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Choi S.H.,Yonsei University | Hwang H.K.,Yonsei University | Hwang H.K.,Young Yonsei Pancreatic Tumor Study Group | Kang C.M.,Yonsei University | And 2 more authors.
Journal of the Pancreas | Year: 2010

Context Mucinous cystic tumors occur almost exclusively in middle-aged women and in the body or tail of the pancreas. Mucinous cystadenocarcinoma, a malignant sub-type of mucinous cystic tumors, in the head of the pancreas and in a middle-aged man is extraordinary, and the prognosis and proper management of mucinous cystadenocarcinoma has not been well documented. Case report A 52-year-old male patient with a mucinous cystadenocarcinoma approximately 5.5 cm in size in the head of the pancreas underwent a total pancreaticoduodenectomy and segmental resection of the superior mesenteric vein-portal vein confluence with an autologous splenic vein graft due to tumor invasion. His postoperative course was uneventful and he received adjuvant chemotherapy. He has been followed-up periodically for more than 30 months after surgery without evidence of recurrence. Conclusion Mucinous cystadenocarcinoma in the head of the pancreas in a middle-aged man is an extremely rare case. Because mucinous cystadenocarcinomas have a relatively good prognosis, an aggressive approach with major vascular resection is warranted in well-selected patients. Splenic vein interposition grafting could be used in cases which undergo total pancreaticoduodenectomy with segmental resection of the superior mesenteric vein-portal vein confluence if the splenic vein is healthy. Source


Hwang H.K.,Yonsei University | Hwang H.K.,Young Yonsei Pancreatic Tumor Study Group | Kim H.,Yonsei University | Kim H.,Young Yonsei Pancreatic Tumor Study Group | And 3 more authors.
Surgical Endoscopy and Other Interventional Techniques | Year: 2012

Background Patients who are diagnosed with symptomatic or ambiguous serous cyst adenoma (SCA) need surgery. The purpose of this study is to suggest a potential management plan based on analysis of surgically treated SCAs. Methods Between August 1995 and December 2010, 38 patients with SCA were surgically treated. Data were analyzed retrospectively. Results Among 38 patients, 28 were female and ten were male. Mean age was 49.6 ± 14.1 years, and five patients (13.2%) were older than 65 years. Among the five patients, two were more than 70 years old. Seventeen patients (44.7%) were symptomatic, and the rest (21, 55.3%) were incidentally found to have SCA. Twenty-seven patients underwent open pancreatectomy, and 11 patients received laparoscopic distal pancreatectomy. Mean tumor size was 4.4 ± 2.8 cm. Most asymptomatic patients of SCA had a left-sided pancreatic tumor and distal pancreatectomy with or without splenectomy were frequently performed with short operative time and less blood transfusion (P\0.05). Minimally invasive surgery was mostly applied to leftsided tumors less than 5 cm in size (11/19 vs. 0/6, P = 0.029). Combined resection of the right colon was performed in two patients (5.3%) due to severe adhesion associated with large tumors. Significant association was noted between age and tumor size in asymptomatic patients (correlation coefficient = 0.541, R 2 = 0.293, P = 0.014). Postoperative pancreatic fistula was observed in five patients (13.2%, grade B) but could be managed conservatively. No mortality was found. Conclusion Before SCA causes symptoms or grows larger than 5 cm, an active surgical approach, such as minimally invasive surgery, needs to be considered. © The Author(s) 2011. Source


Choi S.H.,Yonsei University | Choi S.H.,Young Yonsei Pancreatic Tumor Study Group | Hwang H.K.,Yonsei University | Hwang H.K.,Young Yonsei Pancreatic Tumor Study Group | And 4 more authors.
Surgical Endoscopy and Other Interventional Techniques | Year: 2012

Background: Total pancreatectomy is recommended for intraductal papillary mucinous tumors with widespread involvement of the entire pancreas. Organ-preserving and minimally invasive surgery should be applied in benign and borderline pancreatic lesions. Methods: Pylorus- and spleen-preserving total pancreatoduodenectomy (PpSpTPD) with segmental resection of both splenic vessels was attempted for five patients. The technique was based on the concepts of two surgical procedures: pylorus-preserving pancreatoduodenectomy and distal pancreatectomy with segmental resection of splenic vessels ("extended" Warshaw's procedure). Results: Three patients underwent laparoscopic-assisted PpSpTPD and two underwent open surgery. No mortality was noted. Short-term follow-up (median, 28 months) suggested that all patients tolerated the insulin therapy and showed relatively good nutritional status. Only minimal to moderate perigastric fundal varices were noted without gastrointestinal bleeding. Conclusions: PpSpTPD with segmental resection of both splenic vessels is feasible and safe. Even a minimally invasive approach can be indicated in selected patients. © Springer Science+Business Media, LLC 2012. Source


Choi S.H.,Yonsei University | Choi S.H.,Young Yonsei Pancreatic Tumor Study Group | Hwang H.K.,Yonsei University | Hwang H.K.,Young Yonsei Pancreatic Tumor Study Group | And 3 more authors.
ANZ Journal of Surgery | Year: 2012

Background: Single-incision laparoscopic cholecystectomy (LC) is still technically demanding and usually requires specially designed instruments. This article describes our own technique, a single-fulcrum LC using only standard ports and instruments. Methods: Between March 2009 and December 2010, 130 consecutive patients, all scheduled to undergo elective LC, underwent this single-fulcrum LC for benign gallbladder disease. Perioperative surgical outcomes were retrospectively evaluated. Results: One hundred and ten patients (84.6%) underwent successful single-fulcrum LC, and 20 patients (15.4%) were converted to conventional surgery (n= 18) or required additional trocars (n= 2) during the procedure because of umbilical hernia (n= 3), severe inflammation or adhesion (n= 9), impacted cystic duct stone (n= 3), anatomical anomaly (n= 3) and iatrogenic injury (n= 2). Two intraoperative complications (iatrogenic injury) were securely managed using additional trocars and there was no post-operative morbidity or mortality. This single-fulcrum LC could be performed with comparable cost to conventional LC, and the sequential operative time showed reasonable learning curve. Conclusion: Single-fulcrum LC is feasible, safe and quite reproducible. The surgical wound can be dramatically reduced at a similar cost to conventional LC. It may be an alternative procedure for most uncomplicated benign gallbladder disease. © 2012 The Authors. ANZ Journal of Surgery © 2012 Royal Australasian College of Surgeons. Source


Choi S.H.,Yonsei University | Choi S.H.,Young Yonsei Pancreatic Tumor Study Group | Choi J.J.,Yonsei University | Kang C.M.,Yonsei University | And 4 more authors.
Journal of the Pancreas | Year: 2012

Context Various anastomosis techniques have been introduced for the safe pancreaticoenterostomy. Objective In the present study, we developed an experimental animal model for simple pancreaticojejunostomy and evaluated the feasibility, safety, and efficacy of this technique. Animals Ten dogs were studied. Intervention The dogs underwent the simple approximation ("docking") method for pancreaticojejunostomy and were re-explored on the 30 th post-operative day. Main outcome measure After excision of the remnant pancreas with the jejunal segment of the pancreaticojejunostomy, the degrees of fibrosis in the remnant pancreas were analyzed according to the patency of the pancreaticojejunostomy. Results There were no mortalities and clinically significant complications. The patency of pancreaticojejunostomy remained in six cases and was obliterated in four cases. It was noted that obliterated pancreaticojejunostomy accompanied cases with more dilated pancreatic ducts (3.1±0.4 mm vs. 5.5±0.6 mm, P=0.008). The grade of pancreatic fibrosis was significantly correlated with the obliterated pancreaticojejunostomy (P=0.038) and the size change of the remnant pancreatic duct (P=0.040). Conclusions The suggested simple pancreaticojejunostomy method is easy and shows no evidence of significant pancreatic fistula. However, the potential risk of dysfunction in the remnant pancreas limits its possible clinical applications. The meticulous duct-to-mucosa pancreaticojejunostomy is highly preferred to manage the remnant pancreas following pancreaticoduodenectomy. Source

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