Pancreatic cancer is popular, in our report from 1997 to 1999 in Cho Ray hospital and university of medicine and pharmacy polyclinic, there are 213 patients of which 146 to be operated. There is 54.8% of patients over 59 yeas old. Male is in 58.9% of patients and female is in 41.1% of patients. Predominant symptoms included: abdominal pain (72.6%), jaundice (67.1%), abdominal mass (41.3%). Average total bilirubinemia concentration is 12.3 mg%, average concentration of direct bilirubin direct is 8.2 mg%. Ultrasound diagnosis is correct in 58.2% and CT in 59% of pancreatic cancer. Exact preoperative diagnosis in pancreatic cancer is 76.7% (stage 3) and stage 4 (74.7%). Pancreatic cancer is usually in the head and ampulary of the Vater (78.7%). Curative surgical treatment only indicated for 15.8%, other is palliative surgical treatment. Bilioenterostomy is usually performed by way of cholecystoenterostomy in 64 patients and choledoenterostomy in 32 patients. There are only 3 patients died to be reported
Pancreatic Neoplasms ; Surgery ; Diagnosis ; therapeutics

BACKGROUNDIntraductal papillary mucinous neoplasm (IPMN) is a rare pancreatic cystic neoplasm, accounting for 1% of all exocrine pancreatic neoplasms. This study aimed to summarize the clinicopathological and biological behaviors, as well as the experience in diagnosis and treatment of IPMN.

METHODSClinicopathological data were collected from 36 cases with IPMN who were treated in Department of General Surgery, Peking University Third Hospital from May 2001 to July 2011.

RESULTSThe 36 cases of IPMN patients included 27 males and 9 females (M:F = 3:1). The age of patients ranged from 52 to 78 years, with an average of 67.3 years. Regarding tumor location, 20 tumors were located in pancreatic head, 3 in pancreatic neck, 10 in pancreatic body and tail, and 3 in the whole pancreas. All the 36 cases underwent surgical treatment, with 13 cases of pancreaticoduodenectomy, 3 cases of middle pancreatectomy, 7 cases of tumor resection plus pancreaticojejunostomy, 3 cases of distal pancreatectomy, 7 cases of distal pancreatectomy plus spleen resection, and 3 cases of total pancreaticoduodenectomy. Of the 36 patients, 9 patients underwent the operations under laparoscopy. The 36 cases included main duct type (14 cases, 38.9%), branch duct type (10 cases, 27.7%), and mixed duct type (12 cases, 33.3%). Pathologically, of the 36 cases, there were 7 IPMN adenomas, 11 borderline IPMNs, 6 IPMN with carcinomas in situ, and 12 IPMNs with invasive carcinomas. All the 36 cases were followed up. During an average of 42 months follow-up period (26-129 months), no recurrence occurred.

CONCLUSIONSIPMN, which primarily occurs in male, is a low-grade malignancy which may involve any part of the pancreas, with specific clinicopathological features. IPMN is a different malignancy type from pancreatic ductal carcinoma. Imaging and laboratory examination are helpful for the diagnosis and differential diagnosis. The prediction of invasive IPMN is still difficult. Surgical resection is recommended as the first choice of treatment. Aggressive and proper operation procedure produces better prognosis. Long-term follow-up is necessary for patients after operation. Laparoscopic distal pancreatectomy is a feasible and safe procedure for the indicated patients.

Aged ; Carcinoma, Pancreatic Ductal ; diagnosis ; surgery ; Female ; Humans ; Male ; Middle Aged ; Pancreatectomy ; Pancreatic Neoplasms ; diagnosis ; surgery ; Pancreaticoduodenectomy ; Pancreaticojejunostomy ; Retrospective Studies

glucagonoma is a rare islet alpha-cell tumor. We report a case of glucagonoma in a 55-year-old male patient with such clinical findings of necrolytic migratory erythema, diabetes mellitus, body weight loss, and anemia. CT examination found a space-occupying lesion in the pancreas, and an elevated serum glucagon level indicate the diagnosis of glucagonoma, which was confirmed postoperatively by pathological examination of the tumor tissue. A definite diagnosis of glucagonoma relies on pathological report, and so far no standard treatment strategy has been available for this tumor. Surgical resection is an effective means for treatment of glucagonoma.
Glucagonoma ; diagnosis ; pathology ; surgery ; Humans ; Male ; Middle Aged ; Pancreatectomy ; Pancreatic Neoplasms ; diagnosis ; pathology ; surgery

OBJECTIVE: To explore the diagnosis and surgical treatment for pancreatic vasoactive intestine polypeptide tumor (VIPoma). METHODS: Clinical data of 7 patients with VIPoma from Xiangya Hospital, Central South University between January 1990 and July 2011 were collected and analyzed retrospectively. RESULTS: The different operation modes were selected according to the location of VIPomas, and the postoperative symptoms of all 7 patients were gradually relieved and cured. The follow up showed that life spans of the above-mentioned patients were 3-6 years. CONCLUSION The incidence of pancreatic VIPoma is low but it is easy to misdiagnose. The excision for the tumor is the most effective therapy. Combining with somatostatin, intervention and other effective strategies, the life quality of patients can be improved and long-term survival may be achieved.
Humans ; Pancreatic Neoplasms ; diagnosis ; surgery ; Retrospective Studies ; Somatostatin ; Vipoma ; diagnosis ; surgery

Solid and papillary neoplasms of the pancreas, a rare tumor usually found in young female patients, seldom presents with metastasis since it is a tumor with low potential for malignancy. The prognosis for this lesion is much more favorable than that for other pancreatic neoplasms. In an attempt to understand the characteristics and prognosis of this lesion, we reviewed twenty cases treated at the Department of Surgery, Severance Hospital, Yonsei University from 1985 to 1994. The mean age of the patients was 25.6 years (range: 13 to 39 years), and 19 (95%) were women. Chief complaints were palpable mass (50%), pain (45%), and indigestion(5%). In laboratory studies, tumor markers, including CEA, CA125, CA19-9, and aFP were studied in eight patients, and found negative. Other laboratory findings were also nonspecific. These tumors may occur anywhere in the pancreas. In our studies, the tumor was most often located in the tail (45%), and the head (40%) of the pancreas. These were treated by distal pancreatectomy and splenectomy (55%), Whipple's operation (20%), pylorus preserving pancreatoduodenectomy (10%), enucleation (10%) or excision (5%). Significant morbidity or mortality was not observed during hospitalization, and no recurrence or malignant degeneration occurred during the mean follow-up period of 4 years (range: 1 month to 9 years). In conclusion, this study has suggested that the patients with a solid and papillary neoplasm of the pancreas have a good prognosis for successful treatment, if the disease is diagnosed early and the tumor is completely resected. A higher index of suspicion, and more aggressive diagnostic workups are needed in dealing with this disease entity.
Adolescent ; Adult ; Carcinoma, Papillary/diagnosis/*pathology/surgery ; Female ; Follow-Up Studies ; Human ; Male ; Pancreatic Neoplasms/diagnosis/*pathology/surgery

OBJECTIVETo investigate the diagnosis and treatment of macrocystic serous adenoma of the pancreas (MSAP).

METHODSThe clinical data of 5 patients with MSAP treated from October 1999 to October 2009 were retrospectively analyzed. There were 5 female and 1 male.

RESULTSOf the 5 patients, 3 patients presented with abdominal pain and fullness, 1 patient with jaundice, 1 patient with asymptomatic. Ultrasonography and CT could manifest macrocystic lesion of the pancreas; all the lesion showed a well-defined border, internal septations, enhanced cyst walls, with no intramural (mural) nodule and papillary projections; the wall was smooth and thin in 4 cases; irregular lobulation could be observed in 3 cases, round or oval in 2 cases; 2 cases had pancreatic duct dilatation, 1 case had biliary duct dilatation. The tumors located in the pancreatic body and tail in 3 cases, the tumors located the pancreatic head in 2 cases. The sizes of the tumors ranged from 6.5 cm to 13.0 cm (mean, 8.8 cm). Five patients all accepted surgical intervention. The main postoperative complication was pancreatic fistula (2 cases); all the fistula was cured. Recurrence or metastasis were not found in 5 patient followed up postoperatively from 8 to 35 months.

CONCLUSIONSMSAP has no specific symptoms. The imaging appearance of MSAP is similar to mucinous cystic neoplasm of the pancreas. The tumor can gradually grow up and produce compression symptoms. MSAP can be cured by complete resection.

Adult ; Cystadenoma, Serous ; diagnosis ; surgery ; Female ; Follow-Up Studies ; Humans ; Male ; Middle Aged ; Pancreatic Neoplasms ; diagnosis ; surgery ; Retrospective Studies

BACKGROUNDSince being reclassified by WHO in 1996, solid pseudopapillary tumour (SPT) of pancreas has been recognized as the internationally accepted name. Clinicians are lacking in knowledge of this rare disease so the misdiagnosis and inappropriate therapy are hard to avoid. The clinic data on 22 patients were summarized to study the misdiagnosis and treatment of a sample of SPTs.

METHODSTwenty-two female patients with SPT were studied retrospectively and divided into two groups, the misdiagnosed group and the correctly diagnosed one. The analyses were performed with Fisher test with accurate probability for categorical data, and Kruskal-Wallis test for ranked data.

RESULTSThe rate of misdiagnosis in this sample was 45.5%. The misdiagnosed SPTs were apt to be the incomplete capsule ones (P = 0.020), which resulted in obvious difficulties during operation (P = 0.024). In the misdiagnosed SPT group, the medical expenses increased significantly (P = 0.042), and the number of days in hospital greater than in correctly diagnosed group (P = 0.041).

CONCLUSIONSAlthough SPT has low malignancy with excellent prognosis after surgical treatment in most patients, the misdiagnosis of SPT increases the social and economic burdens on patients. It is important to analyse the causes of misdiagnosis.

Adolescent ; Adult ; Carcinoma, Papillary ; diagnosis ; surgery ; Child ; Diagnostic Errors ; Female ; Humans ; Middle Aged ; Pancreatic Neoplasms ; diagnosis ; surgery

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

Intraductal papillary mucinous neoplasm (IPMN) of the pancreas is a unique disease entity that is characterized by predominant intraductal growth of mucinous cells, copious mucin production, and subsequent cystic dilatation of pancreatic ducts. IPMN shows a spectrum of histologic and imaging findings and possesses as the potential for malignant transformation arising from adenoma to invasive carcinoma. It is important to determine the type, extent of duct involvement, and presence of malignant transformation, and to assess tumor grading prior to surgical resection. Thus, it would be helpful for physicians managing patients with IPMN of the pancreas to have a guideline for the diagnosis and treatment of IPMN. In this review, a role of radiological evaluation for diagnosis and preoperative assessment is described as well as presentation of the guideline for patient management.
Adenocarcinoma, Mucinous/*diagnosis/pathology/surgery ; Carcinoma, Pancreatic Ductal/*diagnosis/pathology/surgery ; Carcinoma, Papillary/*diagnosis/pathology/surgery ; Diagnosis, Differential ; Humans ; Magnetic Resonance Imaging ; Pancreatic Neoplasms/*diagnosis/pathology/surgery ; Preoperative Care ; Prognosis ; Tomography, X-Ray Computed

Adult ; Aged ; Esophageal and Gastric Varices ; diagnosis ; surgery ; Female ; Humans ; Male ; Middle Aged ; Pancreas ; pathology ; surgery ; Pancreatic Neoplasms ; diagnosis ; surgery ; Splenomegaly ; diagnosis ; surgery ; Young Adult