Menghua Dai

Surgical management of patients with insulinomas: Result of 292 cases in a single institution

Insulinoma is rare tumor with an incidence of approximately four cases per million per year. There are few large sample, single‐center series that focus on the surgical management strategy of insulinomas.

Diagnostic accuracy of endoscopic ultrasound-guided fine-needle aspiration for pancreatic cancer: A meta-analysis

BACKGROUND AND OBJECTIVE EUS-FNA of pancreatic lesion has been put into clinical use widely in many centers. The present meta-analysis was conducted to study the diagnostic role of EUS-FNA in pancreatic cancer. METHODS A comprehensive review of study on the precision of EUS-FNA in the diagnosis of pancreatic cancer. A random effects model was used to pool the sensitivity, specificity, positive likelihood ratio (PLR), negative likelihood ratio (NLR) and diagnostic odds ratio (DOR). A summary receiver-operating characteristic (SROC) was constructed to summarize the overall test performance. RESULTS Thirty-one articles were eligible for the meta-analysis. The pooled sensitivity, specificity, PLR, NLR and DOR of EUS-FNA in the diagnosis of pancreatic cancer were 0.89 (95% CI: 0.88-0.90), 0.96 (95% CI: 0.95-0.97), 16.88 (95% CI: 10.63-26.79), 0.13 (95%CI: 0.10-0.16) and 150.80 (95%CI: 95.94-237.03) respectively. In subgroup meta-analysis of the prospective studies, the pooled sensitivity, specificity, PLR, NLR and DOR were 0.91 (95% CI: 0.90-0.93), 0.94 (95% CI: 0.91-0.96), 11.19 (95% CI: 6.36-19.69), 0.10 (95% CI: 0.07-0.15) and 125.22 (62.37-251.41). The area under the curve (AUC) was 0.97, indicating a good performance of overall accuracy. CONCLUSION EUS-FNA has the high sensitivity and specificity in differentiating pancreatic cancer. Moreover, it is also a safe diagnostic modality with little complications.

Primary pancreatic lymphoma: a clinical quandary of diagnosis and treatment.

Objective: To investigate the clinical feature and treatment strategy of primary pancreatic lymphoma. Methods: Thirty-nine cases of primary pancreatic lymphoma reported in China were reviewed retrospectively with their clinical characters, treatment, and outcome, as well as a literature review of worldwide reports. Results: The major clinical presentations included discomfort or pain in the upper abdomen and jaundice without specificity. Only 2 cases were identified correctly by computed tomography, and 5 cases obtained a positive finding in a biopsy before operation. Thirty-two patients accepted operation; 13 pancreatoduodenectomy and 6 distal pancreatectomy were performed. Thirty-one patients accepted postoperative chemotherapy. Until now, 26 patients are still alive at a range of 3 to 72 months; 5 patients died at 5 to 24 months after operation. Literature review revealed 85 additional cases of pancreatic lymphoma in English reports. Their diagnosis and treatment methods varied. Conclusions: Primary pancreatic lymphoma was misdiagnosed as pancreatic adenocarcinoma frequently. Fine needle aspiration biopsy is the most valuable method in preoperative diagnosis. The cyclophosphamide, doxorubicin, vincristine, and prednisone scheme was still the most commonly used regimen of chemotherapy. The value of surgery and radiotherapy remains controversial; an operation combining chemotherapy seems to be an appropriate method of treatment for a patient in whom malignancy cannot be ruled out.

Laparoscopic distal pancreatectomy with or without splenectomy: spleen-preservation does not increase morbidity.

BACKGROUND The indications for laparoscopic spleen-preserving distal pancreatectomy (LSPDP) and its morbidity compared with laparoscopic distal pancreatectomy with splenectomy (LDPS) are ill-defined. This study aimed to share the indications for spleen-preservation and investigate the safety and outcome of LSPDP at our institution. METHODS A retrospective review of patients who were scheduled to receive laparoscopic surgery for distal pancreatic lesions was conducted. The indications, surgical procedures, intra-operative data, and outcomes of the two procedures were collected and compared by statistical analysis. RESULTS LDPS and LSPDP were successfully performed in 16 and 21 patients respectively, whereas they were converted to open surgery in 9 patients. There were no significant differences in age, gender, operation time, blood loss, and conversion rate between the LDPS and LSPDP groups. The mean tumor size showed an inter-group difference (5.05 vs 2.53 cm, P<0.001). There were no significant differences in complication and morbidity rates between the two groups. All patients remained alive without recurrence during a follow-up of 9 to 67 months (median 35). CONCLUSION LSPDP has a morbidity and outcome comparable to LDPS.

Propensity score‐matched analysis of robotic versus open surgical enucleation for small pancreatic neuroendocrine tumours

Enucleation of pancreatic neuroendocrine tumours (pNETs) via robotic surgery has rarely been described. This study sought to assess the safety and efficiency of robotic surgery for the enucleation of small pNETs.

Risk factors for postoperative pancreatic fstula in patients with insulinomas: analysis of 292 consecutive cases

BACKGROUND Pancreatic fistula (PF) remains the most challenging complication in pancreatic surgery, yet few published studies have focused on the risk factors for postoperative PF in patients undergoing surgery for insulinomas. METHODS From January 1990 to February 2010, a total of 292 patients with insulinomas underwent surgery at Peking Union Medical College Hospital. Demographic data, intraoperative procedures, and postoperative data were collected. Particular attention was paid to variables associated with PF as defined by the International Study Group of Pancreatic Fistula (ISGPF). Univariate and multivariate analyses were used to identify possible risk factors for PF. RESULTS PF was found in 132 (45.2%) patients, of whom 90 were classified into ISGPF grade A, 33 grade B, and 9 grade C. Multivariate analysis showed that male patients (OR=2.56; P=0.007) and operative time >180 minutes (OR=3.756; P<0.0001) were independent risk factors for clinical PF. Pancreatic resection with stapler was a protective factor for both total PF (OR=0.022; P=0.010) and clinical PF (OR=0.097; P=0.007). CONCLUSIONS Male gender and operative time >180 minutes were independent risk factors for clinical PF, while pancreatic resection with a stapler was a protective factor. Whether body mass index (BMI) and other variables during operation are risk factors of PF needs further study.

Laparoscopic partial splenectomy for splenic hemangioma: experience of a single center in six cases.

IntRoductIon Despite a higher incidence of postoperative complications, splenectomy is a commonly performed procedure for splenic space-occupying lesions. A retrospective analysis of 2796 splenectomy patients showed that 119 patients (4.25%) had postoperative bacterial infections, and 71 (60%) died due to infections.[1] Therefore, emphasis on the preservation of splenic function has been raised that is, at least 25% of the spleen’s weight must be retained to maintain splenic immunologic functions, with the prerequisite of adequate arterial blood supply. After the partial splenectomy was firstly performed in 1980s, the first case of laparoscopic partial splenectomy was reported in the literature in 1990s.[2] Laparoscopic partial splenectomy has currently become a common option for many spleen diseases. However, laparoscopic partial splenectomy specific for solid hemangioma, which is at a high risk of bleeding, is not commonly reported in the literature. This study reviewed the six cases of laparoscopic partial splenectomy for the splenic hemangioma to evaluate whether the surgical procedure was feasible and safe.

Solid Serous Cystadenoma of the Pancreas: A Case Report of 2 Patients Revealing Vimentin, β-Catenin, α-1 Antitrypsin, and α-1 Antichymotrypsin as New Immunohistochemistry Staining Markers

AbstractSolid serous cystadenoma (SCA) of the pancreas is a rare type of pancreatic solid tumors. Postoperative pathological evaluation is of particular importance for distinguishing solid SCA of the pancreas from other pancreatic solid tumors.Here we present 2 cases of solid SCA of the pancreas, both preoperatively diagnosed with pancreatic neuroendocrine tumors. One case had positive OctreoScan test.Surgical resections were done for both cases. Postoperative immunohistochemistry assays were conducted with marker panels for SCA and 2 types of pancreatic solid tumors, which were neuroendocrine tumor (pNET) and solid pseudopapillary tumor (SPT).Two cases showed typical staining patterns for SCA markers. Notably, both cases showed positivity for 4 SPT markers (vimentin, &bgr;-catenin, &agr;-1 antitrypsin, and &agr;-1 antichymotrypsin).Emphasis should be paid to those 4 new markers for future pathological diagnosis of solid SCA of the pancreas.

Splenic preservation in laparoscopic distal pancreatectomy.

Laparoscopic spleen‐preserving distal pancreatectomy (LSPDP) is designed principally for the removal of benign and low‐grade malignant lesions in the left pancreas. The aims of this study were to compare LSPDP with laparoscopic distal pancreatectomy with splenectomy (LDPS), compare two splenic preservation techniques (splenic vessel preservation and Warshaw technique) and investigate factors that influence splenic preservation.

Emerging role of tumor markers and biochemistry in the preoperative invasive assessment of intraductal papillary mucinous neoplasm of the pancreas

BACKGROUND We explored the significance of laboratory examinations in predicting invasive carcinoma derived from intraductal papillary mucinous neoplasm (IPMN). METHODS We retrospectively reviewed preoperative laboratory examination data and postoperative pathological data for 87 patients with IPMN who underwent surgical resection at Peking Union Medical College Hospital from February 2008 to March 2015. RESULTS Histological review of 87 patients with surgical resection revealed 4 cases of mild-grade dysplasia (4.6%), 34 cases of intermediate dysplasia (39.1%), 16 cases of high-grade dysplasia (18.4%) and 33 cases of invasive carcinoma (37.9%). The first 3 grades were considered noninvasive. In univariate analyses, increased serum concentrations of CA19-9 (p<0.001), CA24-2 (p<0.001), CEA (p<0.001) and hsCRP (p=0.027) were significantly associated with invasive carcinoma. Multivariate analysis showed that increased serum concentrations of CA19-9 (p=0.009) and CEA (p=0.042) were significant independent predictors of invasiveness. The combination of CA19-9, CA 24-2 and CEA improved the accuracy of prediction, and the sensitivity and specificity were 71.0% and 87.7% respectively. CONCLUSIONS The development of diagnostic laboratory tests has important implications for pre-operative IPMN evaluation. Increased serum CA19-9 and CEA concentrations are independent predictors of invasive carcinoma derived from IPMN, and increased serum CA24-2 and hsCRP concentrations are significantly associated with the risk of invasiveness. Combined detection of CA19-9+CA24-2+CEA proved to be the most accurate in predicting the invasiveness of IPMN.