Chirurgia italiana
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Review Case Reports
[Pancreatic metastasis from clear cell renal carcinoma: a clinical case].
Renal cell carcinoma rarely metastasizes to the pancreas. In this report we describe a case of late pancreatic metastases in a seventy-year-old woman, surgically treated 21 years before for renal clear-cell carcinoma. Preoperative staging revealed the presence of four pancreatic lesions. ⋯ This case shows that in patients operated on for renal clear-cell carcinoma we have to consider the possibility of late metastases to the pancreas. Therefore, these patients should be submitted to long-term follow-up. In keeping with the current literature, we advocate aggressive surgical treatment in pancreatic metastases from renal clear-cell carcinoma.
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Laparoscopic cholecystectomy has become the treatment of choice for patients with symptomatic cholelithiasis. About 10-20% of patients with gallbladder stones may also present associated common bile duct stones. The management of the latter remains controversial because many different surgical strategies are available: laparoscopic treatment (laparoscopic common bile duct exploration), sequential endoscopic and laparoscopic treatment (endoscopic retrograde cholangiopancreatography/endoscopic sphincterotomy [ERCP/ES] prior to laparoscopic cholecystectomy), inverted sequential endoscopic-laparoscopic treatment (laparoscopic cholecystectomy followed by ERCP/ES), and combined endoscopic-laparoscopic treatment (laparoscopic cholecystectomy with intraoperative ERCP/ES). ⋯ In the group of patients with no suspicion of common bile duct stones, the conversion rate was 4.9%. Sequential treatment cannot be considered the best approach for patients with cholecystocholedocholithiasis because of its morbidity rate and the high rate of negative preoperative ERCP findings. Combined endoscopic-laparoscopic treatment seems to present more advantages, especially in term of morbidity, hospital stay and patient compliance and may, in future, be considered the treatment of choice for patients with cholecystocholedocholithiasis.