目的探讨全胰切除术(TP)在胰腺肿瘤患者中的近远期疗效。方法回顾性纳入2005年6月至2018年3月复旦大学附属中山医院43例TP患者,分析其临床病理特征、手术情况、术后并发症及总生存期。结果本组共43例,其中胰腺导管腺癌(PDAC)25例,胰腺...目的探讨全胰切除术(TP)在胰腺肿瘤患者中的近远期疗效。方法回顾性纳入2005年6月至2018年3月复旦大学附属中山医院43例TP患者,分析其临床病理特征、手术情况、术后并发症及总生存期。结果本组共43例,其中胰腺导管腺癌(PDAC)25例,胰腺导管内乳头状黏液瘤(IPMN)14例,实性假乳头状瘤2例,腺鳞癌1例,神经内分泌肿瘤(NET)1例。并发症发生率为76.7%,30 d病死率为7.0%,中位生存期为20.0个月。与PDAC组比较,IPMN组患者输血率(21.4%vs 60.0%,P=0.043)、联合血管切除率(21.4%vs 64.0%,P=0.019)和腹腔感染率(0 vs 32.0%,P=0.034)均较低,且术后住院时间较短(11.5 d vs23.0 d,P=0.004)。进一步分析表明,浸润性IPMN患者在TP术后获得了更长的远期生存(35.8个月vs 15.0个月,P=0.033)。结论TP术式安全可行且在部分病例中能获得良好的肿瘤学效果,IPMN可能是较PDAC更优选的手术适应证。展开更多
Pancreatic carcinoma occasionally associated with prominent mucin production and this type of tumor designated as PCM (pancreatic carcinoma with prominent mucin production) was diagnosed depends on subjective estimati...Pancreatic carcinoma occasionally associated with prominent mucin production and this type of tumor designated as PCM (pancreatic carcinoma with prominent mucin production) was diagnosed depends on subjective estimation of the amount of mucous area, and there has been no report on a quantitative evaluation of the amount of mucinous area in the tumor. To examine the feature of PCM, we analyzed 9 cases of PCM among 243 cases of pancreas carcinoma and evaluated the amount of mucin by imaging analysis. Morphologically, 5 cases were classified as intradactal papillary mucinous neoplasms (IPMN)-derived PCM and 4 cases were as ductal adenocarcinoma (DA)-derived PCM. Mucous composition was found to be more than 50% in all IPMN-derived PCM cases, and that was 40% - 50% in DA-derived PCM cases with one exception. IPMN-derived PCM cases showed expansive growth with pancreatic duct dilatation filled with mucin, while DA-derived PCM cases possessed mucin infiltration into interstitial tissue. Immunohisto-chemically, three of 4 DA-derived PCM cases were MUC1(–)/MUC2(+), and the results of expressions for p16 and Dpc4 suggesting that DA-derived PCM was similar to IPMN-derived PCM rather than ordinary DA. Survival rate of DA-derived PCM cases was lower than that of IPMN-derived PCM cases. We advocate that DA-derived PCM may constitute a borderline group between IPMN and ordinary DA.展开更多
Background: Cystic tumours of the pancreas are relatively uncommon tumours but there is an increasing awareness of their importance. Modern advances in imaging had resulted in a more prompt diagnosis of these tumours....Background: Cystic tumours of the pancreas are relatively uncommon tumours but there is an increasing awareness of their importance. Modern advances in imaging had resulted in a more prompt diagnosis of these tumours. The understanding of the pathology, clinical features, diagnosis and management of these tumours is continuously evolving. Data Sources: Systematic literature review. A PubMed database research was performed. Relevant articles published in English were identified and scrutinized. Duplications of information and persistently unsolved uncertainties were excluded. Results: Cystic tumours of the pancreas should be differentiated from pancreatic pseudocysts. Cystic tumours could be classified into: cystic serous neoplasms (SCN), mucinous cystic neoplasms (MCN), intraductal papillary neoplasms (IPMN), solid pseudopapillary neoplasms (SPPN) and the rarer tumours cystic pancreatic endocrine neoplasms (PEN). Except for SCN, all these tumours should be regarded, at least, as potentially malignant but they may be frankly malignant. The age of the patient and site of the lesion may be helpful in the diagnosis. In particular, MCN is always encountered in females in their middle age and often in the body and tail of the pancreas. Many of these tumours are diagnosed incidentally. Pancreatitis and hyperamylasaemia should be interpretted with caution as IPMN may present as pancreatitis. CT is the primary diagnostic tool although MRI, EUS, PET, abdominal ultrasound and ERCP have all been utilised. Biochemical markers are of limited value in the diagnosis. Conclusions: Management decision depends primarily on the understanding of pathology and on how confident the preoperative diagnosis is. SCN may be observed. Partial pancreatectomy is the usual operation performed for most other tumours according to the location of the lesion which means that distal pancreatectomy is usually the operation performed for MCN. Total pancreatectomy for IPMN, enucleation and central pancreatectomy have all been described in the literature. Laparoscopy is more suitable for benign or low grade malignant tumours in the context of distal pancreatectomy. Spleen should be preserved unless splenectomy is indicated and splenic vessels should be preserved wherever possible when preserving the spleen.展开更多
We read with great interest the recent guideline by Ohtsuka et al.entitled“International evidence-based Kyoto guidelines for the management of intraductal papillary mucinous neoplasm of the pancreas”on behalf of the...We read with great interest the recent guideline by Ohtsuka et al.entitled“International evidence-based Kyoto guidelines for the management of intraductal papillary mucinous neoplasm of the pancreas”on behalf of the International Association of Pancreatology(IAP)(1).This most widely used guideline has been updated to incorporate the most recent evidence as well as expert consensus on the management of intraductal papillary mucinous neoplasm(IPMN).One major revision in this guideline is simplifying the surveillance protocol of non-resected IPMN and offering the possibility of stopping surveillance for small branch duct IPMN(BD-IPMN)that remains stable during a 5 years period(1).The changes in the surveillance protocol are particularly important as most people are diagnosed with asymptomatic small BD-IPMN that does not require surgery at the time of diagnosis.展开更多
Pancreatic ductal adenocarcinoma(PDAC)accounts for over 90%of pancreatic cancers and is the seventh leading cause of cancer deaths worldwide(1).Considered one of the most aggressive cancers,PDAC is associated with non...Pancreatic ductal adenocarcinoma(PDAC)accounts for over 90%of pancreatic cancers and is the seventh leading cause of cancer deaths worldwide(1).Considered one of the most aggressive cancers,PDAC is associated with nonspecific symptoms and often presents with widespread metastasis at the time of diagnosis,with an average 5-year survival rate of less than 10%(2).It has both genetic and environmental risk factors and can arise from several precursor lesions,primarily pancreatic intraepithelial neoplasia(PanIN)and,to a lesser extent,intraductal papillary mucinous neoplasms(IPMNs)and mucinous cystic neoplasms.As the predominant form of pancreatic cancer,PDAC poses challenges due to its complex pathology,and understanding of its pathogenesis is critical for management.展开更多
文摘目的探讨全胰切除术(TP)在胰腺肿瘤患者中的近远期疗效。方法回顾性纳入2005年6月至2018年3月复旦大学附属中山医院43例TP患者,分析其临床病理特征、手术情况、术后并发症及总生存期。结果本组共43例,其中胰腺导管腺癌(PDAC)25例,胰腺导管内乳头状黏液瘤(IPMN)14例,实性假乳头状瘤2例,腺鳞癌1例,神经内分泌肿瘤(NET)1例。并发症发生率为76.7%,30 d病死率为7.0%,中位生存期为20.0个月。与PDAC组比较,IPMN组患者输血率(21.4%vs 60.0%,P=0.043)、联合血管切除率(21.4%vs 64.0%,P=0.019)和腹腔感染率(0 vs 32.0%,P=0.034)均较低,且术后住院时间较短(11.5 d vs23.0 d,P=0.004)。进一步分析表明,浸润性IPMN患者在TP术后获得了更长的远期生存(35.8个月vs 15.0个月,P=0.033)。结论TP术式安全可行且在部分病例中能获得良好的肿瘤学效果,IPMN可能是较PDAC更优选的手术适应证。
文摘Pancreatic carcinoma occasionally associated with prominent mucin production and this type of tumor designated as PCM (pancreatic carcinoma with prominent mucin production) was diagnosed depends on subjective estimation of the amount of mucous area, and there has been no report on a quantitative evaluation of the amount of mucinous area in the tumor. To examine the feature of PCM, we analyzed 9 cases of PCM among 243 cases of pancreas carcinoma and evaluated the amount of mucin by imaging analysis. Morphologically, 5 cases were classified as intradactal papillary mucinous neoplasms (IPMN)-derived PCM and 4 cases were as ductal adenocarcinoma (DA)-derived PCM. Mucous composition was found to be more than 50% in all IPMN-derived PCM cases, and that was 40% - 50% in DA-derived PCM cases with one exception. IPMN-derived PCM cases showed expansive growth with pancreatic duct dilatation filled with mucin, while DA-derived PCM cases possessed mucin infiltration into interstitial tissue. Immunohisto-chemically, three of 4 DA-derived PCM cases were MUC1(–)/MUC2(+), and the results of expressions for p16 and Dpc4 suggesting that DA-derived PCM was similar to IPMN-derived PCM rather than ordinary DA. Survival rate of DA-derived PCM cases was lower than that of IPMN-derived PCM cases. We advocate that DA-derived PCM may constitute a borderline group between IPMN and ordinary DA.
文摘Background: Cystic tumours of the pancreas are relatively uncommon tumours but there is an increasing awareness of their importance. Modern advances in imaging had resulted in a more prompt diagnosis of these tumours. The understanding of the pathology, clinical features, diagnosis and management of these tumours is continuously evolving. Data Sources: Systematic literature review. A PubMed database research was performed. Relevant articles published in English were identified and scrutinized. Duplications of information and persistently unsolved uncertainties were excluded. Results: Cystic tumours of the pancreas should be differentiated from pancreatic pseudocysts. Cystic tumours could be classified into: cystic serous neoplasms (SCN), mucinous cystic neoplasms (MCN), intraductal papillary neoplasms (IPMN), solid pseudopapillary neoplasms (SPPN) and the rarer tumours cystic pancreatic endocrine neoplasms (PEN). Except for SCN, all these tumours should be regarded, at least, as potentially malignant but they may be frankly malignant. The age of the patient and site of the lesion may be helpful in the diagnosis. In particular, MCN is always encountered in females in their middle age and often in the body and tail of the pancreas. Many of these tumours are diagnosed incidentally. Pancreatitis and hyperamylasaemia should be interpretted with caution as IPMN may present as pancreatitis. CT is the primary diagnostic tool although MRI, EUS, PET, abdominal ultrasound and ERCP have all been utilised. Biochemical markers are of limited value in the diagnosis. Conclusions: Management decision depends primarily on the understanding of pathology and on how confident the preoperative diagnosis is. SCN may be observed. Partial pancreatectomy is the usual operation performed for most other tumours according to the location of the lesion which means that distal pancreatectomy is usually the operation performed for MCN. Total pancreatectomy for IPMN, enucleation and central pancreatectomy have all been described in the literature. Laparoscopy is more suitable for benign or low grade malignant tumours in the context of distal pancreatectomy. Spleen should be preserved unless splenectomy is indicated and splenic vessels should be preserved wherever possible when preserving the spleen.
基金supported by the National Key Research and Development Program(No.2019YFC1316000)the National Natural Science Foundation of China(No.82071748 and No.82188102).
文摘We read with great interest the recent guideline by Ohtsuka et al.entitled“International evidence-based Kyoto guidelines for the management of intraductal papillary mucinous neoplasm of the pancreas”on behalf of the International Association of Pancreatology(IAP)(1).This most widely used guideline has been updated to incorporate the most recent evidence as well as expert consensus on the management of intraductal papillary mucinous neoplasm(IPMN).One major revision in this guideline is simplifying the surveillance protocol of non-resected IPMN and offering the possibility of stopping surveillance for small branch duct IPMN(BD-IPMN)that remains stable during a 5 years period(1).The changes in the surveillance protocol are particularly important as most people are diagnosed with asymptomatic small BD-IPMN that does not require surgery at the time of diagnosis.
文摘Pancreatic ductal adenocarcinoma(PDAC)accounts for over 90%of pancreatic cancers and is the seventh leading cause of cancer deaths worldwide(1).Considered one of the most aggressive cancers,PDAC is associated with nonspecific symptoms and often presents with widespread metastasis at the time of diagnosis,with an average 5-year survival rate of less than 10%(2).It has both genetic and environmental risk factors and can arise from several precursor lesions,primarily pancreatic intraepithelial neoplasia(PanIN)and,to a lesser extent,intraductal papillary mucinous neoplasms(IPMNs)and mucinous cystic neoplasms.As the predominant form of pancreatic cancer,PDAC poses challenges due to its complex pathology,and understanding of its pathogenesis is critical for management.
