Importance of biochemical markers in routine oncological practice (according to materials of clinical recommendations)

Background. The diagnostics of neuroendocrine tumors (NET) is complex due to many factors such as the heterogeneity of the tumors themselves, different localization of the tumor process, and the presence of severe hormonal syndromes. A special place in the diagnostic search is given to the study of biochemical markers which are conditionally divided into universal and specific ones.Materials and methods. Chromogranin A (CGA) is a universal marker that in most cases identifies tumors of a neuroendocrine nature and is characterized by the best combination of diagnostic sensitivity and specificity. Pancreatic polypeptide (PP) and neuron-specific enolase (NSE) are determined in addition to CGA in pancreatic tumors and in low-grade forms of neuroendocrine cancer. Specific markers, serum serotonin and its metabolite in daily urine 5-hydroxyindolacetic acid (5-GIUC), are the generally recognized specific markers for diagnosing of carcinoid syndrome. Other specific markers such as gastrin, insulin, glucagon, and others, are associated with certain hyperfunctional syndromes and are being investigated to confirm their presence. The article presents generalized recommendations for the use of biochemical markers, taking into account the existing clinical signs, syndromes, and types of NETs. To monitor the course of the tumor process and evaluate the effectiveness of treatment in patients with an established diagnosis of NET, it is recommended to determine the biochemical markers with increased basal levels. At the same time, there is a need to standardize the survey timing. For more accurate monitoring and interpretation of data, serial marker studies should be performed with the same test systems used in the same specialized laboratory.

Download Full-text

Repeated Plastic Stentings of Common Hepatic Duct for Portal Vein Aneurysm Compression in a Patient Unsuitable for Surgery

Case Reports in Gastroenterology ◽

10.1159/000492812 ◽

2018 ◽

Vol 12 (3) ◽

pp. 570-577 ◽

Cited By ~ 1

Author(s):

Jeffrey Sun ◽

Cheuk-Kwan Sun ◽

Cheuk-Kay Sun

Keyword(s):

Portal Vein ◽

Surgical Intervention ◽

Vascular Malformations ◽

Imaging Modality ◽

Hepatic Duct ◽

Therapeutic Option ◽

Clinical Signs ◽

Common Hepatic Duct ◽

Low Grade ◽

Portal Vein Aneurysm

Portal vein aneurysms are rare vascular malformations with unclear etiologies and optimal treatment guidelines. Although Doppler ultrasonography is the most commonly used diagnostic tool, there is no gold standard imaging modality. Despite recommendations of surgical treatment for symptomatic aneurysms, there are limited options in the management of portal vein aneurysm-related complications in patients unfit for surgical intervention. We describe an 85-year-old man who presented with abdominal pain and low-grade fever with clinical signs consistent with cholangitis. Endoscopic retrograde cholangiopancreatography revealed a common hepatic duct stricture and concomitant intraductal ultrasonography identified adjacent aneurysmal portal vein dilatation. The final diagnosis of portal vein aneurysm was made using contrast computerized tomography scan. The patient was considered unsuitable for surgery due to his advanced age and multiple comorbidities. Instead, an endoscopic biliary plastic stent was inserted as a therapeutic alternative, which successfully achieved complete resolution of symptoms 3 days after the procedure. The patient was regularly followed at the outpatient clinic with repeated stent replacements every 3 to 4 months. After a follow-up of over 3.5 years, the patient remained symptom-free without signs of portal vein aneurysm compression. The result suggests that repeated stent replacements may be a therapeutic option for biliary compression by portal vein aneurysm in patients contraindicated for surgical intervention.

Download Full-text

Current aspects of diagnosis and treatment of patients with neuroendocrine tumors

Vestnik of Russian military medical Academy ◽

10.17816/brmma72345 ◽

2021 ◽

Vol 23 (3) ◽

pp. 83-92

Author(s):

Maxim V. Lysanyuk ◽

Pavel N. Romashchenko ◽

Nicolay A. Maistrenko

Keyword(s):

Gastrointestinal Tract ◽

Neuroendocrine Tumors ◽

Survival Rates ◽

Neuron Specific Enolase ◽

Treatment Method ◽

Pancreatic Tumors ◽

Arterial Phase ◽

Computed Tomographic ◽

Positron Emission ◽

Degree Of Malignancy

The article presents modern possibilities and existing problematic aspects of the choice of therapeutic and diagnostic tactics in patients with neuroendocrine tumors of the gastrointestinal tract and pancreas are presented. The asymptomatic course of neuroendocrine tumors of the gastrointestinal tract and pancreas was established in 18.5% and 24.6% of cases, respectively. Carcinoid syndrome was detected in 12.9%. The sensitivity rates of chromogranin A and neuron-specific enolase in the diagnosis of tumors were 54% and 13%, respectively. The levels of cancer-embryonic antigen in G-1/G-2 and G-3 tumors were 5 ng/ml and 8.9 ng/ml, respectively (p 0.001). A pathognomonic sign of neuroendocrine tumors of the small intestine is a mesentery tumor conglomerate, and the sensitivity rates of computed tomography and positron emission tomography with 68Ga to detect this sign were 92.3% and 92.9%, respectively (p 0.05). The computed tomographic density of neuroendocrine pancreatic tumors G-1/G-2 in the arterial phase was 112.1 40.2 HU and that of G-3 tumors was 54.0 10.4 HU (p = 0.025). Surgical treatment was performed in 259 (79.7%) patients. Postoperative complications that developed in localized and locally distributed neuroendocrine tumors of the gastrointestinal tract and of the pancreas were found in 3.5% and 8.8%, and in 58.1% and 40% of the cases, respectively, and those of generalized tumors were noted in 20%. The tumor-specific 5-year survival rates of patients with localized neuroendocrine tumors of the gastrointestinal tract and pancreas were 92.5% and 94.4%, those with locally distributed tumors had 66.8% and 77.8%, and those with generalized tumors had 51.8% and 47.1%, respectively. In patients with generalized tumors, the 5-year survival rates after cytoreduction and removal of the primary tumor were 88.2% and 64.6%, respectively (p = 0.097), and the rate after drug therapy was 28.8% (p 0.001). The prognosis of the 5-year survival of patients is determined by the degree of malignancy and tumor localization, treatment method, and patient age. In general, neuroendocrine tumors are a heterogeneous group of neoplasms that require a multidisciplinary approach to diagnosis and choice of therapeutic strategies.

Download Full-text

Leptomeningeal dissemination of low-grade neuroepithelial CNS tumors in adults: a 15-year experience

Neuro-Oncology Practice ◽

10.1093/nop/npz020 ◽

2019 ◽

Vol 7 (1) ◽

pp. 118-126

Author(s):

Philipp Karschnia, ◽

Frank J Barbiero ◽

Michaela H Schwaiblmair ◽

Leon D Kaulen ◽

Joseph M Piepmeier ◽

...

Keyword(s):

Rare Complication ◽

Clinical Signs ◽

Cns Tumors ◽

Time Interval ◽

Communicating Hydrocephalus ◽

Histopathological Diagnosis ◽

Low Grade ◽

Leptomeningeal Dissemination ◽

Who Grade ◽

Systemic Treatments

Abstract Background Leptomeningeal dissemination (LD) in adults is an exceedingly rare complication of low-grade neuroepithelial CNS tumors (LGNs). We aimed to determine relative incidence, clinical presentation, and predictors of outcome. Methods We searched the quality control database of the Section of Neuro-Oncology, Yale Cancer Center, for patients with LGN (WHO grade I/II) seen between 2002 and 2017. For cases complicated by LD, we recorded demographics, clinical signs, histopathological diagnosis, and imaging findings. A comprehensive literature review was performed. Results Eleven consecutive patients with LD were identified, representing 2.3% of individuals with LGN seen at our institution between 2002 and 2017 (n = 475). Ependymoma was the predominant histological entity. Mean time interval from diagnosis of LGN to LD was 38.6 ± 10 months. Symptoms were mostly attributed to communicating hydrocephalus. Tumor deposits of LD were either nodular or linear with variable enhancement (nonenhancing lesions in 4 of 11 patients). Localized (surgery, radiosurgery, involved-field, or craniospinal radiation therapy) or systemic treatments (chemotherapy) were provided. All patients progressed radiographically. Median overall survival after LD was 102 months. Survival was prolonged when a combination of localized and systemic therapies was administered (188.5 vs 25.5 months; P = .03). Demographics and tumor spectrum reported in the literature were similar to our cohort. Conclusions LD is a rare complication of LGNs. A high level of suspicion is required for timely diagnosis as early symptoms are nonspecific and commonly do not occur until years after initial tumor diagnosis. Repeated aggressive treatment appears to be beneficial in improving survival.

Download Full-text

Investigations on the incidence of rinderpest virus infection in game animals of N. Tanganyika and S. Kenya 1960/63

Journal of Hygiene ◽

10.1017/s0022172400045861 ◽

1967 ◽

Vol 65 (3) ◽

pp. 343-358 ◽

Cited By ~ 17

Author(s):

W. Plowright ◽

B. McCulloch

Keyword(s):

Clinical Signs ◽

Neutralizing Antibody ◽

Low Grade ◽

Serum Samples ◽

Before And After ◽

Antibody Titres ◽

Low Incidence ◽

Connochaetes Taurinus ◽

Low Rate ◽

Game Animals

The incidence of rinderpest infection in game animals in selected localities of South Kenya and North Tanganyika was studied during the period 1960 to 1963. Serum samples from 590 wildebeest (Connochaetes taurinus), 48 eland (Taurotragus oryx), 65 Thompson's gazelle (Gazella thompsoni) and 39 Grant's gazelle (Gazella granti) were tested for rinderpest neutralizing antibody.Rinderpest infection was shown to have been very frequent in yearling wilde-beest in the Mara area of Kenya in 1959/60, in the Serengeti National Park of Tanganyika in late 1960 and also in the Serengeti, and some adjacent areas, during the latter half of 1961. In the Ngorongoro Crater in 1961 infection was far less widespread, with only 11% of the yearlings acquiring antibody, compared to 67% in the Serengeti. The infections in 1959 and 1960 were clinical epizootics, accompanied by a considerable mortality, whereas no overt disease was reported in the course of 1961. Eland were affected in a similar manner to wildebeest up to 1960 but only a low rate of serological conversion was demonstrated in 1961. Adult Thompson's gazelle showed a low rate (ca. 12%) of infection but no anti-body was detected in Grant's gazelle.Only a small proportion of the wildebeest calves born in early 1962 acquired antibody by mid-1963 and this was due, at least in part, to infection late in 1962; it was not clear, unfortunately, whether the positive animals belonged entirely to resident, as opposed to migratory, groups. No clinical signs or mortality were reported in this year.A low incidence of rinderpest infection in wildebeest was also demonstrated both before and after 1960 in the Kajiado district of Kenya, where disease of game has not been reported in recent years. It is possible that the positive animals, as also the 1962 cases in Tanganyika, acquired the virus from low-grade infections of cattle.The transmission of rinderpest antibody from wildebeest dam to calf, presumably via the colostrum, was demonstrated regularly, except in six calves about 1–2 weeks old. No completely satisfactory explanation was obtained for their failure to acquire passive antibody but it may have been due to abnormal disturbance in the herds, associated with the shooting. The antibody titres in calves were initially higher than those in the serum of their dams but by the end of the 3rd month this position had been reversed. Individual calves became serologically negative from about the 10th week of life and all were devoid of antibody by the 6th to 7th month. The half-life of passively-acquired antibody was 4·4 weeks.

Download Full-text

Amoebae in Chronic, Polymicrobial Endodontic Infections Are Associated with Altered Microbial Communities of Increased Virulence

Journal of Clinical Medicine ◽

10.3390/jcm9113700 ◽

2020 ◽

Vol 9 (11) ◽

pp. 3700

Author(s):

Garrit Koller ◽

Federico Foschi ◽

Philip Mitchell ◽

Elizabeth Witherden ◽

Kenneth Bruce ◽

...

Keyword(s):

Microbial Communities ◽

High Throughput Sequencing ◽

Inflammatory Responses ◽

Clinical Signs ◽

Signs And Symptoms ◽

Resistant Bacteria ◽

Low Grade ◽

Taxonomic Assignment ◽

Microbial Composition ◽

Endodontic Infections

Background: Infections of the root canal space involve polymicrobial biofilms and lead to chronic, low grade inflammatory responses arising from the seeding of microbes and by-products. Acute exacerbation and/or disseminating infections occur when established microbial communities undergo sudden changes in phenotypic behaviour. Methods: Within clinical endodontic infections, we assessedcategorical determinants comprising, and changing microbial composition of, chronic polymicrobial infections and their association with amoebae. After standardised assessment, primary or secondary infections underwent sampling and DNA processing, targeting bacteria, fungi and amoebae, including 16S high-throughput sequencing. After taxonomic assignment, community composition was correlated with clinical signs and symptoms. Diversity and abundance analyses were carried out in relation to the presence of non-bacterial amplicons. Results: Clinical specimens revealed two distinct community clusters, where specific changes correlated with clinical signs. An association between the compositions of microbiomes was found between these groups and the presence of Entamoeba gingivalis in 44% of cases. When amoebae were present in endodontic infections, we demonstrate changes in microbial community structure that mirror those observed in treatment-resistant or recurrent infections. Conclusions: Amoeba are present in endodontic infections at a high prevalence, and may promote increased virulence by enrichment for phagocytosis-resistant bacteria.

Download Full-text

The Reliability of Diagnosis of Infection during Revision Arthroplasties

Scandinavian Journal of Surgery ◽

10.1177/145749690209100208 ◽

2002 ◽

Vol 91 (2) ◽

pp. 178-181 ◽

Cited By ~ 69

Author(s):

P. Virolainen ◽

H. Lähteenmäki ◽

A. Hiltunen ◽

E. Sipola ◽

O. Meurman ◽

...

Keyword(s):

Protein Level ◽

Tissue Sample ◽

False Negative ◽

Clinical Signs ◽

Low Grade ◽

Single Test ◽

C Reactive Protein ◽

Reactive Protein ◽

Revision Arthroplasties ◽

Radiological Evidence

Background: Follow up studies have shown that 0.5 to 4 % of the total joint arthroplasties will be complicated by infection. Distinction between aseptic loosening and infection is important for prediction of the final outcome after revision arhtroplasty but also for the choice of operative treatment. However, diagnosis of low grade chronic infection is extremely demanding. Materials and Methods: 68 hip and knee revision arthroplasties were reviewed retrospectively in order to evaluate the reliability of pre- and perioperative analysis of infection during total joint revision arthroplasties. The sensitivity and specificity for clinical signs, blood white-cell count, C-reactive protein level, radiographic analysis, bone and leukocyte scans, joint aspirations, and gram staining were determined. Tissue sample were harvested and cultured in all cases. Positive cultures were regarded as a true infection. Results: We were not able to characterize the infection by clinical signs. Also no single test was able to show the presence of infection in all cases. The best results were obtained from pre- and perioperative joint aspirations. Joint aspiration showed 1.0 specificity and 0.75 sensitivity. Conclusion: It is clear from this study that no single test is able to show the presence of infection in every case. Classical clinical signs, laboratory tests, special imaging studies and joint aspirations have all yielded a notable rate of false negative results. Therefore, we recommend that, if arthroplasty patients have pain in prosthetic joint without clear radiological evidence of loosening, bone scans and preoperative joint aspirations should be undertaken. Also, if radiological evidence of loosening is accompanied with one or more of following criteria; C-reactive protein level elevated, radiologic evidence of infection, loosening within the first five years after implantation. In case of infection a delayed two-stage reconstruction should be managed.

Download Full-text

Oxaliplatin plus 5-fluorouracil/folinic acid as palliative treatment for progressive malignant gastrointestinal neuroendocrine carcinomas

Journal of Clinical Oncology ◽

10.1200/jco.2006.24.18_suppl.14074 ◽

2006 ◽

Vol 24 (18_suppl) ◽

pp. 14074-14074 ◽

Cited By ~ 2

Author(s):

U. Pape ◽

N. Tiling ◽

C. Bartel ◽

U. Plöckinger ◽

B. Wiedenmann

Keyword(s):

Tumor Progression ◽

Folinic Acid ◽

Clinical Signs ◽

Gastrointestinal Neoplasms ◽

Proliferative Potential ◽

Low Grade ◽

Primary Tumors ◽

Platinum Based Chemotherapy ◽

Cytotoxic Treatment ◽

Neuroendocrine Carcinomas

14074 Background: Oxaliplatin in combination with 5-fluorouracil and folinic acid is an antitumoral agent with relatively low toxicity and satisfactory efficacy in several gastrointestinal neoplasms. However, it has not been studied in malignant gastrointestinal neuroendocrine carcinomas (NEC) for which platinum-based chemotherapy is a standard treatment with considerable toxicity. Methods: 16 patients (6 female, 10 male; mean age 57) with documented progress of histologically proven, irresectable, malignant NEC were retrospectively analyzed for safety and efficacy of cytotoxic treatment (from october 2001 to december 2005) according to the FOLFOX-4 regimen. Primary tumors were in the foregut in 9 (2 bronchial, 5 pancreas, 2 stomach), in the midgut in 3 (1 ileum, 2 coecum), and in the hindgut in 2 (1 colon, 1 rectum) patients. The primary tumor was unknown in 2 patients. No patient had clinical signs of hormone hypersecretion. NEC were low-grade malignant in 8 and high grade malignant in the remaining 8 cases. The ki67-index was ≥ 10% in 13 cases (81.3%). Results: A mean of 7.25 cycles (range 1–19) of FOLFOX-4 were administered. Stable disease for a minimum of 9 weeks was observed in 62.5% (10/16) for a mean duration of 19.4 weeks; overall mean time to progression (TTP) as measured by imaging studies was 17.8 weeks (range 2–70 weeks). Reasons for discontinuation of treatment included documented tumor progression in 8 cases (50%) and adverse events in 4 cases (25%) (grade II neurotoxicitiy in 3 cases and grade III neutropenia in 2 cases). 2 patients died during treatment due to tumor progression. 4 patients currently still receive FOLFOX-4 after a mean treatment period of 16 weeks. Side effects according to CTC-NCI-criteria include mild anemia (grade I: n=15), thrombocytopenia (I: n=4, II: n=1), neutropenia (I: n=1, III: n=2), increased serum creatinine (I: n=2), nausea (I: n=4, II: n=4, III: n=1), vomiting (I: n=2, II: n=2), and neurotoxicity (I: n=1, II: n=4). Conclusions: The FOLFOX-4 regimen was well tolerated and effective in progressive malignant NEC with increased proliferative potential. Response may be comparable to current standard regimens. FOLFOX-4 should be evaluated in a prospective controlled clinical trial. No significant financial relationships to disclose.

Download Full-text

Prognostic value of somatosensory evoked potentials, neuron-specific enolase, and S100 for short-term outcome in ischemic stroke

Journal of Neurophysiology ◽

10.1152/jn.01012.2015 ◽

2016 ◽

Vol 115 (3) ◽

pp. 1273-1278 ◽

Cited By ~ 11

Author(s):

Walter F. Haupt ◽

Ghesal Chopan ◽

Jan Sobesky ◽

Wei-Chi Liu ◽

Christian Dohmen

Keyword(s):

Ischemic Stroke ◽

Evoked Potentials ◽

Somatosensory Evoked Potentials ◽

Biochemical Markers ◽

S100 Protein ◽

Neuron Specific Enolase ◽

Short Term ◽

Term Outcome ◽

Poor Outcome ◽

Short Term Outcome

To predict short-term outcome in acute ischemic stroke, we analyzed somatosensory evoked potentials (SEP) and biochemical parameters [neuron-specific enolase (NSE) and S100 protein] in a prospective study with serial measurement. In 31 patients with 1st middle cerebral artery infarction, serum NSE and S100 protein were measured daily between days 1 and 6 poststroke. The N20 and N70 components of the SEP (SEP20 and SEP70) were determined on days 1 and 6. SEP and biochemical markers in stroke patients were compared with a control group. Short-term outcome was assessed by the modified Rankin Scale (mRS) at days 7-10 and was dichotomized between good (mRS 0–2) and poor (mRS ≥3) outcome. Specificity and positive predictive value (PPV) were high at day 1 for SEP (SEP20: 100% for both; SEP70: 93 and 88%, respectively) compared with lower values for NSE (67 and 50%) and S100 (23 and 57%). In contrast, S100 showed the highest sensitivity at day 1 with 77% compared with a relatively low sensitivity of NSE (31%) and SEP (SEP20: 35%, SEP70: 47%). The biochemical markers showed an improving sensitivity over time with best values (>90%) between days 3 and 4 at the expense of a lower specificity. Specificity and PPV of SEP on day 6 was still 100% with sensitivity increasing up to 53% (SEP20) and 60% (SEP70). SEP could early differentiate between good and poor outcome and reliably predict poor outcome. Since biochemical markers and SEP complement each other in the prognosis of stroke, a combined application of these markers seems promising.

Download Full-text

Evaluation of Serotonin and Hystamine Exchange in Women with Premature Birth in Different Terms of Gestation

Galician Medical Journal ◽

10.21802/gmj.2018.2.9 ◽

2018 ◽

Vol 25 (2) ◽

Author(s):

Sergey Korovay

Keyword(s):

Pregnant Women ◽

Biogenic Amine ◽

Preterm Labor ◽

Late Onset ◽

Clinical Signs ◽

Enzyme Inactivation ◽

Serotoninergic System ◽

Histamine Concentration ◽

Biogenic Monoamines ◽

Daily Urine

In modern obstetrics and gynecology, the problem of preterm labor is considered one of the most urgent.A significant number of factors affects on the run of pregnancy and it`s result, it`s activity is realized through numerical metabolic interactions, where an important role is given to biogenic monoamines, in particular serotonin and histamine.The aim of the study - to study the features of serotonin and histamine exchange in women`s body with different periods of abortion by determining in the blood the content of biogenic amines level of excretion with daily urine of serotonin 5-oxyindoloacetic acid and activity in the blood serum of the enzyme inactivation of histamine - histaminase.Material and methods of research – there were examined 227 pregnant women, 190 of these had clinical signs of the threat of preterm delivery in the gestation period of 23-36 weeks in the form of premature and timely childbirth.Women with early premature pregnancy, which ended with childbirth in the period from 23 to 27 weeks have a depletion of the functional activity of the serotonergic system.In women with late onset of pregnancy, there is an increasing of the serotoninergic system`s functional state, is probably with inhibition purpose of excessive excitement of stress-implementing systems. In women with a physiological course of pregnancy indicating an increasing of the histamine-histamine system activity with signs of a balance between the synthesis of biogenic amine and its inactivation. In women with early onset of pregnancy the inferiority of the blood system "histamine-histamine" develops, which is confirmed by a significant increasing of biogenic monoamine and reduction in the activity of the enzyme inactivation. In women with onset of pregnancy, there is a probable increasing of the histamine concentration in the blood indicating some exhaustion of "histamine-histaminase" systems with predominance signs of biogenic amine synthesis over its inactivation.Revealed changes in the state of serotonin and histamine in pregnant women indicate the violation of the adaptation mechanisms and the promoting possibility of the preterm labor development.

Download Full-text

Laparoscopic pancreatectomy for benign or low-grade malignant pancreatic tumors: outcomes in a single high-volume institution

BMC Surgery ◽

10.1186/s12893-021-01414-w ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

He Cai ◽

Lu Feng ◽

Bing Peng

Keyword(s):

Surgical Techniques ◽

Operation Time ◽

High Volume ◽

Long Term Results ◽

Pancreatic Tumors ◽

Low Grade ◽

Central Pancreatectomy ◽

Laparoscopic Pancreatectomy ◽

Spleen Preserving

Abstract Objective To investigate the perioperative and long-term outcomes of laparoscopic pancreatectomy for benign and low-grade malignant pancreatic tumors, and further compare the outcomes between different surgical techniques. Methods We retrospectively collected clinical data of consecutive patients with benign or low-grade malignant pancreatic tumors underwent surgery from February 2014 to February 2019. Patients were grouped and compared according to different surgical operations they accepted. Results Totally 164 patients were reviewed and 83 patients underwent laparoscopic pylorus-preserving pancreaticoduodenectomy (LPPPD), 41 patients underwent laparoscopic spleen-preserving distal pancreatectomy (LSPDP) and 20 patients underwent laparoscopic central pancreatectomy (LCP) were included in this study, the rest 20 patients underwent laparoscopic enucleation were excluded. There were 53 male patients and 91 female patients. The median age of these patients was 53.0 years (IQR 39.3–63.0 years). The median BMI was 21.5 kg/m2 (IQR 19.7–24.0 kg/m2). The postoperative severe complication was 4.2% and the 90-days mortality was 0. Compare with LCP group, the LPPPD and LSPDP group had longer operation time (300.4 ± 89.7 vs. 197.5 ± 30.5 min, P < 0.001) while LSPDP group had shorter operation time (174.8 ± 46.4 vs. 197.5 ± 30.5 min, P = 0.027), more blood loss [140.0 (50.0–1000.0) vs. 50.0 (20.0–200.0) ml P < 0.001 and 100.0 (20.0–300.0) vs. 50.0 (20.0–200.0 ml, P = 0.039, respectively), lower rate of clinically relevant postoperative pancreatic fistula [3 (3.6%) vs. 8 (40.0%), P < 0.001 and 3 (7.3%) vs. 8 (40.0%), P = 0.006, respectively], lower rate of postpancreatectomy hemorrhage [0 (0%) vs. 2 (10.0%), P = 0.036 and (0%) vs. 2 (10.0%) P = 0.104, respectively] and lower rate of postoperative severe complications [2 (2.4%) vs.4 (20.0%), P = 0.012 and 0 (0%) vs. 4 (20.0%), P = 0.009, respectively], higher proportion of postoperative pancreatin and insulin treatment (pancreatin: 39.8% vs., 15% P = 0.037 and 24.4%vs. 15%, P = 0.390; insulin: 0 vs. 18.1%, P = 0.040 and 0 vs. 12.2%, P = 0.041). Conclusions Overall, laparoscopic pancreatectomy could be safely performed for benign and low-grade malignant pancreatic tumors while the decision to perform laparoscopic central pancreatectomy should be made carefully for fit patients who can sustain a significant postoperative morbidity and could benefit from the excellent long-term results even in a high-volume center.

Download Full-text