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Incidental Intraductal Papillary Mucinous Neoplasms(IPMN) of the Pancreas after Liver Transplantation.

Kwan Il KIM ; Kyung Suk SUH ; Joohyun KIM ; Woo Young SHIN ; Nam Joon YI ; Jin Young JANG ; Sun Whe KIM ; Se Hyung KIM ; Kuhn Uk LEE

Korean Journal of Hepato-Biliary-Pancreatic Surgery.2008;12(2):124-127.

PURPOSE: The incidence and risk of malignancy are elevated in solid organ transplant recipients compared to persons in the general population. Epidemiological data reveal that the length of exposure to immunosuppressive therapy and the intensity of therapy are clearly related to the post-transplant risk of malignancy. The purpose of this study was to investigate the course of incidental intraductal papillary mucinous neoplasms (IPMN) of the pancreas after liver transplantation. METHODS: We retrospectively reviewed the medical records of 17 patients with IPMNs of the pancreas who underwent liver transplantation between January 2000 and December 2006. The mean follow-up duration was 29.6 +/- 22.8 months. RESULTS: The mean patient age was 55.2 +/- 7.2 years, and the male to female ratio was 14:3. All patients had branch duct type IPMNs. The lesions were located principally in the head (64.7%) and body (52.9%) of the pancreas. The mean tumor size was 13.0 +/- 6.2 mm. There were no newly developed symptoms associated with these lesions, and none of the lesions enlarged during the follow-up period. No patients underwent surgical resection of their lesions. CONCLUSION: The course of each of the incidental small IPMNs of the pancreas was uneventful for more than 2 years after liver transplantation. Therefore, patients with incidental small IPMNs of the pancreas are not immediate candidates for surgical pancreas resection. However, a longterm follow-up study with a larger sample size will be required to establish treatment guidelines in immunosuppressed patients.
Female ; Follow-Up Studies ; Head ; Humans ; Incidence ; Liver ; Liver Transplantation ; Male ; Medical Records ; Mucins ; Pancreas ; Retrospective Studies ; Sample Size ; Transplants

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Cryosurgery of Hepatic Malignancy: Is Cryosurgery Appropriate Treatment for hepatic malignancies?.

Dong Hoon SHIN

Korean Journal of Hepato-Biliary-Pancreatic Surgery.2008;12(2):117-123.

PURPOSE: Hepatic resection has proven to be an effective treatment for primary and secondary malignant hepatic tumors, but the majority of patients cannot be treated with resection. Candidates for cryosurgery are patients who are considered unresectable, but who have no evidence of disease outside the liver. The purpose of cryosurgery is to destroy all present tumors (including a margin of healthy tissue) by freezing them. The purpose of this study was to evaluate clinical outcomes after cryosurgery for hepatic malignancies. METHODS: Freezing is performed using high pressure argon or liquid nitrogen and utilizing the Joule-Thomson effect. Two freeze-thaw cycles performed at each location have been previously documented to increase tissue destruction. Mechanisms of freezing-induced cellular destruction include intracellular and extracellular ice crystal formation, cell membrane damage, cellular dehydration, ischemic damage from thrombosed vessels, and apoptosis. Cryosurgery is performed through open placement of cryoprobes in the tumor, using laparoscopic and percutaneous approaches. The cryosurgery procedure is usually monitored with ultrasonography, computed tomography, and magnetic resonance imaging. RESULTS: Hepatic cryosurgery was performed in 6 patients (follow-up period more than 1 year) at our hospital. We noted no local tumor recurrence, and we achieved effective treatment of hepatic malignancies. CONCLUSION: Hepatic cryosurgery is increasingly recognized as a safe and effective treatment modality for nonresectable patients, or as a modality to be used in conjunction with liver resection.
Apoptosis ; Argon ; Cell Membrane ; Cryosurgery ; Dehydration ; Freezing ; Humans ; Ice ; Liver ; Magnetic Resonance Spectroscopy ; Nitrogen ; Recurrence

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Surgical Treatment of Benign Biliary Stricture.

Hee Jung WANG

Korean Journal of Hepato-Biliary-Pancreatic Surgery.2008;12(2):109-116.

No abstract available.
Constriction, Pathologic

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Interventional Management of Benign Biliary Stricture.

Kyu Bo SUNG

Korean Journal of Hepato-Biliary-Pancreatic Surgery.2008;12(2):104-108.

No abstract available.
Constriction, Pathologic

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Endoscopic Diagnosis and Treatment of Benign Biliary Strictures.

Young Deok CHO

Korean Journal of Hepato-Biliary-Pancreatic Surgery.2008;12(2):96-103.

Benign biliary strictures constitute about 25% of all biliary strictures. Benign biliary strictures are a heterogenous group of lesions with variousvariable pathogenesis. The majority of benign biliary strictures occur as a result of bile duct injury during surgery or as a consequence of bile duct repair after accidental injury, performing , choledochotomy, or performing duct-to-duct anastomosis after liver transplantation. However, bile duct strictures are also typical of other diseases, such as chronic pancreatitis, primary sclerosing cholangitis, and other uncommon cholangiopathies. The aim of treatment is to relieve the symptoms of biliary obstruction or cholangitis, and to prevent of secondary biliary cirrhosis. The Management of benign biliary stricture remains a challenge for both the surgeons and the therapeutic endoscopists. Surgery is, though traditionally considered as the mainstay of treatment, but this is associated with significant morbidity and variousvariable long-term outcomes. Endoscopic management, i.e., stricture dilatation and stent placement, is more appealing because it is less invasive, better tolerated, and it may be safer than operative management in selected patients. Recently, benign biliary strictures are now being increasing treated with endoscopic techniques. The Outcome of endoscopic management depends on both the etiology and location of the stricture. The benign nature of the stricture should be first confirmed in order to ensure appropriate therapy. The Current data suggest that the long-term results with using multiple plastic stent are superior to those with using a single plastic stent. Removable covered metal stents are also a good alternative. The role of bio-absorbable self-expanding stents for treating benign biliay strictures needs to be evaluated further.
Bile Ducts ; Cholangitis ; Cholangitis, Sclerosing ; Constriction, Pathologic ; Dietary Sucrose ; Dilatation ; Humans ; Liver Cirrhosis, Biliary ; Liver Transplantation ; Pancreatitis, Chronic ; Plastics ; Stents

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Radiological Diagnosis of Benign Biliary Stricture.

Joon Koo HAN

Korean Journal of Hepato-Biliary-Pancreatic Surgery.2008;12(2):91-95.

No abstract available.
Constriction, Pathologic

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Postoperative portal vein thrombosis and gastric hemorrhage associated with late-onset hemorrhage from the common hepatic artery after pancreaticoduodenectomy.

Ikuo WATANOBE ; Yuzuru ITO ; Eigo AKIMOTO ; Yuuki SEKINE ; Yurie HARUYAMA ; Kota AMEMIYA ; Shozo MIYANO ; Taijiro KOSAKA ; Michio MACHIDA ; Toshiaki KITABATAKE ; Kuniaki KOJIMA

Korean Journal of Hepato-Biliary-Pancreatic Surgery.2016;20(1):44-47. doi:10.14701/kjhbps.2016.20.1.44

Portal vein thrombosis (PVT) is a rare but serious postoperative complication of pancreaticoduodenectomy (PD). We reported a case of late-onset postoperative PVT with hemorrhage from the common hepatic artery (CHA) in a 73-year-old man who underwent pylorus-preserving pancreaticoduodenectomy (PPPD) for duodenum papilla cancer, followed by reconstruction using the modified Child's technique. The pancreaticojejunostomy was achieved by end-to-side, 2-layer invagination anastomosis without pancreatic duct stenting. Drain removal and hospital discharge were scheduled on postoperative day (POD) 18, but blood-stained fluid in the drain and sudden hematemesis were noted. Emergency surgery was performed because PVT and imaging findings were suggestive of necrosis of the lifted jejunum. Although no jejunal necrosis was identified during surgery, bleeding from the side of the CHA was detected and the bleeding point was suture-closed to achieve hemostasis. We suspected late-onset postoperative arterial hemorrhage and subsequent hematoma formation, which caused portal vein compression and PVT formation. We chose a conservative treatment strategy for PVT, taking into account the operation time, intraoperative vital signs and blood flow in the portal vein. Despite the complicated postoperative course, he was discharged home in a fully ambulatory state on POD 167.
Aged ; Duodenum ; Emergencies ; Hematemesis ; Hematoma ; Hemorrhage* ; Hemostasis ; Hepatic Artery* ; Humans ; Jejunum ; Necrosis ; Pancreatic Ducts ; Pancreaticoduodenectomy* ; Pancreaticojejunostomy ; Portal Vein* ; Postoperative Complications ; Postoperative Hemorrhage ; Stents ; Venous Thrombosis* ; Vital Signs

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Successful salvage treatment of acute graft-versus-host disease after liver transplantation by withdrawal of immunosuppression: a case report.

Wei QIU ; Guo Yue LV ; Chao JIANG ; Ping ZHANG ; Xiao Dong SUN ; Xiao Ju SHI ; Xue Yan LIU ; Guang Yi WANG

Korean Journal of Hepato-Biliary-Pancreatic Surgery.2016;20(1):38-43. doi:10.14701/kjhbps.2016.20.1.38

Acute graft-versus-host disease (GVHD) following liver transplantation is a rare but fatal complication. The correct diagnosis and management of GVHD after liver transplantation are still major challenges. Herein, we reported successful salvage treatment of acute GVHD by withdrawal of immunosuppression in a patient who presented with fever, skin rashes, and decreased blood cell counts after liver transplantation. This case highlights the need for awareness of drug-induced liver injury if liver function tests are elevated during treatment, especially in patients taking multiple potentially hepatotoxic drugs, such as broad-spectrum antibiotics. When occurs, an artificial liver support system is a useful tool to provide temporary support of liver function for the patient in the event of drug-induced liver injury.
Anti-Bacterial Agents ; Blood Cell Count ; Diagnosis ; Drug-Induced Liver Injury ; Exanthema ; Fever ; Graft vs Host Disease* ; Humans ; Immunosuppression* ; Liver Function Tests ; Liver Transplantation* ; Liver* ; Liver, Artificial

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Benefit of pyloroplasty to prevent gastric stasis in intrahepatic cholangiocarcinoma patients undergoing extensive left-sided lymph node dissection.

Jae Won CHO ; Hae Won LEE ; Shin HWANG

Korean Journal of Hepato-Biliary-Pancreatic Surgery.2016;20(1):32-37. doi:10.14701/kjhbps.2016.20.1.32

BACKGROUNDS/AIMS: Intrahepatic cholangiocacinoma (IHCC) can result in spread of tumor cells to the lymph nodes (LNs) around the gastric lesser curvature. Extensive dissection of the gastric lesser curvature can induce injury to the extragastric vagus nerve branches that control motility of the pyloric sphincter and result in intractable gastric stasis. Herein, we presented our experience of preventive pyloroplasty added to resection of IHCC to address dissection-induced gastric stasis in 6 patients during 15-years. METHODS: We analyzed the survival outcomes of 54 IHCC patients presenting left-sided LN metastasis. Nine study patients who underwent extended left-sided LN dissection including lesser curvature LN dissection were selected and divided into 2 groups according to performance of preventive pyloroplasty and the incidence of gastric stasis was analyzed. RESULTS: All 54 patients were classified as stage IV due to T1-3N1M0 stage. The tumor recurrence rate were 56.4% at 1 year, 84.3% at 3 years and 84.3% at 5 years; and the overall patient survival rate were 51.9% at 1 year, 13.6% at 3 years and 6.8% at 5 years. In all 3 study patients who did not receive pyloroplasty, overt postoperative gastric stasis persisted for >10 days leading to prolonged hospital stay. In contrast, none of the 6 study patients who underwent pyloroplasty suffered from gastric stasis. CONCLUSIONS: Pyloroplasty is a useful surgical option to prevent gastric stasis when extensive left-sided LN dissection is required in IHCC patients with LN metastasis who have very poor post-resection prognosis.
Cholangiocarcinoma* ; Gastroparesis* ; Humans ; Incidence ; Length of Stay ; Lymph Node Excision* ; Lymph Nodes* ; Neoplasm Metastasis ; Prognosis ; Pylorus ; Recurrence ; Survival Rate ; Vagus Nerve

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Postoperative biological and clinical outcomes following uncomplicated pancreaticoduodenectomy.

Emilie LERMITE ; Tao WU ; Alain SAUVANET ; Christophe MARIETTE ; Francois PAYE ; Fabrice MUSCARI ; Antonio Sa CUNHA ; Bernard SASTRE ; Jean Pierre ARNAUD ; Patrick PESSAUX

Korean Journal of Hepato-Biliary-Pancreatic Surgery.2016;20(1):23-31. doi:10.14701/kjhbps.2016.20.1.23

BACKGROUNDS/AIMS: The aim of this study was to describe clinical and biological changes in a group of patients who underwent pancreaticoduodenectomy (PD) without any complication during the postoperative period. These changes reflect the "natural history" of PD, and a deviation should be considered as a warning sign. METHODS: Between January 2000 and December 2009, 131 patients underwent PD. We prospectively collected and retrospectively analyzed demographic data, pathological variables, associated pathological conditions, and preoperative, intraoperative, and postoperative variables. Postoperative variables were validated using an external prospective database of 158 patients. RESULTS: The mean postoperative length of hospital stay was 20.3+/-4 days. The mean number of days until removal of nasogastric tube was 6.3+/-1.6 days. The maximal fall in hemoglobin level occurred on day 3 and began to increase after postoperative day (POD) 5, in patients with or without transfusions. The white blood cell count increased on POD 1 and persisted until POD 7. There was a marked rise in aminotransferase levels at POD 3. The peak was significantly higher in patients with hepatic pedicle occlusion (866+/-236 IU/L versus 146+/-48 IU/L; p<0.001). For both gamma-glutamyl transpeptidase and alkaline phosphatase, there was a fall on POD1, which persisted until POD 5, followed with a stabilization. Bilirubin decreased progressively from POD 1 onwards. CONCLUSIONS: This study facilitates a standardized biological and clinical pathway of follow-up. Patients who do not follow this recovery indicator could be at risk of complications and additional exams should be made to prevent consequences of such complications.
Alkaline Phosphatase ; Bilirubin ; Critical Pathways ; Follow-Up Studies ; gamma-Glutamyltransferase ; Humans ; Length of Stay ; Leukocyte Count ; Natural History ; Pancreaticoduodenectomy* ; Postoperative Period ; Prospective Studies ; Retrospective Studies

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