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Solid pseudopapillary neoplasm of the pancreas: A descriptive name for an old still enigmatic entity
Abstracts / Pancreatology 12 (2012) 502–597
months after SPD and 16.5 for EPD. Local recurrence rate was 59% after SPD and 15% after EPD (p¼0.006). Tumor stage of 9 (30%) patients after EPD was changed from II to IV. Conclusion: EPDs are technically and time-demanding procedures, but they are as safe as standard ones. EPD increases OS and significantly decreases the local recurrence rate. Longer OSR for stage 2b after EPD can be explained by the efficacy of EPD and by inadequate staging after SPD. There were 20 radical and 10 extended radical operations among EPD, one vessel resection in SPD (1.6%) and 9 (30%) in the EPD group.
561
Birkmeyer criteria into low volume (LV: 1-2 resection/year) and high volume (HV: > 16 resections/year) hospitals. Adjusted for age, sex, Charlson index, type of procedure, tumor location, and time period the overall (HR 0.76; CI 0.67-0-85), 90-day (HR 0.57; CI 0.42-0.77), and 5 year (HR 0.82; CI 0.71-0.95) mortality was decreased in HV compared to LV hospitals (p<0.01). Considering only resections due to malignant disease 90-day (HR 0.65; CI 0.45-0.93) and 5-year (HR 0.61; CI 0.39-0.93) mortality was further decreased in HV compared to LV hospitals (p¼0.01). Conclusion: Centralization of pancreatic surgery to high-volume centers results in decreased perioperative mortality and better long term survival. Centralization should be further encouraged.
P-199. Solid pseudopapillary neoplasm of the pancreas: A descriptive name for an old still enigmatic entity N. Vassos 1, A. Agaimy 2, P. Klein 1, W. Hohenberger 1, R.S. Croner 1. 1
Department of Surgery, University Hospital, Erlangen, Germany 2 Institute of Pathology, University Hospital, Erlangen, Germany
P-201. Pancreatic pure hepatoid carcinoma: A review of the literature Giovanni Marchegiani 1, *, Alice Parisi 2, *, Giuseppe Malleo 1, Roberto Salvia 1, Paola Capelli 2, Claudio Bassi 1. 1 2
Background: Solid pseudopapillary neoplasm (SPN) of pancreas is infrequently-encountered tumor typically affecting young women without significant symptoms. Its behavior is relatively indolent and largely benign. Material and methods: We report a case series of four patients with SPN of pancreas. Clinicopathological and immunohistochemical parameters as well as therapy and follow-up were investigated retrospectively. Results: All four patients were female whose ages ranged between 15 and 42 years. Two patients presented with abdominal pain, one with abdominal mass and one with acute abdominal signs following blunt trauma. Tumor's size ranged between 1 and 16cm. Two of them were diagnosed preoperatively through percutaneous-needle-biopsy and two underwent surgery because of high clinical and radiological suspicion of SPN. By immunohistochemistry, all cases were stained strongly for vimentin, progesterone-receptor and beta-catenin and variably with pankeratin and neuroendocrine markers. Proliferation index (Ki-67) was less than 2%. After median follow-up of 25 months, all patients were alive with no evidence of disease. Conclusion: SPN of pancreas should be considered in differential diagnosis of any solid or partly cystic pancreatic or upper abdominal mass, particularly in young females. It has low malignant potential and treatment of choice consists of surgical resection. Adequate surgical intervention is associated with excellent prognosis.
P-200. Short and long-term mortality after pancreatic resections is decreased in high-volume centers E. Rangelova, O. Sadr Azodi, M. Nilsson, R. Segersvärd. Division of Surgery, Department of Clinical Science, Intervention and Technology (CLINTEC), Karolinska Institutet at Karolinska University Hospital, Stockholm, Sweden Background: Performing pancreatic surgery in high-volume centers has lead to decreased perioperative morbidity and mortality. However, there is sparse data on whether hospital volume affects the long-term outcome. Aim: To evaluate the effect of hospital volume on perioperative and long-term mortality after pancreatic resections in Sweden. Methods: Using the Swedish Patient Register, data on all patients who underwent pancreatic resection between 1987 and 2008 was collected. By linkage to the Swedish Cancer Register, information on underlying malignancy was retrieved. Information on the date of death was retrieved by linkage to the Swedish Cause of Death Register. Multivariate Cox regression analyses were performed to study the effect of hospital volume on short- and long-term mortality after pancreatic resection. Results: Overall 6,101 patients undergone pancreatic resection were identified during the period. Hospitals were defined according to
Department of Surgery, Verona University Hospital, Italy Department of Pathology, Verona University Hospital, Italy
Introduction: Hepatoid carcinomas (HCs) are uncommon extrahepatic neoplasms exhibiting features of hepatocellular carcinomas in terms of morphology and immunohistochemistry. Pancreatic forms of HCs can present in pure forms or in association with other morphological aspects, such as endocrine tumors or ductal adenocarcinomas. Aims/objectives: To evaluate demography, clinical presentation, cytological and histological findings before and after surgical excision. To discuss possible etiological pathways. Patients/methods: Retrospective analysis of personal experience was performed. A literature review based on a Medline@ search was undertaken. Results: A total number of 19 pancreatic HCs, 9 of which as pure forms were found. Six patients were female (31.5%), 13 were males (68.5%). Mean age was 51.4 years (range 21–80). Most common presenting symptoms were pain (33.3%), followed by weight loss (22.2%), nausea/vomiting (16.6%) and jaundice (16.6%). Elevated AFP serum levels were found in 55,5% of cases at time of diagnosis. 6 patients (33,3%) underwent preoperative cytological examination: in only one case (16,6%) a partial correct diagnosis was possible. Long term follow up after surgical excision shows divergent results. Discussion: Demography and common presenting symptoms are typical of a slow growing mass forming tumor. Cytology is most of the times non-diagnostic, while histology on specimen seems to be straightforward. Once complete surgical resection can be achieved, outcome seems to be related to the possible association with other pancreatic neoplasms. The common embryologic origin of the pancreas and liver, together with peculiar environmental factors, may explain their development. Conclusions: Pancreatic HCs are extremely uncommon neoplasms presenting with non-specific clinical, laboratory and cytological findings. Further studies are needed to clarify pathogenesis and postoperative longterm outcome.
P-202. Early drainage versus delayed debridement for fulminant necrotizing pancreatitis M. Rubtsov, S. Galeev, Y. Abdullaev, A. Kostigyn. Clinical Hospital of Saint-Luke, Saint-Petersburg, Russia Introduction: Controversy still exists in surgical management of fulminant acute pancreatitis.
* Corresponding authors. Chirurgia Generale B, Policlinico G.B. Rossi, P.le Scuro 10, 37134 Verona, Italy. Tel.: +39 0458124553.
months after SPD and 16.5 for EPD. Local recurrence rate was 59% after SPD and 15% after EPD (p¼0.006). Tumor stage of 9 (30%) patients after EPD was changed from II to IV. Conclusion: EPDs are technically and time-demanding procedures, but they are as safe as standard ones. EPD increases OS and significantly decreases the local recurrence rate. Longer OSR for stage 2b after EPD can be explained by the efficacy of EPD and by inadequate staging after SPD. There were 20 radical and 10 extended radical operations among EPD, one vessel resection in SPD (1.6%) and 9 (30%) in the EPD group.
561
Birkmeyer criteria into low volume (LV: 1-2 resection/year) and high volume (HV: > 16 resections/year) hospitals. Adjusted for age, sex, Charlson index, type of procedure, tumor location, and time period the overall (HR 0.76; CI 0.67-0-85), 90-day (HR 0.57; CI 0.42-0.77), and 5 year (HR 0.82; CI 0.71-0.95) mortality was decreased in HV compared to LV hospitals (p<0.01). Considering only resections due to malignant disease 90-day (HR 0.65; CI 0.45-0.93) and 5-year (HR 0.61; CI 0.39-0.93) mortality was further decreased in HV compared to LV hospitals (p¼0.01). Conclusion: Centralization of pancreatic surgery to high-volume centers results in decreased perioperative mortality and better long term survival. Centralization should be further encouraged.
P-199. Solid pseudopapillary neoplasm of the pancreas: A descriptive name for an old still enigmatic entity N. Vassos 1, A. Agaimy 2, P. Klein 1, W. Hohenberger 1, R.S. Croner 1. 1
Department of Surgery, University Hospital, Erlangen, Germany 2 Institute of Pathology, University Hospital, Erlangen, Germany
P-201. Pancreatic pure hepatoid carcinoma: A review of the literature Giovanni Marchegiani 1, *, Alice Parisi 2, *, Giuseppe Malleo 1, Roberto Salvia 1, Paola Capelli 2, Claudio Bassi 1. 1 2
Background: Solid pseudopapillary neoplasm (SPN) of pancreas is infrequently-encountered tumor typically affecting young women without significant symptoms. Its behavior is relatively indolent and largely benign. Material and methods: We report a case series of four patients with SPN of pancreas. Clinicopathological and immunohistochemical parameters as well as therapy and follow-up were investigated retrospectively. Results: All four patients were female whose ages ranged between 15 and 42 years. Two patients presented with abdominal pain, one with abdominal mass and one with acute abdominal signs following blunt trauma. Tumor's size ranged between 1 and 16cm. Two of them were diagnosed preoperatively through percutaneous-needle-biopsy and two underwent surgery because of high clinical and radiological suspicion of SPN. By immunohistochemistry, all cases were stained strongly for vimentin, progesterone-receptor and beta-catenin and variably with pankeratin and neuroendocrine markers. Proliferation index (Ki-67) was less than 2%. After median follow-up of 25 months, all patients were alive with no evidence of disease. Conclusion: SPN of pancreas should be considered in differential diagnosis of any solid or partly cystic pancreatic or upper abdominal mass, particularly in young females. It has low malignant potential and treatment of choice consists of surgical resection. Adequate surgical intervention is associated with excellent prognosis.
P-200. Short and long-term mortality after pancreatic resections is decreased in high-volume centers E. Rangelova, O. Sadr Azodi, M. Nilsson, R. Segersvärd. Division of Surgery, Department of Clinical Science, Intervention and Technology (CLINTEC), Karolinska Institutet at Karolinska University Hospital, Stockholm, Sweden Background: Performing pancreatic surgery in high-volume centers has lead to decreased perioperative morbidity and mortality. However, there is sparse data on whether hospital volume affects the long-term outcome. Aim: To evaluate the effect of hospital volume on perioperative and long-term mortality after pancreatic resections in Sweden. Methods: Using the Swedish Patient Register, data on all patients who underwent pancreatic resection between 1987 and 2008 was collected. By linkage to the Swedish Cancer Register, information on underlying malignancy was retrieved. Information on the date of death was retrieved by linkage to the Swedish Cause of Death Register. Multivariate Cox regression analyses were performed to study the effect of hospital volume on short- and long-term mortality after pancreatic resection. Results: Overall 6,101 patients undergone pancreatic resection were identified during the period. Hospitals were defined according to
Department of Surgery, Verona University Hospital, Italy Department of Pathology, Verona University Hospital, Italy
Introduction: Hepatoid carcinomas (HCs) are uncommon extrahepatic neoplasms exhibiting features of hepatocellular carcinomas in terms of morphology and immunohistochemistry. Pancreatic forms of HCs can present in pure forms or in association with other morphological aspects, such as endocrine tumors or ductal adenocarcinomas. Aims/objectives: To evaluate demography, clinical presentation, cytological and histological findings before and after surgical excision. To discuss possible etiological pathways. Patients/methods: Retrospective analysis of personal experience was performed. A literature review based on a Medline@ search was undertaken. Results: A total number of 19 pancreatic HCs, 9 of which as pure forms were found. Six patients were female (31.5%), 13 were males (68.5%). Mean age was 51.4 years (range 21–80). Most common presenting symptoms were pain (33.3%), followed by weight loss (22.2%), nausea/vomiting (16.6%) and jaundice (16.6%). Elevated AFP serum levels were found in 55,5% of cases at time of diagnosis. 6 patients (33,3%) underwent preoperative cytological examination: in only one case (16,6%) a partial correct diagnosis was possible. Long term follow up after surgical excision shows divergent results. Discussion: Demography and common presenting symptoms are typical of a slow growing mass forming tumor. Cytology is most of the times non-diagnostic, while histology on specimen seems to be straightforward. Once complete surgical resection can be achieved, outcome seems to be related to the possible association with other pancreatic neoplasms. The common embryologic origin of the pancreas and liver, together with peculiar environmental factors, may explain their development. Conclusions: Pancreatic HCs are extremely uncommon neoplasms presenting with non-specific clinical, laboratory and cytological findings. Further studies are needed to clarify pathogenesis and postoperative longterm outcome.
P-202. Early drainage versus delayed debridement for fulminant necrotizing pancreatitis M. Rubtsov, S. Galeev, Y. Abdullaev, A. Kostigyn. Clinical Hospital of Saint-Luke, Saint-Petersburg, Russia Introduction: Controversy still exists in surgical management of fulminant acute pancreatitis.
* Corresponding authors. Chirurgia Generale B, Policlinico G.B. Rossi, P.le Scuro 10, 37134 Verona, Italy. Tel.: +39 0458124553.