Benign Pancreatic Tumors Research Articles

Splenic preservation versus splenectomy during laparoscopic distal pancreatectomy for benign and low-grade malignant pancreatic tumor: A propensity score matching analysis

Previous studies showed the advantages of spleen preservation during laparoscopic distal pancreatectomy (LDP) such as preventing overwhelming postsplenectomy infection, and early infectious complications, maintaining immune surveillance, less postoperative pancreatic fistula, less postpancreatectomy diabetes, and less gastric ileus. However, there were limitations of these results such as heterogenous population, and small number of patients. This study was aimed to compare clinical outcomes of patients with LDP with splenectomy (LDPS) and laparoscopic spleen preserving distal pancreatectomy (LSDP) using propensity score matching analysis from data of multi centers in Korea and Japan. The patients were identified who underwent LDPS and LSDP in Korea and Japan. Perioperative outcomes including postoperative infectious complication were compared between LDPS and LSDP before and after PSM. Matching variables were used such as nation, age, sex, BMI, ASA scores, underlying disease, previous abdominal surgery, preoperative pancreatitis, malignant disease and tumor locations. LDPS and LSDP were classified in 1,728 (39.6%), and 2,635 (60.4%), respectively. In the mean age and body mass index were 56.3 and 23.4. And 1,166 (26.7%) patients underwent previous abdominal surgery and tumor was located in body and tail in 2,041 (46.8%) and 2,290 (52.5%), respectively. Pancreas was transected at pancreas neck and tail level in 1,794 (41.1%) and 2,521 (57.8%), respectively. Splenic vessels were preserved in 1,244 (28.5%) of 2,635 patients with LSDP. Two hundred patients (4.6%) experienced conversion to open during surgery. Of patients, 1,303 (29.9%) patients experienced postoperative complications. Clinically related postoperative pancreatic fistula (CR-POPF) and infectious complication rates were 693 (15.3%) and 760 (17.4%) patients, respectively. After PSM, 1,594 patients were selected in each group. The patients with LSDP showed comparable overall complication (35.7 % vs. 38.4 %, p = 0.094), however LSDP group showed lower infectious complications (15.2 % vs. 19.1 %, p = 0.036), CR-POPF (13.7 % vs. 18.7 %, p < 0.001), infected POPF (5.7 % vs. 9.7 %, p < 0.001), complicated fluid collection (0.94% vs. 2.82%, p < 0.001) compared with the patients with LDP. The results of this study showed that LSDP was related with lower infectious complication rate including lower infected POPF, and lower complicated fluid collection compared with LDPS, and this result is helpful to decide splenic preservation in patients who needs LDP for pancreatic body or tail lesions.

The risk factors of new onset diabetes mellitus following distal pancreatectomy: The ideal candidate for active surveillance

In pancreatic resection, the focus has been mainly on the oncologic safety, however, the endocrine function of the remnant pancreas also should be considered due to relatively longer life expectancy of the patients with benign or borderline malignant pancreatic tumor. We investigated risk factors for occurring new onset diabetes mellitus (NODM) after distal pancreatectomy (DP). Total 205 patients were diagnosed with benign or borderline malignant tumor of the pancreas and underwent DP from 2005 to 2019 in Severance hospital, Seoul, Korea. The patients diagnosed with NODM postoperatively under American Diabetes Association guidelines were included to DM group (n = 51), and other patients were included in non-DM group (n = 154). Preoperative characteristics and surgical outcomes were compared between two groups. We investigated risk factors for occurring NODM by univariate and multivariate analysis and analyzed cumulative NODM ratio by time sequence. Age (DM: 55.3 ± 12.3 vs. non-DM: 47.6 ± 15.2, p < 0.001) and BMI (DM: 24.1 ± 3.4 vs. non-DM: 23.0 ± 3.1, p = 0.026) were significantly higher in DM group than non-DM group. DM group showed more operation time (p = 0.033), more blood loss (p = 0.024), and more extended range of pancreatectomy (neck level resection. DM 51.0% vs. non-DM 26.6%, p = 0.002). Pathologic and postoperative outcomes did not differ between the two groups. Age over 50 (p = 0.001), pancreatectomy on neck level (p = 0.003), underline chronic pancreatitis (p = 0.039) and blood loss (p = 0.019) remained significant risk factors for NODM in multivariate analysis. About half of the NODM patients were diagnosed within 1 year postoperatively. The patients who underwent distal pancreatectomy with high risk of NODM should be actively under surveillance for at least 1 year postoperatively.

A merged method for targeted analysis of amino acids and derivatives using parallel reaction monitoring combined with untargeted profiling by HILIC-Q-Orbitrap HRMS

With continuously increased scan rate and sensitivity, high resolution mass spectrometry (HRMS) allows for both reliable targeted analysis (e.g., parallel reaction monitoring, PRM) and a global overview for discovery-based untargeted profiling (e.g., data dependent acquisition, DDA) to be performed. Based on previous study on PRM for large scale targeted metabolomics quantification, we developed an innovative method merged targeted and untargeted approaches in a single run. In our workflow, the scheduled PRM for targeted analysis of amino acids and derivatives combined with the full scan was acquired in every sample injection by hydrophilic interaction liquid chromatography tandem quadrupole-Orbitrap high resolution mass spectrometry (HILIC-Q-Orbitrap HRMS). The identification of metabolic features from full scan was further performed with DDA methodology on grouped quality control (QC) samples and matched with available database. Specifically, 20 amino acids and 40 derivatives were selected for targeted analysis with optimal chromatographic separation and PRM parameters. All isomers within the selected metabolites were totally separated in the robust HILIC condition. 36 of selected metabolites were well-detected and showed a good linearity and reproducibility in NIST SRM 1950 plasma. Moreover, the absolute quantification performance of targeted PRM method was systematically validated using 10 amino acids with the corresponding stable isotope-labeled internal standards (SIL-IS). Finally, the newly developed method was successfully applied to analysis of the plasma samples from patients of pancreatic benign tumor and pancreatic cancer. The significant reduction of circulating amino acids in patients with pancreatic malignancy was confirmed by targeted PRM method and other amino acids modifications as well as polar metabolites were identified with untargeted profiling. Therefore, we have established a workflow that combines specifically and reliably targeted PRM method as well as broad-coverage untargeted profiling, which provides an innovative strategy for basic and clinical metabolomics study.

Investigating difficult to detect pancreatic lesions: Characterization of benign pancreatic islet cell tumors using multiparametric pancreatic 3-T MRI.

IntroductionPancreatic islet-cell tumors (PICT) often present with atypical signal-characteristics and are often missed on preoperative imaging. The aim of this study is to provide a multiparametric PICT characterization and investigate factors impeding PICT detection.Material and methodsThis is a detailed MRI analysis of a prospective, monocenter study, including 49 consecutive patients (37 female, 12 male; median age 50) with symptoms due to endogenous hyperinsulinemic hypoglycemia (EHH) and mostly negative prior-imaging. All patients received a 3-T MRI and a 68Ga-DOTA-exendin-4-PET/CT. Pooled accuracy, sensitivity, specificity and inter-reader agreement were calculated. Reference-standard was histopathology and 68Ga-DOTA-Exendin-4-PET/CT in one patient who refused surgery. For PICT analyses, 34 patients with 49 PICTs (48 histologically proven; one 68Ga-DOTA-exendin-4-PET/CT positive) were assessed. Dynamic contrast-enhanced (DCE) Magnetic Resonance Images (MRI) with Golden-Angle-Radial-Sparse-Parallel (GRASP) reconstruction, enabling imaging at high spatial and temporal resolution, was used to assess enhancement-patterns of PICTs. Tumor-to-background (T2B) ratio for each sequence and the employed quantitative threshold for conspicuity of PICTs were analyzed in regard to prediction of true-positive PICTs.ResultsEvaluation of 49 patients revealed a pooled lesion-based accuracy, sensitivity and specificity of 70.3%, 72.9% and 62.5%, respectively. Mean PICT size was 12.9±5.3mm for detected, 9.0±2.9mm for undetected PICTs (p-value 0.0112). In-phase T1w detected the most PICT (67.3%). Depending on the sequence, PICTs were isointense and poorly visible in 29–68%. Only 2/41(4.9%) PICTs showed typical signal-characteristics across T1w, T2w, DWI and ceT1w combined. 66.6% of PICTs enhanced simultaneously to the parenchyma, 17.8% early and 15.6% late. Predictor screening analysis showed number of sequences detecting a PICT, lesion size and in-phase T1w T2B ratio had the highest contribution for detecting a true-positive PICT.ConclusionThe majority of PICTs enhance simultaneously to surrounding parenchyma, present with atypical signal-characteristics and thus are poorly visible. In non-enhancing PICTs, radiologists should search for small lesions most likely conspicuous on unenhanced T1w or DWI.

Relationship between pancreatic parenchyma loss and early postoperative hyperglycemia in patients with benign pancreatic diseases

ObjectiveTo evaluate the relationship between pancreatic parenchyma loss and early postoperative hyperglycemia in patients with benign pancreatic diseases.MethodsA total of 171 patients with benign pancreatic tumors or chronic pancreatitis, whose preoperative fasting blood glucose (FBG) was normal and who underwent partial pancreatectomy were reviewed. The pancreatic volume was measured by CT imaging before and after the operation. According to their different pancreatic resection volume (PRV), 171 patients were divided into five groups: < 30%, 30%–39%, 40%–49%, 50%–59%, and ≥ 60%. The correlation between the PRV and postoperative FBG was investigated. According to the postoperative FBG value, the patients were divided into a hyperglycemia group (HG) and nonhyperglycemia group (non-HG) to explore the best cutoff value of the PRV between the two groups.ResultsThere were significant differences in the postoperative FBG among the five groups (PRV < 30%, 30%–39%, 40%–49%, 50%–59%, and ≥ 60%). The PRV was positively correlated with postoperative FBG in the benign tumor group and chronic pancreatitis group (R = 0.727 and 0.651, respectively). ROC curve analysis showed that the best cutoff value of the PRV between the HG (n = 84) and non-HG (n = 87) was 39.95% with an AUC = 0.898; the sensitivity was 89.29%, and the specificity was 82.76%.ConclusionThere was a linear positive correlation between the postoperative FBG level and PRV. Patients with a PRV ≥ 40% are more likely to develop early postoperative hyperglycemia.

Laparoscopic versus open radical antegrade modular pancreatosplenectomy for pancreatic cancer: a single-institution comparative study.

Laparoscopic distal pancreatosplenectomy is an effective and safe surgical modality for treating benign and borderline distal pancreatic tumors, but rarely for pancreatic cancer. This study aimed to compare the feasibility and safety of laparoscopic and open radical antegrade modular pancreatosplenectomy for pancreatic cancer. Fifty-one patients with pancreatic cancer who underwent radical antegrade modular pancreatosplenectomy at Ningbo Medical Center Lihuili Hospital between January 2014 and July 2018 were enrolled. 20 patients underwent laparoscopic radical antegrade modular pancreatosplenectomy and 31 patients received open radical antegrade modular pancreatosplenectomy. Postoperative and short-term outcomes of the two groups of patients were analyzed. The mean operation time, length of postoperative hospital stay, and overall postoperative morbidity were similar in the two groups (P>0.05). The laparoscopic radical antegrade modular pancreatosplenectomy group lost less blood (252.5±198.3 vs. 472.6±428.0 mL, P=0.037) and had lower transfusion rates (10.0% vs. 35.4%, P=0.041) than the open radical antegrade modular pancreatosplenectomy group. The laparoscopic group also had statistically significantly earlier passing of first flatus (2.5±0.8 vs. 3.2±1.2 days, P=0.028) and first oral intake (2.9±1.0 vs. 3.7±1.6 days, P=0.042). Furthermore, the rates of postoperative pancreatic fistula (45.0% vs. 32.3%) and overall complications (70.0% vs. 74.2%) were not statistically difference between the two groups. The survival rates at 6 months, 1 year, and 2 years after surgery were not statistically difference between the laparoscopic and open groups (94.4% vs. 93.5, 67.0% vs. 78.0%, and 50.2% vs. 38.3%, respectively). The results of this study show that laparoscopic radical antegrade modular pancreatosplenectomy is feasible and safe for the treatment of pancreatic cancer.

Comparison between robot-assisted middle pancreatectomy and robot-assisted distal pancreatectomy for benign or low-grade malignant tumours located in the neck of the pancreas: A propensity score matched study.

To compare the short-term and long-term outcomes between robot-assisted middle pancreatectomy (RMP) and robot-assisted distal pancreatectomy (RDP). From August 2010 to May 2018, more than 800 patients were diagnosed with benign or low-grade malignant pancreatic tumours. According to the inclusion criteria, a total of 164 patients were included in our study. Among them 123 patients received RMP and 41 patients received RDP with spleen-preserving. These patients were divided into two groups, and propensity score matching (PSM) was used to minimize bias. Short-term and long-term outcomes were recorded and analysed. After 1:1 matching, 38 cases of RMP and RDP were recorded and the baseline data was balanced. In the RMP group, 14 patients (36.8%) were female. In the RDP group, 13 patients (34.2%) were female. RDP had advantages in short-term outcomes including overall morbidity (28.9% vs. 60.5%, p=0.011), Severe morbidity (0 vs. 10.5%, p=0.017), clinical-relevant postoperative pancreatic fistula (CR-POPF) rate (10.5% vs. 36.8%, p=0.007) and postoperative length of hospital stay (16.5±8.6 days vs. 23.6±12.9 days, p=0.006). The operative time was similar; however, there were less estimated blood loss (EBL) in RMP group (31.3±33.0ml vs. 62.3±38.2ml, p<0.001). Patients in these two groups had a similar result in preservation of the pancreatic function. There was no statistic difference in incidence rate of exocrine and endocrine insufficiency between two groups (2.6% vs. 7.9%, p=0.608; 5.3% vs. 10.5%, p=0.671). For benign or low-grade malignant tumours located at the neck of the pancreas, RMP and RDP could both be considered. The morbidity especially CR-POPF rate after RDP would be lower, but RMP would be more helpful in reducing EBL. RMP should be chosen with caution as it did not show a huge advantage in preserving normal pancreatic function. Further prospective randomised studies should be designed to compare these two types of surgery.

Surgery of pancreas tumors in children and adolescents: a single institution experience

Purpose: The aim of this study is the surgical management and the clinical and pathological features of patients who underwent pancreatic resection for benign and malignant pancreatic tumors in childhood and adolescence and described the morbidity and mortality of this group of patients. Methods: This is a retrospective review of medical reports of patients ≤19 years with pancreatic tumors who underwent surgery in National Cancer Center, Lima, Peru from January 2000 to January 2019. Results: Thirty-two patients underwent surgery, the mean age was 13.65 years (3-18), 26 patients were women and 6 men. The tumor location was in the head (n = 18), tail (n = 9) and body (n = 5), the mean tumor size 7.34cm (2-13.5cm). The histological types were: solid pseudopapillary tumor (SSP) (n = 27), pancreatoblastoma (n = 3) and neuroendocrine tumor (n = 2) of which one was neuroendocrine carcinoma and another insulinoma. All tumors had R0 in bloc resection, surgical treatment was: pancreaticoduodenectomy (n = 18), distal pancreatectomy (n = 9), central pancreatectomy (n = 4) and tumor enucleation (n = 1). The survival rate according to 5-year Kaplan Meier analysis was 74%. The median duration of follow-up was 33 months. The postoperative mortality was 0%. Conclusions: Radical surgery is a safe treatment in patients with primary tumors of the pancreas with a low mortality rate and postoperative complications. The SSP is the most frequent pathology with a good prognosis.

Enucleation for benign or borderline tumors of the pancreas: comparing open and minimally invasive surgery

BackgroundThe feasibility and safety of minimally invasive enucleation (ME) for benign or borderline pancreatic tumors is still unclear. The aim of this study was to compare outcomes between ME and open enucleation (OE). MethodsAll patients undergoing pancreatic enucleation between October 2001 and January 2020 were analyzed from a prospective database. Consecutive patients undergoing ME were compared with patients undergoing OE in a matched-pair analysis (1:2). ResultsOf 358 patients, undergoing enucleation, 120 matched patients (ME n = 40, OE n = 80) were included. Patients undergoing ME had less blood loss (median 50 vs. 100 ml, P = 0.025) and had a higher proportion of patients discharged by 7 days, than patients undergoing OE (38% vs. 18%, P = 0.016). The rates of clinically relevant postoperative pancreatic fistula (POPF) and major complications (Clavien grade ≥ 3) were similar between both groups. Risk factor analysis for POPF B/C showed no significant parameters associated with POPF, including tumor size and proximity to the main pancreatic duct. ConclusionCompared with conventional OE, ME reduces the amount of bleeding and allows earlier postoperative discharge, without increasing the incidence of major complications. Thus, minimally invasive enucleation should be considered for benign tumors of the pancreas when technically and oncologically feasible.

Identification of Patients with Pancreatic Cancer by Electron Paramagnetic Resonance Spectroscopy of Fatty Acid Binding to Human Serum Albumin.

An effective biological marker for pancreatic adenocarcinoma (PAC) is not available so far. Here, we investigate how electron paramagnetic resonance (EPR) spectroscopy of spin-labeled fatty acid (FA) molecules binding to human serum albumin (HSA) in human serum is a suitable method for the identification of patients with PAC through detection of PAC-induced changes of FA binding to albumin. The functionality of HSA to bind FA is investigated in serum samples of 35 patients with PAC, 26 patients with benign pancreatic tumors (BPD), and 24 healthy individuals by continuous wave (CW) EPR spectroscopy by simply dissolving 16-DOXYL stearic acid as spin-labeled FA. It is found that FA binding to HSA in PAC is significantly modified when compared with healthy and BPD individuals. The PAC group could best be discriminated from the healthy group based on EPR characteristics at the loading ratio of 1:4 (HSA:FA), while patients with PAC and BPD are distinguishable at a loading ratio of 1:6. Using nanoscale distance measurements through double electron-electron resonance (DEER), it is found that the distribution of FAs in the HSA of one PAC patient is similar to that of FAs in healthy individuals. Combining all EPR spectroscopic data, this leads to a tentative molecular interpretation of only small changes in hydration at the protein's surface as origin of the detectable characteristics for PAC patients. Thus, EPR of FA/HSA binding is a simple and promising tool for clinical detection of patients with PAC and needs to be tested with larger ensembles of different patient groups.

Effects of pancreatic resection for benign pancreatic neoplasms on pancreatic volume and endocrine function: A long-term computed tomography-based study

BackgroundPancreatic surgery may result in changes in pancreatic volume and endocrine function. The effects of pancreatic resection for benign neoplasms on pancreatic volume and endocrine function have not been established yet. This study aimed to investigate the long-term results of different pancreatic surgeries for benign pancreatic neoplasms on pancreatic volume and endocrine function. MethodsThe medical records of 30 patients who underwent pancreaticoduodenectomy (PD) and 30 patients who underwent left-sided pancreatectomy(LP) for benign pancreatic neoplasms between 2005 and 2012 were reviewed. The changes in pancreatic volume after pancreatic surgery were assessed using multi-detector row computed tomography volumetry. Endocrine pancreatic function was evaluated on the basis of fasting glucose level or oral glucose tolerance test result. ResultsThe median follow-up duration was 91.3 months (interquartile range, 75.7–119.1 months). Reduction in pancreatic volume after surgery was more pronounced in patients who underwent PD than in those who underwent LP (median percentage of volume reduction, 23.8% vs 5.1%, p < .001). Multivariable analysis of prognostic factors for endocrine insufficiency showed that PD to be significant factor. (HR 3.87, 95% CI 1.12-14.66, p = .037). ConclusionsThe surgical methods for benign pancreatic neoplasms affect the reduction in pancreatic volume. Furthermore, the methods of pancreatic surgery were associated with the risk of endocrine insufficiency. Further studies with a large number of patients are warranted to evaluate the association between the degree of volume reduction and the development of endocrine insufficiency.

Unique position of a pancreatic head insulinoma during laparoscopic enucleation: case report

Insulinomas are benign pancreatic neuroendocrine tumors that require surgical intervention as a therapeutic measure. We describe an 18-year-old male patient who presented to the emergency department with a history of syncope, blurred vision, and diaphoresis. His blood sugar level was low upon admission, and a 72-hour fasting plasma glucose test showed low serum glucose, high serum insulin, and high C-peptide. An abdominal computed tomography scan and magnetic resonant imaging revealed a solitary tumor in the pancreatic head with no sign of ductal dilatation. Laparoscopic enucleation was performed, and a histopathological examination revealed findings consistent with insulinoma. The patient’s postoperative course was uneventful, and his follow-up examination was unremarkable. In conclusion, physicians should have a high clinical suspicion index for insulinomas, especially in young patients with a history of syncope, blurred vision, and diaphoresis, in order to avoid delayed diagnosis.

Robotic-assisted versus open distal pancreatectomy for benign and low-grade malignant pancreatic tumors: a propensity score-matched study

BackgroundThis study aimed to compare the short-term outcomes of open and robotic-assisted distal pancreatectomy (ODP and RDP) for benign and low-grade malignant tumors.MethodsThe patients who underwent RDP and ODP for benign or low-grade malignant pancreatic tumors at our center were included. After PSM at a 1:1 ratio, the perioperative variations in the two cohorts were compared.ResultsAfter 1:1 PSM, 219 cases of RDP and ODP were recorded. The RDP cohort showed advantages in the operative duration [120 (90–150) min vs 175 (130–210) min, P < 0.001], estimated blood loss [50 (30–175) ml vs 200 (100–300) ml, P < 0.001], spleen preservation rate (63.5% vs 26.5%, P < 0.001), infection rate (4.6% vs 12.3%, P = 0.006), and gastrointestinal function recovery [3 (2–4) vs. 3 (3–5), P = 0.019]. There were no significant differences in postoperative pancreatic fistula, postoperative hemorrhage, and delayed gastric emptying. Multivariate analysis showed that RDP (HR 0.24; 95% CI 0.16–0.36, P < 0.001), age (HR 1.02; 95% CI 1.00–1.03, P = 0.033), tumor size (HR 1.28; 95% CI 1.17–1.40, P < 0.001), pathological inflammatory neoplasm type (HR 5.12; 95% CI 2.22–11.81, P < 0.001), and estimated blood loss (HR 1.003; 95% CI 1.001–1.004, P < 0.001) were independent predictors of spleen preservation; RDP (HR 0.27; 95% CI 0.17–0.43, P < 0.001), age (HR 1.02; 95% CI 1.00–1.03, P = 0.022), elevated CA 19–9 level (HR 2.55; 95% CI 1.02–6.39, P = 0.046), tumor size (HR 1.44; 95% CI 1.29–1.61, P < 0.001), pathological inflammatory neoplasm type (HR 4.48; 95% CI 1.69–11.85, P = 0.003), and estimated blood loss (HR 1.003; 95% CI 1.001–1.004, P < 0.001) were independent predictors of spleen preservation with the Kimura technique.ConclusionRDP has advantages in the operative time, blood loss, spleen preservation, infection rate, and gastrointestinal function recovery over ODP in treating benign and low-grade malignant pancreatic tumors. The robotic-assisted approach was an independent predictor of spleen preservation and use of the Kimura technique.

Bile Acids Quantification by Liquid Chromatography-Tandem Mass Spectrometry: Method Validation, Reference Range, and Interference Study.

Bile acids (BA) play a pivotal role in cholesterol metabolism. Their blood concentration has also been proposed as new prognostic and diagnostic indicator of hepatobiliary, intestinal, and cardiovascular disease. Liquid chromatography tandem mass spectrometry (LC–MS/MS) currently represents the gold standard for analysis of BA profile in biological samples. We report here development and validation of a LC–MS/MS technique for simultaneously quantifying 15 BA species in serum samples. We also established a reference range for adult healthy subjects (n = 130) and performed a preliminary evaluation of in vitro and in vivo interference. The method displayed good linearity, with high regression coefficients (>0.99) over a range of 5 ng/mL (lower limit of quantification, LLOQ) and 5000 ng/mL for all analytes tested. The accuracies were between 85–115%. Both intra- and inter-assay imprecision was <10%. The recoveries ranged between 92–110%. Each of the tested BA species (assessed on three concentrations) were stable for 15 days at room temperature, 4 °C, and −20 °C. The in vitro study did not reveal any interference from triglycerides, bilirubin, or cell-free hemoglobin. The in vivo interference study showed that pools obtained from hyper-cholesterolemic patients and hyper-bilirubinemic patients due to post-hepatic jaundice for benign cholestasis, cholangiocarcinoma and pancreatic head tumors had clearly distinct patterns of BA concentrations compared with a pool obtained from samples of healthy subjects. In conclusion, this study proposes a new suitable candidate method for identification and quantitation of BA in biological samples and provides new insight into a number of variables that should be taken into account when investigating pathophysiological changes of BA in human diseases.

Pancreatic Adenocarcinoma with Primary Tumor Calcification and Calcified Liver Metastasis: Report of a Rare Case and Review of Literature

AbstractCalcification is a feature of benign pancreatic diseases such as chronic calcific pancreatitis (CCP) or benign pancreatic tumors such as solid and papillary epithelial neoplasm of the pancreas and serous cystadenoma. The presence of calcification in a primary malignant pancreatic tumor is uncommon except for neuroendocrine tumors of the pancreas. Calcification in adenocarcinoma of the pancreas involving the primary tumor as well as the metastasis resulting thereof is extremely rare in the absence of CCP. To our knowledge, this is the first report of a case of primary adenocarcinoma of the pancreas that presented with calcification of the primary tumor as well as the metastatic liver nodules, accompanied by hypercalcemia.

Acinar cell cystadenoma of the pancreatic head

Acinar cell cystadenoma is one of the rarest benign pancreatic tumors. A clinical case of acinar cell cystadenoma of the pancreatic head in a 67-year-old patient is presented. The tumor was detected during a routine examination. The patient was undergoing surgery, enucleation of the neoplasm was performed. With a planned histologic examination and immunohistochemical analysis the diagnosis was confirmed. Surgical tactics depend on the location, size of the tumor and position to the adjacent structures. Given the benign nature of tumor, preference should be given to organpreserving interventions.

Rapid identification of benign and malignant pancreatic tumors using serum Raman spectroscopy combined with classification algorithms

The survival time of patients with pancreatic tumors is closely related to the type of tumor. To diagnose patients with malignant pancreatic tumors as early as possible in order to improve patient survival, we proposed a new method for the assisted diagnosis of pancreatic tumors. First, we used partial least squares (PLS) to extract the Raman spectrum information of patients with pancreatic tumors. The study extracted ten eigenvalues experimentally. The cumulative variance of the first six PLS components reached 97.045 %, and then the feature information extracted by PLS was classified. This experiment used three classification algorithms: linear discriminant analysis (LDA), support vector machine (SVM), and k-nearest neighbor (KNN). Among them, the cubic kernel of SVM achieved the best classification effect, and its classification accuracy reached 96.4 %. This is the first time that serum Raman spectroscopy has been used to distinguish patients with benign and malignant tumors of the pancreas. The experimental results show that serum Raman spectroscopy may become a new auxiliary method for the clinical diagnosis of pancreatic cancer.

The Safety and Feasibility of&amp;nbsp;Robot-Assisted Pancreatic Surgery at&amp;nbsp;a High-Volume Center: A Nine-Year Retrospective Single-Center Analysis of 1396 Patients

Objective: We aimed to share our experience with 1396 cases of robot-assisted pancreatic surgery (RAPS) over nine years. Methods:The medical records of 1396 patients who underwent RAPS between May 2010 and December 2018 at Shanghai Ruijin Hospital were retrospectively analyzed. Operative outcomes, including the operative duration, estimated blood loss (EBL), and incidence of morbidities, especially postoperative pancreatic fistula (POPF), are discussed. We also recorded and illustrate our progress along the learning curve for RAPS in this large cohort. Results: During the study period, 1396 patients underwent RAPS at our center. Among them, 450 patients underwent robot-assisted pancreaticoduodenectomy (RPD), 605 patients underwent robot-assisted distal pancreatectomy (RDP), 144 patients underwent robot-assisted middle pancreatectomy (RMP), 119 patients underwent robot-assisted enucleation (REn), 40 patients underwent robot-assisted duodenum-preserving pancreatic head resection (R-DPPHR), 12 patients underwent robot-assisted total pancreatectomy (R-TP) and 26 patients underwent other types of surgery with a robot-assisted platform. A total of 442 patients (31.7%) suffered malignant tumors, while 357 (25.6%) patients had pancreatic ductal adenocarcinoma (PDAC). The mean operative duration was 195.3±107.4 min. The mean EBL was 197.5±107.4 ml. There were a total of 13 cases (0.9%) of conversion to open surgery due to adhesion and vascular invasion by the tumor. The total incidence rate of complications was 39.1% (546/1396). The incidence rate of clinically related (CR)-POPF of the total cohort was 16.5% (230 patients). The mean postoperative length of hospital stay (LOS) of the total cohort was 20.0±12.9 days. Conclusions: To the best of our knowledge, this is the largest sample size of RAPS cases ever reported. In conclusion, for benign and low-grade malignant pancreatic tumors, minimally invasive pancreatic surgery is safe and feasible and might be a good choice. Operative outcomes improve with accumulated experience. Further prospective analyses of RAPS should be designed to verify the advantages of RAPS. Funding Statement: The study was funded by National Natural Science Foundation of China (NSFC) directly to Baiyong Shen. Serial number: 81871906. It was also sponsored bu the Interdisciplinary Program of Shanghai Jiao Tong University directly to Jiabin Jin. Serial number: YG2019QNB26. Declaration of Interests: All the authors, Dr Yusheng Shi, Dr Jiabin Jin, Dr Junjie Xie, Dr Yuanchi Weng, Dr Mengmin Chen, Dr Kai Qin, Dr Hao Chen, Dr Xiaxing Deng, Dr Baiyong Shen and Dr Chenghong Peng have no conflicts or financial ties to disclose. Ethics Approval Statement: This retrospective study was approved by the institutional review board of Shanghai Ruijin Hospital. Every patient provided written informed consent to undergo the operation and for the use of the data we collected before and after the surgery.

Comparison of laparoscopic versus open distal pancreatectomy for benign, pre-malignant, and low grade malignant pancreatic tumors.

Backgrounds/AimsThe purpose of this study is to demonstrate that laparoscopic distal pancreatectomy in benign disease is is safer and more favorable to patients than open distal pancreatectomy.MethodsWe retrospectively reviewed data of 150 patients who underwent laparoscopic (n=69) or open (=81) distal pancreatectomy at a double institutes from 2008 to 2018. We reviewed each patient's history for age, sex, pathologic diagnosis. Specific outcomes that were included hospital stay, operative time (in minutes), operative blood loss (in milliliters), 30-daymajormorbidity and mortality (Clavian-Dindo classification), pancreatic leak rate (grade of leak A, B, or C), pancreatic hemorrhage.ResultsFrom 2008 to 2018, there were 150 patients underwent distal pancreatectomy with or without splenectomy for benign pancreatic disease. 81 patients underwent open and 69 patients underwent laparoscopic distal pancreatectomy (LDP) Intra-operative estimated blood loss was significantly lower in the LDP group than in the OPD group (200 vs. 400 ml p<0.01). There was no difference in blood transfusion between the two groups. There was a significant difference in the resection method between the two groups (p<0.01) and there was a significant difference in the use of mesh for prevention of postoperative pancreatic fistula (POPF) (53 vs. 34 p<0.01). There was no significant difference in incidence of POPF (15.9% in LDP vs 7.4% in ODP, p=0.235) between the two groups, morbidity rate between the two groups (18 vs. 30 p=0.152), post - pancreatectomy hemorrhage, wound infection, hospital stay and readmission.ConclusionsLDP showed there was no difference in the occurrence of POPF, complication and hospital stay. In contrast, intra-operative blood loss was significantly lower in the LDP group than in the ODP group, and LDP was also significantly better in the view point of the feeding advance. In other words, LDP is safer and more favorable to patients than ODP.

News of European pancreatology (by materials of the 51st Meeting of the European Pancreatic Club)

This article presents an overview of the results of practical and basic research in the field of pancreatology, which were presented during the 51st Meeting of the European Pancreatic Club (2019). Achievements of leading European pancreatologists in the study of the etiology, pathogenesis, diagnosis, treatment of pancreatitis, pancreatic tumors are briefly described. The article presents clinical features of acute and chronic pancreatitis, depending on the variety of concomitant pathology, genetic characteristics, bad habits, drugs taken. New opportunities for the differential diagnosis of chronic pancreatitis and pancreatic cancer using miRNA are considered, as well as the feasibility of determining the soluble urokinase-type plasminogen activator receptor (suPAR) in order to differentiate benign and malignant pancreatic tumors. Approaches to the diagnosis of abdominal pain, use of computed tomography for the diagnosis of sarcopenia are described. Results of basic research analyzing the mechanisms of pancreatic cancer development are presented. Modern theory on the role of microbiota and syndrome of bacterial overgrowth in the pancreatic oncogenesis processes is revealed. Pathogenetic features of the formation of exocrine pancreatic insufficiency and effectiveness of its correction via enzyme replacement therapy with the use of modern drugs are emphasized. Results of randomized controlled studies that proved effectiveness and safety of microtablet preparation in correction of exocrine pancreatic insufficiency in patients undergoing pancreatoduodenectomy are presented.&#x0D;