A Reassessment of the Clinical Utility of Ga-DOTATATE PET/CT in Patients With Gastroenteropancreatic Neuroendocrine Tumors.

Background: Gastroenteropancreatic neuroendocrine tumors (GEP-NETs) are a rare and biologically diverse group of tumors that are challenging to image. Ga-DOTATATE PET/CT is the most sensitive imaging tool for these tumors, and while its use has increased over time, its clinical impact remains unclear, particularly for clinical scenarios involving surveillance after treatment. We sought to reassess its clinical utility across all stages.

Intrathecal Morphine and Effect on Opioid Consumption and Functional Recovery after Pancreaticoduodenectomy.

Background: Single-shot intrathecal morphine (ITM) is an effective strategy for postoperative analgesia, but there are limited data on its safety, efficacy, and relationship with functional recovery among patients undergoing pancreaticoduodenectomy.

Study Design: This was a retrospective review of patients undergoing pancreaticoduodenectomy from 2014 to 2020 as identified by the institutional NSQIP Hepato-pancreato-biliary database. Patients were categorized by having received no spinal analgesia, ITM, or ITM with transversus abdominus plane block (ITM+TAP).

Sometimes You Have to Judge a Book by Its Cover: The Case of a Masquerading Pancreatic Mucinous Cyst.

Pancreatic cystic lesions are difficult to evaluate amid acute pancreatitis. Without previous pancreatic imaging, it is challenging to discern between pancreatic acute fluid collections and cystic neoplasms. We present a 29-year-old woman with acute pancreatitis and initial cross-sectional imaging suggesting a 2.

Early Prediction of Length of Stay After Pancreaticoduodenectomy.

Background: Enhanced recovery after surgery (ERAS) is an evidence-based clinical pathway designed to standardize and optimize care. We studied the impact of ERAS and sought to identify the most important recommendations to predict shorter length of stay (LOS) after pancreaticoduodenectomy (PD).

Methods: We retrospectively reviewed all patients undergoing PD at our institution between January 2014 and June 2018.

Use of image-guided bone scalpel for resection of spine tumors: technical note.

In the literature, the use of navigation for spine tumor surgery has largely centered on implant placement. We describe the cases of two patients with spinal tumors on whom we utilized our resection technique of registering an ultrasonic bone scalpel (UBS) to a navigation system. In both cases, we achieved a satisfactory tumor resection with negative margins and excellent neurologic outcomes.

Open adrenalectomy through a makuuchi incision: A single institution's experience.

Background: Surgical techniques for adrenalectomy have evolved substantially over the last century. Although minimally invasive approaches are favored for benign disease, open adrenalectomy remains the gold standard for large tumors and those concerning for malignancy. Most reports describe the use of midline, subcostal, or thoracoabdominal incisions for open adrenalectomy.

Surgical readmissions: results of integrating pre-, peri- and postsurgical care.

Aims: To explore the feasibility of recruiting surgical oncology patients and implementing a surgical integrated discharge (SID) programme led by advanced practice providers (APP).

Background: Burden of illness and complexity of treatment regimen makes it challenging for surgical oncology patients to participate in research. Surgical oncology nurses may have the necessary expertise to overcome this problem.

Long-Term Survival of a Patient with Metastatic Small-Cell Carcinoma of the Stomach Treated with Radiation Therapy.

Small-cell carcinoma (SCC), or high-grade neuroendocrine carcinoma of the stomach, is a rare subtype of extra-pulmonary SCC which is almost invariably lethal. Gastric SCC often presents with local symptoms indistinguishable from other primary stomach cancers; however, both regional and distant spread are common at the initial presentation. Depending on symptoms and patient performance status, treatment typically consists of chemotherapy or resection followed by adjuvant chemotherapy, as even patients with limited stage gastric SCC likely have micrometastatic disease at the time of diagnosis.

The influence of staple size on fistula formation following distal pancreatectomy.

Background: Pancreatic fistula continues to be a source of significant morbidity following distal pancreatic resections. The technique of pancreatic division varies widely among surgeons, and there is no evidence that identifies a single method as superior. In our practice, the technique of distal pancreatic resection has evolved from cut-and-sew to stapled technique with green and recently white cartridge.

Giant pancreatic tumor with clinical characteristics of insulinoma but without common pathologic features.

Objective: To report a case of a large pancreatic tumor that had clinical characteristics of an insulinoma without classic pathologic features.

Methods: We describe a 58-year-old woman who presented with a 3-month history of symptomatic hypoglycemic episodes, which were characterized by confusion. The laboratory, imaging, and pathologic findings are summarized, the current literature on giant insulinomas is reviewed, and the distinction between clinical and pathologic diagnosis of neuroendocrine tumors is discussed.

For patients undergoing pancreatoduodenectomy, epidural anesthesia and analgesia improves pain but increases rates of intensive care unit admissions and alterations in analgesics.

Objectives: For some procedures, epidural anesthesia and analgesia (EAA) improves clinical outcomes. It is used during pancreatoduodenectomy (PD) to mitigate morbidities and shorten hospitalizations. Although widespread, the use of this practice has not been examined extensively.

Solitary fibrous tumor of the pancreas: a case report.

Solitary fibrous tumor (SFT) is an unusual mesenchymal neoplasm that most often arises in the pleura; however, it has recently been described in a number of extrapleural sites. This report describes an extremely rare case of a benign SFT arising in the pancreas. A 41-year-old woman presented in the clinic with right upper abdominal pain.

Pancreaticoduodenectomy in the presence of superior mesenteric venous obstruction.

The study goal was to determine the technical feasibility and outcomes associated with pancreaticoduodenectomy for periampullary malignancies with near (>80%) or complete (100%) superior mesenteric venous (SMV) obstruction. A retrospective examination of 11 patients with high-grade or complete SMV obstruction who underwent pancreaticoduodenectomy at five academic medical centers is reviewed. Pancreaticoduodenectomy for locally advanced periampullary malignancies causing high-grade or complete SMV obstruction is technically feasible.

Laparoscopic spleen-preserving distal pancreatectomy.

Distal pancreatectomy with spleen preservation may be the preferred procedure for certain benign tumors and cystic lesions of the pancreatic body or tail. Alternatively, laparoscopic removal including either distal pancreatectomy with splenectomy or splenic-preservation with ligation of the splenic vessels have also been described. We describe, herein, our method to perform spleen-preserving laparoscopic distal pancreatectomy that preserves the splenic vessels and hence splenic function.

Small bowel obstruction due to a paracolonic retroperitoneal hernia.

Hernias involving the retroperitoneum are unusual. The most common of these are the paraduodenal hernias. A retroperitoneal hernia occurring from a lateral defect in the colonic retroperitoneal attachments is presented.