Chapters authored
The Role of Neoadjuvant Therapy in Surgical Treatment of Pancreatic Cancer
Pancreatic cancer is a leading cause of cancer-related death worldwide, and its burden is destined to increase. Multimodal treatment is crucial to achieve a cure, but standardization is far to come. Borderline resectable disease is the most challenging situation to face. An anatomically resectable disease may hide a biologically aggressive or undiagnosed systemic disease. Whether the patient has to undergo surgery first or after locoregional or systemic therapy is still unknown. Decision-making stands on low-quality evidences since RCTs are lacking. Neoadjuvant treatment may downstage the tumor and treat an early systemic disease, selecting patients for surgery in order to achieve a margin-free resection and avoid early recurrences and useless pancreatectomies. Resectable patients without other worrisome features may benefit from a surgery-first approach, while all other nonmetastatic patients should be enrolled in trials to rule out the outcomes of neoadjuvant treatments.
Part of the book: Advances in Pancreatic Cancer
Pediatric Pancreatitis: Not a Rare Entity
The incidence of acute pancreatitis is increasing in children and it should be considered as part of differential diagnosis in case of abdominal pain. The etiology of acute pancreatitis in this subpopulation is related to several conditions and risk factors, such as drugs, obesity, infections, trauma and anatomic abnormalities. In older children abdominal pain is the first symptom in more than 90% of cases, where as in younger children vomiting represents an early clinical manifestation. Diagnosis is based on laboratory investigation, such as serum levels of lipase, and imaging findings (ultrasonography, CT scanning or MRI) such as detecting edema, hemorrage or necrosis of pancreatic parenchyma or in peripancreatic fat. Treatments for adults and children are similar. Rapid and accurate assessment of the severity of pancreatitis is absolutely indicated for selecting the appropriate treatment and predicting the prognosis.
Part of the book: Pancreatitis