included duodenal adenocarcinoma (n = 6), adenomas (n = 5), gastrointestinal stromal tumours (n = 4) and lipoma, bleeding duodenal diverticulum, locally advanced colonic adenocarcinoma and extrinsic compression (n = 1 each). Median postoperative length of stay (LOS) was 8 d and morbidity was low [pain and nausea/vomiting (n = 2), anastomotic stricture (n = 1), pneumonia (n = 1), and overwhelming post-splenectomy sepsis (n = 1, asplenic patient)]. PPDD was associated with a significantly shorter L
基金Supported by Sichuan Cancer Hospital and InstituteChengdu+1 种基金Sichuan ProvinceChina
文摘Major duodenal papilla cancer(MDPC) represents the primary type of duodenal cancer, and is typically considered a periampullary carcinoma as most tumors arise in this region. This report describes an extremely rare case involving a patient with rapidly and extensively recurrent MDPC following pancreaticoduodenectomy, who achieved complete response by concurrent image-guided radiation and intravenous oxaliplatin plus oral capecitabine therapies. The patient was a 50-year-old female who was admitted to our hospital 6 wk after resection for MDPC for evaluation of a nontender and enlarged node in the left side of her neck. After clinical work-up, the patient was diagnosed with postoperatively recurrent MDPC with widespread lymph node metastases at the bilateral cervix, mediastinum, abdominal cavity, and retroperitoneal area. She was administered whole field image-guided radiation therapy along with four cycles of the intravenous oxaliplatin plus oral capecitabine regimen. A complete response by positron emission tomography with 18-fluorodeoxyglucose was observed 4 months after treatment. The patient continues to be disease-free 2 years after the diagnosis of recurrence.
文摘BACKGROUND The management of cystic dystrophy of the duodenal wall(CDDW),or groove pancreatitis(GP),remains controversial.Although pancreatoduodenectomy(PD)is considered the most suitable operation for CDDW,pancreas-preserving duodenal resection(PPDR)has also been suggested as an alternative for the pure form of GP(isolated CDDW).There are no studies comparing PD and PPDR for this disease.AIM To compare the safety,efficacy,and short-and long-term results of PD and PPDR in patients with CDDW.METHODS A retrospective analysis of the clinical,radiologic,pathologic,and intra-and postoperative data of 84 patients with CDDW(2004-2020)and a comparison of the safety and efficacy of PD and PPDR.RESULTS Symptoms included abdominal pain(100%),weight loss(76%),vomiting(30%)and jaundice(18%)and data from computed tomography,magnetic resonance imaging,and endoUS led to the correct preoperative diagnosis in 98.8%of cases.Twelve patients were treated conservatively with pancreaticoenterostomy(n=8),duodenum-preserving pancreatic head resection(n=6),PD(n=44)and PPDR(n=15)without mortality.Weight gain was significantly higher after PD and PPDR and complete pain control was achieved significantly more often after PPDR(93%)and PD(84%)compared to the other treatment modalities(18%).New onset diabetes mellitus and severe exocrine insufficiency occurred after PD(31%and 14%),but not after PPDR.CONCLUSION PPDR has similar safety and better efficacy than PD in patients with CDDW and may be the optimal procedure for the isolated form of CDDW.The pure form of GP is a duodenal disease and PD may be an overtreatment for this disease.Early detection of CDDW provides an opportunity for pancreas-preserving surgery.
基金Supported by The National Natural Science Foundation of China,No.81660398The Hospital Key Program of National Scientific Research Cultivation Plan,No.19SYPYA-12.
文摘BACKGROUND Duodenal papillary tumor is a rare tumor of the digestive tract,accounting for about 0.2%of gastrointestinal tumors and 7%of periampullary tumors.The clinical manifestations of biliary obstruction are most common.Some benign tumors or small malignant tumors are often not easily found because they have no obvious symptoms in the early stage.Surgical resection is the only treatment for duodenal papillary tumors.At present,the methods of operation for duodenal papillary tumors include pancreatoduodenectomy,duodenectomy,ampullectomy,and endoscopic resection.CASE SUMMARY A 47-year-old man was admitted to because of a duodenal mass that had been discovered 2 mo previously.Electronic gastroscopy at another hospital revealed a duodenal papillary mass that had been considered to be a high-grade intraepithelial neoplasia.Therefore,we conducted a multidisciplinary group discussion and decided to perform a pancreas-preserving duodenectomy and a R0 resection was successfully performed.After surgery,the patient underwent a follow-up period of 5 yr.No recurrence or metastasis occurred.CONCLUSION According to our experience with a duodenal papillary tumor,compared with pancreaticoduodenectomy,the use of pancreas-preserving duodenectomy can preserve pancreatic function,maintain gastrointestinal structure and function,reduce tissue damage and complications,and render the postoperative recovery faster.Pancreas-preserving duodenectomy for treatment of a duodenal papillary tumor is feasible under strict control of surgical indications.
基金supported by grants from the Institut de Investigació Biomèdica de Bellvitge(IDIBELL Foundation)the CERCA Programme/Generalitat de Catalunya。
文摘Background:There are no clearly defined indications for pancreas-preserving duodenectomy.The present study aimed to analyze postoperative morbidity and the outcomes of patients undergoing pancreaspreserving duodenectomy.Methods:Patients undergoing pancreas-preserving duodenectomy from April 2008 to May 2020 were included.We divided the series according to indication:scenario 1,primary duodenal tumors;scenario 2,tumors of another origin with duodenal involvement;and scenario 3,emergency duodenectomy.Results:We included 35 patients.Total duodenectomy was performed in 1 patient of adenomatous duodenal polyposis,limited duodenectomy in 7,and third+fourth duodenal portion resection in 27.The indications for scenario 1 were gastrointestinal stromal tumor(n=13),adenocarcinoma(n=4),neuroendocrine tumor(n=3),duodenal adenoma(n=1),and adenomatous duodenal polyposis(n=1);scenario 2:retroperitoneal desmoid tumor(n=2),recurrence of liposarcoma(n=2),retroperitoneal paraganglioma(n=1),neuroendocrine tumor in pancreatic uncinate process(n=1),and duodenal infiltration due to metastatic adenopathies of a germinal tumor with digestive hemorrhage(n=1);and scenario 3:aortoenteric fistula(n=3),duodenal trauma(n=1),erosive duodenitis(n=1),and biliopancreatic limb ischemia(n=1).Severe complications(Clavien-Dindo≥IIIb)developed in 14%(5/35),and postoperative mortality was 3%(1/35).Conclusions:Pancreas-preserving duodenectomy is useful in the management of primary duodenal tumors,and is a technical option for some tumors with duodenal infiltration or in emergency interventions.
文摘BACKGROUND:With the improvement of perioperative management over the years,pancreatico-duodenectomy has become a safe operation despite its technical complexity.The presence of concomitant visceral artery occlusion unrelated to the underlying malignancy and concomitant major venous infiltration by tumor poses additional hazards to resection which could compromise the postoperative outcome.DATA SOURCES:A MEDLINE database search was performed to identify relevant articles using the key ords 'median arcuate ligament syndrome','superior mesenteric artery','replaced right hepatic artery',and 'portal vein resection'.Additional papers and book chapters were identified by a manual search of the references from the key articles.RESULTS:Computed tomography with 3-dimensional reconstruction of the vascular anatomy provides most key information on the potential vascular problems encountered during surgery.A trial clamping of the gastroduodenal artery provides a simple intraoperative assessment for the presence of any significant visceral arterial occlusion.Depending on the timing of diagnosis,division of the median arcuate ligament,bypass or endovascular stenting should be considered.Portal and superior mesenteric vein resection had been used with increasing frequency and safety.The steps and methods taken to reconstruct the venous continuity vary with individual surgeons,and the anatomical variations encountered.With segmental loss of the portal vein,opinions differs with regard to the preservation of the splenic vein,and when divided,the necessity of restoring its continuity;source of the autologous vein graft when needed and whether the use of synthetic graft is a safe alternative.CONCLUSIONS:During a pancreatico-duodenectomy,images of computed tomography must be carefully studied to appreciate the changes and variation of vascular anatomy.Adequate preoperative preparation,acute awareness of the probable arterial and venous anatomical variation and the availability of expertise,especially micro-vascular surgery,for vascul
