Amalia Pelegrina

Laparoscopic Distal Pancreatectomy for Pancreatic Tumors: Does Size Matter?

Background: Laparoscopic distal pancreatectomy (LDP) for large pancreatic tumors may require prolonged dissection, and this could be associated with increased operative time and intraoperative complications. Methods: From a total cohort of 190 consecutive patients undergoing LDP, 18 patients were found to have pancreatic tumors >5 cm and were included in the retrospective study of prospectively collected data. Three techniques were used to approach the splenic vessels: the superior pancreatic, the inferior supracolic and post-pancreatic transection. Results: Of these 18 patients, 13 were women and 5 were men, the median age was 68 years and their median tumor size 7 cm. Exocrine pancreatic malignancy was diagnosed in 8 patients, 6 patients had neuroendocrine pancreatic tumors and 4 patients cystic neoplasm. The median number of resected nodes was 14. R1 resections for exocrine pancreatic malignancies were found in 50% of patients. Morbidity (grade >II) was found in 16.6% of patients and 30 days mortality in 1 patient. Overall median survival was 50 months and 29 months for patients with exocrine pancreatic malignancies. Conclusions: LDP for large tumors, while technically demanding, is possible without additional morbidity and did not compromise short- and long-term oncological outcomes.

Prognostic prediction by liver tissue proteomic profiling in patients with colorectal liver metastases

AIM To obtain proteomic profiles in patients with colorectal liver metastases (CRLM) and identify the relationship between profiles and the prognosis of CRLM patients. MATERIALS & METHODS Prognosis prediction (favorable or unfavorable according to Fongs score) by a classification and regression tree algorithm of surface-enhanced laser desorption/ionization TOF-MS proteomic profiles from cryopreserved CRLM (patients) and normal liver tissue (controls). RESULTS The protein peak 7371 m/z showed the clearest differences between CRLM and control groups (94.1% sensitivity, 100% specificity, p < 0.001). The algorithm that best differentiated favorable and unfavorable groups combined 2970 and 2871 m/z protein peaks (100% sensitivity, 90% specificity). CONCLUSION Proteomic profiling in liver samples using classification and regression tree algorithms is a promising technique to differentiate healthy subjects from CRLM patients and to classify the severity of CRLM patients.

Cirugía del gastrinoma: Resultados inmediatos y a largo plazo

INTRODUCTION Zollinger-Ellison syndrome (Z-E) is characterized by gastrin-secreting tumors, responsible for causing refractory and recurrent peptic ulcers in the gastrointestinal tract. The optimal approach and the extension of tumor resection remains the subject of debate. METHODS During the period February 2005 and February 2014, 6 patients with Z-E underwent surgery, 4 men and 2 women with a median age 46.8 years (22-61). Two patients were affected with multiple endocrine neoplasia type-1 (MEN-1). Fasting gastrin levels greater than 200pg/ml (NV: <100) was diagnostic. Radiologic imaging to localize the lesion included octreoscan 6/6, computer tomography (CT) 6/6, and endoscopic ultrasonography (EUS) 1/6. RESULTS The octreoscan was positive in 5 patients. The CT localized the tumor in the pancreas in 2 patients, in the duodenum in 3 patients (1 confirmed by EUS) and between the common bile duct and vena cava in one patient. The laparoscopic approach was used in 4 patients, 2 patients converted to open surgery. The following surgical techniques were performed: 2 pylorus-preserving pancreatico-duodenectomy (PPPD), one spleen-preserving distal pancreatectomy, one duodenal nodular resection, 1 segmental duodenectomy and one extrapancreatic nodular resection. Pathological studies showed lymph nodes metástasis in 2 patients with pancreatic gastrinomas, and in one patient with duodenal gastrinoma. The median follow-up was 76,83 months (5-108) and all patients presented normal fasting gastrin levels. CONCLUSIONS Surgery may offer a cure in patients with Z-E. The laparoscopic approach remains limited to selected cases.

Letter in reply: Prognostic prediction by liver tissue proteomic profiling in patients with colorectal liver metastases

In response to: S Sabour. Prognostic prediction by liver tissue proteomic profiling in patients with colorectal liver metastases; rule of thumb.

Intususcepción intestinal en paciente intervenida de by pass gástrico

Paciente de 42 años, con antecedente de by pass gástrico en 2008, que acudió por vómitos en escopetazo de 48 h de evolución. A la exploración fı́sica solo destacaba un abdomen doloroso en hipocondrio derecho. Se colocó sonda nasogástrica que fue muy productiva de contenido alimentario. La radiologı́a simple de abdomen mostró asas de delgado dilatadas y en la tomografı́a computarizada abdominal se identificó una invaginación del asa comú n del by pass (fig. 1). Durante la intervención quirú rgica se halló una intususcepción de 17 cm del asa comú n en sentido craneal que ocluı́a tanto el asa alimenticia como la biliar. Se realizó resección con anastomosis término-terminal manual. El curso postoperatorio transcurrió sin complicaciones. c i r e s p . 2 0 1 2 ; 9 0 ( 1 0 ) : 6 6 7