Introduction: Primary pancreatic cancer is rare in children, with an incidence rate of 0.018 cases per 100,000. There are no large patient series of pancreatic cancer in the pediatric population. Method: Clinical data on 103 pediatric pancreatic cancer patients (age19) from the Surveillance Epidemiology and End Result (SEER) database (1973 -2017) was analyzed.Results: 103 cases were identified. There were 8 ductal adenocarcinomas (7.8%), 5 acinar cell carcinomas (4.8%), 18 pancreatoblastomas (17.5%), 32 solid-cystic tumors (31.1%), 31 endocrine tumors (30.1%), 3 sarcomas (2.9%), and 6 undetermined (5.8%). 50.5% patients were Caucasian and 61.2% female with mean age 13. Most cancers were well differentiated (46.7%), size >4 cm (75.4%) and in the head of the pancreas (41.7%). 44.4% cancers had metastasis, except for solid-cystic tumors (52.2% localized disease). Longest survival seen among endocrine tumors (18.9 years) and shortest in acinar cell carcinoma (5.1 years). Highest mortality was seen in ductal cell carcinoma (75.0%) and lowest amongst solid-cystic (6.3%). Surgical resection with chemotherapy conferred the longest survival (33.7 years), compared to no treatment (8.8 years), or combination surgery and radiation (5.1 years), p< 0.005. Multivariate analysis identified a survival advantage for females (OR 0.18) and resection (OR 0.06), p< 0.001. Conclusions: Pediatric pancreatic cancer is rare, and presents more often in female Caucasian children age >10 as well-differentiated tumors >4 cm in size at the head of the pancreas. Surgery is the most common and effective treatment. Enrollment into clinical trial registries will allow for more defined multimodality management.
Result: Two cases were IPMC( intraductal papillary mucinous carcinoma ) and six cases were PDAC( pancreas ductal adenocarcinoma) and the median interval time between first operation and diagnosis of remnant pancreas cancer was 37( range: 11-84 ) months. The patients who had metachronous recurrence were 5 and recurrence of resection stump were 2, respectively. Radical resection were performed all of two IPMC patients but only one PDAC patient. The resectability status of PDAC patients were R( resectable ) 1, BR( borderline resectable ) 3, UR ( unresectable ) 1, respectively. Multimordal therapy were performed four unresected PDAC patients and the median survival time was 18 months (range: 13-23). Conclusion: PDAC of remnant pancreas were diagnosed advanced stage regardless of regular follow up and monitoring after initial pancreatectomy. To determine adequate surveillance and therapeutic strategies, further more investigation is needed.
Aims: Recent guidelines have recommended the routine prescription of extended thromboprophylaxis following all major abdominal cancer surgery. For the majority of patients this will involve receiving injections of low molecular weight heparin (LMWH) after discharge. Most commonly this is achieved with patients or their relatives trained to selfadminister injections of LMWH. Whilst there is significant data proving the safety of extended prophylaxis, there is very little data regarding compliance with LMWH administration following major hepatobiliary resection. The aim of this study is to assess patient compliance with extended prophylaxis as well as satisfaction with the process. Methods: Patient notes were retrospectively reviewed over a 6 week period. All patients discharged with a prescription for extended VTE prophylaxis were included. Patients were contacted via telephone and interviewed with a standardised questionnaire to assess compliance and satisfaction with administration of LMWH in the home setting. Results: A total of 10 patients were identified. One patient was excluded as they were not contactable. All of the remaining 9 stated that they successfully completed the 28 day course, with no patient recalling any missed doses. LMWH was self administered in 6 patients with the remaining three administered by a relative. Seven patients felt entirely satisfied with the process with two feeling there was scope for improvement in the education and demonstration of the administration of the LMWH. Conclusions: Self-administered extended VTE prophylaxis is not only safe, but is also well tolerated. Proper patient education is key to ensuring satisfaction with the process.
This study considered 412 patients who underwent ERCP, from January 2010 to December 2014. Unsuccessful ERCP were excluded and the remaining patients were divided into two age groups: <60 years (Group 1) and >60 years (Group 2). They were analyzed according to gender, indications of ERCP, radiologic findings, therapeutic success and occurrence of immediate adverse events.The main indication in both groups was choledocholithiasis. In group 2, the number of cases of acute cholangitis (p = 0.001), biliary stenosis (p = 0.002) and papillary cancer (p = 0.046) was increased. In this group the indication of urgency ERCP was higher (p = 0.042) as well as the diagnosis of dilatation of the bile duct (p < 0.001). In group 1, successful catheterization and the chance of getting the bile duct clear were significantly higher than in group 2 (p = 0.016, OR = 2.1).The main indications of ERCP were choledocholithiasis, acute cholangitis and biliary strictures. The most frequently performed procedure in both groups was the insertion of prostheses, but more frequently in group 2. On the other hand, in the group of young patients, the success of catheterization and the chance to achieve complete clearance of the biliary tract was significantly higher.
b)clear all the hydatid cysts remaining inside the main hepatic duct. c)disconnecting the biliary tract of the hydatid cavity. d)performing a procedure that avoids the biliary stricture and respecting the morphological integrity of the bile duct, when it's possible.
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