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Pancreatectomy for neoplasms originated from other organs
Abstracts / Pancreatology 16 (2016) S1eS192
rate, procedural steps have regarded as almost established one, and similar standardize process are employed in world-wide institutions. This standard procedure includes i) common bile duct resection -> ii) stomach transection -> iii) pancreas tunneling and transection -> iv) jejunum transection -> v) SMA nerve plexus transection, resulting specimen removal. Our unique procedure in PD resection phase is so we call “pancreas transection at last method”, which involves approaching SMA-nerve plexus, SMA and SMV from back, without tunneling the pancreas-PV space. Sequentially, pancreatic head was mobilized by a right-caudal site approach, and pancreas head was totally freed from SMA and SMV with keeping continuity to pancreas body. Transecting pancreas was carried out just prior to specimen removal. This procedure confer several merit that can not be obtain with conventional approach includes tunneling the pancreas-PV space and transect pancreas at early stage of operation. In conventional approach, especially with cases of direct invasion by a cancer and/or severe adhesion by inflammations, a possible damage of PV system, causing massive bleeding may occurs in tunneling process. Moreover, two pancreatic cut surfaces could be a source of continuous bleeding and pancreatic juice leakage during the procedure, causing auto digestion of surgical field. Transecting pancreas just prior to specimen removal become realistic by mobilization of pancreatic head from SMA/SMV by a right-caudal site approach followed Kocherization. We have been providing Zero mortality for a series of 280 PD, and the original methods may contribute to the prominent result. Clinically relevant PF (grade B+C) and median hospital stay at former half of recent decade was 31.8% and 20.5 days, and they have improved to 13.8% and 15.5 days at these 5 years by standardizing these two unique procedure.
F-130. Intraductal tubulopapillary neoplasms of the pancreato-biliary system (ITPN, ITNB): Report of three cases and review of the literature
S83
F-131. The efficacy of EUS-FNA for the metastatic tumors of the pancreas Keiichi Hatamaru, Yoshito Uenoyama, Yukitaka Yamashita Department of Hepatology and Gastroenterology, Japan Red Cross Society Wakayama Medical Center Introduction: Metastatic tumors of the pancreas is rare, and determining whether a pancreatic mass is a primary or metastatic neoplasm is often difficult. We studied cases of diagnosed metastatic tumors of the pancreas using endoscopic ultrasound-guided fine needle aspiration (EUS-FNA). Object: During the period from January 2011 to September 2015, we performed 244 cases of EUS-FNA for the pancreatic tumors, 5 cases diagnosed of metastatic tumors of the pancreas. Results: The mean age 63.8±19.0 years old, man four, woman one. The lesion part was two pancreas heads, pancreas body one, frequent occurrence two in the pancreas. The mean tumor diameter was 31.2±14.1mm, mean puncture number of times was 4±2.7 times, and the FNA puncture needle, 21G was three cases, 22G was two. It was 80% (4/5) to have been diagnosable in EUS-FNA, there is no accidental occurrence symptom in all cases. The primary lesion is cecal cancer, lung small cell carcinoma, renal cell carcinoma, thymic carcinoid, chronic lymphocytic leukemia (CLL), of these, a case of CLL was not able to be diagnosed. Lung small cell carcinoma was pancytokeratinpositive, CD56-positive, chromogranin-negative. As for renal cell carcinoma, clear cell was recognized, and each pancytokeratin, vimentin, CD10, p504s was positive. Thymic carcinoid was with positive chromogranin, synaptophysin, NSE, CD56. As for the case of CLL, the last diagnosis was provided by the percutaneous needle biopsy. In this case, it was difficult to collect FNA specimen in EUS-FNA and was not given a diagnosis. Discussion: The immunohistological findings were the most important to the EUS-FNA diagnosis in metastatic pancreas tumor, and it was necessary to collect FNA specimen of enough quantity. In addition, to using a 21G needle in the FNA and to increasing the number of puncture times led to obtain a satisfactory diagnostic result.
Balazs Tihanyi 1, Laszlo Nehez 1, Katalin Borka 2, Tamas Szekely 2, Tibor Frigyes Tihanyi 1, Laszlo Harsanyi 1 1 2
1st. Department of Surgery, Semmelweis University, Hungary 2nd. Department of Pathology, Semmelweis University, Hungary
Aim: of our study to demonstrate our findings of intraductal tubulopapillary neoplasm of the pancreas and of the bile duct (ITPN and ITNB) as rare entities of the hepato-pancreato-biliary tract. ITPN and ITNB are rare and not a well characterized lesions. The first description of ITPN was published in 2009. Patients and methods: During the last 6 years we found two cases of ITPN (1:grade II, T2N0;2:grade I, T1N0 stage ITPN) and one case of ITNB (grade III, T4Nx). Macroscopically solid nodules without visible mucin secretion were seen. The histological morphology with hematoxylin eosin staining showed special tubulopapillary growth. Polymorph and highgrade atypical cells were seen. The neoplastic cells showed no visible mucin secretion. Special immunohistochemical examinations were performed as well. Results: Immunohistochemically the tumor cells showed strong positivity of CK7, CK19 and MUC6. MUC1 positivity was proved in 10-30%, but they were for MUC2 and MUC5AC negative. The CEA, Tripsin, Synaptophysin, EMA, Chromogranine, Vimentin and NSE reactions were negative, too. KRAS was negative, while the Ki67 labeling index was in 30% of the tumor cells positive and p53 was found to be positive in one ITPN case in 10%. The ITPN cases could have radical resection (1:PPPD, 2:total pancreato-duodenectomy), but the ITNB patient was found inoperable due to local invasion of the portal region. Conclusions: ITPNs are distinct from other intraductal tumors of the pancreas. To distinguish this specific intraductal tumor from IPMNs histological and immunohistochemical examinations, such as MUC1, MUC2, MUC5AC and MUC6 are obligatory. We did not find any low-grade atypia beside the tubulopapillary tumors, while beside invasive IPMNs low or high grade dysplasia could be detected.
F-132. Pancreatectomy for neoplasms originated from other organs Hiromune Shimamura 1, Hideaki Kodama 1, Ayako Endo 1, Youichi Narushima 2, Shuichi Ishiyama 3, Kazunori Takeda 1 1
Department of Surgery, Sendai Medical Center, Japan Department of Surgery, Towada City Central Hospital, Japan 3 Department of Surgery, Sendai Kosei Hospital, Japan 2
Introduction: Pancreatectomies are operative procedures that accompany great difficulties in terms of high morbidity rate. When tumors originated from organs other than pancreas directly invade or metastasize to the pancreas, pancreatectomy will be necessary to obtain radical resection of the tumor. Here we review our cases of pancreatectomy for neoplasms originated from other organs. Patients and methods: Patients, with tumors originated from organs other than pancreas, underwent pancreatectomy in our hospital between September 1999 and October 2015, were retrospectively reviewed. Results: Seventeen patients were recruited. Original organs of neoplasm were as follows:stomach (cancer, lymphoma, GIST; n¼5), colon (cancer; n¼5), kidney (cancer; n¼3), and others (brain, adrenal gland, mesocolon, retroperitoneum; each n¼1). Pancreaticoduodenectomy (PD) was performed for 9 patients, whereas 8 patients underwent distal pancreatectomy (DP). Postoperative pancreatic fistula (ISGPF grade B, C) occurred in 3 cases of PD, whereas in one case of DP. All patients discharged hospital (median postoperative hospital stay:29days) in good status, except for one renal cancer case, which renal cancer recurred so early. Conclusion: When neoplasms, originated from organs other than pancreas, directly invade or metastasize to pancreas, and radical pancreatic resection may lead to long term survival, pancreatectomy should aggressively be performed.
rate, procedural steps have regarded as almost established one, and similar standardize process are employed in world-wide institutions. This standard procedure includes i) common bile duct resection -> ii) stomach transection -> iii) pancreas tunneling and transection -> iv) jejunum transection -> v) SMA nerve plexus transection, resulting specimen removal. Our unique procedure in PD resection phase is so we call “pancreas transection at last method”, which involves approaching SMA-nerve plexus, SMA and SMV from back, without tunneling the pancreas-PV space. Sequentially, pancreatic head was mobilized by a right-caudal site approach, and pancreas head was totally freed from SMA and SMV with keeping continuity to pancreas body. Transecting pancreas was carried out just prior to specimen removal. This procedure confer several merit that can not be obtain with conventional approach includes tunneling the pancreas-PV space and transect pancreas at early stage of operation. In conventional approach, especially with cases of direct invasion by a cancer and/or severe adhesion by inflammations, a possible damage of PV system, causing massive bleeding may occurs in tunneling process. Moreover, two pancreatic cut surfaces could be a source of continuous bleeding and pancreatic juice leakage during the procedure, causing auto digestion of surgical field. Transecting pancreas just prior to specimen removal become realistic by mobilization of pancreatic head from SMA/SMV by a right-caudal site approach followed Kocherization. We have been providing Zero mortality for a series of 280 PD, and the original methods may contribute to the prominent result. Clinically relevant PF (grade B+C) and median hospital stay at former half of recent decade was 31.8% and 20.5 days, and they have improved to 13.8% and 15.5 days at these 5 years by standardizing these two unique procedure.
F-130. Intraductal tubulopapillary neoplasms of the pancreato-biliary system (ITPN, ITNB): Report of three cases and review of the literature
S83
F-131. The efficacy of EUS-FNA for the metastatic tumors of the pancreas Keiichi Hatamaru, Yoshito Uenoyama, Yukitaka Yamashita Department of Hepatology and Gastroenterology, Japan Red Cross Society Wakayama Medical Center Introduction: Metastatic tumors of the pancreas is rare, and determining whether a pancreatic mass is a primary or metastatic neoplasm is often difficult. We studied cases of diagnosed metastatic tumors of the pancreas using endoscopic ultrasound-guided fine needle aspiration (EUS-FNA). Object: During the period from January 2011 to September 2015, we performed 244 cases of EUS-FNA for the pancreatic tumors, 5 cases diagnosed of metastatic tumors of the pancreas. Results: The mean age 63.8±19.0 years old, man four, woman one. The lesion part was two pancreas heads, pancreas body one, frequent occurrence two in the pancreas. The mean tumor diameter was 31.2±14.1mm, mean puncture number of times was 4±2.7 times, and the FNA puncture needle, 21G was three cases, 22G was two. It was 80% (4/5) to have been diagnosable in EUS-FNA, there is no accidental occurrence symptom in all cases. The primary lesion is cecal cancer, lung small cell carcinoma, renal cell carcinoma, thymic carcinoid, chronic lymphocytic leukemia (CLL), of these, a case of CLL was not able to be diagnosed. Lung small cell carcinoma was pancytokeratinpositive, CD56-positive, chromogranin-negative. As for renal cell carcinoma, clear cell was recognized, and each pancytokeratin, vimentin, CD10, p504s was positive. Thymic carcinoid was with positive chromogranin, synaptophysin, NSE, CD56. As for the case of CLL, the last diagnosis was provided by the percutaneous needle biopsy. In this case, it was difficult to collect FNA specimen in EUS-FNA and was not given a diagnosis. Discussion: The immunohistological findings were the most important to the EUS-FNA diagnosis in metastatic pancreas tumor, and it was necessary to collect FNA specimen of enough quantity. In addition, to using a 21G needle in the FNA and to increasing the number of puncture times led to obtain a satisfactory diagnostic result.
Balazs Tihanyi 1, Laszlo Nehez 1, Katalin Borka 2, Tamas Szekely 2, Tibor Frigyes Tihanyi 1, Laszlo Harsanyi 1 1 2
1st. Department of Surgery, Semmelweis University, Hungary 2nd. Department of Pathology, Semmelweis University, Hungary
Aim: of our study to demonstrate our findings of intraductal tubulopapillary neoplasm of the pancreas and of the bile duct (ITPN and ITNB) as rare entities of the hepato-pancreato-biliary tract. ITPN and ITNB are rare and not a well characterized lesions. The first description of ITPN was published in 2009. Patients and methods: During the last 6 years we found two cases of ITPN (1:grade II, T2N0;2:grade I, T1N0 stage ITPN) and one case of ITNB (grade III, T4Nx). Macroscopically solid nodules without visible mucin secretion were seen. The histological morphology with hematoxylin eosin staining showed special tubulopapillary growth. Polymorph and highgrade atypical cells were seen. The neoplastic cells showed no visible mucin secretion. Special immunohistochemical examinations were performed as well. Results: Immunohistochemically the tumor cells showed strong positivity of CK7, CK19 and MUC6. MUC1 positivity was proved in 10-30%, but they were for MUC2 and MUC5AC negative. The CEA, Tripsin, Synaptophysin, EMA, Chromogranine, Vimentin and NSE reactions were negative, too. KRAS was negative, while the Ki67 labeling index was in 30% of the tumor cells positive and p53 was found to be positive in one ITPN case in 10%. The ITPN cases could have radical resection (1:PPPD, 2:total pancreato-duodenectomy), but the ITNB patient was found inoperable due to local invasion of the portal region. Conclusions: ITPNs are distinct from other intraductal tumors of the pancreas. To distinguish this specific intraductal tumor from IPMNs histological and immunohistochemical examinations, such as MUC1, MUC2, MUC5AC and MUC6 are obligatory. We did not find any low-grade atypia beside the tubulopapillary tumors, while beside invasive IPMNs low or high grade dysplasia could be detected.
F-132. Pancreatectomy for neoplasms originated from other organs Hiromune Shimamura 1, Hideaki Kodama 1, Ayako Endo 1, Youichi Narushima 2, Shuichi Ishiyama 3, Kazunori Takeda 1 1
Department of Surgery, Sendai Medical Center, Japan Department of Surgery, Towada City Central Hospital, Japan 3 Department of Surgery, Sendai Kosei Hospital, Japan 2
Introduction: Pancreatectomies are operative procedures that accompany great difficulties in terms of high morbidity rate. When tumors originated from organs other than pancreas directly invade or metastasize to the pancreas, pancreatectomy will be necessary to obtain radical resection of the tumor. Here we review our cases of pancreatectomy for neoplasms originated from other organs. Patients and methods: Patients, with tumors originated from organs other than pancreas, underwent pancreatectomy in our hospital between September 1999 and October 2015, were retrospectively reviewed. Results: Seventeen patients were recruited. Original organs of neoplasm were as follows:stomach (cancer, lymphoma, GIST; n¼5), colon (cancer; n¼5), kidney (cancer; n¼3), and others (brain, adrenal gland, mesocolon, retroperitoneum; each n¼1). Pancreaticoduodenectomy (PD) was performed for 9 patients, whereas 8 patients underwent distal pancreatectomy (DP). Postoperative pancreatic fistula (ISGPF grade B, C) occurred in 3 cases of PD, whereas in one case of DP. All patients discharged hospital (median postoperative hospital stay:29days) in good status, except for one renal cancer case, which renal cancer recurred so early. Conclusion: When neoplasms, originated from organs other than pancreas, directly invade or metastasize to pancreas, and radical pancreatic resection may lead to long term survival, pancreatectomy should aggressively be performed.