Yong-Bum Yoon

Branch duct intraductal papillary mucinous neoplasms in a retrospective series of 190 patients.

A consensus conference has recommended close observation of branch duct intraductal papillary mucinous neoplasms (BD‐IPMNs) smaller than 30 mm, without symptoms or mural nodules. This study investigated whether these recommendations could be validated in a single‐centre experience of BD‐IPMNs.

Detection of pancreatic adenocarcinoma: relative value of arterial and late phases of spiral CT.

Abstract.Background: Spiral computed tomography (CT) allows the pancreas to be imaged during peak contrast levels owing to the capability of fast data acquisition. The objective of this study was to evaluate the relative value of the arterial and late phases of spiral CT for detecting pancreatic adenocarcinomas.n Methods: Twenty-two patients with pathologically proved pancreatic adenocarcinomas underwent two-phase spiral CT. The CT scans were performed with 5 mm collimation and 5 mm/s table speed. Images during the arterial and late phases were obtained at 30- and 180-second delays, respectively. The images of the arterial phase were compared with those of the late phase in terms of tumor conspicuity from surrounding pancreatic parenchyma and tumor detectability by means of a 3-point grading system: 1 (poor), 2 (fair), and 3 (good).n Results: In terms of tumor conspicuity from surrounding pancreatic parenchyma, 16 lesions (73%) were good, 5 lesions (23%) were fair, and 1 lesion (4%) was poor during the arterial phase, whereas 6 lesions (27%) were good, 9 lesions (41%) were fair, and 7 lesions (32%) were poor during the late phase (p= 0.0007). The arterial phase was superior to the late phase in 16 patients (73%) and equal in 6 patients (27%). For tumor detectability, 18 lesions (82%) were good, 3 lesions (14%) were fair, and 1 lesion (4%) was poor during the arterial phase, whereas 10 lesions (45%) were good, 7 lesions (32%) were fair, and 5 lesions (23%) were poor during the late phase (p= 0.0033). For detectability, the arterial phase was superior to the late phase in 14 patients (64%) and equal in 8 patients (36%).n Conclusion: The arterial phase of spiral CT is superior to the late phase, which is equivalent to conventional CT for detecting pancreatic adenocarcinoma.n

Non-surgical treatment of post-surgical bile duct injury: Clinical implications and outcomes

AIMnTo investigate the prognostic factors determining the success rate of non-surgical treatment in the management of post-operative bile duct injuries (BDIs).nnnMETHODSnThe study patients were enrolled from the pancreatobiliary units of a tertiary teaching hospital for the treatment of BDIs after hepatobiliary tract surgeries, excluding operations for liver transplantation and malignancies, from January 1999 to August 2010. A total of 5167 patients underwent operations, and 77 patients had BDIs following surgery. The primary end point was the treatment success rate according to different types of BDIs sustained using endoscopic or percutaneous hepatic approaches. The type of BDI was defined using one of the following diagnostic tools: endoscopic retrograde cholangiography, percutaneous transhepatic cholangiography, computed tomography scan, and magnetic resonance cholangiography. Patients with a final diagnosis of BDI underwent endoscopic and/or percutaneous interventions for the treatment of bile leak and/or stricture if clinically indicated. Patient consent was obtained, and study approval was granted by the Institutional Review Board in accordance with the legal regulations of the Human Clinical Research Center at the Seoul National University Hospital in Seoul, South Korea.nnnRESULTSnA total of 77 patients were enrolled in the study. They were divided into three groups according to type of BDI. Among them, 55 patients (71%) underwent cholecystectomy. Thirty-six patients (47%) had bile leak only (type 1), 31 patients had biliary stricture only (type 2), and 10 patients had both bile leak and biliary stricture (type 3). Their initial treatment modalities were non-surgical. The success rate of non-surgical treatment in each group was as follows: BDI type 1: 94%; type 2: 71%; and type 3: 30%. Clinical parameters such as demographic factors, primary disease, operation method, type of operation, non-surgical treatment modalities, endoscopic procedure steps, type of BDI, time to diagnosis and treatment duration were evaluated to evaluate the prognostic factors affecting the success rate. The type of BDI was a statistically significant prognostic factor in determining the success rate of non-surgical treatment. In addition, a shorter time to diagnosis of BDI after the operation correlated significantly with higher success rates in the treatment of type 1 BDIs.nnnCONCLUSIONnEndoscopic or percutaneous hepatic approaches can be used as an initial treatment in type 1 and 2 BDIs. However, surgical intervention is a treatment of choice in type 3 BDI.

Natural history and malignant risk factors of solid pseudopapillary tumors of the pancreas.

Abstract Background and Aim: Solid pseudopapillary tumors (SPTs) of the pancreas are unusual neoplasms of uncertain prognosis. Most patients with SPTs have a good prognosis after undergoing surgical resection, but there are rare cases in which a locally infiltrative growth pattern and metastatic variety are exhibited, or recurrence of the disease after surgery occurs; these cases have been reported with very poor clinical outcomes. Our study investigated the natural history of SPTs and delineated the clinicopathologic features that may predict the malignancy potential of the disease. Methods: A total of 100 patients with suspected SPTs were enrolled in our study and 77 patients underwent surgical resection. A resulting 60 tumors were pathologically proven to be SPTs and the affected patients were followed-up regularly after surgery. Clinical and pathologic data for all 100 patients were analyzed. Results: Of the 60 total patients with histologically positive SPTs, 55 (92%) were women and 5 (8%) were men. The median patient age was 34 years (range, 13−77 years). Among the 60 patients, 9 had malignant SPTs and 51 had benign SPTs. Deep parenchymal invasion into the surrounding tissue was the most frequent pathologic feature suggesting malignancy (75%) among the 60 patients who underwent surgical resection. Patient clinicopathologic characteristics and demographic factors were compared between those who had benign SPTs and those who had malignant SPTs. There were no significant differences in the various patient features between the 2 groups, including age, sex, symptoms, tumor size, tumor location, internal tumor composition, pattern of tumor calcification, tumor necrosis, hemorrhage, and immunohistochemical tumor tissue patterns. There were 2 patients who had distant metastasis; 1 presented with distal metastasis in the liver and the other patient had recurrence of cancer with a peritoneal mass after surgery. Metastasectomy was performed on the 2 patients and there was no mortality or disease progression during the follow-up period (median, 143 months; range, 53−319 months). Conclusion: Solid pseudopapillary tumors are low-grade tumors that have a generally good prognosis. However, the clinical development and malignancy potential of SPTs are neither fully understood nor predictable, even with histologically benign tumors. Further investigations in tumor biology, along with long-term patient follow-up, may provide insight into the disease process and clinical development of SPTs.