Pancreaticoduodenectomy for lymphoepithelial cyst of the pancreas

Lymphoepithelial tumors of the pancreas are rare cystic tumors characterized by the presence of a keratinizing squamous epithelium and a dense lymphoid infiltrate on histologic examination. This case report describes the first lymphoepithelial tumor to be resected from the pancreatic head by pancreaticoduodenectomy. This case is also the first in which the cyst was found to be secondarily infected. The radiologic and clinicopathologic features of these unusual tumors are discussed.     

A perioperative multidisciplinary care bundle reduces surgical site infections in patients undergoing synchronous colorectal and liver resection

Background

Surgical site infections (SSIs) are a major cause of morbidity, mortality, and healthcare costs, and patients undergoing simultaneous colorectal/liver resections are at an especially high SSI risk.

Suppression of β-Catenin by Antisense Oligomers Augments Tumor Response to Isolated Limb Perfusion in a Rodent Model of Adenomatous Polyposis Coli–Mutant Colon Cancer

Background Isolated hepatic perfusion has been used in patients with colorectal cancer (CRC) metastatic to the liver. We sought to determine whether perfusion with antisense oligodeoxynucleotides results in the downregulation of β-catenin and whether this improves tumor response to isolated limb perfusion (ILP) in a heterotopic model of human CRC.Methods Adenomatous polyposis coli–mutant human CRC xenografts were implanted into athymic rats. Animals were randomized to the following groups: (1) no treatment, (2) control ILP, (3) melphalan ILP, (4) ILP with antisense specific for β-catenin, (5) ILP with nonspecific antisense, and (6) melphalan plus β-catenin–specific antisense ILP. Tumor response and Western blot analysis of protein expression were evaluated.Results The maximal decrease (mean ± SE) in tumor volume was 0% ± 10% for no treatment, 19% ± 14% for control ILP, 58% ± 3% for melphalan ILP, 58% ± 9% for β-catenin–specific ILP, 13% ± 19% for nonspecific antisense ILP, and 73% ± 6% for melphalan plus β-catenin–specific ILP (P < .05 for melphalan ILP, β-catenin–specific ILP, and melphalan plus antisense ILP). Tumor regrowth was delayed for 6 days after control ILP, 24 days after melphalan ILP, 20 days after β-catenin–specific ILP, 10 days after nonspecific antisense ILP, and 60 days after melphalan plus β-catenin–specific ILP (P < .05 for melphalan plus β-catenin–specific ILP compared with all others). Western blotting revealed prolonged suppression of β-catenin expression after β-catenin–specific ILP.Conclusions Short-term β-catenin antisense treatment improves tumor response rates after ILP in a rodent model of human CRC.Presented in part at the Surgical Forum of the American College of Surgeons, Chicago, Illinois, October 19–23, 2003.     

Five-year survival after resection of hepatic metastases from colorectal cancer in patients screened by positron emission tomography with F-18 fluorodeoxyglucose (FDG-PET)

OBJECTIVE: To report the first 5-year overall survival results in patients with colorectal carcinoma metastatic to the liver who have undergone hepatic resection after staging with [18F] fluoro-2-deoxy-D-glucose-positron emission tomography (FDG-PET). SUMMARY BACKGROUND DATA: The 5-year overall survival after hepatic resection for colorectal cancer metastases without preoperative FDG-PET has been established in 19 studies (6070 patients). The median 5-year overall survival rate in these studies is 30% and has not improved over time. FDG-PET detects unsuspected tumor in 25% of patients considered to have resectable hepatic metastasis by conventional staging. METHODS: From March 1995 to June 2002, all patients having hepatic resection for colorectal cancer metastases had preoperative FDG-PET. A prospective database was maintained. RESULTS: One hundred patients (56 men, 44 women) were studied. Metastases were synchronous in 52, single in 63, unilateral in 78, and <5 cm in diameter in 60. Resections were major (>3 segments) in 75 and resection margins were > or = 1 cm in 52. Median follow up was 31 months, with 12 actual greater than 5-year survivors. There was 1 postoperative death. The actuarial 5-year overall survival was 58% (95% confidence interval, 46-72%). Primary tumor grade was the only prognostic variable significantly correlated with overall survival. CONCLUSIONS: Screening by FDG-PET is associated with excellent postresection 5-year overall survival for patients undergoing resection of hepatic metastases from colorectal cancer. FDG-PET appears to define a new cohort of patients in whom tumor grade is a very important prognostic variable.     

Volumetric rendering techniques: applications for three-dimensional imaging of the hip

Volumetric rendering is a new approach to three-dimensional (3D) imaging that overcomes many of the drawbacks of currently available surface-rendering systems. Its application on the Pixar Imaging System in two cases of acetabular fracture was assessed to illustrate the features of the technique. The fast-computing architecture and large memory of this system allow rapid generation of a series of high-quality 3D images in each plane of rotation (x or spinal axis, z or somersaulting axis) that can be viewed as independent static images or as an animated real-time video loop. Editing to remove the normal contralateral hemipelvis enhances appreciation of acetabular abnormalities. Every pixel of computed tomographic data is preserved, allowing representation of both soft tissue and bone as translucent overlap. The presentation of data also allows detection of subtle abnormalities and features and minimizes the artifact generation common in surface-rendered images.     

Decision-Making for the Management of Cystic Lesions of the Pancreas: How Satisfied Are Patients with Surgery?

Introduction

This study aims to understand patients’ perspectives and satisfaction with choosing surgery for the treatment of pancreatic cystic lesions (PCLs).

Methods

A 62-question survey was administered to 113 patients who had a resection for a PCL by 12 surgeons at two pancreatic specialty centers (2004–2016). Patients’ final diagnoses and perioperative outcomes were correlated to the survey’s results using univariate analysis.

Results

Fear of cancer was quite or extremely important in most respondents’ decision to have surgery (95.4%). Respondents were quite or fully satisfied with the outcomes of surgery (91.1%) and with the decision-making process (89.3%). Distress from anxiety about the cyst before surgery (58.6%) largely outweighed that from postsurgical lifestyle changes (14.4%). Furthermore, 88.7% of patients with pathologically non-malignant disease were quite or fully satisfied with their decision to have surgery, and patients with mucinous neoplasms reported high satisfaction rates independent of grade of dysplasia or malignancy (p = 0.641).

Conclusion

Patients with a resected PCL are highly satisfied with their decision to have surgery, regardless of the final diagnosis or clinical outcome. Fear of cancer is the main driver in the decision-making process, and the anxiety of harboring a cyst is a greater cause of distress than are postsurgical lifestyle changes.