Low progression of intraductal papillary mucinous neoplasms with worrisome features and high-risk stigmata undergoing non-operative management: a mid-term follow-up analysis
Objective To evaluate mid-term outcomes and predictors of survival in non-operated patients with pancreatic intraductal papillary mucinous neoplasms (IPMNs) with worrisome features or high-risk stigmata as defined by International Consensus Guidelines for IPMN. Reasons for non-surgical options were physicians’ recommendation, patient personal choice or comorbidities precluding surgery. Methods In this retrospective, multicentre analysis, IPMNs were classified as branch duct (BD) and main duct (MD), the latter including mixed IPMNs. Univariate and multivariate analysis for overall survival (OS) and disease-specific survival (DSS) were obtained. Results Of 281 patients identified, 159 (57%) had BD-IPMNs and 122 (43%) had MD-IPMNs; 50 (18%) had high-risk stigmata and 231 (82%) had worrisome features. Median follow-up was 51 months. The 5-year OS and DSS for the entire cohort were 81% and 89.9%. An invasive pancreatic malignancy developed in 34 patients (12%); 31 had invasive IPMNs (11%) and 3 had IPMN-distinct pancreatic ductal adenocarcinoma (1%). Independent predictors of poor DSS in the entire cohort were age>70 years, atypical/malignant cyst fluid cytology, jaundice and MD>15 mm. Compared with MD-IPMNs, BD-IPMNs had significantly better 5-year OS (86% vs 74.1%, p=0.002) and DSS (97% vs 81.2%, p
Quick diagnosis units (QDU) have become an alternative hospital-based ambulatory medicine strategy to inpatient hospitalization for potentially serious illnesses in Spain. Whether diagnosis of pancreatic cancer is better accomplished by an ambulatory or inpatient approach is unknown. The main objective of this retrospective study was to examine and compare the diagnostic effectiveness of a QDU or inpatient setting in patients with pancreatic cancer. Patients with a diagnosis of pancreatic adenocarcinoma who had been referred to a university, tertiary hospital-based QDU or hospitalized between 2005 and 2018 were eligible. ...
Abstract Primary pancreatic lymphoma is a rare clinical entity representing
CONCLUSIONS This new nomogram could be conveniently used to predict the selection preference of robotic surgery for patients with pancreatic head cancer. PMID: 31654999 [PubMed - in process]
AbstractAutoimmune pancreatitis (AIP) is an inflammatory process of the pancreas that occurs most commonly in elderly males and clinically can mimic pancreatic adenocarcinoma and present with jaundice, weight loss, and abdominal pain. Mass-forming lesions in the pancreas are seen in the focal form of AIP and both clinical and imaging findings can overlap those of pancreatic cancer. The accurate distinction of AIP from pancreatic cancer is of utmost importance as it means avoiding unnecessary surgery in AIP cases or inaccurate steroid treatment in patients with pancreatic cancer. Imaging concomitantly with serolo...
This report reminds us to pay close attention to the likelihood of MPM and other low-incidence diseases. The physicians and imaging clinicians should explore all clinical possibilities to avoid misdiagnosis of this rare disease and formulate effective treatment plans to maximize the therapeutic benefits for the patient.
ConclusionDiagnosing and managing ampullary adenocarcinoma in pregnant patients in their 3rd trimester is challenging. Yet, a delayed viable delivery followed by a definitive surgery in the form of pancreaticoduodenectomy offers the best outcomes for both the mother &fetus in case of early stage disease.
Pancreatic adenocarcinoma is the third leading cause of cancer related death. Data suggests that neoadjuvant chemotherapy prior to resection improves survival. In patients with jaundice, this requires preoperative ERCP with biliary stenting. Some patients with biliary stents develop cholangitis, requiring additional intervention. The impact of preoperative cholangitis on outcomes of patients with pancreatic cancer who undergo surgery is unknown. Here, we evaluated the impact of preoperative cholangitis on post operative outcomes and disease recurrence.
We present three cases, one cholangiocarcinoma and two pancreatic adenocarcinomas, with jaundice due to biliary stenosis. RFA was used with an ELRA catheter during endoscopic retrograde cholangiopancreatography (ERCP). The patients were monitored for ten months in order to assess the difficulty of treatment, efficacy and immediate and medium-term complications. PMID: 31140283 [PubMed - as supplied by publisher]
The most common form of pancreatic cancer is pancreatic ductal adenocarcinoma. The long-term outcome of pancreatic cancer is extremely poor: the overall median survival from diagnosis is 3 –6 months without treatment, increasing to around 23 months with resectional surgery and adjuvant treatment. Pancreatic cancer is usually diagnosed late and has a biological phenotype characterized by resistance to all cancer treatment modalities and early metastasis. Jaundice is the most common p resenting symptom.
Conclusion: Cholestasis resulting from primary duodenal papillary carcinoma is rare in pediatric patients but should be considered in the differential diagnosis.