Methods: We selected 32 patients among 241 patients with advanced pancreatic cancer. All 32 patients took abdominal CT more than one time, before their pancreatic cancers were diagnosed. Eight of the 32 patients underwent pancreatic resection.We reviewed all patients' abdominal CT and checked how abnormal findings appeared in the pancreas before finding their pancreatic cancer. Results: Twenty-three (71.8%) of the 32 patients had a localized constriction of the pancreatic parenchyma before appearing the pancreatic cancer. We named it "K-shaped sign" based on the figure. All of the 23 patients showed focal fatty changes around the area the K-shaped sign appeared. Four (17.3%) of the 23 patients had both K-shape sign and a partial main pancreatic duct dilatation. Nineteen of the 32 patients had a normal pancreas without focal fatty change on CT before the K-shaped sign occurred. Thirteen of the 32 patients had detected the Kshaped sign since the initial abdominal CT. All the 32 patients had the pancreatic cancer in the K-shaped sign's area. Conclusion: We introduced new CT finding before pancreatic cancer could be found, and named it "K-shaped sign" on CT. Although the "K-shaped sign" phenomenon has to be associated with early pancreatic cancer, it is unclear what the cause of the phenomenon is. When the K-shaped sign is observed on CT, the onset of a pancreatic cancer should be considered and determined by using more precise modalities.
postoperative outcomes of the selected patients were analysed. Results: LRH/OLR was performed in overall 20 patients. Indication was recurrent HCC in 12 patients (60%), CRLM in 4 patients (20%) with recurrent CRLM, other in 4 patients (20%).There were two (10%) conversions, the first due to vascular and duodenal injury while the second for difficulty in access to the tumor. The median operative time, intraoperative blood loss and postoperative hospital stay were 199 (60-349) minutes, 100 (20-500) ml and 5 (2-15) days respectively. One patient (5%) died of postoperative pancreatitis (the patient converted after duodenal injury). Morbidity rate was of 15%, classified as 2 or less Clavien-Dindo classification.R1 resection was obtained in 2 cases (10%), the rest were R0. Conclusion: This short series shows the feasibility of LRH/ OLR with a low conversion and morbidity rates, making it a realistic option to be considered in selected patients. In most cases the procedure was unexpectedly easy after the first screen of adhesions was detached form the abdominal wall. However,conversion should be considered when adhesions are more severe than expected.
Conclusion: The proximity of the great vessels is not a contraindication to perfome CS of PT. CS for PC at inoperable pts is interference,greatly improving the quality of life of PC,primarily by reducing pain. Survival rates is increased with the use of chemotherapeutic treatment.
In the field of pancreatic surgery for pancreatic neuroendocrine neoplasms (PNEN), robotic surgery has yet to be evaluated against open and laparoscopic approaches. Aim of this study was to analyze and compare the outcomes of robotic surgery for distal pancreatectomy for PNEN. Methods: Retrospective reviews were made of 25 patients who underwent minimally invasive distal pancreatectomy at three institutions between 2010 and 2014 with two different approaches: 10 robot-assisted procedures (RADP) and 15 laparoscopic procedures (LDP). Patients who underwent minimally invasive distal pancreatectomy were compared with a case-matched group of 20 patients who underwent open distal pancreatectomy (ODP). Results: The rate of conversion were similar among RADP and LDP groups (10% versus 20%, P = 0.504). Three groups were similar as regards of age, BMI, ASA score, and tumor size. Overall mortality was nil. The median number of examined lymph nodes was significantly higher in the RADP group as compared with the LDP group (11.5 versus 6, P = 0.003). Robot-assisted procedures were significantly longer compared to ODP (257.5 minutes versus 200 minutes, p = 0.030) and to LDP (190 minutes, P = 0.006). The median estimated blood loss was lower during RADP compared with ODP (115 ml versus 350 ml, P = 0.030) whereas was comparable to LDP group (200 ml, P = 0.199). Rate of postoperative complications did not differ between the three types of procedures. Patients in the RADP group had a significantly shorter length of hospital stay (LOS) compared with the ODP group (5.5 days versus 10.5 days, P = 0.001). Conclusions: RADP for PNEN is as safe as the laparoscopic approach. RADP seems to be associated with a highest median number of harvested lymph nodes compared to LDP.
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