1/67. Efficacy of applied cardiovascular surgery techniques for extended resection in hepato-biliary-pancreatic malignancies.The application of extracorporeal circulation (ECC) and vascular surgery techniques provide the possibility to resect severely advanced hepato-biliary-pancreatic (HBP) malignancies that had been adjudged unresectable hitherto. In this paper, recent two successful cases are reported for the purpose of indicating the efficacy of ECC and vascular surgery techniques in HBP surgery. Two patients had a cholangiocellular carcinoma and a carcinoma of the pancreatic head, those metastatic lymph nodes invaded to the portal veins and the hepatic arteries. These tumors could be resected en bloc with these Glissonian vessels using a centrifugal pump through veno-venous bypass. Reconstruction of these portal veins was performed with autologous external iliac vein graft. Postoperative angiographies showed no anastomotic leakage or occlusion on vascular anastomotic sites in both cases, and they have gone on uneventful postoperative courses. Application of cardiovascular techniques in the field of HBP surgery might expand surgical indication for advanced malignancies.- - - - - - - - - - ranking = 1keywords = vessel (Clic here for more details about this article) |
2/67. Benign pancreatic tumor treated with duodenum-preserving resection of the head of the pancreas. Case report.Cystic neoplasms of the pancreas constitute about 9% of all cystic lesions of the pancreas and less than 1% of all pancreatic neoplasms. Authors report the case of a 70 year-old woman with microcystic cystadenoma. Computed tomography (CT) scan of the abdomen diagnosed a 5 cm multilocular septated cyst, with calcifications in the context, localized in the head-uncinate process of the pancreas. The mass was well separated by a sharp cleavage plane with portal vein and superior mesenteric vessels. An endoscopic retrograde cholangiopancreatography (ERCP) showed cephalic symmetrical stenosis (diameter: 3 mm) of the main pancreatic duct (MPD), mildly dilated in the remaining tract (diameter: 6 mm). An intra-operative biopsy of the cystic wall had been performed. Therefore, it was decided to proceed with a duodenum-preserving resection of the head of the pancreas (DPPHR), including stenosis tract of the MPD in the surgical specimen. The reconstructive procedure consisted, by i.v. jejunal loop transposition, of a side-to-side pancreatico-jejunostomy, including in the anastomosis both corpocaudal stump and the resection cavity of the pancreatic head, and an end-to-side Roux-en-Y jejuno-jejunostomy. With respect to long-lasting pain relief and preservation of the endocrine and exocrine functions of the pancreas, duodenum-preserving resection of the head of the pancreas is a highly effective surgical procedure with low early and late morbidity and mortality due to limited surgical resections. This technique, introduced into surgical practice in 1972 by Beger, is indicated in patients with chronic pancreatitis with an inflammatory mass in the head of the pancreas. The authors conclude that this procedure can also be performed in cases of pancreatic benign tumors, such as microcystic cystadenoma. Advantages of this technique make DPPHR an attractive alternative to pylorus-preserving pancreatico-duodenectomy (PPPD).- - - - - - - - - - ranking = 1keywords = vessel (Clic here for more details about this article) |
3/67. Intra-operative color Doppler ultrasonography for assessing splenic blood supply during spleen-preserving distal pancreatectomy: a case report.A 67 year-old Japanese woman presented with a cystic tumorous lesion, measuring 5 cm in diameter, in the tail of the pancreas. She underwent a spleen-preserving distal pancreatectomy (SPDP), in which the splenic artery and vein were divided because they were involved in scar formation around the lesion. Intra-operative color Doppler ultrasonography (CDUS) confirmed that splenic circulation via collaterals (short gastric and left gastroepiploic vessels) was preserved throughout the salvaged spleen. histology of the resected specimen showed localized pancreatitis with a pseudocyst without neoplastic tissue. The patient's post-operative course was uneventful with no evidence of splenic failure and she was discharged 20 days after the operation. A literature review suggests that SPDP without preserving the splenic artery and vein may result in failure of the preserved spleen due to inadvertent injury to the remaining collaterals. Based on the experience of our case, we think that intra-operative CDUS is useful for assessing splenic circulation after SPDP with division of the splenic artery and vein.- - - - - - - - - - ranking = 1keywords = vessel (Clic here for more details about this article) |
4/67. portal vein resection without reconstruction during Appleby operation in a patient with pancreatic body carcinoma with cavernous transformation.The prognosis of pancreatic body carcinoma has been poor due to cancerous invasion of major vessels. Resection of the involved vessels may improve resectability and prognosis. We report a patient who had a pancreatic body carcinoma with cavernous transformation of the portal vein, in whom the portal vein was resected without reconstruction during an Appleby operation. A 67 year-old man was admitted for evaluation of back pain. Enhanced computed tomography showed no main trunk of the portal vein but a developed collateral circulation. Celiac angiography revealed encasement of the common hepatic, splenic and celiac artery. Venous angiography revealed obstruction of the portal and splenic veins with cavernous transformation surrounding these veins. Pre-operative diagnosis was carcinoma in the pancreatic body, which invaded the portal vein, the celiac and common hepatic arteries. The Appleby operation combined with resection of the portal vein without reconstruction could be performed, by preserving collateral vessels and monitoring hepatic venous oxygen saturation (ShvO2) to prevent hepatic ischemia caused by occlusion of the portal vein. The post-operative course was uneventful.- - - - - - - - - - ranking = 3keywords = vessel (Clic here for more details about this article) |
5/67. Extended survival of carcinoma head of pancreas following palliative treatment.A 48 year old woman presented with obstructive jaundice 10 years back. Upper gastrointestinal endoscopy revealed a growth infiltrating the ampulla of vater, which was confirmed to be adenocarcinoma on cytology. At laparotomy, a large nodular growth was seen in the head of pancreas. Surgical resection could not be done because of encasement of superior mesenteric vessels, hence a cholecystojejunostomy was performed. The patient remained asymptomatic for 9 years, when she developed cholangitis. duodenoscopy at this stage revealed an ulcerated growth at the ampulla and biopsy from the growth confirmed a well differentiated adenocarcinoma. A straight flap 10 F stent was placed in the common bile duct. Thereafter the patient has remained asymptomatic for more than a year.- - - - - - - - - - ranking = 1keywords = vessel (Clic here for more details about this article) |
6/67. Adenosquamous carcinoma of the pancreas: report of two cases.Adenosquamous carcinoma (ASqC) of the pancreas is a rare tumor. We analyzed the radiologic findings and clinical manifestations in two such cases. In both cases (a 51-year-old woman and a 67-year-old man), the portal system was selectively and largely invaded, the superior mesenteric vein in one and the splenic vein in the other, without arterial invasion. Thus, peripancreatic vessels should be carefully observed in patients with ASqC of the pancreas. One case showed an unusual mode of spread. Only a huge metastatic lesion was initially detected, leading to the misdiagnosis of primary malignant mesenteric tumor. Such an unusual growth pattern is also worth noting.- - - - - - - - - - ranking = 1keywords = vessel (Clic here for more details about this article) |
7/67. New developments in pancreatic cancer.adenocarcinoma of the pancreas is the fifth most common cause of cancer death in the united states. It affects men and women fairly equally and is most frequently diagnosed in the eighth decade of life. It may occur as part of hereditary/familial pancreatitis with an identified genetic mutation, and smokers are at increased risk. Cancer most often occurs in the pancreatic head and often leads to biliary obstruction with a clinical presentation of painless jaundice. The principal diagnostic modality is dedicated pancreatic computed tomography (CT) scanning, although other imaging techniques have a role. Endoscopic retrograde cholangiopancreatography (ERCP) is generally reserved for obtaining tissue, for which it is insensitive, or for palliative stenting. Surgery with the Whipple procedure offers the only chance of cure. patients are staged as resectable if there are no distant metastases to lymph nodes or organs and there is no major vessel involvement. The 5-year survival rate for resectable patients is about 10% with a median survival of 12 to 18 months. Unresectable patients live about 6 months. Adjuvant chemotherapy with 5-fluorouracil (5-FU) or gemcitabine provides modest benefits. Palliative biliary decompression, pain control, and maintenance of gastric drainage are the usual forms of therapy.- - - - - - - - - - ranking = 1keywords = vessel (Clic here for more details about this article) |
8/67. Spindle cell carcinoma of the pancreas.We experienced a rare case of spindle cell carcinoma of the pancreas. The patient was a 74-year-old man who complained of abdominal pain and loss of weight. Ultrasonographic scans revealed a hypoechoic solid mass in the head of the pancreas, 4 cm in diameter, with a high echoic spot suggestive of central necrosis or hemorrhage. The mass was hypodense on enhanced computed tomographic scans and hypovascular on angiograms. At laparotomy, the tumor had invaded to the mesocolon, but dissemination and distant metastasis were not found. We therefore performed pylorus-preserving pancreatoduodenectomy and ascending colectomy. The patient was discharged on postoperative day 26 after an uneventful recovery. Two months later, he was readmitted because of ascites, with positivity of spindle cells shown on cytology; he died on day 92 after surgery. In the resected specimen, the tumor had a mostly sarcomatous component, consisting of spindle-shaped cells, and a small glandular component. Immunohistochemically, both components were positive for cytokeratin and epithelial membrane antigen, but negative for vimentin and desmin. The tumor was diagnosed as a spindle cell carcinoma of the pancreas. Perineural invasion, lymphatic permeation, and blood vessel invasion were found, but lymph node metastasis was not found. Although a curative operation was performed, the outcome in this patient was very poor.- - - - - - - - - - ranking = 3.9353735593284keywords = blood vessel, vessel (Clic here for more details about this article) |
9/67. Evaluation of splenic circulation after spleen-preserving distal pancreatectomy by dividing the splenic artery and vein.BACKGROUND/AIM: In the present study, we investigated the acute and late phases of splenic circulation after spleen-preserving distal pancreatectomy (SPDP) involving the division of splenic vessels. methods: An acute phase of splenic circulation was evaluated by laser flow meter and the late phase was estimated by (99m)Tc-galactosyl human serum albumin spleen scintigraphy. RESULTS: Splenic blood supply, evaluated by laser flow meter immediately after SPDP, dropped to one half of the prior blood supply. However, blood supply recovered 10 days after SPDP, as estimated by (99m)Tc-galactosyl human serum albumin spleen scintigraphy. CONCLUSION: There are two variations of SPDP: SPDP without preservation of the splenic artery and vein, and SPDP with preservation of the splenic artery and vein. The disadvantage of the former is the resulting decrease in splenic blood supply. The present findings may help to make up for this disadvantage.- - - - - - - - - - ranking = 1keywords = vessel (Clic here for more details about this article) |
10/67. spleen-preserving laparoscopic distal pancreatectomy for cystic adenoma.For borderline malignant diseases of the pancreas such as cystic adenoma, partial pancreatectomy or pancreatoduodenectomy including pylorus-preserving pancreaticoduodenectomy have been performed depending on tumor location under large median laparotomy. To investigate the feasibility of a technique with minimal skin incision, while retaining safety equivalent to conventional resection of the pancreatic tail, by making use of the advantages of laparoscopic procedure, we performed a minimally invasive laparoscopic resection of the pancreatic tail with preservation of the spleen. A 69-year-old woman underwent surgery for a diagnostic therapy for a cystic lesion of the pancreatic tail. The procedure was performed as follows: All procedures were performed completely laparoscopically under CO2 insufflation. After dissection of the omentum, laparoscopic ultrasound was performed to identify the location of the tumor and splenic vessels. The splenic hilus was dissected with preservation of the splenocolic ligament to maintain the lower blood supply to the spleen. The left gastroepiploic artery and the short gastric arteries and veins could be preserved. After division of the splenic hilus, the splenic artery and vein were identified from behind the pancreas by being held up and dissected individually by intracorporeal ligation by 3-0 Nylon. Then, pancreatic transection was performed 1 cm proximal to the tumor with the Endo-GIAII. The duration of operation was 4.5 hours. Intraoperative blood loss was under 50 mL. Histological examination revealed mucinous cytadenoma. She could walk the day after surgery and was discharged from the hospital uneventfully. CT prior to discharge from the hospital revealed sufficient blood flow in the spleen. Thus, it may be feasible to select laparoscopic spleen-preserving distal pancreatectomy as a first choice for diagnostic therapy for cystic lesions of the pancreatic tail.- - - - - - - - - - ranking = 1keywords = vessel (Clic here for more details about this article) |
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