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1.
OBJECTIVE: To update the authors' experience with intraductal papillary mucinous neoplasms (IPMNs) of the pancreas. BACKGROUND DATA: IPMNs are intraductal mucin-producing cystic neoplasms of the pancreas with clear malignant potential. Since the authors' 2001 report, the number of IPMNs resected at our institution has more than doubled, providing an opportunity to define the clinical features of this distinct neoplasm. METHODS: All patients undergoing pancreatic resection for an IPMN at the Johns Hopkins Hospital between January 1987 and March 2003 were evaluated. Noninvasive IPMNs were classified as "adenoma," "borderline," or "carcinoma-in situ" (CIS) depending on the degree of dysplasia within the specimen. Invasive cancers were classified as tubular, colloid, mixed, or anaplastic types. Pathology was retrospectively reviewed to identify main-duct or branch-duct origin of the tumors. Long-term overall survival for patients having IPMNs with invasive cancer was compared with those patients having IPMNs without an invasive component. RESULTS: Between January 1987 and March 2003, inclusive, 136 pancreatic resections were performed for patients with IPMNs, with 78 resections performed since January 2001. The mean age of the patients was 66.8 +/- 1.1 years, with 57% being male and 89% white. Pancreaticoduodenectomy was performed in 71% of patients, total pancreatectomy in 15%, distal pancreatectomy in 12%, and central pancreatic resection in 2%. IPMNs without evidence of invasive cancer were identified in 62% (n = 84) of patients (17% adenoma, 28% borderline, or 55% CIS). The remaining 38% (n = 52) of patients had IPMNs with associated invasive cancer (60% tubular, 27% colloid, 7% mixed, and 6% anaplastic). The mean age of patients with IPMN adenoma was 63.2 years, 66.7 years for those with borderline/CIS IPMNs, and 68.1 years for those with invasive cancer (P = 0.08, adenomas vs. invasive cancer). In those patients with invasive cancers, 15% had invasive cancer at the final surgical margin, 23% had IPMN without invasive cancer at the margin, and 54% had lymph node metastases. Residual IPMN was identified at the neck or uncinate margin in 24% of patients with noninvasive IPMNs. The overall 5-year survival for patients having IPMNs without invasive cancer was 77% (several deaths secondary to metachronous invasive cancer), compared with 43% in those patients with an invasive component (P < 0.0001). There were no differences in survival when comparing adenomas, borderline neoplasms, and CIS. Similarly, there were no statistically significant differences in survival when comparing branch-duct, main-duct, and combined variants; however, the branch-duct variants were more often noninvasive. For those patients with invasive IPMNs, 2-year survival was 40% when margins were positive for invasive cancer or for IPMN without invasive cancer, and 60% when margins were tumor-free (P = 0.15). Those patients with colloid carcinomas (n = 14) had improved survival compared with those with tubular carcinomas (n = 31), with 5-year survival rates of 83% and 24%, respectively. IPMN recurrences and deaths from cancer occurred in patients with both invasive and noninvasive IPMNs at initial resection. CONCLUSIONS: IPMNs continue to be recognized with increasing frequency. Five-year survival for those patients following resection of IPMNs with invasive cancer (43%) is improved compared with those patients with resected pancreatic ductal adenocarcinoma in the absence of IPMN (averages 15%-25%). Survival following resection of IPMNs without invasive cancer (regardless of degree of dyplasia) is good, but recurrent disease in the residual pancreas suggests that long-term surveillance is critical. Based on the age at resection data, there appears to be a 5-year lag time from IPMN adenoma (63.2 years) to invasive cancer (68.1 years).  相似文献   

2.
Background Noninvasive and minimally invasive intraductal papillary-mucinous neoplasms (IPMNs) have a favorable surgical outcome. However, cases of recurrent noninvasive or minimally invasive IPMN are sometimes encountered, and the patterns of the recurrence of those tumors have not yet been fully clarified. In this study, we evaluated the surgical outcome of noninvasive and minimally invasive IPMNs, concentrating particularly on the pattern of recurrences. Methods Twenty patients with noninvasive and minimally invasive IPMNs were assessed. Resected specimens were evaluated histopathologically with regard to the malignant nature of the tumors, the status of the surgical margin, and peripancreatic lymph node involvement. Cumulative overall survival rates and recurrence after surgery were assessed. Results Of the 20 patients, 13 had benign IPMNs, including adenomas (n = 10) and borderlines (n = 3), and 7 had malignant IPMNs, including carcinomas in situ (n = 4) and minimally invasive IPMNs (n = 3). Histopathologic examination confirmed the absence of tumor involvement in the resected lymph nodes and at the surgical margins. During the follow-up period, one patient with minimally invasive IPMN and one patient with noninvasive IPMN died of tumor recurrence in the peritoneum that was presumably caused by intraoperative manipulation. All of the patients with benign IPMNs survived, whereas the 10-year survival rate of the patients with malignant IPMNs was 67%. Conclusions Surgical resection can offer a favorable outcome for noninvasive and minimally invasive IPMNs. Tumor recurrence was observed only in the peritoneal cavity. More careful perioperative management concerned with peritoneal recurrence should be emphasized for noninvasive and minimally invasive IPMNs.  相似文献   

3.
4.
Nakao A  Fernández-Cruz L 《Annals of surgery》2007,246(6):923-8; discussion 929-31
OBJECTIVE: To evaluate the usefulness and long-term results with pancreatic head resection with segmental duodenectomy (PHRSD; Nakao's technique) in patients with branch-duct type intraductal papillary mucinous neoplasms (IPMNs). A prospective study from Nagoya (Japan) and Barcelona (Spain). SUMMARY BACKGROUND DATA: Surgery should be the first choice of treatment of IPMNs. An aggressive surgery (eg, pancreatoduodenectomy) should be questioned in patients with an indolent disease or with noninvasive tumors. Recently, organ-preserving pancreatic resections for benign and noninvasive IPMN located in the head of the pancreas have been described. We have PHRSD in which the pancreatic head can be completely resected and the major portion of the duodenum can be preserved by this procedure. There have been only 4 reports concerning PHRSD with <8 patients (each one) in the English literature. METHODS: Thirty-five patients underwent PHRSD (20 men, 15 women), mean age 65.1 +/- 9.0 (range, 55-75). Mean maximal diameter of the cystic lesion was 26.4 +/- 5.3 mm (range, 20-33 mm) and mean diameter of the main pancreatic duct was 3.3 +/- 0.5 mm (range, 3.0-4.0 mm). Alimentary tract reconstruction was performed in 20 patients by pancreatogastrostomy, duodenoduodenostomy, and choledochoduodenostomy (type A) and 15 patients by pancreaticojejunostomy, duodenoduodenostomy and choledochojejunostomy (Roux-en-Y; type B). Surgical parameters, postoperative complications, endocrine function, exocrine function, and long-term outcomes were evaluated. To compare the perioperative factors, a matched-pairs analysis between PHRSD patients and patients with pylorus preserving pancreaticoduodenectomy (PPPD) was performed. In the latter group were included 32 patients with branch-duct type of IPMN operated during the same time period that patients with PHRSD. The mean follow-up period was 48.8 months. RESULTS: Mean operative time after PHRSD was 365 +/- 50 and mean surgical blood loss was 615 +/- 251 mL. There was no mortality. Pancreatic fistula occurred in 10% and 13% with types (alimentary tract reconstruction) A and B, respectively. Noninvasive IPMN was found in 31 patients and invasive IPMN in 4 patients (11.4%). In the matched-pairs analysis between PHRSD and PPPD, the 2 procedures were comparable in regard to operation time and intraoperative blood loss. The overall incidence of pancreatic fistula was higher after PPPD than after PHRSD; the difference was not statistically significant. When fistulas occurred after PHRSD they were grade A (biochemical). In contrast, pancreatic fistulas after PPPD were grade A in 78% of cases and grade B in 22% (clinically relevant fistula). The incidence of delayed gastric emptying was significantly higher in the PPPD group compared with the PHRSD group (P < 0.01). Endocrine pancreatic function, measured by fasting blood glucose levels and HbA1, levels was unchanged in 94.28% of patients, in the PHRSD group, and in 87.87% in the PPPD group. Body weight was unchanged in 80% after PHRSD and in 59% after PPPD. Postoperative enzyme substitution was needed in 20% of patients after PHRSD and in 40% patients after PPPD. The 5-year survival rate was 100% in patients with benign IPMN and 42% in patients with invasive IPMN. CONCLUSION: PHRSD is a safe and reasonable technique appropriate for selected patients with branch-duct IPMN. The major advantages of PHRSD are promising long-term results in terms of pancreatic function (exocrine and endocrine) with important consequences in elderly patients. Long-term outcome was satisfactory without tumor recurrence in noninvasive carcinoma. PHRSD should therefore be considered as an adequate operation as an organ-preserving pancreatic resection for branch-duct type of IPMN located at the head of the pancreas.  相似文献   

5.
Background: Accurate information is currently lacking regarding the values of positive margins (M(+)) and lymph node (LN) metastases as independent predictors of postoperative recurrence in invasive and noninvasive intraductal papillary mucinous neoplasms (IPMNs) of the pancreas. Methods: A comprehensive online literature search identified all types of primary studies that included M(+) and LN metastases as risk factors and de?ned recurrence as an outcome in patients with IPMNs. Suitable articles were also identified by manually researching references in qualifying articles. A meta-analysis of the result was performed using a random effects model. Results: The recurrence rate in noninvasive IPMNs was 3.72% in patients with negative margin (M(-)) versus 9.56% in those with M(+) (odds ratio, OR = 0.37, 95% con?dence interval, 95% CI: 0.17-0.78, p = 0.010). The recurrence rate in invasive M(-) IPMNs in was 33.85% compared to 53.66% in M(+) IPMNs (OR = 0.47, 95% CI: 0.25-0.88, p = 0.020). The recurrence rate in invasive IPMNs with positive LN was 76.92% compared to 30.86% with negative LN; OR = 0.15, 95% CI: 0.06-0.37, p < 0.0001). Conclusions: M(+) were associated with disease recurrence in all patients with IPMN, and nodal metastases were significantly associated with recurrence in invasive IPMN.  相似文献   

6.
目的 分析胰腺导管内乳头状黏液性肿瘤患者的临床特征及手术疗效.方法 收集1999年1月至2008年12月复旦大学附属中山医院手术切除的76例胰腺导管内乳头状黏液性肿瘤的病史资料,并进行随访,分析其临床特征及手术疗效.结果 76例患者中,男性49例,女性27例;肿瘤位于胰头者63例,胰体尾10例,全胰3例;32例为非浸润性肿瘤(腺瘤16例,交界性肿瘤6例,原位癌10例),44例为浸润癌,两者在发病年龄及黄疸、消瘦、无症状患者、CA199升高等方面差异有统计学意义(P<0.05);胰十二指肠切除59例,联合门静脉切除重建4例,胰体尾切除6例,局部切除2例,节段性胰腺切除2例,全胰切除3例;总体并发症发生率为28.9%,无手术相关死亡病例;非浸润性及浸润性肿瘤患者5年生存率分别为100%及35%;非浸润性肿瘤患者7例切缘阳性,其中1例术后67个月复发转移;多因素分析显示肿瘤直径及淋巴结状况是影响浸润性癌患者预后的独立因素.结论 非浸润性胰腺导管内乳头状黏液性肿瘤手术疗效极佳,而浸润癌患者的预后较差;及早手术是防止病变进展及改善预后的关键;术后必须进行长期随访.
Abstract:
Objective To investigate the outcome of intraductual papillary mucious neoplasms (IPMN) of the pancreas after surgical resection. Method Clinical data of 76 patients with intraductal papillary neoplasms of the pancreas undergoing surgical resection at Zhongshan Hospital, Fudan University between January 1999 and December 2008 were retrospectively analyzed. Results Among the 76 patients,49 were male, 37 were female. 32 had noninvasive IPMNs, including adenomas( n = 16), borderline tumors (n =6 ), carcinomas in situ (n = 10 ). 44 had invasive IPMNs. Lesions were present in the head in 63 cases, in the body or tail in 10, in the whole pancreas in 3. There were significant difference in age,jaundice, weight loss, asymptomatic cases and CA199 value between noninvasive and invasive IPMNs.Three patients underwent total pancreatectomy, 59 patients underwent pancreaticoduodenectomy, 4 patients underwent pancreaticoduodenectomy with portal vein resection and reconstruction, six patients underwent distal pancreatectomy, two patients each underwent central pancreatectomy or enucleation. The overall postoperative morbidity rate were 28.9%, there was no operative mortality. Positive pancreatic margin was identified in seven patients of noninvasive neoplasms, among thoee one developed recurrence after 67 months. The five-year survival rate for patients with noninvasive and invasive neolpasms was 100% and 35% ,respectively. Size and lymph node metastasis were significant prognostic factors after surgical resection of the invasive IPMNs. Conclusions Surgical resection provides a favorable outcome for patients with noninvasive IPMNs. In contrast, invasive IPMNs was associated with a poor survival. Early resection is essential for improving survival. Long-term follow-up is necessary for all patients with IPMNs after resection.  相似文献   

7.
目的 分析胰腺导管内乳头状黏液性肿瘤患者的临床特征及手术疗效.方法 收集1999年1月至2008年12月复旦大学附属中山医院手术切除的76例胰腺导管内乳头状黏液性肿瘤的病史资料,并进行随访,分析其临床特征及手术疗效.结果 76例患者中,男性49例,女性27例;肿瘤位于胰头者63例,胰体尾10例,全胰3例;32例为非浸润性肿瘤(腺瘤16例,交界性肿瘤6例,原位癌10例),44例为浸润癌,两者在发病年龄及黄疸、消瘦、无症状患者、CA199升高等方面差异有统计学意义(P<0.05);胰十二指肠切除59例,联合门静脉切除重建4例,胰体尾切除6例,局部切除2例,节段性胰腺切除2例,全胰切除3例;总体并发症发生率为28.9%,无手术相关死亡病例;非浸润性及浸润性肿瘤患者5年生存率分别为100%及35%;非浸润性肿瘤患者7例切缘阳性,其中1例术后67个月复发转移;多因素分析显示肿瘤直径及淋巴结状况是影响浸润性癌患者预后的独立因素.结论 非浸润性胰腺导管内乳头状黏液性肿瘤手术疗效极佳,而浸润癌患者的预后较差;及早手术是防止病变进展及改善预后的关键;术后必须进行长期随访.  相似文献   

8.
目的 分析胰腺导管内乳头状黏液性肿瘤患者的临床特征及手术疗效.方法 收集1999年1月至2008年12月复旦大学附属中山医院手术切除的76例胰腺导管内乳头状黏液性肿瘤的病史资料,并进行随访,分析其临床特征及手术疗效.结果 76例患者中,男性49例,女性27例;肿瘤位于胰头者63例,胰体尾10例,全胰3例;32例为非浸润性肿瘤(腺瘤16例,交界性肿瘤6例,原位癌10例),44例为浸润癌,两者在发病年龄及黄疸、消瘦、无症状患者、CA199升高等方面差异有统计学意义(P<0.05);胰十二指肠切除59例,联合门静脉切除重建4例,胰体尾切除6例,局部切除2例,节段性胰腺切除2例,全胰切除3例;总体并发症发生率为28.9%,无手术相关死亡病例;非浸润性及浸润性肿瘤患者5年生存率分别为100%及35%;非浸润性肿瘤患者7例切缘阳性,其中1例术后67个月复发转移;多因素分析显示肿瘤直径及淋巴结状况是影响浸润性癌患者预后的独立因素.结论 非浸润性胰腺导管内乳头状黏液性肿瘤手术疗效极佳,而浸润癌患者的预后较差;及早手术是防止病变进展及改善预后的关键;术后必须进行长期随访.  相似文献   

9.
Intraductal papillary mucinous neoplasms (IPMN) are mucin producing cystic neoplasms of the pancreas histologically classified as having non-invasive and invasive components. The five-year survival rates for non-invasive and associated invasive carcinoma are 90% and 40%, respectively in resected IPMN lesions. Invasive carcinoma within IPMN lesions can be further classified by histological subtype into colloid carcinoma and tubular carcinoma. Estimated five-year survival rates following resection of colloid carcinoma range from 57%-83% and estimated five-year survival following resection of tubular carcinoma range from 24%-55%. The difference in survival outcome between invasive colloid and tubular IPMN appears to be a function of disease biology, as patients with the tubular subtype tend to have larger tumors with a propensity for metastasis to regional lymph nodes. When matched to resected conventional pancreatic adenocarcinoma lesions by the Memorial Sloan Kettering Cancer Center pancreatic adenocarcinoma nomogram, the colloid carcinoma histological subtype has an improved estimated five-year survival outcome compared to conventional pancreatic adenocarcinoma, 87% and 23% (P = 0.0001), respectively. Resected lesions with the tubular carcinoma subtype overall have a similar five-year survival outcome compared to conventional pancreatic adenocarcinoma. However, when these groups were stratified by regional lymph node status patients with negative regional lymph nodes and the tubular subtype experienced significantly better survival than patients with a similar nodal status and ductal adenocarcinoma with estimated five-year survival rates of 73% and 27% (P = 0.01), respectively.  相似文献   

10.
Background The natural history and prognosis for patients with intraductal papillary mucinous neoplasms (IPMN) with and without invasion remain poorly defined. This study evaluated the outcome after pancreatectomy for IPMN according to the pancreatic transection margin status and the presence or absence of invasive carcinoma. Methods Data from a prospective pancreatic tumor database and medical records were reviewed for all patients who underwent pancreatic resection for IPMN at our institution between July 1990 and July 2003. Surgical specimens were re-reviewed by a single pathologist. Results IPMN was diagnosed in 35 (26%) of 137 patients who underwent pancreatic resection for cystic neoplasms. Invasive IPMN was confirmed in 13 (37%) of 35 patients. Noninvasive IPMN was found in 22 (63%) of 35 patients; pathology re-review changed the original diagnosis from invasive to noninvasive IPMN in 6 patients. Noninvasive IPMN was found at the final pancreatic margin in eight patients; none developed recurrent disease at a median follow-up of 34 months. Recurrent disease was identified in 7 (58%) of 13 patients with invasive IPMN and in none with noninvasive IPMN. The median overall survival was 22.9 and 84.9 months in patients with invasive and noninvasive IPMN, respectively (P = .0009). Conclusions Distinction between invasive and noninvasive IPMN is essential in estimating prognosis and determining the need for adjuvant therapy and the frequency of follow-up surveillance. Noninvasive IPMN, even if present at the pancreatic margin, was not associated with recurrent disease. In contrast, invasive IPMN was associated with early recurrence and short survival. Presented at the 57th Annual Cancer Symposium of the Society of Surgical Oncology, New York, New York, March 18–21, 2004.  相似文献   

11.
OBJECTIVE: To define the natural history of resected intraductal papillary mucinous neoplasms (IPMN) of the pancreas and to identify clinical and pathologic prognostic features. SUMMARY BACKGROUND DATA: IPMN of the pancreas is a recently described pancreatic tumor. Because of a limited number of cases, prognostic factors and the natural history of resected cases have not been well defined. MATERIALS AND METHODS: A prospective pancreatic database was reviewed to identify patients with IPMN who were surgically managed. Pathologic re-review of each case was performed, and the clinicopathologic features were examined. Log rank and chi2 analysis were used to identify factors predictive of survival and recurrence. RESULTS: Over a 17-year period, 63 patients were identified. One patient was unresectable, 6 (10%) underwent a total pancreatectomy, and 56 (89%) had a partial pancreatectomy. Invasive carcinoma was present in 30 patients (48%). Transection margins were involved with atypia or carcinoma in 32 patients (51%). The median follow-up for survivors was 38 months. Disease-specific 5- and 10-year survival were 75% and 60%, respectively. Significant predictors of poor outcome included presentation with elevated bilirubin, presence of invasive carcinoma, increasing size and percentage of invasive carcinoma, histologic type of invasive carcinoma, positive lymph nodes, and vascular invasion. The presence of atypia or carcinoma in situ at the ductal resection margin was not associated with a poor outcome. CONCLUSIONS: Overall, IPMN has a favorable prognosis. Poor outcome in a subset of patients is largely the result of the presence, extent, and type of an invasive component, lymph node metastases, and vascular invasion.  相似文献   

12.
Radiographically, there have been new advances in spiral computed tomography (CT) scanning are currently being studied as a screening tools. As a result, many cases of small-sized lung cancer have been discovered. Some are noninvasive or minimally invasive bronchioloalveolar carcinoma, which is characterized by a the unique sign of ground-glass opacity (GGO) on high-resolution CT (HRCT) scanning. In such cases, lymph node metastases are extremely rare. However, there is currently no definitive surgical modality for such lesions. To clarify the indications of limited resection (segmentectomy or wedge resection), preoperative tumor diameter, location, and, GGO area on HRCT were estimated in patients with clinical T1N0 disease. In patients whose tumor included > or = 50% GGO area and was 15 mm or less in diameter, or patients with pure GGO regardless of tumor size, wedge resection without lymph node dissection should be considered as an acceptable treatment. Video-assisted thoracic surgery is a useful approach for selected patients. On the other hand, in patients with tumors < 50% GGO area in the range of 10-15 mm in diameter, segmentectomy with systematic lymph node dissection or diligent lymph node sampling should be considered.  相似文献   

13.
Precursors to pancreatic cancer have been investigated for a century. Previous studies have revealed three distinct precursors, i.e. mucinous cystic neoplasm (MCN), intraductal papillary mucinous neoplasm (IPMN), and pancreatic intraepithelial neoplasia (PanIN), harboring identical or similar genetic alterations as does invasive pancreatic carcinoma. The current understanding of precursors to pancreatic cancer can be illustrated by progressive pathways from noninvasive MCN, IPMN, and PanIN toward invasive carcinoma. MCNs consist of ovarian-type stroma and epithelial lining with varying grades of atypia, and are occasionally associated with invasive adenocarcinoma. The epithelium of noninvasive IPMNs shows a variety of different directions of differentiation, including gastric, intestinal, pancreatobiliary (PB), and oncocytic types. IPMNs can also harbor varying grades of architectural and cytologic atypia. IPMNs confined to branch ducts are mostly the gastric type, and IPMNs involving the main ducts are often intestinal type, while PB and oncocytic types are rare. Small (<1 cm) IPMNs of the gastric type are not always morphologically distinguishable from low-grade PanINs. Mucin expression profiles suggest intestinal-type IPMNs progress to mucinous noncystic (colloid) carcinoma, while PB-type IPMNs progress toward ductal adenocarcinoma. It is a well-described paradigm that PanIN lesions progress toward ductal adenocarcinoma through step-wise genetic alterations. The activation of Hedgehog and Notch signaling pathways in PanIN lesions as well as in pancreatic adenocarcinoma suggest that developmental pathways may be disregulated during carcinogenesis of the pancreas. Further study is needed to elucidate the pathways from precursors toward invasive carcinoma of the pancreas.  相似文献   

14.
Background Resection is recommended for main duct intraductal papillary mucinous neoplasms (IPMNs) of the pancreas because of the high risk of malignancy, but the indications for resection of branch duct and mixed-type IPMNs remain controversial. Our objective was to determine the appropriate management of IPMNs based on clinicopathologic characteristics and survival data obtained after resection. Methods A total of 72 consecutive IPMN patients who underwent resection between January 1984 and June 2006 were reviewed. The lesions were classified as main duct, branch duct, or mixed-type IPMNs and histologically graded as noninvasive (adenoma, borderline neoplasm, carcinoma in situ) or invasive. Results Main duct IPMNs (n = 15) were associated with a significantly worse prognosis than other subtypes. For branch duct (n = 49) and mixed-type IPMNs (n = 8), the diameter of the cystic lesions was an independent predictor of malignancy by multivariate analysis. However, four patients with cysts <30 mm in diameter and no mural nodules had a malignancy. No patient with noninvasive IPMN died of this disease, showing excellent survival, whereas the 5-year survival rate of patients with invasive IPMNs was only 57.6% and was significantly worse than that of patients with noninvasive IPMNs (p = 0.0002). Conclusions Resection of all main duct IPMNs seems to be reasonable. Invasive IPMNs were associated with significantly worse survival than noninvasive IPMNs. Although the diameter of cystic lesions was a predictor of malignancy for branch duct and mixed-type IPMNs, precise preoperative identification of malignancy was difficult. Therefore, these lesions should be managed by aggressive resection before invasion occurs to improve survival.  相似文献   

15.
The appropriate management for patients with multifocal branch-duct intraductal papillary mucinous neoplasms (IPMNs) of the pancreas involving the entire pancreatic gland remains unclear. We present a 66-year-old woman who underwent pylorus-preserving pancreaticoduodenectomy for a branch-duct intraductal papillary mucinous carcinoma demonstrating a grape-like multilocular cyst, 35 mm in diameter, in the head of the pancreas along with numerous number of small branch-duct IPMNs in the whole pancreas. Histologically, the multifocal cystic lesions were lined by a single row of columnar mucin-containing epithelial cells without atypia. The patient has been doing well without any recurrence during 9-year follow-up after surgery. Surgical removal of the prominent lesions suspicious of malignancy and a close observation of the remaining lesions in the remnant pancreas may be a reasonable treatment plan for patients with multifocal branch-duct IPMNs involving the entire pancreatic gland.  相似文献   

16.
Is lymphadenectomy needed for all submucosal gastric cancers?   总被引:5,自引:0,他引:5  
OBJECTIVE: To find out if it is feasible to extend the indication for local resection of submucosal gastric cancer without increasing the risk of lymph node metastases. DESIGN: Retrospective study. SETTING: University hospital, Japan. SUBJECTS: 104 patients with gastric cancer confined to the submucosal layer who underwent conventional gastrectomy with lymphadenectomy. INTERVENTIONS: The risk of nodal metastases was analysed retrospectively depending on the depth of submucosal invasion, size of the tumour, and other clinicopathological findings. MAIN OUTCOME MEASURES: The degree of submucosal invasion, size of the tumour, and incidence of lymph node metastasis. RESULTS: 15/104 patients (14%) had lymph node metastases. No patient in whom submucosal invasion was less than 500 microm or tumour was less than 15 mm in diameter developed lymph node metastases. Fewer patients had lymphatic permeation (37/89) and venous involvement (21/89) in the group without lymph node metastases. CONCLUSION: These data seem to support the hypothesis that early, minimally invasive, gastric cancer measuring < 15 mm in diameter could be treated by endoscopic mucosal or local resection, and gastrectomy with lymphadenectomy might be unnecessary.  相似文献   

17.
Introduction and importanceIntraductal papillary mucinous neoplasm (IPMN) of the pancreas is often found incidentally during examination for other diseases. In addition to the risk of malignant transformation, patients with IPMN are at risk of developing pancreatic cancer. We report a case of pancreatic tail cancer that developed separately from a preexisting IPMN after minimally invasive esophagectomy for cancer of the esophagogastric junction and was resected successfully by laparoscopic distal pancreatectomy.Case presentationA 72-year-old man underwent thoracoscopic and laparoscopic esophagectomy for esophagogastric junction cancer. He had undergone surgery for ascending colon cancer 20 years ago. At that time, IPMN was confirmed in the pancreatic body by a preoperative examination. Computed tomography was regularly performed for postoperative work-up and follow-up of the IPMN, and a solid lesion with cystic components was detected in the pancreatic tail 9 months after the operation. On detailed examination, pancreatic ductal adenocarcinoma concomitant with IPMN, accompanied by a retention cyst, was considered. Laparoscopic distal pancreatectomy was successfully performed after neoadjuvant chemotherapy. Pathological diagnosis of the lesion in the pancreatic tail was of an invasive intraductal papillary mucinous carcinoma (ypT3ypN0yM0 ypStageIIA).Clinical discussionIf an IPMN is detected during preoperative examination for malignancies of other organs, careful follow-up is necessary due to the high risk of pancreatic cancer development. Furthermore, initial operation with minimally invasive surgery may reduce adhesion and facilitate subsequent surgeries.ConclusionWe have provided evidence that supports the importance of a careful follow-up of IPMNs, even if they are low risk.  相似文献   

18.
Murakami Y  Uemura K  Ohge H  Hayashidani Y  Sudo T  Sueda T 《Surgery》2006,140(3):448-453
BACKGROUND: Intraductal papillary-mucinous neoplasms (IPMN) and mucinous cystic neoplasms (MCN) of the pancreas have similar clinicopathologic findings. This study was intended to clarify clinicopathologic characteristics in IPMNs and MCNs differentiated by ovarian-type stroma. METHODS: Medical records for 77 patients with pancreatic cystic neoplasms with mucin secretion were reviewed. Patients were divided into IPMN (n = 70) or MCN (n = 7) according to the presence of ovarian-type stroma, and clinicopathologic parameters were compared between groups. RESULTS: IPMNs consisted of 32 adenomas, 12 borderline neoplasms, 13 adenocarcinomas in situ, and 13 invasive adenocarcinomas; MCNs included 6 adenomas and 1 invasive adenocarcinoma. The mean age of IPMN patients (66 years) was significantly older than that of MCN patients (55 years). The male:female ratio in IPMN (53/17) was significantly greater (P < .001) than in MCN (0/7). The location of the pancreatic mass differed, with 76% 0f IPMNs occurring in the head, while 86% of MCNs occurred in the body or tail. Mass mean size was significantly smaller (28 mm vs 78 mm, P < .001), and mean diameter of the main pancreatic duct was larger (6.8 mm vs 3.1 mm, P < .001) in IPMN than in MCN. Patulous papilla was present in 44% (31/70) of IPMNs, but none was present in MCNs. Communication between the cyst and main pancreatic duct was more frequent in IPMNs (67/70) than in MCNs (1/7). Overall 5-year survival rates were 84% (IPMN) and 100% (MCN). CONCLUSIONS: Clinicopathologic differences between IPMN and MCN are much clearer when differentiated by presence of ovarian-type stroma. Favorable prognosis for both neoplasms is offered by complete resection.  相似文献   

19.
Nakayama H  Wada N  Masudo Y  Rino Y 《Surgery today》2007,37(4):311-315
We report a case of axillary lymph node metastasis (LNM) from papillary thyroid carcinoma (PTC) in a 21-year-old man. The patient presented with bilateral cervical and right axillary lymphadenopathy, and computed tomography (CT) showed a primary tumor of the thyroid and gross lymphadenopathy from the neck to the right axilla. We performed a total thyroidectomy with therapeutic nodal dissection. The resection of the primary thyroid tumor and all the node metastases was curative. Pathological examination confirmed that the resected lesions were PTC and nodal metastases from the primary tumor. Six years after the operation, cervical, upper mediastinal, and axillary lymph node recurrence developed and multiple lung metastases were found on a CT scan. He was treated with radioactive iodine therapy. Axillary LNM from PTC is unusual and seems to be associated with a poor prognosis. Thus, comprehensive treatment strategies are needed to improve the outcome of patients with PTC who present with axillary LNM.  相似文献   

20.
Wada K  Kozarek RA  Traverso LW 《American journal of surgery》2005,189(5):632-6; discussion 637
BACKGROUND: Since any intraductal papillary mucinous neoplasm (IPMN) is at least premalignant, avoiding conversion to invasion by pancreatic resection should provide a survival advantage-but how much? METHODS: We reviewed 100 cases of IPMN that were resected. Survival was compared between 3 groups: noninvasive IPMN (n = 75), invasive IPMN (n = 25), and invasive ductal adenocarcinoma (n = 24), the latter matched by tumor-node-metastasis (TNM) stage to the IPMN invasive group. RESULTS: The 5-year disease-specific survival was significantly better for the noninvasive IPMN group (100%) than the invasive IPMN group (46%). Tumor recurrence was infrequent with noninvasive IPMNs (1.3% benign IPMN). Recurrence was common in the invasive IPMN group (46%). Even the subgroup with stage 1 disease had a 25% recurrence of malignancy. Survival curves were not different (P = .11) between the cases matched by stage for those with invasive IPMN cases versus cases with ductal adenocarcinoma. CONCLUSION: Patients with the invasive form of IPMN will have a similarly poor survival as those with ductal adenocarcinoma. In patients thought to have a benign IPMN, these lesions should be removed to avoid conversion to invasive cancer and to preserve the opportunity for the more favorable prognosis observed in this study.  相似文献   

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