Cancer of the uncinate process of the pancreas:surgical anatomy and clinicopathological features

BACKGROUND:The clinicopathological features of uncinate process pancreatic cancer(UPPC) are poorly described.Furthermore the anatomy of the uncinate process and its division during surgery are central to pancreaticoduodenectomy for UPPC.We set out to describe the embryology and anatomy of the uncinate process and the clinicopathological features of UPPC.DATA SOURCES:All published case series of UPPC were reviewed and included in this review.RESULTS:The true incidence of UPPC is difficult to quantify,with the reported incidence ranging from 2.5% to 10.7% of pancreatic cancer.There are 5 published series of UPPC including 117 patients,72 males and 45 females,aged from 45-53 years to 61-84 years.The median survival was 5 or 5.5 months in 3 of the series,12.1 months in another based only on potentially resectable lesions and 17 months in another based only on resected cases.CONCLUSIONS:The number of reported series of UPPC is limited,with vague symptoms as the predominant presenting features of the disease.The prognosis is poor with synchronous venous resection demonstrating a survival advantage.

Resection of the uncinate process of the pancreas due to a ganglioneuroma

A 33-year-old woman who presented with epigastric discomfort and diarrhea underwent an abdominal ultrasound(US).This investigation and subsequent contrastenhanced computed tomography,magnetic resonance imaging and endoscopic US with fine needle aspiration (FNA)revealed a 40 mm well-circumscribed mass in the uncinate process of the pancreas.Findings were suggestive of a mucinous or solid-cystic pseudopapillary tumor of the pancreas,although other lesions such as a nonfunctioning neuroendocrine tumor could not be ruled out.FNA samples were negative for malignant cells,but of limited value due to poor cellularity.It was decided to surgically remove the tumor because malignancy could not be discounted.Multiple intraoperative biopsies were suggestive of mesenchymal tumor and consequently a conservative resection(uncinatectomy)was performed. The postoperative course was uneventful.The definitive diagnosis was ganglioneuroma.Immunocytochemistry showed positive staining with vimentin,S-100 protein, neurofilament and neuron-specific enolase.Ganglioneuroma is a rare benign tumor that can also present as a pancreatic tumor.Uncinatectomy is feasible,safe and a good surgical technique for the treatment of nonmalignant tumors located in the uncinate process of the pancreas.

Clinical analysis of uncinate process carcinoma of the pancreas

OBJECTIVE: To analyse the clinical features of uncinate process carcinoma of the pancreas and the diagnosis and treatment of this malignancy. METHOD: Fifty-nine patients with pancreas uncinate process carcinoma treated from January 1998 to September 2002 at our hospital were analysed retrospectively. RESULTS: Major symptoms of these patients were upper abdominal pain accompanied with lumbar pain, body weight loss and jaundice. Thirty-seven patients received regional pancreaticoduodenectomy (RP), 16 partial resection of the superior mesenteric vein-portal vein (SMV-PV) or superior mesenteric artery (SMA) and reconstruction, 1 anhydrous alcohol injection in the celiac nerve plexus, regional chemotherapy via a chemotherapy pump, and liver biopsy, and 5 no operation. The survival of the patients after operation was 2-46 months (median 12.1 months). Eleven patients are still alive with a longest survival of 46 months. The 1- and 3-year survival rates were 37.7% and 5.6%. CONCLUSIONS: Pancreas uncinate process carcinoma invading the adjacent SMV/SMA-PV causes difficulty in early diagnosis and poor prognosis, which are related to its location, not tumor's aggressive nature. This carcinoma has a high resection rate of 89.8%.

Surgical treatment for uncinate process carcinoma of the pancreas

Objectives: To analyze the clinical features of unci- nate process carcinoma of the pancreas and to im- prove the resection rate. Methods: From January 1990 to June 1999, 10 pa- tients with pancreas uncinate process carcinoma re- ceived Whipple's operation. Portal vein (PV) resec- tion and reanastomosis were performed in 5 patients, and the resected length varied from 2.0 to 4.2 cm. Two patients underwent PV lateral wall partial resec- tion. Results: Among the 7 patients undergoing PV resec- tion, 1 died of hepatic failure 3 days after operation. One patient suffered from postoperative chylous asci- tes. These 6 patients survived 13 to 29 months post- operatively. Among the 3 patients without PV resec- tion, 2 survived 13 months and 14 months respective- ly. One patient was alive by the end of follow-up for 11. 5 months postoperatively. Conclusion: Although uncinate process carcinoma of the pancreas has a tendency to invade the adjacent PV and superior mesentery vein, it should not be simply regarded as a contraindication of radical resection.

绕开钩突由筛泡径路的内镜精准术式的临床观察

目的探讨应用绕开钩突由筛泡径路的内镜精准术式在临床应用可行性及疗效。方法回顾性分析 2018年6月~2020年6月间30例行绕开钩突由筛泡径路的内镜精准术式患者的临床资料,详细分析和记录术中情况及总体疗效。结果由筛泡径路术式适合目前精准手术要求,特别适合有筛上颌窦气房、眶下气房及Haller气房等存在变异患者。术后随访6个月以上,临床症状逐步消失,病变均未复发。结论绕开钩突由筛泡径路的内镜精准术式可行,更能满足鼻腔生理需求,达到精准治疗的目的。