Dvylikapirštę žarną išsauganti kasos rezekcija Frey būdu yra standartinė operacija gydant sergančiuosius komplikuotu lėtiniu pankreatitu. Kasos ir plonosios žarnos jungtis įprastai atliekama dviejų aukštų siūlėmis. Disertacinio darbo tikslas – palyginti Frey operacijos, naudojant vieno arba dviejų aukštų kasos – tuščiosios žarnos siūlę, rezultatatus, taip pat įvertinti operuotų pacientų gyvenimo kokybės pokyčius, praėjus 12 mėn. po operacijos. Perspektyviniame atsitiktinių imčių klinikiniame tyrime dalyvavo aštuoniasdešimt pacientų. Tiriamieji prieš operaciją atsitiktine tvarka suskirstyti į dvi grupes: pirmos grupės pacientams atlikta operacija, formuojant kasos – tuščiosios žarnos jungtį vieno aukšto ištisine siūle; antros grupės pacientams, kasos – tuščiosios žarnos jungtis suformuota dviejų aukštų pavienėmis siūlėmis. Tyrime nustatėme, kad bendras operacijos laikas (208±46 min ir 255±58 min), bei pankreojejunoanastomozės siuvimo laikas (19±6 min. ir 51±18 min.) buvo statistiškai reikšmingai mažesnis „vieno aušto siūlės“ grupėje nei „dviejų aukštų pavienių siūlių“ grupėje. Pooperacinės komplikacijos, kasos fistulės dažnis, pooperacinė hospitalizavimo trukmė abiejose grupėse nesiskyrė. Vertinant gyvenimo kokybės pokyčius, praėjus 12 mėn. po operacijos, nustatytas statistiškai reikšmingas gyvenimo kokybės pagerėjimas abiejose pacientų grupėse. / The duodenum-preserving pancreatic resection according to Frey is a standard operation for patients with complicated chronic pancreatitis. The pancreatojejunostomy is usually performed using two layer suture. The aim of doctoral dissertation was to compare single- and two-layer suture in pancreatojejunostomy performed in duodenum-preserving pancreatic resection according to Frey modification and to assess the changes of the quality of life 12 months after operation. A total of 80 patients were enrolled in the prospective randomized clinical. They were randomly allocated into two groups. In the first group of patients, pancreatojejunostomy was constructed by using single-layer continuous suture. In the second group of patients, pancreatojejunostomy was constructed by using two-layer interrupted suture. Overall time of the operation (208 ± 46 min. and 255 ± 58 min.) and the suturing time (19 ± 6 min. and 51 ± 18 min.) were significantly shorter in the single layer anastomosis group. Postoperative complications, the prevalence of pancreatic fistula, the length of stay did not differ in both groups. There was a statistically significant improvement of the quality of life 12 months after operation in the both groups of patients.

The duodenum-preserving pancreatic resection according to Frey is a standard operation for patients with complicated chronic pancreatitis. The pancreatojejunostomy is usually performed using two layer suture. The aim of doctoral dissertation was to compare single- and two-layer suture in pancreatojejunostomy performed in duodenum-preserving pancreatic resection according to Frey modification and to assess the changes of the quality of life 12 months after operation. A total of 80 patients were enrolled in the prospective randomized clinical. They were randomly allocated into two groups. In the first group of patients, pancreatojejunostomy was constructed by using single-layer continuous suture. In the second group of patients, pancreatojejunostomy was constructed by using two-layer interrupted suture. Overall time of the operation (208 ± 46 min. and 255 ± 58 min.) and the suturing time (19 ± 6 min. and 51 ± 18 min.) were significantly shorter in the single layer anastomosis group. Postoperative complications, the prevalence of pancreatic fistula, the length of stay did not differ in both groups. There was a statistically significant improvement of the quality of life 12 months after operation in the both groups of patients. / Dvylikapirštę žarną išsauganti kasos rezekcija Frey būdu yra standartinė operacija gydant sergančiuosius komplikuotu lėtiniu pankreatitu. Kasos ir plonosios žarnos jungtis įprastai atliekama dviejų aukštų siūlėmis. Disertacinio darbo tikslas – palyginti Frey operacijos, naudojant vieno arba dviejų aukštų kasos – tuščiosios žarnos siūlę, rezultatatus, taip pat įvertinti operuotų pacientų gyvenimo kokybės pokyčius, praėjus 12 mėn. po operacijos. Perspektyviniame atsitiktinių imčių klinikiniame tyrime dalyvavo aštuoniasdešimt pacientų. Tiriamieji prieš operaciją atsitiktine tvarka suskirstyti į dvi grupes: pirmos grupės pacientams atlikta operacija, formuojant kasos – tuščiosios žarnos jungtį vieno aukšto ištisine siūle; antros grupės pacientams, kasos – tuščiosios žarnos jungtis suformuota dviejų aukštų pavienėmis siūlėmis. Tyrime nustatėme, kad bendras operacijos laikas (208±46 min ir 255±58 min), bei pankreojejunoanastomozės siuvimo laikas (19±6 min. ir 51±18 min.) buvo statistiškai reikšmingai mažesnis „vieno aušto siūlės“ grupėje nei „dviejų aukštų pavienių siūlių“ grupėje. Pooperacinės komplikacijos, kasos fistulės dažnis, pooperacinė hospitalizavimo trukmė abiejose grupėse nesiskyrė. Vertinant gyvenimo kokybės pokyčius, praėjus 12 mėn. po operacijos, nustatytas statistiškai reikšmingas gyvenimo kokybės pagerėjimas abiejose pacientų grupėse.

Background: Pancreatic métastases from renal cell carcinoma (RCC) are clinically rare but highly resectable. The aim of this article is to identify patients who profit from pancreatic resection of RCC despite the invasiveness of the surgery. Methods: Between January 1996 and December 2007, data from 744 patients were collected in a prospective pancreatic surgery database, and patients with metastasis into the pancreas from RCC were identified. Results: Resective surgery was performed in 14 patients with metastasis to the pancreas from RCC. Most patients were clinically asymptomatic. The median interval between primary treatment of RCC and occurrence of pancreatic metastasis was 94 months (range 32–158). The morbidity rate was 42.8%. Patients with a metastasis size <2.5 cm had a much better survival after resection (100 months) than those with a metastasis size >2.5 cm (44 months). Moreover, the number of métastases predicts the survival after resection. Conclusions: In patients with pancreatic métastases from RCC who have only limited disease, complete resection of all lesions can be successfully performed with a low rate of complications. Thus, patients with a history of RCC should be monitored for more than 10 years after nephrectomy to detect recurrence. / Dieser Beitrag ist mit Zustimmung des Rechteinhabers aufgrund einer (DFG-geförderten) Allianz- bzw. Nationallizenz frei zugänglich.

Background: Pancreatic métastases from renal cell carcinoma (RCC) are clinically rare but highly resectable. The aim of this article is to identify patients who profit from pancreatic resection of RCC despite the invasiveness of the surgery. Methods: Between January 1996 and December 2007, data from 744 patients were collected in a prospective pancreatic surgery database, and patients with metastasis into the pancreas from RCC were identified. Results: Resective surgery was performed in 14 patients with metastasis to the pancreas from RCC. Most patients were clinically asymptomatic. The median interval between primary treatment of RCC and occurrence of pancreatic metastasis was 94 months (range 32–158). The morbidity rate was 42.8%. Patients with a metastasis size <2.5 cm had a much better survival after resection (100 months) than those with a metastasis size >2.5 cm (44 months). Moreover, the number of métastases predicts the survival after resection. Conclusions: In patients with pancreatic métastases from RCC who have only limited disease, complete resection of all lesions can be successfully performed with a low rate of complications. Thus, patients with a history of RCC should be monitored for more than 10 years after nephrectomy to detect recurrence. / Dieser Beitrag ist mit Zustimmung des Rechteinhabers aufgrund einer (DFG-geförderten) Allianz- bzw. Nationallizenz frei zugänglich.

Background Pancreatic heterotopia (PH) is defined as ectopic pancreatic tissue outside the normal pancreas and its vasculature and duct system. Most frequently, PH is detected incidentally by histopathological examination. The aim of the present study was to analyze a large single-center series of duodenal PH with respect to the clinical presentation. Methods A prospective pancreatic database was retrospectively analyzed for cases of PH of the duodenum. All pancreatic and duodenal resections performed between January 2000 and October 2015 were included and screened for histopathologically proven duodenal PH. PH was classified according to Heinrich’s classification (Type I acini, ducts, and islet cells; Type II acini and ducts; Type III only ducts). Results A total of 1274 pancreatic and duodenal resections were performed within the study period, and 67 cases of PH (5.3%) were identified. The respective patients were predominantly male (72%) and either underwent pancreatoduodenectomy (n = 60); a limited pancreas resection with partial duodenal resection (n = 4); distal pancreatectomy with partial duodenal resection (n = 1); total pancreatectomy (n = 1); or enucleation (n = 1). Whereas 65 patients (83.5%) were asymptomatic, 11 patients (18.4%) presented with symptoms related to PH (most frequently with abdominal pain [72%] and duodenal obstruction [55%]). Of those, seven patients (63.6%) had chronic pancreatitis in the heterotopic pancreas. The risk of malignant transformation into adenocarcinoma was 2.9%. Conclusions PH is found in approximately 5% of pancreatic or duodenal resections and is generally asymptomatic. Chronic pancreatitis is not uncommon in heterotopic pancreatic tissue, and even there is a risk of malignant transformation. PH should be considered for the differential diagnosis of duodenal lesions and surgery should be considered, especially in symptomatic cases.

Background Pancreatic heterotopia (PH) is defined as ectopic pancreatic tissue outside the normal pancreas and its vasculature and duct system. Most frequently, PH is detected incidentally by histopathological examination. The aim of the present study was to analyze a large single-center series of duodenal PH with respect to the clinical presentation. Methods A prospective pancreatic database was retrospectively analyzed for cases of PH of the duodenum. All pancreatic and duodenal resections performed between January 2000 and October 2015 were included and screened for histopathologically proven duodenal PH. PH was classified according to Heinrich’s classification (Type I acini, ducts, and islet cells; Type II acini and ducts; Type III only ducts). Results A total of 1274 pancreatic and duodenal resections were performed within the study period, and 67 cases of PH (5.3%) were identified. The respective patients were predominantly male (72%) and either underwent pancreatoduodenectomy (n = 60); a limited pancreas resection with partial duodenal resection (n = 4); distal pancreatectomy with partial duodenal resection (n = 1); total pancreatectomy (n = 1); or enucleation (n = 1). Whereas 65 patients (83.5%) were asymptomatic, 11 patients (18.4%) presented with symptoms related to PH (most frequently with abdominal pain [72%] and duodenal obstruction [55%]). Of those, seven patients (63.6%) had chronic pancreatitis in the heterotopic pancreas. The risk of malignant transformation into adenocarcinoma was 2.9%. Conclusions PH is found in approximately 5% of pancreatic or duodenal resections and is generally asymptomatic. Chronic pancreatitis is not uncommon in heterotopic pancreatic tissue, and even there is a risk of malignant transformation. PH should be considered for the differential diagnosis of duodenal lesions and surgery should be considered, especially in symptomatic cases.