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Borgo Maggiore, San Marino

Zanini N.,Maggiore Hospital | Lombardi R.,Maggiore Hospital | Masetti M.,Maggiore Hospital | Giordano M.,San Marino State Hospital | And 2 more authors.
Updates in Surgery | Year: 2015

The resection of liver metastases from pancreatic ductal adenocarcinoma has been discouraged because it is commonly thought that it does not improve survival. However, the role of potential prognostic factors is unclear, and universally accepted strategies have not been proposed. Between 2003 and 2014, 15 patients with isolated synchronous or metachronous metastases from pancreatic cancer underwent liver resection in our department. The role of potential prognostic factors was analyzed to predict survival. One right hepatectomy, 1 bisegmentectomy and 13 wedge resections were performed. Eleven patients underwent simultaneous pancreatic and liver resection for synchronous disease. The median overall survival (OS) was 9.1 months (95 % CI 8.6–9.7). The only potential prognostic factor that significatively affected survival was the timing of metastases (metachronous vs. synchronous). Median OS in patients with metachronous disease was 11.4 months (95 % CI 0–25.1) vs. 8.3 months (95 % CI 6.9–9.7), p = 0.038. Surgery for liver metastases from pancreatic cancer is not suggested for most patients. If resection is considered, timing of metastatic disease could be a prognostic factor for survival after surgery. © 2015, Italian Society of Surgery (SIC). Source


Zanini N.,San Marino State Hospital | Giordano M.,San Marino State Hospital | Smerieri E.,San Marino State Hospital | Cipolla D'Abruzzo G.,San Marino State Hospital | And 10 more authors.
Pancreatology | Year: 2015

Background There has been a dramatic increase in the number of pancreatic cystic lesions observed in the past two decades but data regarding the prevalence of cysts in the general population are lacking. Methods All the individuals who undergo CT at the San Marino State Hospital are residents of the Republic of San Marino; their demographic distribution is available and precise. CT scans carried out over 1 year at the State Hospital were reviewed for asymptomatic pancreatic cysts. Results 1061 relevant CT scans were carried out on 814 patients; 762 individuals were eligible for the study and 650 patients underwent contrast-enhanced CT. Thirty-five patients had at least one cyst at contrast-enhanced CT (5.4%). The prevalence of cysts increased with increasing age up to 13.4% (95% CI 6.6-20) in individuals 80-89 years of age (p <.001). Cyst prevalence was significantly higher in patients who underwent CT for malignancy (p =.038) but this difference was no longer significant in multivariate analysis. The odds of a cyst being present increased by 1.05 (95% CI 1.02-1.09) for each increasing year of age (p =.002). Approximately a quarter of the patients with cysts died within 1 year after CT from non pancreas-related disease. The estimated standardized age-adjusted cyst prevalence is 2194 per 100,000 people. Conclusions The likelihood of having a pancreatic cyst correlates with increasing age, not with the presence of extra-pancreatic malignancies. The estimated prevalence of CT-detectable asymptomatic pancreatic cysts in the general population is 2.2%. © 2015, IAP and EPC. Published by Elsevier India, a division of Reed Elsevier India Pvt. Ltd. All rights reserved. Source

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