26 results on '"Cheow PC"'
Search Results
2. Propensity-Score Matched Analyses Comparing Clinical Outcomes of Minimally Invasive Versus Open Distal Pancreatectomies: A Single-Center Experience.
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Raghupathy J, Lee CY, Huan SKW, Koh YX, Tan EK, Teo JY, Cheow PC, Ooi LLPJ, Chung AYF, Chan CY, and Goh BKP
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- Humans, Length of Stay, Pancreatectomy, Postoperative Complications epidemiology, Propensity Score, Retrospective Studies, Treatment Outcome, Laparoscopy, Pancreatic Neoplasms surgery
- Abstract
Background: Minimally invasive distal pancreatectomy (MIDP) is being adopted increasingly worldwide. This study aimed to compare the short-term outcomes of patients who underwent MIDP versus open distal pancreatectomy (ODP)., Methods: A retrospective review of all patients who underwent a DP in our institution between 2005 and 2019 was performed. Propensity score matching based on relevant baseline factors was used to match patients in the ODP and MIDP groups in a 1:1 manner. Outcomes reported include operative duration, blood loss, postoperative length of stay, morbidity, mortality, postoperative pancreatic fistula rates, reoperation and readmission., Results: In total, 444 patients were included in this study. Of 122 MIDP patients, 112 (91.8%) could be matched. After matching, the median operating time for MIDP was significantly longer than ODP [260 min (200-346.3) vs 180 (135-232.5), p < 0.001], while postoperative stay for MIDP was significantly shorter [median 6 days (5-8) versus 7 days (6-9), p = 0.015]. There were no significant differences noted in any of the other outcomes measured. Over time, we observed a decrease in the operation times of MIDP performed at our institution., Conclusion: Adoption of MIDP offers advantages over ODP in terms of a shorter postoperative hospital stay, without an increase in morbidity and/or mortality but at the expense of a longer operation time., (© 2021. Société Internationale de Chirurgie.)
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- 2022
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3. Resected pancreatic adenocarcinoma: An Asian institution's experience.
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Ng KYY, Chow EWX, Jiang B, Lim C, Goh BKP, Lee SY, Teo JY, Tan DMY, Cheow PC, Ooi LLPJ, Chow PKH, Lee JJX, Kam JH, Koh YX, Jeyaraj PR, Tan EK, Choo SP, Chan CY, Chung AYF, and Tai D
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- Adult, Aged, Aged, 80 and over, Carcinoma, Pancreatic Ductal pathology, Carcinoma, Pancreatic Ductal therapy, Combined Modality Therapy, Female, Follow-Up Studies, Humans, Male, Middle Aged, Neoplasm Recurrence, Local pathology, Neoplasm Recurrence, Local therapy, Pancreatic Neoplasms pathology, Pancreatic Neoplasms therapy, Prognosis, Retrospective Studies, Singapore, Survival Rate, Antineoplastic Combined Chemotherapy Protocols therapeutic use, Carcinoma, Pancreatic Ductal mortality, Chemotherapy, Adjuvant mortality, Neoplasm Recurrence, Local mortality, Pancreatectomy mortality, Pancreatic Neoplasms mortality
- Abstract
Background: Pancreatic adenocarcinoma (PDAC) is highly lethal. Surgery offers the only chance of cure, but 5-year overall survival (OS) after surgical resection and adjuvant therapy remains dismal. Adjuvant trials were mostly conducted in the West enrolling fit patients. Applicability to a general population, especially Asia has not been described adequately., Aim: We aimed to evaluate the clinical outcomes, prognostic factors of survival, pattern, and timing of recurrence after curative resection in an Asian institution., Methods and Results: The clinicopathologic and survival outcomes of 165 PDAC patients who underwent curative resection between 1998 and 2013 were reviewed retrospectively. Median age at surgery was 62.0 years. 55.2% were male, and 73.3% had tumors involving the head of pancreas. The median OS of the entire cohort was 19.7 months. Median OS of patients who received adjuvant chemotherapy was 23.8 months. Negative predictors of survival include lymph node ratio (LNR) of >0.3 (HR = 3.36, P = .001), tumor site involving the body or tail of pancreas (HR = 1.59, P = .046), presence of perineural invasion (PNI) (HR = 2.36, P = .018) and poorly differentiated/undifferentiated tumor grade (HR = 1.86, P = .058). The median time to recurrence was 8.87 months, with 66.1% and 81.2% of patients developing recurrence at 12 months and 24 months respectively. The most common site of recurrence was the liver., Conclusion: The survival of Asian patients with resected PDAC who received adjuvant chemotherapy is comparable to reported randomized trials. Clinical characteristics seem similar to Western patients. Hence, geographical locations may not be a necessary stratification factor in RCTs. Conversely, lymph node ratio and status of PNI ought to be incorporated., (© 2021 The Authors. Cancer Reports published by Wiley Periodicals LLC.)
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- 2021
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4. Use of Reinforced Staplers Decreases the Rate of Postoperative Pancreatic Fistula Compared to Bare Staplers After Minimally Invasive Distal Pancreatectomies.
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Goh BKP, Lee CY, Koh YX, Teo JY, Kam JH, Cheow PC, Chung AYF, Chan CY, and Lee SY
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- Humans, Pancreas surgery, Pancreatic Fistula epidemiology, Pancreatic Fistula etiology, Pancreatic Fistula prevention & control, Postoperative Complications epidemiology, Postoperative Complications prevention & control, Retrospective Studies, Pancreatectomy adverse effects, Pancreatic Neoplasms surgery
- Abstract
Background: Postoperative pancreatic fistula (POPF) is the most common and important cause of morbidity after distal pancreatectomy. Various transection and closure techniques of the pancreatic stump have been proposed with no robust evidence unanimously supporting one technique over the other. This study aims to compare the outcomes of minimally invasive distal pancreatectomy (MIDP) performed with reinforced stapler (RS) versus bare stapler (BS) with particular attention to the POPF. Methods: Retrospective review of 90 consecutive elective MIDP performed at a single institution between 2014 and 2019 was performed. The primary outcome was POPF as defined by the latest International Study Group of Pancreatic Fistula classification. MIDP with RS was adopted by two surgeons who subsequently performed all their consecutive surgeries with RS. Results: There were 25 and 65 patients who underwent MIDP with RS and BS, respectively. There were 8 (8.9%) open conversions and 17 (18.9%) patients experienced a POPF. Patients who underwent MIDP with RS had a significantly lower POPF rate (4% versus 24.6%, P = .025), lower major (>grade 2) morbidity rate (4% versus 21.5%, P = .046), and lower readmission rate (4% versus 27.7%, P = .014). On multivariate analysis, only the use of BS and obesity (body mass index ≥27.5) was independently associated with the development of a POPF. Conclusion: MIDP performed with RS was associated with a significantly lower rate of POPF, major morbidity, and readmissions compared to BS. The use of RS was protective against POPF.
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- 2021
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5. Validation of the clinical utility of 4 guidelines in the initial triage of mucinous cystic lesions of the pancreas based on cross-sectional imaging: Experience with 188 surgically-treated patients.
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Park RHS, Lim GRS, Wu JJY, Koh YX, Teo JY, Cheow PC, Chan CY, Ooi LLPJ, Chung AYF, and Goh BKP
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- Adenocarcinoma, Mucinous diagnostic imaging, Adenocarcinoma, Mucinous physiopathology, Adenocarcinoma, Mucinous surgery, Adult, Aged, Aged, 80 and over, Biopsy, Fine-Needle, Dilatation, Pathologic, Female, Humans, Jaundice, Obstructive physiopathology, Lymphadenopathy diagnostic imaging, Male, Middle Aged, Neoplasms, Cystic, Mucinous, and Serous diagnostic imaging, Neoplasms, Cystic, Mucinous, and Serous pathology, Neoplasms, Cystic, Mucinous, and Serous physiopathology, Neoplasms, Cystic, Mucinous, and Serous surgery, Pancreatic Intraductal Neoplasms diagnostic imaging, Pancreatic Intraductal Neoplasms physiopathology, Pancreatic Intraductal Neoplasms surgery, Pancreatic Neoplasms diagnostic imaging, Pancreatic Neoplasms physiopathology, Pancreatic Neoplasms surgery, Pancreatitis physiopathology, Retrospective Studies, Risk Assessment, Triage, Tumor Burden, Young Adult, Adenocarcinoma, Mucinous pathology, CA-19-9 Antigen metabolism, Pancreatic Ducts diagnostic imaging, Pancreatic Intraductal Neoplasms pathology, Pancreatic Neoplasms pathology
- Abstract
Introduction: Over the years, several guidelines have been introduced to guide management of mucinous pancreatic cystic neoplasms (mPCN). In this study, we aimed to evaluate and compare the clinically utility of the Sendai-06, Fukuoka-12, Fukuoka-17 and European-18 guidelines in predicting malignancy of mPCN., Methods: One hundred and eighty-eight patients with mucinous cystic neoplasms (MCN) or intraductal papillary mucinous neoplasm (IPMN) who underwent surgery were retrospectively reviewed and classified under the 4 guidelines. Malignancy was defined as high grade dysplasia and invasive carcinoma., Results: Raised CA19-9>37U/ml, enhancing mural nodule≥5 mm and main pancreatic duct≥10 mm were significantly associated with malignancy on multivariate analysis. Increasing number of high risk features, absolute indications (European-18), worrisome risk or relative indications (European-18) were significantly associated with an increased likelihood of malignancy. The positive predictive values (PPV) of high risk features for Sendai-06, Fukuoka-12, Fukuoka-17 and absolute indications (European-18) for malignancy were 53%, 76%, 78% and 78% respectively. The negative predictive values (NPV) of the Sendai-06, Fukuoka-12 and Fukuoka-17 were 100%, while that of the European-18 was 92%. Risk of malignancy for patients with ≥4 worrisome features (Fukuoka-17) and ≥3 relative indications (European-18) was 66.7% and 75.0% respectively., Conclusions: All 4 guidelines studied were useful in the initial triage of mPCN for the risk stratification of malignancy. The Fukuoka-17 had the highest PPV and NPV., Competing Interests: Declaration of competing interest None., (Copyright © 2020 Elsevier Ltd, BASO ~ The Association for Cancer Surgery, and the European Society of Surgical Oncology. All rights reserved.)
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- 2020
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6. Minimally Invasive Versus Open Pancreatectomies for Pancreatic Neuroendocrine Neoplasms: A Propensity-Score-Matched Study.
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Tan HL, Teo RYA, Syn NL, Teo JY, Lee SY, Cheow PC, Chow PKH, Chung AYF, Ooi LLPJ, Chan CY, and Goh BKP
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- Aged, Disease-Free Survival, Female, Humans, Male, Middle Aged, Operative Time, Retrospective Studies, Laparoscopy methods, Laparotomy methods, Pancreatectomy methods, Pancreatic Neoplasms surgery, Propensity Score
- Abstract
Background: Pancreatic neuroendocrine neoplasms (PNENs) are increasingly prevalent with modern imaging, and surgical excision remains mainstay of treatment. This study aims to perform a propensity-score-matched (PSM) comparison of perioperative and oncologic outcomes following minimally invasive pancreatectomy (MIP) versus open pancreatectomy (OP) for PNEN., Methods: A retrospective review was performed on patients who underwent curative-intent surgery for PNEN at Singapore General Hospital from 1997 to 2018. A 1:1 PSM was performed between MIP and OP, after which both groups were balanced for baseline variables., Results: We studied 134 patients who underwent surgery (36 MIP and 98 OP) for PNEN. Propensity-score-matched comparison between 35 MIP and 35 OP patients revealed that the MIP group had a longer operating time (MD = 75.0, 95% CI 15.2 to 134.8, P = 0.015), lower intraoperative blood loss (MD = - 400.0, 95% CI - 630.5 to - 169.5, P = 0.001), shorter median postoperative stay (MD = - 1.0, 95% CI - 1.9 to - 0.1, P = 0.029) and shorter median time to diet (MD = - 1.0, 95% CI - 1.9 to - 0.1, P = 0.039). There were no differences between both groups for short-term adverse outcomes and oncologic clearance. Overall survival (HR = 0.84, 95% CI 0.28 to 2.51, P = 0.761) and disease-free survival (HR = 0.57, 95% CI 0.20 to 1.64, P = 0.296) were comparable., Conclusion: MIP is a safe and feasible approach for PNEN and is associated with a lower intraoperative blood loss, decreased postoperative stay and time to oral intake, at the expense of a longer operative time compared to OP.
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- 2020
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7. External validation of the Japanese difficulty scoring system for minimally-invasive distal pancreatectomies.
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Goh BKP, Kabir T, Koh YX, Teo JY, Lee SY, Kam JH, Cheow PC, Jeyaraj PR, Chow PKH, Ooi LLPJ, Chung AYF, and Chan CY
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- Adult, Aged, Aged, 80 and over, Blood Loss, Surgical, Blood Transfusion, Female, Humans, Japan, Laparoscopy, Male, Middle Aged, Operative Time, Retrospective Studies, Robotic Surgical Procedures, Treatment Outcome, Young Adult, Minimally Invasive Surgical Procedures classification, Pancreatectomy classification, Pancreatic Neoplasms surgery
- Abstract
Introduction: Preoperative prediction of the difficulty of surgery would be useful for surgeons embarking on MIDP. A novel difficulty scoring system(DSS) was recently developed in Japan but has not been externally validated. This study aims to externally validate the DSS determine its association with important clinical outcome parameters., Methods: Retrospective review of 90 patients who underwent MIDP from 2006 to 2018. The patients were stratified into 3 groups (low, intermediate and high difficulty) according to the DSS with some minor modifications., Results: Difficulty of MIDP was classified as low in 45(50%), intermediate in 32(35.5%) and high in 13(14.4%). Comparison between the baseline characteristics across the 3 difficulty groups demonstrated a significant difference in the frequency of malignant tumors, larger tumor size, frequency of extended pancreatectomies and use of robotic assistance. There was statistically significant increase in operation time, blood loss and blood transfusion rate across the 3 groups from low to high difficulty., Conclusion: The DSS correlated significantly with operation time, blood loss and blood transfusion rate. These findings support the validity of the system., (Copyright © 2019 Elsevier Inc. All rights reserved.)
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- 2019
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8. Factors associated with and consequences of open conversion after laparoscopic distal pancreatectomy: initial experience at a single institution.
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Goh BKP, Chan CY, Lee SY, Chan WH, Cheow PC, Chow PKH, Ooi LLPJ, and Chung AYF
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- Adult, Aged, Blood Transfusion trends, Conversion to Open Surgery statistics & numerical data, Epidemiologic Factors, Hospital Mortality trends, Humans, Laparoscopy methods, Middle Aged, Pancreatic Fistula complications, Pancreatic Neoplasms mortality, Pancreatic Neoplasms pathology, Postoperative Complications mortality, Professionalism, Prospective Studies, Retrospective Studies, Robotic Surgical Procedures methods, Splenectomy statistics & numerical data, Treatment Outcome, Conversion to Open Surgery trends, Laparoscopy adverse effects, Pancreatectomy methods, Pancreatic Neoplasms surgery
- Abstract
Background: Laparoscopic distal pancreatectomy (LDP) is increasingly adopted today. This study aims to determine factors associated with and consequences of open conversion after LDP., Methods: Retrospective review of the first 40 consecutive LDP performed for pancreatic tumors from 2006 to 2015 was performed. Individual surgeon volume was stratified by ≤5 versus >5 cases and institution experience was stratified by two time periods 2006-2010 and 2011-2015., Results: Two high-volume surgeons performed 19 cases with an average case volume of ≥2/year whereas 10 low-volume surgeons performed 21 cases with an average case volume of <1/year. Median age of patients was 57.6 (range, 21-78) years. LDP was performed for malignancy in four (10%) patients. The median tumor size was 25 (range, 8-75) mm. Eight patients (20%) underwent subtotal pancreatectomies and seven (17.5%) had concomitant surgeries. Eleven (27.5%) LDP were spleen-saving procedures. Ten (25%) procedures were converted to open. Twenty-nine (72.5%) patients experienced 90-day/in-hospital morbidity of which eight (20%) were major (>grade II). There were 24 (60%) pancreatic fistulas of which 10 (25%) were grade B. Univariate analyses demonstrated that splenectomy (10 (34.5%) versus 0, P = 0.025), individual surgeon volume (<5 cases) (8 (38.1%) versus 2 (10.15%), P = 0.044) and institution experience (5 (55.6%) versus 5 (16.1%), P = 0.016) were factors associated with open conversion after LDP. Open conversion was associated with an increased rate of intra-operative blood transfusion (P = 0.053)., Conclusions: Splenectomy, institution experience and individual surgeon volume were the factors associated with open conversion after LDP., (© 2016 Royal Australasian College of Surgeons.)
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- 2017
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9. Validation and comparison between current prognostication systems for pancreatic neuroendocrine neoplasms: A single-institution experience with 176 patients.
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Teo R, Goh BKP, Tai DWM, Allen JC, Lim TKH, Hwang JSG, Tan DM, Lee SY, Chan CY, Cheow PC, Chow PKH, Ooi LLPJ, Chung AYF, and Ong S
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- Adult, Aged, Aged, 80 and over, Female, Humans, Male, Middle Aged, Neoplasm Grading, Neoplasm Staging, Neuroendocrine Tumors mortality, Pancreatic Neoplasms mortality, Prognosis, Reproducibility of Results, Retrospective Studies, Survival Rate, Neuroendocrine Tumors diagnosis, Neuroendocrine Tumors therapy, Pancreatic Neoplasms diagnosis, Pancreatic Neoplasms therapy
- Abstract
Background: This article aims to validate and compare the performance of 6 prognostication systems-the World Health Organization 2010 grading criteria, the European Neuroendocrine Tumour Society and the American Joint Committee for Cancer staging systems, the Memorial Sloan Kettering Cancer Center staging and grading systems, as well as the Bilimoria criteria in a cohort of patients with pancreatic neuroendocrine neoplasms at a single institution., Methods: A retrospective review of 176 patients with histologically proven pancreatic neuroendocrine neoplasm was performed. The prognostic ability of the various prognostication systems for pancreatic neuroendocrine neoplasm was assessed by analyzing the homogeneity, discriminatory ability, monotonicity of gradient, and Akaike information criteria., Results: The 5-year overall survival for the 176 patients was 69% and 5-year recurrence-free survival in 119 patients who underwent curative resection was 78%. Comparison between the 6 prognostication systems demonstrated that the World Health Organization 2010 system had the lowest Akaike information criteria score and was hence the best prognostication system in predicting overall survival and recurrence-free survival rates in our cohort of patients. The European Neuroendocrine Tumour Society was superior to the American Joint Committee for Cancer in prognosticating overall survival rates for pancreatic neuroendocrine neoplasms, as there was a statistically significant difference in overall survival across the different stages when stratified by the European Neuroendocrine Tumour Society, while the use of the American Joint Committee for Cancer was limited to distinguishing between patients in stages I and II versus stages III and IV only., Conclusion: All 6 prognostication systems were useful in the prognostication of pancreatic neuroendocrine neoplasm. The World Health Organization 2010 grading system was the best prognostication system in predicting both overall survival in our entire cohort of patients and recurrence-free survival in the subset of patients who underwent curative resection., (Copyright © 2016 Elsevier Inc. All rights reserved.)
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- 2017
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10. A comparison between robotic-assisted laparoscopic distal pancreatectomy versus laparoscopic distal pancreatectomy.
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Goh BK, Chan CY, Soh HL, Lee SY, Cheow PC, Chow PK, Ooi LL, and Chung AY
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- Adult, Aged, Female, Hospital Mortality, Humans, Length of Stay, Male, Middle Aged, Operative Time, Pancreatic Fistula, Retrospective Studies, Spleen surgery, Treatment Outcome, Young Adult, Laparoscopy methods, Pancreatectomy methods, Pancreatic Neoplasms surgery, Robotic Surgical Procedures methods
- Abstract
Background: This study aims to compare the early perioperative outcomes of robotic-assisted laparoscopic distal pancreatectomy (RDP) versus laparoscopic distal pancreatectomy (LDP)., Methods: The clinicopathologic features of 45 consecutive patients who underwent minimally-invasive distal pancreatectomy from 2006 to 2015 were retrospectively reviewed., Results: Thirty-nine patients who met our study criteria were included. Eight patients underwent RDP and 31 had LDP. There were 10 (25.6%) open conversions. Six (15.4%) patients had major (> grade 2) morbidities and there was no in-hospital mortality. There were 14 (35.9%) grade A and 9 (23.1%) grade B pancreatic fistulas. Comparison between RDP and LDP demonstrated no significant difference between the patients' baseline characteristics except there was increased frequency of spleen-preserving pancreatectomies (3 (37.5%) vs 25 (80.6%), P=0.016) and splenic-vessel preservation (5 (62.5%) vs 4 (12.9%), P=0.003) in RDP. Comparison between outcomes demonstrated that RDP was associated with a longer median operation time (452.5 (range, 300-685) vs 245 min (range, 85-430), P=0.001) and increased frequency of the procedure completed purely laparoscopically (8 (100%) vs 18 (58.1%), P=0.025)., Conclusions: RDP can be safely adopted and is equivalent to LDP in most perioperative outcomes. It is also associated with a decreased frequency of the need for hand-assistance laparoscopic surgery or open conversion but needed a longer operation time. Copyright © 2016 John Wiley & Sons, Ltd., (Copyright © 2016 John Wiley & Sons, Ltd.)
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- 2017
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11. Preoperative platelet-to-lymphocyte ratio improves the performance of the international consensus guidelines in predicting malignant pancreatic cystic neoplasms.
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Goh BK, Teo JY, Allen JC Jr, Tan DM, Chan CY, Lee SY, Tai DW, Thng CH, Cheow PC, Chow PK, Ooi LL, and Chung AY
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- Adolescent, Adult, Aged, Aged, 80 and over, Consensus, Female, Guidelines as Topic, Humans, Jaundice, Obstructive complications, Male, Middle Aged, Neoplasm Invasiveness pathology, Neoplasms, Cystic, Mucinous, and Serous surgery, Neutrophils, Pancreatic Neoplasms surgery, Predictive Value of Tests, Prognosis, Retrospective Studies, Triage methods, Young Adult, Lymphocyte Count, Neoplasms, Cystic, Mucinous, and Serous blood, Neoplasms, Cystic, Mucinous, and Serous diagnosis, Pancreatic Neoplasms blood, Pancreatic Neoplasms diagnosis, Platelet Count
- Abstract
Introduction: To determine if neutrophil-to-lymphocyte ratio (NLR) and platelet-to-lymphocyte ratio (PLR) were predictive of malignancy in pancreatic cystic neoplasms (PCN) and if these improved the performance of the international consensus guidelines (ICG) in the initial triage of these patients., Methods: 318 patients with surgically-treated suspected PCN were retrospectively reviewed. Malignant neoplasms were defined as neoplasms harbouring invasive carcinoma. The optimal cut-off for NLR and PLR were determined by plotting the receiver operating characteristics (ROC) curves of NLR/PLR in predicting malignant PCN and utilizing the Youden index., Results: The optimal NLR and PLR cut-offs were determined to be 3.33 and 205, respectively. Univariate analyses demonstrated that symptomatic PCNs, age, obstructive jaundice, presence of solid component, dilatation of main pancreatic duct ≥10 mm, high NLR and high PLR were predictive of a malignant PCN. Multivariate analyses demonstrated that obstructive jaundice, presence of solid component, MPD ≥10 mm and high PLR but not NLR were independent predictors of a malignant PCN. A high PLR significantly predicted invasive carcinoma in patients classified within the ICG(HR) group. Comparison between the ROC curves of the ICG versus ICG plus high PLR in predicting malignant PCN demonstrated a significant improvement in the accuracy of the ICG when PLR was included [AUC 0.784 (95% CI: 0.740-0.829) vs AUC 0.822 (95% CI: 0.772-0.872) (p = 0.0032)]., Conclusions: High PLR is an independent predictor of malignancy in PCN. The addition of PLR as a criterion to the ICG improved the accuracy of these guidelines in detecting invasive neoplasms., (Copyright © 2016 IAP and EPC. Published by Elsevier B.V. All rights reserved.)
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- 2016
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12. First experience with robotic spleen-saving, vessel-preserving distal pancreatectomy in Singapore: a report of three consecutive cases.
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Goh BK, Wong JS, Chan CY, Cheow PC, Ooi LL, and Chung AY
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- Female, Follow-Up Studies, Humans, Male, Middle Aged, Organ Sparing Treatments, Patient Positioning, Prospective Studies, Singapore, Young Adult, Laparoscopy methods, Pancreatectomy methods, Pancreatic Neoplasms surgery, Robotic Surgical Procedures, Spleen surgery
- Abstract
Introduction: The use of laparoscopic distal pancreatectomy (LDP) has increased worldwide due to the reported advantages associated with this minimally invasive procedure. However, widespread adoption is hindered by its technical complexity. Robotic distal pancreatectomy (RDP) was introduced to overcome this limitation, but worldwide experience with RDP is still lacking. There is presently evidence that RDP is associated with decreased conversion rate and increased splenic preservation as compared to LDP., Methods: We conducted a prospective study on our initial experience with robotic spleen-saving, vessel-preserving distal pancreatectomy (SSVP-DP) between July 2013 and April 2014., Results: Three consecutive patients underwent attempted robotic SSVP-DP. The indications were a 2.1-cm indeterminate cystic neoplasm, 4.5-cm solid pseudopapillary neoplasm and 1.2-cm pancreatic neuroendocrine tumour. For all three patients, the procedure was completed without conversion, and the spleen, with its main vessels, was successfully conserved. The median total operation time, blood loss and postoperative stay were 350 (range 300-540) minutes, 200 (range 50-300) mL and 7 (range 6-14) days, respectively. Two patients had minor Clavien-Dindo Grade I complications (one Grade A pancreatic fistula and one postoperative ileus). One patient had a Clavien-Dindo Grade IIIa complication (Grade B pancreatic fistula requiring percutaneous drainage). All patients were well at the time of reporting after at least six months of follow-up., Conclusion: Our preliminary experience with robotic SSVP-DP confirmed the feasibility of the procedure.
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- 2016
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13. Are preoperative blood neutrophil-to-lymphocyte and platelet-to-lymphocyte ratios useful in predicting malignancy in surgically-treated mucin-producing pancreatic cystic neoplasms?
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Goh BK, Tan DM, Chan CY, Lee SY, Lee VT, Thng CH, Low AS, Tai DW, Cheow PC, Chow PK, Ooi LL, and Chung AY
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- Adult, Aged, Aged, 80 and over, Blood Platelets metabolism, Female, Follow-Up Studies, Humans, Lymphocytes metabolism, Male, Middle Aged, Neoplasm Invasiveness, Neoplasm Staging, Neutrophils metabolism, Pancreatic Cyst metabolism, Pancreatic Cyst surgery, Pancreatic Neoplasms metabolism, Pancreatic Neoplasms surgery, Preoperative Care, Prognosis, Retrospective Studies, Young Adult, Blood Platelets pathology, Lymphocytes pathology, Mucins metabolism, Neutrophils pathology, Pancreatic Cyst pathology, Pancreatic Neoplasms pathology
- Abstract
Introduction: The aim of this study was to determine if neutrophil-to-lymphocyte ratio (NLR) and platelet-to-lymphocyte ratio (PLR) were predictive of malignancy in mucin-producing pancreatic cystic neoplasms (MpPCN)., Methods: One hundred and twenty patients with MpPCN were retrospectively reviewed. Malignant neoplasms were defined as neoplasms harbouring invasive carcinoma or high grade dysplasia. A high NLR and PLR were defined as ≥2.551 and ≥208.1, respectively., Results: High NLR was significantly associated with symptomatic tumors, larger tumors, solid component, main-duct IPMN, and Sendai high risk category. High PLR was significantly associated with jaundice and Sendai high risk category. On univariate analyses, symptomatic tumors, jaundice, solid component, dilated pancreatic duct, and both a high NLR and PLR were significant predictors of malignant and invasive MpPCN. On multivariate analyses, solid component and dilated pancreatic duct were independent predictors of malignant and invasive MpPCN. PLR was an independent predictor for invasive MpPCN. When MpPCN were stratified by the Fukuoka and Sendai Guidelines, both a high NLR and PLR were significantly associated with malignant neoplasms within the high risk categories., Conclusions: PLR is an independent predictor of invasive carcinoma. The addition of PLR as a criterion to the FCG and SCG significantly improved the predictive value of these guidelines in detecting invasive neoplasms., (© 2015 Wiley Periodicals, Inc.)
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- 2015
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14. Evaluation of the Sendai and 2012 International Consensus Guidelines based on cross-sectional imaging findings performed for the initial triage of mucinous cystic lesions of the pancreas: a single institution experience with 114 surgically treated patients.
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Goh BK, Thng CH, Tan DM, Low AS, Wong JS, Cheow PC, Chow PK, Chung AY, Wong WK, and Ooi LL
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- Adenocarcinoma, Mucinous blood, Adenocarcinoma, Mucinous diagnostic imaging, Adenocarcinoma, Mucinous pathology, Adult, Aged, Biomarkers, Tumor blood, Carcinoma, Pancreatic Ductal blood, Carcinoma, Pancreatic Ductal diagnostic imaging, Carcinoma, Pancreatic Ductal pathology, Carcinoma, Pancreatic Ductal surgery, Cross-Sectional Studies, Female, Humans, Male, Middle Aged, Pancreatic Neoplasms blood, Pancreatic Neoplasms diagnostic imaging, Pancreatic Neoplasms pathology, Practice Guidelines as Topic, Predictive Value of Tests, Radiography, Retrospective Studies, Adenocarcinoma, Mucinous surgery, Pancreatic Neoplasms surgery
- Abstract
Background: The Sendai Consensus Guidelines (SCG) were formulated in 2006 to guide the management of mucinous cystic lesions of the pancreas (CLPs) and were updated in 2012 (International Consensus Guidelines, ICG 2012). This study aims to evaluate the clinical utility of the ICG 2012 with the SCG based on initial cross-sectional imaging findings., Methods: One hundred fourteen patients with mucinous CLPs were reviewed and classified according to the ICG 2012 as high risk (HR(ICG2012)), worrisome (W(ICG2012)), and low risk (LR(ICG2012)), and according to the SCG as high risk (HR(SCG)) and low risk (LR(SCG))., Results: On univariate analysis, the presence of symptoms, obstructive jaundice, elevated serum carcinoembryonic antigen (CEA)/carbohydrate antigen (CA)19-9, solid component, main pancreatic duct ≥ 10 mm, and main pancreatic duct ≥ 5 mm was associated with high grade dysplasia/invasive carcinoma in all mucinous CLPs. Increasing number of HR(SCG) or HR(ICG2012) features was associated with a significantly increased likelihood of malignancy. The positive predictive value of HR(SCG) and HR(ICG2012) for high grade dysplasia/invasive carcinoma was 46% and 62.5% respectively. The negative predictive value of both LR(SCG) and LR(ICG2012) was 100%., Conclusion: Both the guidelines were useful in the initial cross-sectional imaging evaluation of mucinous CLPs. The ICG 2012 guidelines were superior to the SCG guidelines., (Copyright © 2014 Elsevier Inc. All rights reserved.)
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- 2014
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15. Are the Sendai and Fukuoka consensus guidelines for cystic mucinous neoplasms of the pancreas useful in the initial triage of all suspected pancreatic cystic neoplasms? A single-institution experience with 317 surgically-treated patients.
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Goh BK, Tan DM, Thng CH, Lee SY, Low AS, Chan CY, Wong JS, Lee VT, Cheow PC, Chow PK, Chung AY, Wong WK, and Ooi LL
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- Adolescent, Adult, Aged, Aged, 80 and over, CA-19-9 Antigen blood, Carcinoembryonic Antigen blood, Dilatation, Pathologic pathology, Endosonography, Female, Humans, Japan, Jaundice, Obstructive etiology, Magnetic Resonance Imaging, Male, Middle Aged, Neoplasms, Cystic, Mucinous, and Serous diagnostic imaging, Pancreatic Ducts diagnostic imaging, Pancreatic Neoplasms diagnostic imaging, Predictive Value of Tests, Retrospective Studies, Risk Assessment, Tomography, X-Ray Computed, Triage, Young Adult, Neoplasms, Cystic, Mucinous, and Serous classification, Neoplasms, Cystic, Mucinous, and Serous pathology, Pancreatic Ducts pathology, Pancreatic Neoplasms classification, Pancreatic Neoplasms pathology, Practice Guidelines as Topic
- Abstract
Background: The Sendai Consensus Guidelines (SCG) were formulated in 2006 and updated in Fukuoka in 2012 (FCG) to guide management of cystic mucinous neoplasms of the pancreas. This study aims to evaluate the clinical utility of the SCG and FCG in the initial triage of all suspected pancreatic cystic neoplasms., Study Design: Overall, 317 surgically-treated patients with a suspected pancreatic cystic neoplasm were classified according to the SCG as high risk (HR(SCG)) and low risk (LR(SCG)), and according to the FCG as high risk (HR(FCG)), worrisome (W(FCG)), and low risk (LR(FCG)). Cystic lesions of the pancreas (CLP) were classified as potentially malignant/malignant or benign according to the final pathology., Results: The presence of symptoms, proximal lesions with obstructive jaundice, elevated serum carcinoembryonic antigen/carbohydrate antigen 19-9 (CEA/CA 19-9), size ≥3 cm, presence of solid component, main pancreatic duct dilatation, thickened enhancing walls, and change in ductal caliber with distal atrophy were predictive of a potentially malignant/malignant CLP on univariate analyses. The positive predictive value (PPV) and negative predictive value (NPV) of HR(SCG) and HR(ICG2012) for a potentially malignant/malignant lesion was 67 and 88 %, and 88 and 92.5 %, respectively. There were no malignant lesions in both LR groups but some potentially malignant lesions such as cystic pancreatic neuroendocrine neoplasms with uncertain behavior were classified as LR., Conclusion: The updated FCG was superior to the SCG for the initial triage of all suspected pancreatic cystic neoplasms. CLP in the LR(FCG) group can be safely managed conservatively, and those in the HR(FCG) group should undergo resection.
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- 2014
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16. Education and Imaging. Hepatobiliary and pancreatic: Intrapancreatic splenunculus mimics a hypervascular neoplasm.
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Chanyaputhipong J, Sittampalam KM, Goh BK, and Cheow PC
- Subjects
- Aged, Choristoma pathology, Choristoma surgery, Diagnosis, Differential, Humans, Male, Pancreatectomy, Pancreatic Diseases diagnosis, Pancreatic Diseases pathology, Pancreatic Diseases surgery, Pancreatic Neoplasms blood supply, Tomography, X-Ray Computed, Choristoma diagnosis, Pancreatic Neoplasms diagnosis, Spleen
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- 2013
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17. Validation of five contemporary prognostication systems for primary pancreatic endocrine neoplasms: results from a single institution experience with 61 surgically treated cases.
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Goh BK, Chow PK, Tan YM, Cheow PC, Chung YF, Soo KC, Wong WK, and Ooi LL
- Subjects
- Adult, Aged, Aged, 80 and over, Female, Humans, Male, Middle Aged, Neuroendocrine Tumors surgery, Pancreatic Neoplasms surgery, Prognosis, Reproducibility of Results, Retrospective Studies, Singapore, Survival Analysis, Neoplasm Staging methods, Neuroendocrine Tumors pathology, Pancreatic Neoplasms pathology
- Abstract
Background: Presently, several systems for the prognostication of pancreatic endocrine neoplasms (PENs) exist and the most appropriate classification system has not been clearly defined. This study aims to validate the performance of the 2004 World Health Organization (WHO), European Neuroendocrine Tumor Society (ENETS), Memorial Sloan-Kettering Cancer Center (MSKCC), American Joint Committee for Cancer (AJCC) TNM staging and Bilimoria criteria in a cohort of patients with PENs who underwent surgery at a single institution., Methods: This study is a retrospective review of 61 consecutive patients who underwent surgical treatment for PEN. Actuarial disease-specific survival (DSS) of all 61 patients and recurrence-free survival (RFS) of 53 patients who had curative resection were analysed., Results: On univariate analyses, tumour size ≥50 mm, non-curative resection, lymph node involvement, presence of distant metastases, presence of necrosis, mitotic count ≥2/10 hpf and poor differentiation were associated with decreased DSS. Tumour size ≥50 mm, lymph node involvement, lymphovascular invasion, presence of necrosis and mitotic count ≥2/10 hpf were associated with decreased actuarial RFS. All five staging systems were useful in stratifying the 61 patients according to actuarial DSS. However, the MSKCC grading and ENETS grading systems were not statistically significant in stratifying DSS in the 61 patients. In the 53 patients who underwent curative resection, the WHO, ENETS, MSKCC, AJCC staging and the MSKCC grading systems were successful in stratifying the patients according to actuarial RFS. However, the Bilimoria scoring and ENETS grading systems were not useful in prognosticating these 53 patients., Conclusion: All five classification systems were useful for the prognostication of surgically treated PENs in our patient cohort., (© 2010 The Authors. ANZ Journal of Surgery © 2010 Royal Australasian College of Surgeons.)
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- 2011
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18. Accurate preoperative localization of insulinomas avoids the need for blind resection and reoperation: analysis of a single institution experience with 17 surgically treated tumors over 19 years.
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Goh BK, Ooi LL, Cheow PC, Tan YM, Ong HS, Chung YF, Chow PK, Wong WK, and Soo KC
- Subjects
- Adult, Aged, Aged, 80 and over, Chi-Square Distribution, Female, Humans, Insulinoma pathology, Lymphatic Metastasis, Male, Middle Aged, Pancreatectomy, Pancreatic Neoplasms pathology, Postoperative Complications, Retrospective Studies, Sensitivity and Specificity, Statistics, Nonparametric, Treatment Outcome, Insulinoma surgery, Pancreatic Neoplasms surgery
- Abstract
Introduction: Presently, the need for and choice of preoperative localization tests for insulinomas remain controversial. We report the results from a single institution experience whereby the management policy adopted was that of accurate preoperative localization before surgical exploration., Materials and Methods: From 1990 to 2008, 17 patients with a clinical and biochemical diagnosis of an insulinoma who underwent surgery were retrospectively reviewed. The diagnosis of all insulinomas were confirmed pathologically., Results: All tumors were localized preoperatively and an average of 2.2 preoperative localization studies including 1.4 noninvasive studies and 0.8 invasive studies were utilized per patient. Invasive localization modalities were more sensitive (92%) than noninvasive modalities in localizing insulinomas (71%). Intra-arterial calcium stimulation with hepatic venous sampling was the most sensitive invasive modality (100%), whereas magnetic resonance imaging was the most sensitive noninvasive modality (63%). Fifteen of 17 tumors (88%) were localized intraoperatively via inspection/palpation and/or intraoperative ultrasonography. Both insulinomas which were not localized intraoperatively were localized correctly to the distal pancreas via preoperative transhepatic portal venous sampling. None of the patients required a blind resection or surgical reexploration for failed localization. All 17 patients underwent complete surgical resection which included eight enucleations and nine distal pancreatectomies with a cure rate of 94% (16/17) at a median follow-up of 35 (range, 1-217) months. The postoperative morbidity and long-term outcome of enucleation was similar to distal pancreatectomy despite a higher rate of microscopic margin involvement., Conclusion: Accurate preoperative localization of insulinomas is useful as it eliminates the need for blind distal pancreatectomy and avoids reoperation. Complete surgical resection is the treatment of choice, and whenever possible, a pancreas-sparing approach such as enucleation should be adopted.
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- 2009
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19. Pancreaticoduodenectomy for locally advanced stomach cancer: preliminary results.
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Chan WH, Cheow PC, Chung AY, Ong HS, Koong HN, and Wong WK
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- Duodenal Neoplasms secondary, Feasibility Studies, Humans, Neoplasm Invasiveness, Pancreatic Neoplasms secondary, Stomach Neoplasms pathology, Treatment Outcome, Duodenal Neoplasms surgery, Pancreatic Neoplasms surgery, Pancreaticoduodenectomy, Stomach Neoplasms surgery
- Abstract
Background: Pancreaticoduodenectomy (PD) for locally advanced stomach cancer involving duodenum or/and pancreatic head was controversial and rarely carried out. It was mainly reported from the Japanese institutions., Methods: A review of prospective database from January 2003 to December 2006 of patients who had locally advanced stomach cancer involving duodenum or/and head of pancreas that precluded curative subtotal gastrectomy who underwent diagnostic laparoscopy or exploratory laparotomy to exclude peritoneal metastatic disease. Patients were advised to undergo neoadjuvant chemotherapy before PD., Results: Seven patients underwent PD during the above-mentioned period. Only four patients had neoadjuvant chemotherapy before PD. The median operative time was 8 h (range 6-9 h). Five patients had combined tranverse colectomy done. There was no 30-day operative mortality or re-operation. Three patients developed controlled pancreatic leaks and fistulas that were successfully treated with conservative measures. The length of hospital stay was 10-53 days (median 15 days). Median survival was 13 months and 2-year survival rate was 60%. Patients who received neoadjuvant chemotherapy seemed to have better survival rate (P = 0.039)., Conclusion: Our initial experience has shown that with careful and stringent patients selection, PD for locally advanced stomach cancer can be carried out with acceptable morbidity and mortality. Early results for patients who received neoadjuvant chemotherapy showed trend towards prolonged survival. However, longer follow up and further patient recruitment are needed to confirm our initial optimistic findings.
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- 2008
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20. Outcome of distal pancreatectomy for pancreatic adenocarcinoma.
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Goh BK, Tan YM, Cheow PC, Chung YF, Chow PK, Wong WK, and Ooi LL
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- Adenocarcinoma pathology, Adult, Aged, Aged, 80 and over, Female, Humans, Male, Middle Aged, Pancreatic Neoplasms pathology, Retrospective Studies, Treatment Outcome, Adenocarcinoma surgery, Pancreatectomy, Pancreatic Neoplasms surgery
- Abstract
Objectives: To determine the outcome of patients undergoing distal pancreatectomy for pancreatic adenocarcinoma., Methods: A retrospective review of 39 patients undergoing distal pancreatectomy for adenocarcinoma., Results: Thirty patients underwent surgery for ductal adenocarcinoma, 5 for malignant intraductal papillary mucinous neoplasm and 4 for mucinous cystadenocarcinoma. Malignant cystic neoplasms were significantly less likely to demonstrate perineural invasion, more likely to be well-differentiated, of lower T stage and of lower AJCC staging compared to ductal adenocarcinoma. These had a longer median disease-specific survival (42 (3-144) vs. 15 (14-16) months, p = 0.002). Eight patients underwent extended resections. These were associated with longer operating times compared to standard resections but there was no difference in surgical morbidity or mortality, blood transfusions, length of hospitalization or long-term survival. Univariate analysis demonstrated that R2 resection, size >30 mm, lymph node involvement, need for perioperative blood transfusion, serum albumin <40 g/l and platelet count <200/microl were predictors of survival for ductal adenocarcinoma., Conclusions: Malignant cystic neoplasms have less aggressive behavior and more favorable outcome compared to ductal adenocarcinoma. R2 resection, larger tumor size, lymph node involvement, perioperative transfusion, decreased serum albumin and low platelet count are factors associated with decreased survival in patients with ductal adenocarcinoma undergoing distal pancreatectomy.
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- 2008
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21. Solid pseudopapillary neoplasms of the pancreas: an updated experience.
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Goh BK, Tan YM, Cheow PC, Chung AY, Chow PK, Wong WK, and Ooi LL
- Subjects
- Adolescent, Adult, Carcinoma, Papillary pathology, Colectomy, Female, Humans, Male, Middle Aged, Omentum surgery, Pancreatic Neoplasms pathology, Pancreatic Pseudocyst pathology, Portal Vein surgery, Retrospective Studies, Treatment Outcome, Carcinoma, Papillary surgery, Pancreatectomy, Pancreatic Neoplasms surgery, Pancreatic Pseudocyst surgery, Pancreaticoduodenectomy
- Abstract
Introduction: The aim of this study is to report an update of the surgical experience at a single institution with these unusual tumors., Methods: Sixteen consecutive patients who underwent surgery for a pathologically confirmed solid pseudopapillary neoplasm (SPPN) were retrospectively reviewed., Results: Fifteen of the patients were female and the median age at diagnosis was 30 years (range, 14-53 years). Abdominal and back pain were the most common presenting symptoms. The tumors appeared on cross-sectional imaging as solid and cystic (n = 14) or cystic (n = 2) masses. The median tumor size was 9.5 cm (range, 5.0-24.0 cm). All 16 patients had curative resections including 3 pancreaticoduodenectomies and 13 distal pancreatectomies. Three patients required extended resections including pancreaticoduodenectomy with portal vein resection, distal pancreatectomy with tranverse colectomy, and distal pancreactomy with omentectomy. Two of the resections were R1 whereas 14 were R0. All patients were alive and disease-free at a median follow-up of 43 months (range, 3-186 months)., Conclusion: SPPNs should be considered in young women presenting with a large solid-cystic pancreatic mass. Aggressive en bloc resection should always be attempted including resection of concomitant metastases as patients demonstrate excellent long-term survival even in the presence of distant spread., (Copyright 2007 Wiley-Liss, Inc.)
- Published
- 2007
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22. A review of mucinous cystic neoplasms of the pancreas defined by ovarian-type stroma: clinicopathological features of 344 patients.
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Goh BK, Tan YM, Chung YF, Chow PK, Cheow PC, Wong WK, and Ooi LL
- Subjects
- Adolescent, Adult, Aged, Aged, 80 and over, Female, Humans, Male, Middle Aged, Cystadenocarcinoma, Mucinous classification, Cystadenocarcinoma, Mucinous pathology, Pancreatic Neoplasms classification, Pancreatic Neoplasms pathology
- Abstract
Introduction: Despite formal definitions of mucinous cystic neoplasms (MCNs) and intraductal papillary neoplasms (IPMNs) by the World Health Organization (WHO) and Armed Forces Institute of Pathology (AFIP), several controversies with regard to MCNs remain. The aim of this review was to determine the clinicopathological features of MCNs defined by ovarian-type stroma (OS) as proposed by the WHO and AFIP and to compare them with MCNs defined by less stringent criteria., Methods: A MEDLINE search was conducted to identify English-language articles on pancreatic MCNs from 1996 to 2005. Twenty-five studies were identified. The studies were divided into 2 groups: group A included 10 studies with 344 patients whereby the presence of OS was a criteria for the diagnosis of MCNs, and group B, included 15 studies comprising 761 patients whereby the presence of OS was not mandatory for the diagnosis of MCNs., Results: Patients in group A (MCNs as defined by OS) were almost always female (99.7%), with a mean age of 47 (range, 18-95) years. MCNs were located predominantly in the body or tail of the pancreas (94.6%) and had a mean size of 8.7 cm (range, 0.6-35 cm); 76% were symptomatic, 6.8% demonstrated ductal communication, and 27% were malignant. At a mean follow-up of 57.5 (range, 1-264) months and 43 (range, 2-257) months after surgery, 97.9% of benign and 61.9% of malignant neoplasms were disease free, respectively. Patients in group B were older and had a higher proportion of males. Neoplasms were more evenly distributed in the pancreas, were smaller, communicated more frequently with the pancreatic duct, and were composed of a higher proportion of malignant tumors compared with group A. Their clinicopathological features were intermediate between those of group A and patients with IPMN., Conclusion: Pancreatic MCNs with OS have unique and distinct clinicopathological features. MCNs should be defined by the presence of OS, as it is the most reliable way of distinguishing MCNs from IPMN. Adoption of "looser" criteria will result in misclassification of some IPMNs as MCNs.
- Published
- 2006
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23. Pancreatic serous oligocystic adenomas: clinicopathologic features and a comparison with serous microcystic adenomas and mucinous cystic neoplasms.
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Goh BK, Tan YM, Yap WM, Cheow PC, Chow PK, Chung YF, Wong WK, and Ooi LL
- Subjects
- Adult, Aged, Aged, 80 and over, Cystadenocarcinoma, Mucinous surgery, Cystadenocarcinoma, Serous surgery, Cystadenoma, Mucinous surgery, Cystadenoma, Serous surgery, Female, Humans, Male, Middle Aged, Pancreatectomy, Pancreatic Neoplasms surgery, Preoperative Care, Retrospective Studies, Tomography, X-Ray Computed, Cystadenocarcinoma, Mucinous diagnosis, Cystadenocarcinoma, Serous diagnosis, Cystadenoma, Mucinous diagnosis, Cystadenoma, Serous diagnosis, Pancreatic Neoplasms diagnosis
- Abstract
Introduction: The preoperative distinction between serous cystic neoplasms (SCNs) and mucinous cystic neoplasms (MCNs) is essential, as all MCNs are considered malignant or potentially malignant and should be surgically resected, whereas SCNs are almost always benign. However, the radiologic distinction between SCNs and MCNs is frequently difficult especially with serous oligocystic adenoma (SOA), a morphologic variant of SCN, as both SOA and MCN appear on cross-sectional imaging as a solitary macrocystic lesion in the pancreas. We reviewed all SOAs managed at our institution to determine if any clinicopathologic features would prove useful for establishing a preoperative diagnosis., Methods: Over a 15-year period, 64 patients with a pathologically confirmed diagnosis of a pancreatic cystadenoma or cystadenocarcinoma treated at Singapore General Hospital were retrospectively reviewed. There were 27 MCNs and 37 SCNs including 12 SOAs. In addition, 40 cases of SOA previously reported in the literature were reviewed and analyzed together with the 12 patients, making this a series of 52 SOAs., Results: In our experience, SOAs comprised 32.4% of the SCNs, and females predominated (7/12). The median age of the patients was 42.5 years (range 22-74 years), and only 4 of the 12 patients were symptomatic. Most of the cysts were located in the body or tail of the pancreas (9/12), and the median cyst size was 52.5 mm (range 10-190 mm). When the clinicopathologic features of SOAs and serous microcystic adenomas (SMAs) were compared, there was no difference between the patients with SOAs and SMAs in terms of age, sex, presence of symptoms, cyst size, or site of the lesion. However, SOAs occurred in the women less frequently (67.3% vs. 96.3%, P=0.004), were smaller [40 mm (range 10-190 mm) vs. 95 mm (range 25-180 mm), P<0.001], and occurred more commonly in the head of the pancreas [25 (48.1%) vs. 2(7.4%)] compared to MCNs. None of the SOAs were frankly malignant compared to the 29.6% of MCNs that were., Conclusions: SOAs and SMAs have similar clinicopathologic features. On the other hand, SOAs differ from MCNs by their relatively higher male/female ratio, higher frequency of tumors occurring in the head of the pancreas, and smaller cyst size. Knowledge of these distinguishing clinical features when used in combination with other diagnostic modalities such as endoscopic ultrasonography/fine-needle aspiration will enable clinicians to better differentiate these two pathologic entities preoperatively.
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- 2006
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24. Clinico-pathological features of cystic pancreatic endocrine neoplasms and a comparison with their solid counterparts.
- Author
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Goh BK, Ooi LL, Tan YM, Cheow PC, Chung YF, Chow PK, and Wong WK
- Subjects
- Abdominal Pain diagnosis, Adult, Age Factors, Aged, Aged, 80 and over, Cohort Studies, Female, Gastrinoma pathology, Humans, Insulinoma pathology, Male, Middle Aged, Multiple Endocrine Neoplasia Type 1 pathology, Neoplasms, Multiple Primary pathology, Pancreatectomy, Pancreatic Cyst pathology, Retrospective Studies, Sex Factors, Stomach Neoplasms pathology, Tomography, X-Ray Computed, Vipoma pathology, Weight Loss, Pancreatic Neoplasms pathology
- Abstract
Aim: Pancreatic endocrine neoplasms (PENs) may occasionally manifest as cystic lesions of the pancreas. The aim of this study is to report our experience with cystic PENs and to compare their clinico-pathological features with their solid counterparts., Materials and Methods: From 1990 to 2004, 38 patients with PENs were reviewed. Six of these tumours appeared on radiological imaging as a cystic lesion of the pancreas., Results: Of the 38 patients with a PEN, 21 of the patients were female and with a median age of 54.5 (range, 33-83) years. Sixteen patients had functional endocrine tumours of which insulinoma was the most common. The six patients with cystic PEN had a median age of 55.5 (range, 41-70) years and half were female. Cystic PENs were significantly larger [48 (range, 25-170) mm vs 19 (range, 3-120) mm, P = 0.013] and were less likely to be benign (0 vs 50%, P = 0.017) compared to their solid counterparts. There was no difference between cystic and solid PENs in terms of age, sex, presence of symptoms, proportion of functioning tumours and location of tumours within the pancreas., Conclusion: Cystic PENs share many clinico-pathological features with solid PENs. These differ only in the cystic appearance and tend to be of a larger size. Hence, these findings suggest that cystic and solid PENs are unlikely to be distinct pathological entities but are likely to be morphological variants of the same entity.
- Published
- 2006
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25. Clinicopathological features of patients with concomitant intraductal papillary mucinous neoplasm of the pancreas and pancreatic endocrine neoplasm.
- Author
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Goh BK, Ooi LL, Kumarasinghe MP, Tan YM, Cheow PC, Chow PK, Chung YF, and Wong WK
- Subjects
- Adenocarcinoma, Mucinous metabolism, Adenocarcinoma, Mucinous surgery, Adult, Aged, Biomarkers, Tumor metabolism, Carcinoma, Neuroendocrine metabolism, Carcinoma, Neuroendocrine surgery, Carcinoma, Pancreatic Ductal metabolism, Carcinoma, Pancreatic Ductal surgery, Carcinoma, Papillary metabolism, Carcinoma, Papillary surgery, Chromogranins metabolism, Female, Humans, Male, Middle Aged, Neoplasms, Second Primary metabolism, Neoplasms, Second Primary surgery, Pancreatic Neoplasms metabolism, Pancreatic Neoplasms surgery, Synaptophysin metabolism, Tomography, X-Ray Computed, Treatment Outcome, Adenocarcinoma, Mucinous pathology, Carcinoma, Neuroendocrine pathology, Carcinoma, Pancreatic Ductal pathology, Carcinoma, Papillary pathology, Neoplasms, Second Primary pathology, Pancreatic Neoplasms pathology
- Abstract
Background/aims: The occurrence of concomitant pancreatic endocrine neoplasm (PEN) and intraductal papillary neoplasm (IPMN) of the pancreas has rarely been reported. We describe our experience with 3 patients with this association and review the existing literature., Methods: From 1990 to 2005, 65 patients who underwent surgery for a PEN or IPMN were retrospectively reviewed. Forty-three patients had a PEN, 19 had an IPMN and 3 had both an IPMN and PEN. The 3 patients with concomitant IPMN and PEN are the focus of the current study and their clinicopathological features are reported together with 7 patients previously reported in the literature., Results: There were 10 patients with a median age of 62 years (range 40-73). The male:female ratio was equal. Seven of 10 patients were symptomatic and the most common symptoms were abdominal pain (n = 5), jaundice (n = 2) and loss of weight (n = 2). The median size of the endocrine neoplasms was 14 mm (range 2-30) and they occurred in the head (n = 3), body (n = 2) and tail (n = 5). Seven of the PENs were classified as benign, 2 were potentially malignant, and 1 was frankly malignant with lymph node involvement. None of the endocrine neoplasms were functioning. The IPMNs were found in the tail (n = 4), head (n = 3), head and body (n = 1), body (n = 1) and the entire pancreas (n = 1). Five of these neoplasms were benign, 2 were borderline and 3 were malignant (1 carcinoma in situ)., Conclusion: The occurrence of concomitant IPMN and PEN is more frequent than would be expected. However, it is difficult in the present analysis to determine if this association is more than just fortuitous., (Copyright 2006 S. Karger AG, Basel and IAP.)
- Published
- 2006
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26. Cystic neoplasms of the pancreas with mucin-production.
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Goh BK, Tan YM, Cheow PC, Chung YF, Chow PK, Wong WK, and Ooi LL
- Subjects
- Adult, Aged, Analysis of Variance, Carcinoma, Pancreatic Ductal metabolism, Cystadenocarcinoma metabolism, Cystadenocarcinoma, Mucinous pathology, Cystadenocarcinoma, Papillary pathology, Cystadenoma metabolism, Cystadenoma, Mucinous pathology, Cystadenoma, Papillary pathology, Female, Humans, Male, Middle Aged, Pancreatic Neoplasms etiology, Pancreatic Neoplasms metabolism, Pancreatitis complications, Carcinoma, Pancreatic Ductal pathology, Cystadenocarcinoma pathology, Cystadenoma pathology, Mucins metabolism, Pancreatic Neoplasms pathology
- Abstract
Aim: To compare the clinico-pathological features of intraductal papillary mucinous cystic tumours (IPMT) and mucinous cystic tumours (MCT) of the pancreas., Methods: Eighteen patients with IPMT and 18 with MCT who underwent surgical resection between 1990 and 2004 were retrospectively reviewed. Their clinico-pathological features were compared using univariate analysis. Statistical analyses of potential predictive factors of malignancy for each of these two groups were also conducted., Results: Patients with IPMT were found to be older (64+/-10 vs 43+/-18 years, p<0.001) and were predominantly male (male:female ratio, 5:4 vs 1:17, p=0.003) as compared to patients with MCT. MCTs were found in the body-tail region (100%) whereas IPMTs were more evenly distributed (50% in the head) (p=0.001). Pathologically, IPMT was distinct from MCT in terms of size (3.8+/-3.2 vs 9.1+/-4.4 cm, p=0.001), association with secondary pancreatitis (50 vs 0%, p=0.011), communication with the pancreatic duct (94 vs 0%, p<0.001), presence of a dilated main pancreatic duct (61 vs 0%, p<0.001) and the presence of ovarian-type stroma (0 vs 44%, p=0.003)., Conclusion: IPMT and MCT are distinct clinico-pathological entities. This distinction is important as management and outcome of these entities may differ.
- Published
- 2005
- Full Text
- View/download PDF
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