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Traian Dumitrascu,Andra Scarlat,Mihnea Ionescu,Irinel Popescu 한국간담췌외과학회 2017 Annals of hepato-biliary-pancreatic surgery Vol.21 No.2
Backgrounds/Aims: Standard pancreatic resections are the current approach for patients with resectable, isolated pancreatic metastases of other neoplasms. However, the role of parenchyma-sparing pancreatectomies for such pathology is poorly investigated. The aim of the present study is to assess the oncological safety of central pancreatectomies for pancreatic metastases of other neoplasms. Methods: A literature search was performed in order to identify patients with central pancreatectomies for pancreatic metastases of other neoplasms. The available data of the patients were extracted and analyzed. Results: A total number of 16 patients were identified. Renal carcinoma was the primary origin for the largest number of these patients (11 patients - 69%). The mean overall survival time was 109 months, with 1-, 5- and 10-year survival rates of 100%, 84%, and 60%, respectively. Conclusions: Although not often performed, a central pancreatectomy appears to be an oncologically safe surgical procedure in select patients with pancreatic metastases of other neoplasms of the pancreatic body and isthmus. However, no definitive conclusions should be drawn, based on the data provided in the present study, due to the limited number and heterogeneity of the patients.
Martiniuc, Alexandru,Dumitrascu, Traian,Ionescu, Mihnea,Tudor, Stefan,Lacatus, Monica,Herlea, Vlad,Vasilescu, Catalin The Korean Gastric Cancer Association 2021 Journal of gastric cancer Vol.21 No.1
Purpose: Incidence, risk factors, and clinical consequences of pancreatic fistula (POPF) after D1+/D2 radical gastrectomy have not been well investigated in Western patients, particularly those from Eastern Europe. Materials and Methods: A total of 358 D1+/D2 radical gastrectomies were performed by surgeons with high caseloads in a single surgical center from 2002 to 2017. A retrospective analysis of data that were prospectively gathered in an electronic database was performed. POPF was defined and graded according to the International Study Group for Pancreatic Surgery (ISGPS) criteria. Uni- and multivariate analyses were performed to identify potential predictors of POPF. Additionally, the impact of POPF on early complications and long-term outcomes were investigated. Results: POPF was observed in 20 patients (5.6%), according to the updated ISGPS grading system. Cardiovascular comorbidities emerged as the single independent predictor of POPF formation (risk ratio, 3.051; 95% confidence interval, 1.161-8.019; P=0.024). POPF occurrence was associated with statistically significant increased rates of postoperative hemorrhage requiring re-laparotomy (P=0.029), anastomotic leak (P=0.002), 90-day mortality (P=0.036), and prolonged hospital stay (P<0.001). The long-term survival of patients with gastric adenocarcinoma was not affected by POPF (P=0.661). Conclusions: In this large series of Eastern European patients, the clinically relevant rate of POPF after D1+/D2 radical gastrectomy was low. The presence of co-existing cardiovascular disease favored the occurrence of POPF and was associated with an increased risk of postoperative bleeding, anastomotic leak, 90-day mortality, and prolonged hospital stay. POPF was not found to affect the long-term survival of patients with gastric adenocarcinoma.
Pseudoaneurysm of the splenic artery
Radu Dumitru,Ana Carbunaru,Mugur Grasu,Mihai Toma,Mihnea Ionescu,Traian Dumitrascu 한국간담췌외과학회 2016 Annals of hepato-biliary-pancreatic surgery Vol.20 No.4
Delayed post-pancreatectomy hemorrhage (PPH) is a relatively uncommon, but feared, complication after pancreaticoduodenectomy (PD). A splenic artery pseudoaneurysm is a rare cause of delayed PPH after a PD. This paper describes the case of a patient with PD used to treat a distal bile duct cholangiocarcinoma complicated with a clinically significant pancreatic fistula and secondary intraabdominal abscess. Computed tomography-guided drainage of the abscess was performed with an apparently favourable outcome; the patient was discharged on postoperative day (POD) 35 and the abdominal drains were removed on POD 50. On POD 80, the patient was readmitted for a severe digestive hemorrhage. Computed tomography revealed a pseudoaneurysm of the splenic artery with a subsequent hematoma formation. Immediately, an angiography was performed and coils were successfully mounted. This case illustrates the rare possibility of the development of a splenic artery pseudoaneurysm with severe delayed PPH after PD complicated with a clinically significant pancreatic fistula, even after the patient was discharged from the hospital. An interventional radiology approach represents the first treatment option in hemodynamically stable patients with high success rates.