Perioperative and long-term results after left pancreatectomy: a single-institution, non-randomized, comparative study between open and laparoscopic approach.

Background: Laparoscopic left pancreatic resections are being increasingly performed. In this study, we provide a nonrandomized comparison between laparoscopic and open left pancreatectomy (OLP) for benign and borderline tumors, focusing on both perioperative and long-term results.

Methods: Demographic, pathologic, and perioperative details from patients who underwent laparoscopic and OLP between 1999 and 2006 were retrieved from our database and analyzed.

Extent of surgical resections for intraductal papillary mucinous neoplasms.

Intraductal papillary mucinous neoplasms (IPMNs) can involve the main pancreatic duct (MD-IPMNs) or its secondary branches (BD-IPMNs) in a segmental of multifocal/diffuse fashion. Growing evidence indicates that BD-IPMNs are less likely to harbour cancer and in selected cases these lesions can be managed non operatively. For surgery, clarification is required on: (1) when to resect an IPMN; (2) which type of resection should be performed; and (3) how much pancreas should be resected.

Differences between main-duct and branch-duct intraductal papillary mucinous neoplasms of the pancreas.

In the last decade, intraductal papillary mucinous neoplasms (IPMNs) have become commonly diagnosed. From a morphological standpoint, they are classified in main-duct IPMNs (MD-IPMNs) and branch-duct IPMNs (BD-IPMNs), depending on the type of involvement of the pancreatic ductal system by the neoplasm. Despite the fact that our understanding of their natural history is still incomplete, recent data indicate that MD-IPMNs and BD-IPMNs show significant differences in terms of biological behaviour with MD-IPMNs at higher risk of malignant degeneration.

Delayed gastric emptying after pylorus-preserving pancreaticoduodenectomy: validation of International Study Group of Pancreatic Surgery classification and analysis of risk factors.

Objectives: This study evaluates the incidence and clinical features and associated risk factors of delayed gastric emptying (DGE) after pancreaticoduodenectomy, employing the International Study Group of Pancreatic Surgery (ISGPS) consensus definition.

Methods: Demographic, pathological and surgical details for 260 consecutive patients who underwent pylorus-preserving pancreaticoduodenectomy at a single institution were analysed using univariate and multivariate models.

Results: Postoperative complications occurred in 108 (41.

Pancreatic cystic endocrine tumors: a different morphological entity associated with a less aggressive behavior.

Background: Cystic pancreatic endocrine tumors (CPETs) are rare lesions and their biological features have been scarcely investigated.

Aim: To compare clinical and pathological features of resected non-functioning sporadic CPETs (NF-CPETs) with solid pancreatic endocrine tumors (SPETs) in a single-institution experience.

Methods: All patients with a pathologically confirmed diagnosis of sporadic non-functioning pancreatic endocrine tumors who underwent curative resection between 1990 and 2008 were included.

Total pancreatectomy: indications, different timing, and perioperative and long-term outcomes.

Background: Total pancreatectomy (TP) has been performed rarely in the past because of its high morbidity and mortality. Because outcomes of pancreatic surgery as well as management of pancreatic insufficiency have improved markedly, enthusiasm for TP has an increased.

Methods: Between 1996 and 2008, 65 patients (33 females, 32 males; median age, 63 years) underwent TP at a single, high-volume center.

Invasive intraductal papillary mucinous carcinomas of the pancreas: predictors of survival and the role of lymph node ratio.

Introduction: Intraductal papillary mucinous neoplasms (IPMNs) are being increasingly recognized, and often harbor cancer. Lymph node metastases are an important prognostic factor for patients with invasive intraductal papillary carcinoma (I-IPMC), but the role of lymph node ratio (LNR) in predicting survival after surgery for I-IPMC is unknown.

Methods: The combined databases from the Surgical Department of Massachusetts General Hospital of Boston and the University of Verona were queried.

Intraductal papillary mucinous neoplasms of the pancreas with multifocal involvement of branch ducts.

Introduction: The appropriate management of patients with branch-duct intraductal papillary mucinous neoplasm (BD-IPMN) with multiple involvements of branch ducts (multifocal BD-IPMN) remains challenging.

Patients And Methods: Our database of patients affected by IPMN was queried to identify patients with a clinicoradiologic or a pathologic diagnosis of multifocal BD-IPMN between January 1990 and December 2006.

Results: One hundred thirty-one patients (52 male and 79 female; median age 67 years) had a clinicoradiologic or a histopathologic diagnosis of multifocal BD-IPMN.

Parenchyma-sparing resections for pancreatic neoplasms.

Background/purpose: In recent years there has been an increase in the indications for pancreatic resection of benign or low-grade malignant lesions, especially in young patients with long life expectancy. In this setting, patients may benefit from parenchyma-sparing resections in order to decrease the risk of development of exocrine/endocrine insufficiency.

Methods: A review of the literature and authors experience was undertaken.

Mucin-producing neoplasms of the pancreas: an analysis of distinguishing clinical and epidemiologic characteristics.

Background & Aims: Mucin-producing neoplasms (MPNs) of the pancreas include mucinous cystic neoplasms (MCNs) and main-duct, branch-duct, and combined intraductal papillary mucinous neoplasms (IPMNs). MCNs and branch-duct IPMNs are frequently confused; it is unclear whether main-duct, combined, and branch-duct IPMNs are a different spectrum of the same disease. We evaluated their clinical and epidemiologic characteristics.

Middle-preserving pancreatectomy for multicentric body-sparing lesions of the pancreas.

Background: The appropriate surgical approach of a pancreatic multifocal disease that skips the body of the gland remains unknown. We sought to analyze a parenchyma-sparing surgical technique consisting of a middle-preserving pancreatectomy (MPP) evaluating feasibility, safety, and oncological and functional outcomes.

Patients And Methods: Between 1999 and 2007, 5 patients affected by pancreatic benign or slow malignant multicentric body-sparing disease underwent MPP.

Resectable pancreatic cancer: who really benefits from resection?

Background: The 1-year disease-related mortality after resection for pancreatic cancer is approximately 30%. This study examined potential preoperative parameters that would help avoid unnecessary surgery.

Methods: Among the patients resected at our institution from 1997 to 2006, a total of 228 underwent pancreatic resection for ductal adenocarcinoma.

Alteration in emergency theatre prioritisation does not alter outcome for acute appendicitis: comparative cohort study.

Background: Despite dedicated emergency theatre, emergency surgery can be often delayed due to competing urgencies, suggesting a need for innovative theatre time management.

Aim: To investigate if a change in the emergency theatre prioritisation affects outcomes for a common urgent operation such as appendicectomy.

Methods: We prospectively recorded data from 67 patients undergoing appendicectomy, for two cohorts of patients: before and after change in theatre prioritisation: Group 1 (Jan-Mar) and 2 (Aug-Oct) respectively.

Middle pancreatectomy: indications, short- and long-term operative outcomes.

Objective: To evaluate the indications, perioperative, and long-term outcomes of a large cohort of patients who underwent middle pancreatectomy (MP).

Summary Background Data: MP is a parenchyma-sparing technique aimed to reduce the risk of postoperative exocrine and endocrine insufficiency. Reported outcomes after MP are conflicting.