BACKGROUNDPancreatic endocrine tumors (PETs) are rare and their surgical treatment is often debated. The purpose of this retrospective study was to analyze the diagnosis and surgical strategy of functioning and non-functioning PETs.

METHODSFrom May 1980 to March 2006, 36 patients with pancreatic endocrine tumors at the Second Affiliated Hospital of Zhejiang University were retrospectively studied.

RESULTSAmong the 36 patients, 29 (81%) had functioning tumors, and 7 (19%) had nonfunctioning tumors. Ninety-two percent of insulinomas were benign, whereas 4 (57%) of nonfunctioning PETs were malignant. The size of functioning tumors was (2.3 +/- 0.3) cm, that of nonfunctioning tumors was less than (5.1 +/- 0.5) cm. The combination CT and transabdominal ultrasonography resulted in a diagnostic sensitivity of 84%. Thirty-three primary lesions were precisely located in 32 patients (89%). Atypical tumor resection was performed for 73% of functioning tumors, while typical pancreatectomy was performed for 6 (85%) of nonfunctioning tumors. Moreover, 5 liver resections and 1 lymph node dissection were performed. During the follow-up, fifteen complications occurred in 12 (36%) patients after operation. The 5-year survival rate for patients with benign tumors was 92% compared to 50% for those with malignant tumors. Surgical cure was achieved in 95% of patients with benign insulinomas.

CONCLUSIONSSurgical strategy for PETs depends on the size and location of the tumor and the risk of malignancy. The optimal surgical procedure is key to prevent postoperative complication. Radical resection including initial and metastatic lesion may benefit patients with malignant PETs.

Adolescent ; Adult ; Aged ; Female ; Humans ; Insulinoma ; diagnosis ; mortality ; surgery ; Male ; Middle Aged ; Pancreatic Neoplasms ; diagnosis ; mortality ; surgery ; Positron-Emission Tomography

PURPOSE: Cystic pancreatic neoplasms are rare, but interesting, because of their high cure rate. With the exception of pseudocysts and serous cystadenomas, which are always benign, these cystic neoplasms are either premalignant or malignant. However, there is no reliable clinical criteria for differential diagnosis, and the treatment plan may be confusing. METHODS: From October 1994 to November 1999, 60 cases, diagnosed as a cystic neoplasm preoperatively were reviewed retrospectively. The clinical findings of benign lesions (benign group) and those for malignant or premalignant tumors (malignant group) were compared. RESULTS: The postoperative pathology results indicate 10 serous cystadenomas, 13 mucinous cystic neoplasms, 11 solid and papillary neoplasms, 10 duct ectasias, 2 cystic islet cell tumors, 1 metastatic papillary carcinoma, 1 lymphepithelial cyst, 2 simple cysts, 6 pseudocysts, and 4 retension cysts without malignancy. The mean age of the patients was 48.6 years, and the male-to-female ratio was 5 to 7. The accuracy of CT for diagnosing the malignancy of malignant tumors was 37.8% (14/37) and that of US was 22.2% (4/18). The rate of tumors having malignant potential was 71.7% (37/60). The mean size of the tumors in the benign group was smaller than that in the malignant group (p=0.014). There was a higher proportion of females in the malignant group than in the benign group (p=0.001). Heavy alcohol consumption was found more frequently in the benign group (p=0.021). There were no differences in the other clinical findings. The mortality rate of the operations was 0%, and the morbidity rate was 18%. CONCLUSION: Since it is difficult to determine the precise tumor type of a cystic pancreatic neoplasm preoperatively, all these lesions should be treated with surgical resection in order to identify and remove the malignant or premalignant neoplasms early. However, if the operative risk is high, malignant risk factors having large sized tumor, especially more than 6 cm, female, and having no history of heavy alcohol consumption may be useful for deciding the treatment plan.
Adenoma, Islet Cell ; Alcohol Drinking ; Carcinoma, Papillary ; Cystadenoma, Serous ; Diagnosis, Differential ; Dilatation, Pathologic ; Female ; Humans ; Mortality ; Mucins ; Pancreatic Cyst* ; Pancreatic Neoplasms ; Pathology ; Retrospective Studies ; Risk Factors

BACKGROUND/AIMS: Neuroendocrine tumors (NET) of the pancreas are rare. Its prognosis is better than pancreas adenocarcinoma due to the slow growth, however, malignant NET of the pancreas are observed. The purposes of this study were to evaluate the clinical characteristics and to find the predictive factors of NET which are associated with malignancy and survival. METHODS: We retrospectively evaluated the clinical outcomes of 122 patients with NET of the pancreas who were pathologically diagnosed at Asan Medical Center between 1990 and 2006. RESULTS: Mean age of the patients was 48.9+/-14.0 years and there was no gender predilection. The major clinical manifestations were abdominal pain (44.0%) in non-functional tumor, neuroglycopenic symptoms (100%) in insulinoma and diarrhea (60%) in gastrinoma. Tumor size ranged from 4 to 140 mm (average 29.8+/-23.22). Ninety cases (73.8%) were classified as benign tumors and 32 cases (26.2%) as malignant. In multivariate analysis of clinical characteristics, large sized tumor (>20 mm, p=0.001) was confirmed as sole independent factor to predict malignant NET. Surgical resection was performed in 114 patients. All patients with benign NET are still alive without recurrence. Six out of 32 patients with malignant NET died at an average 40.3 months after diagnosis. The factors indicating favorable outcome were small size of tumors (p=0.046), resection of primary tumor (p=0.000), absence of lymph node invasion (p=0.0116) and distant metastasis (p=0.0005). CONCLUSIONS: Large NET of the pancreas, regardless of their functioning status, were more likely to be associated with malignancy and predictor of worse survival.
Adult ; Aged ; Female ; Humans ; Male ; Middle Aged ; Multivariate Analysis ; Neuroendocrine Tumors/*diagnosis/mortality/pathology ; Pancreatectomy ; Pancreatic Neoplasms/*diagnosis/mortality/pathology ; Predictive Value of Tests ; Prognosis ; Retrospective Studies ; Survival Analysis

Pancreatic cancer is a leading cause of cancer-related morbidity and mortality, but any meaningful improvement in its prognosis remains elusive. The lack of early diagnostic methods means that many patients only present when symptoms develop, such as obstructive jaundice. Once a diagnosis of pancreatic cancer has been made in a patient with obstructive jaundice, then a decision should be made if the patient is a candidate for surgical resection. Patients who are candidates for surgical resection generally do not need preoperative biliary drainage, unless they present with cholangitis, or if they require neo-adjuvant chemotherapy. If preoperative biliary drainage is to be done, then patient factors and local expertise should guide appropriate interventions. The evidence for endoscopic retrograde cholangiopancreatography as a first-line therapy for biliary decompression is strong; However, the use of percutaneous transhepatic biliary drainage as well as endoscopic ultrasound-guided biliary drainage has generally not been found to be inferior. Finally, to ensure ongoing patency and minimize complications, an appropriate self-expanding metal stent should ideally be placed.
Cholangiopancreatography, Endoscopic Retrograde ; Cholangitis ; Decompression ; Diagnosis ; Drainage ; Drug Therapy ; Endoscopy ; Humans ; Jaundice, Obstructive ; Mortality ; Pancreatic Neoplasms ; Prognosis ; Stents ; Ultrasonography

Pancreatic malignancy is the third leading cause of cancer related death in the United States with limited viable screening options. By the end of this decade, cancers are poised to become the leading cause of death with pancreatic cancer projected to be the second leading cause of cancer related mortality. Pancreatic cystic lesions (PCLs) are found in approximately 5%–14% of patients due to the increased utilization of cross-sectional imaging, with approximately 8%–10% of pancreatic cancers originating as PCLs. Current screening guidelines have shown discrepancies between morphologic characteristics of PCLs and identifying advanced pancreatic disease. Molecular analysis has emerged as a novel technology to aid in adequate diagnosis and management decisions of PCLs. Mucinous cysts including intraductal papillary mucinous neoplasms (IPMNs) or mucinous cystic neoplasms have similar oncogenic mutations including KRAS, TP53, SMAD4, PIK3CA, PTEN, or CKDN2A, while GNAS and RNF43 mutations are specific only to IPMNs. Serous cystadenomas have been associated with a loss of tumor suppressor gene VHL, while solid-psuedopapillary neoplasms have an oncogenic mutation CTNNB1. A specific molecular marker to diagnose existing high-grade dysplasia or impending malignant transformation is yet to be identified. Moving forward it is important to advance technology in isolating and identifying high-risk molecular markers from cyst fluid while considering their increased utilization in the evaluation of PCLs.
Biomarkers, Tumor ; Cause of Death ; Cyst Fluid ; Cystadenoma, Serous ; Diagnosis ; Genes, Tumor Suppressor ; Humans ; Loss of Heterozygosity ; Mass Screening ; Mortality ; Mucins ; Neoplasms, Cystic, Mucinous, and Serous ; Pancreatic Cyst* ; Pancreatic Diseases ; Pancreatic Neoplasms ; United States

Pancreatic cancer is a major cause of cancer-related mortality and morbidity, and its incidence is increasing as the population is aging. On the other hand, significant improvement in the prognosis has not occurred. The absence of early diagnosis means that many patients are diagnosed only when they develop symptoms, such as jaundice, due to a biliary obstruction. The role of endoscopy in multidisciplinary care for patients with pancreatic cancer continues to evolve. Controversy remains regarding the best preoperative biliary drainage in patients with surgically resectable pancreatic head cancer. In general, patients undergoing a surgical resection usually do not require preoperative biliary drainage unless they have cholangitis or receive neoadjuvant chemotherapy. If biliary drainage is performed prior to surgery, the patient's condition and a multidisciplinary approach should be considered. With the increasing life expectancy of patients with pancreatic cancer, the need for more long-time biliary drainage or pre-operative biliary drainage is also increasing. Strong evidence of endoscopic retrograde cholangiopancreatography (ERCP) as a first-line and essential treatment for biliary decompression has been provided. On the other hand, the use of endoscopic ultrasound-guided biliary drainage as well as percutaneous biliary drainage has been also recommended. During ERCP, self-expandable metal stent could be recommended instead of a plastic stent for the purpose of long stent patency and minimizing stent-induced complications. In this review, several points of view regarding the relief of obstruction in patients with pancreatic cancer, and optimal techniques are being discussed.
Aging ; Cholangiopancreatography, Endoscopic Retrograde ; Cholangitis ; Decompression ; Drainage ; Drug Therapy ; Early Diagnosis ; Endoscopy ; Hand ; Head and Neck Neoplasms ; Humans ; Incidence ; Jaundice ; Life Expectancy ; Mortality ; Pancreatic Neoplasms ; Plastics ; Prognosis ; Stents

Pancreatic cancer is a major cause of cancer-related mortality and morbidity, and its incidence is increasing as the population is aging. On the other hand, significant improvement in the prognosis has not occurred. The absence of early diagnosis means that many patients are diagnosed only when they develop symptoms, such as jaundice, due to a biliary obstruction. The role of endoscopy in multidisciplinary care for patients with pancreatic cancer continues to evolve. Controversy remains regarding the best preoperative biliary drainage in patients with surgically resectable pancreatic head cancer. In general, patients undergoing a surgical resection usually do not require preoperative biliary drainage unless they have cholangitis or receive neoadjuvant chemotherapy. If biliary drainage is performed prior to surgery, the patient's condition and a multidisciplinary approach should be considered. With the increasing life expectancy of patients with pancreatic cancer, the need for more long-time biliary drainage or pre-operative biliary drainage is also increasing. Strong evidence of endoscopic retrograde cholangiopancreatography (ERCP) as a first-line and essential treatment for biliary decompression has been provided. On the other hand, the use of endoscopic ultrasound-guided biliary drainage as well as percutaneous biliary drainage has been also recommended. During ERCP, self-expandable metal stent could be recommended instead of a plastic stent for the purpose of long stent patency and minimizing stent-induced complications. In this review, several points of view regarding the relief of obstruction in patients with pancreatic cancer, and optimal techniques are being discussed.
Aging ; Cholangiopancreatography, Endoscopic Retrograde ; Cholangitis ; Decompression ; Drainage ; Drug Therapy ; Early Diagnosis ; Endoscopy ; Hand ; Head and Neck Neoplasms ; Humans ; Incidence ; Jaundice ; Life Expectancy ; Mortality ; Pancreatic Neoplasms ; Plastics ; Prognosis ; Stents

PURPOSE: We evaluated the prognostic value of 18F-2-fluoro-2-deoxyglucose positron emission tomography (FDG PET) in patients with resectable pancreatic cancer. MATERIALS AND METHODS: We retrospectively reviewed the medical records of pancreatic cancer patients who underwent curative resection, which included 64 consecutive patients who had preoperative FDG PET scans. For statistical analysis, the maximal standardized uptake value (SUVmax) of primary pancreatic cancer was measured. Survival time was estimated by the Kaplan-Meier method, and Cox's proportional hazard model was used to determine whether SUVmax added new predictive information concerning survival together with known prognostic factors. p<0.05 indicated statistical significance. RESULTS: Overall survival (OS) and disease-free survival (DFS) were respectively 42.9 months (27.6-58.2; 95% CI) and 14.9 months (10.1-19.7; 95% CI). When subjects were divided into two groups according to SUVmax with a cutoff value of 3.5, the high SUVmax group (n=32; SUVmax >3.5) showed significantly shorter OS and DFS than the low SUVmax group. Multivariate analysis of OS and DFS showed that both high SUVmax and poor tumor differentiation were independent poor prognostic factors. CONCLUSION: Our study showed that degree of FDG uptake was an independent prognostic factor in pancreatic cancer patients who underwent curative resection.
Aged ; Aged, 80 and over ; Disease-Free Survival ; Female ; Fluorodeoxyglucose F18/*diagnostic use ; Humans ; Male ; Middle Aged ; Pancreatic Neoplasms/*diagnosis/mortality ; Positron-Emission Tomography/*methods ; Retrospective Studies

PURPOSE: The survival after a pancreaticoduodenectomy, for a periampullary adenocarcinoma is limited. However, the improvement in perioperative management, and the development of interventional medicine have made the survival from that cancer favorable. Due to the anatomical proximity of periampullary tumors, surgeons perform same procedure. It is accepted that the outcome of periampullary cancers vary after resection. The purpose of this study was to evaluate the risk factors, and the differences in survival, from periampullary cancers according to the origin of the tumor. METHODS: From March 1992 to December 2000, 87 patients, with periampullary tumors, who underwent a pancreatico duodenectomy, were analyzed for the location of the tumor and the tumor status. Of the 87 patients, the 85 surviving more than 30 days were included in the statistic analysis. The survival was calculated using the Kaplan-Meier Method. The risk factors were also analyzed between the locations. RESULT: Of the 87 resected adenocarcinomas, 25 were pancreatic cancers, 30 distal CBD (common bile duct) cancers, 26 mpulla of Vater cancers and 6 duodenal cancers. The patients had a mean age of 60 (40~78) years. The total bilirubin, ALT, and CA 19-9 levels were statistically different for each cancer. There were no statistical differences between the cancer groups in operative methods, the amount of transfusion, postoperative hospital stay, and complications. The overall morbidity and mortality were 37 and 2%, respectively. The 5-year survival rates for the pancreatic, distal CBD, and Ampulla of Vater cancers were 9.6, 45.5, and 72.1%, respectively, was and were statistically significant (P<0.001). A univariate analysis of the 85 patients indicated that the predictors of long term survival included: a pathologic diagnosis of Ampulla of Vater cancer, absence of lymph node metastasis, tumor diameter<3 cm and complication. CONCLUSION: The factors influencing the survival were nodal metastasis, size of the tumor, age, and complications. The differences in the tumor biology will affect the survival, and although a pancreaticoduodenectomy remains the procedure of choice for periampullary tumors, adjuvant, or neoadjuvant, therapy for a pancreatic head tumor is especially needed.
Adenocarcinoma ; Ampulla of Vater ; Bile ; Bilirubin ; Biology ; Diagnosis ; Head ; Humans ; Length of Stay ; Lymph Nodes ; Mortality ; Neoplasm Metastasis ; Pancreatic Neoplasms ; Pancreaticoduodenectomy* ; Prognosis* ; Risk Factors ; Survival Rate

OBJECTIVE: To retrospectively evaluate the safety and efficacy of percutaneous radiofrequency ablation (RFA) in patients with metachronous hepatic metastases arising from pancreatic adenocarcinoma who had previously received curative surgery.MATERIALS AND METHODS: Between 2002 and 2017, percutaneous RFA was performed on 94 metachronous hepatic metastases (median diameter, 1.5 cm) arising from pancreatic cancer in 60 patients (mean age, 60.5 years). Patients were included if they had fewer than five metastases, a maximum tumor diameter of ≤ 5 cm, and disease confined to the liver or stable extrahepatic disease. For comparisons during the same period, we included 66 patients who received chemotherapy only and met the same eligibility criteria described.RESULTS: Technical success was achieved in all hepatic metastasis without any procedure-related mortality. During follow-up, local tumor progression of treated lesions was observed in 38.3% of the tumors. Overall median survival and 3-year survival rates were 12 months and 0%, respectively from initial RFA, and 14.7 months and 2.1%, respectively from the first diagnosis of liver metastasis. Multivariate analysis showed that a large tumor diameter of > 1.5 cm, a late TNM stage (≥ IIB) before curative surgery, a time from surgery to recurrence of < 1 year, and the presence of extrahepatic metastasis, were all prognostic of reduced overall survival after RFA. Median overall (12 months vs. 9.1 months, p = 0.094) and progression-free survival (5 months vs. 3.3 months, p = 0.068) were higher in the RFA group than in the chemotherapy group with borderline statistical difference.CONCLUSION: RFA is safe and may offer successful local tumor control in patients with metachronous hepatic metastases arising from pancreatic adenocarcinoma. Patients with a small diameter tumor, early TNM stage before curative surgery, late hepatic recurrence, and liver-only metastasis benefit most from RFA treatment. RFA provided better survival outcomes than chemotherapy for this specific group with borderline statistical difference.
Adenocarcinoma ; Catheter Ablation ; Diagnosis ; Disease-Free Survival ; Drug Therapy ; Follow-Up Studies ; Humans ; Liver ; Mortality ; Multivariate Analysis ; Neoplasm Metastasis ; Pancreatic Neoplasms ; Recurrence ; Retrospective Studies ; Survival Rate