The increasingly widespread use of minimally invasive surgery has allowed surgeons to exploit this approach for complex procedures, such as pancreatic resections, though its actual role outside simple operations remains debated.
This is a study of 12 consecutive patients, 5 men and 7 women, with pancreatic insulinoma who were treated at our institution from 2000 to September 2005. All patients presented with typical symptoms and laboratory findings of hyperinsulinism and were good candidates for laparoscopic surgery. Preoperative diagnostic work-up, operating time, postoperative complication rate, length of hospital stayd and clinical outcome were assessed.
Successful laparoscopic resection was performed in 11 out of 12 patients: 4 had tumor enucleation, and 7 had distal pancreatectomy; among these latter 5 had spleen-preserving distal pancreatectomy. In 1 case conversion to open surgery was necessary. Mean operative time was 170 minutes. The median tumor size was 18 mm, and all the insulinomas were benign. Four complications were observed in this group, and the median hospital stay was 8 days.
The laparoscopic approach proved to be feasible and safe, although the average operative time was longer and demanded good surgical skills as well as precise localization of the tumor and definition of its nature. Tumors located in the body or tail of the pancreas that are benign in nature can better benefit of laparoscopic approach.
"If the tumor cannot be identified precisely by laparoscopic ultrasound, conversion to open surgery should be considered . Laparoscopic pancreatic surgery demands a high level of surgical skills in minimally invasive surgery and should be performed in specialized centers . "
[Show abstract][Hide abstract] ABSTRACT: Pancreatic neuroendocrine tumors (PNETs) are rare neoplasms. They are clinically diverse and divided into functioning and nonfunctioning disease, depending on their ability to produce symptoms due to hormone production. Surgical resection is the only curative treatment and remains the cornerstone therapy for this patient group, even in patients with advanced disease. Over the last decade there has been a noticeable trend towards more aggressive surgery as well as more minimally invasive surgery in patients with PNETs. This has resulted in improved long-term survival in patients with locally advanced and metastatic disease treated aggressively, as well as shorter hospital stays and comparable long-term outcomes in patients with limited disease treated minimally invasively. There are still controversies related to issues of surgical treatment of PNETs, such as to what extent enucleation, lymph node sampling, and vascular reconstruction are beneficial for the oncologic outcome. Histopathologic tumor classification is of high clinical importance for treatment planning and prognostic evaluation of patients with PNETs. A constant challenge, which relates to the treatment of PNETs, is the lack of an internationally accepted histopathological classification system. This paper reviews current issues on the surgical treatment of sporadic PNETs with specific focus on surgical approaches and tumor classification.
The Scientific World Journal 12/2012; 2012(1):357475. DOI:10.1100/2012/357475 · 1.73 Impact Factor
"Based on clinical, biochemical, and imaging studies, the patient was referred to a surgical division (F.M. and M.P.) with long-standing experience in the diagnosis and treatment of endocrine pancreatic tumors . Under general anesthesia, the patient underwent laparotomy and surgical exploration of the pancreas; a 10 mm nodule was found where indicated by digital angiography and was enucleated from the pancreatic tail without local complications or bleeding. "
[Show abstract][Hide abstract] ABSTRACT: We describe an unusual case of hypoglycemic syndrome in a 69-year old woman with a proinsulin-only secreting pancreatic endocrine adenoma. The clinical history was highly suggestive of an organic hypoglycemia, with normal or relatively low insulin concentrations and elevated proinsulin levels. Magnetic resonance and computed tomography of the abdomen showed a 1 cm pancreatic nodule and multiple accessory spleens. The diagnosis was confirmed by selective angiography, showing location and vascularization of the nodule, despite no response to intra-arterial calcium. After resection, the hypoglycemic syndrome resolved. The surgical specimen was comprised of a neuroendocrine adenomatous tissue with high proinsulin immunoreactivity. Study of this unusual case of proinsulinoma underlines (i) the need to assay proinsulin in patients with hypoglycemia and normal immunoreactive insulin, (ii) the differential diagnosis in the presence of accessory spleens, (iii) the unresponsiveness to intra-arterial calcium stimulation, and (iv) the extensive evaluation needed to reach a final diagnosis.
Case Reports in Medicine 07/2011; 2011:930904. DOI:10.1155/2011/930904
[Show abstract][Hide abstract] ABSTRACT: Crohn's disease and ulcerative colitis are chronic dis- abling inflammatory bowel diseases (IBDs). Although the causes of IBD are unknown, defects in innate and adaptive immune pathways have been identified and biological therapies that target key molecules have been designed. Infliximab, a chimeric immunoglobulin (Ig)G1 monoclonal antibody to tumor necrosis factor, dramatically improved treatment of patients with Crohn's disease and ulcerative colitis. Infliximab has achieved treatment goals such as mucosal healing and decreasing the need for hospitalizations and surgeries. Although several anti-tumor necrosis factor therapies have been developed, there is a great need for drugs that target other pathways. Natalizumab, an antibody against the integrin 4 subunit, blocks leukocyte adhe- sion and has reached the clinic in the United States but has not been approved in the European Union; other anti-adhesion molecules currently are under develop- ment. Additional approaches under clinical develop- ment include therapeutics that target cytokines, such as interleukin-12/23, as well as those that block T-cell sig- naling. The use of recombinant human proteins, in- cluding immunoregulatory cytokines and growth fac- tors, has not been successful so far. The efficacy of each therapy must be shown in carefully designed clinical programs. Biological therapies carry a definite safety risk, so their place in treatment algorithms must be defined carefully.
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