The role of adjuvant therapy in resected periampullary adenocarcinomas is equivocal due to contrasting data and limited prospective trials.
Methods
The Multicentre Indian Pancreatic & Periampullary Adenocarcinoma Project (MIPPAP), included data from 8 institutions across India. Of the 1679 pancreatic resections, 736 patients with T3/T4 and/or Node positive adenocarcinomas (considered as high risk for recurrence) were included for analysis. Three (adjuvant): one (observation) matching, using T3/T4 T staging, nodal positivity and ampullary subtype was performed by using the nearest neighbour matching method.
Results
Of 736 patients eligible for inclusion, 621 patients were matched of which 458 patients received adjuvant therapy (AT) (predominantly gemcitabine-based) and 163 patients were observed (O). With a median follow-up of 42 months, there was a statistical difference in overall survival in favour of patients receiving AT as compared to those on observation [68.7 months vs. 61.1 months, Hazard ratio: 0.73 (95% CI: 0.54–0.97); p = 0.03]. Besides AT, presence of nodal involvement (median OS: 65.4 months vs not reached; p = 0.04) predicted for inferior OS.
Conclusions
The results of the match-pair analysis suggest that adjuvant therapy improves overall survival in periampullary adenocarcinomas at high risk of recurrence with a greater benefit in T3/T4, node-positive and ampullary subtypes.
由于数据对比不一且前瞻性试验有限，辅助治疗在切除的胰腺周围腺癌中的作用并不明确。印度胰腺和胰周腺癌多中心项目（MISSPAP）的数据来自印度8家主要学术机构。在 1679 例胰腺切除术中，有 736 例 T3/T4 和/或结节阳性腺癌患者（被认为复发风险高）符合纳入标准，可供分析。采用最近邻匹配法，使用 T3/T4 T 分期、结节阳性和髓质亚型进行三（辅助）：一（观察）匹配，无替换。在符合纳入条件的 736 名患者中，有 621 名患者进行了配对，其中 458 名患者接受了辅助治疗（AT）（主要以吉西他滨为主），163 名患者接受了观察治疗（O）。中位随访时间为42个月，接受辅助治疗和接受观察的患者的3年、估计5年OS和中位OS分别为67.1%（95% CI：62.4-72.2）和62%（95% CI：54.2-70.7）、57.5%（52-63.8）和51.1%（95% CI：42.5%-61.4%）以及68.7（95% CI：59.6-73.1）个月和61.1个月（95% CI：50.8-71.5）。与接受观察的患者相比，接受 AT 治疗的患者的 OS 存在统计学差异[危险比：0.73（95% CI：0.54-0.97）；P = 0.03]。除了 AT 外，结节受累（中位 OS：65.4 个月 vs 未达到；p = 0.04）也预示着较差的 OS。在大多数亚组中，AT有改善OS的趋势，对T3/T4 T分期、结节阳性和髓瓿亚型患者的影响更大。配对分析结果表明，辅助治疗可提高复发风险高的胰周腺癌患者的总生存率，对T3/T4、结节阳性和胰腺亚型患者的益处更大。
{"title":"Adjuvant therapy may improve overall survival in high-risk periampullary adenocarcinomas patients – A match-pair analysis from a multi-institutional cohort study (The MIPPAP study)","authors":"Anant Ramaswamy , Vikram Chaudhari , Sujay Srinivas , Prabhat Bhargava , Sadhana Kannan , Ajit Agarwal , Ramakrishnan A. Seshadri , Vineet Talwar , Shaifali Goel , Varun Goel , Shivendra Singh , Smita Kayal , Pradeep Rebala , G.V. Rao , Bharat Prajapati , Devendra Parikh , Jagdish Kothari , Jacob M. Kadamapuzha , Hariharan Ramesh , Deeksha Kapoor , Vikas Ostwal","doi":"10.1016/j.hpb.2024.06.010","DOIUrl":"10.1016/j.hpb.2024.06.010","url":null,"abstract":"<div><h3>Background</h3><div>The role of adjuvant therapy in resected periampullary adenocarcinomas is equivocal due to contrasting data and limited prospective trials.</div></div><div><h3>Methods</h3><div>The Multicentre Indian Pancreatic & Periampullary Adenocarcinoma Project (MIPPAP), included data from 8 institutions across India. Of the 1679 pancreatic resections, 736 patients with T3/T4 and/or Node positive adenocarcinomas (considered as high risk for recurrence) were included for analysis. Three (adjuvant): one (observation) matching, using T3/T4 T staging, nodal positivity and ampullary subtype was performed by using the nearest neighbour matching method.</div></div><div><h3>Results</h3><div>Of 736 patients eligible for inclusion, 621 patients were matched of which 458 patients received adjuvant therapy (AT) (predominantly gemcitabine-based) and 163 patients were observed (O). With a median follow-up of 42 months, there was a statistical difference in overall survival in favour of patients receiving AT as compared to those on observation [68.7 months vs. 61.1 months, Hazard ratio: 0.73 (95% CI: 0.54–0.97); p = 0.03]. Besides AT, presence of nodal involvement (median OS: 65.4 months vs not reached; p = 0.04) predicted for inferior OS.</div></div><div><h3>Conclusions</h3><div>The results of the match-pair analysis suggest that adjuvant therapy improves overall survival in periampullary adenocarcinomas at high risk of recurrence with a greater benefit in T3/T4, node-positive and ampullary subtypes.</div></div>","PeriodicalId":13229,"journal":{"name":"Hpb","volume":"26 10","pages":"Pages 1261-1269"},"PeriodicalIF":2.7,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141612217","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-10-01DOI: 10.1016/j.hpb.2024.06.002
Background
Postoperative pancreatic fistulas lead to substantially increased morbidity, mortality, and healthcare costs after pancreatectomy. Studies have reported conflicting data on the role of prophylactic somatostatin analogs in the reduction of postoperative pancreatic fistula. Current practice patterns, surgeon beliefs, and barriers to using these drugs in the Americas is not known.
Methods
An online 26-question cross-sectional survey was distributed via email to the members of the Americas Hepato-Pancreato-Biliary Association in April 2023.
Results
One hundred and two surgeons responded in spring 2023. 48.0% of respondents reported using prophylactic SSAs during their surgical training, however, only 29.4% do so in their current practice, most commonly when performing Whipple procedures. Octreotide was the most frequently used SSA (34.3%), followed by octreotide LAR (12.7%) and pasireotide (11.8%). Reasons for not prescribing included a lack of high-quality data (62.7%), perception of limited efficacy (34.3%) and high cost (30.4%).
Conclusion
These results highlight key areas for future study including understanding surgeon rationale for patient and drug selection. Variable practice patterns amongst surgeons also underscore the importance of generalizability in the design of future clinical trials in order to maximize impact.
{"title":"Prophylactic somatostatin analogs for postoperative pancreatic fistulas: a cross-sectional survey of AHPBA surgeons","authors":"","doi":"10.1016/j.hpb.2024.06.002","DOIUrl":"10.1016/j.hpb.2024.06.002","url":null,"abstract":"<div><h3>Background</h3><div>Postoperative pancreatic fistulas<span><span> lead to substantially increased morbidity, mortality, and healthcare costs after pancreatectomy. Studies have reported conflicting data on the role of prophylactic </span>somatostatin analogs in the reduction of postoperative pancreatic fistula. Current practice patterns, surgeon beliefs, and barriers to using these drugs in the Americas is not known.</span></div></div><div><h3>Methods</h3><div>An online 26-question cross-sectional survey was distributed via email to the members of the Americas Hepato-Pancreato-Biliary Association in April 2023.</div></div><div><h3>Results</h3><div>One hundred and two surgeons responded in spring 2023. 48.0% of respondents reported using prophylactic SSAs during their surgical training, however, only 29.4% do so in their current practice, most commonly when performing Whipple procedures. Octreotide<span> was the most frequently used SSA (34.3%), followed by octreotide LAR (12.7%) and pasireotide (11.8%). Reasons for not prescribing included a lack of high-quality data (62.7%), perception of limited efficacy (34.3%) and high cost (30.4%).</span></div></div><div><h3>Conclusion</h3><div>These results highlight key areas for future study including understanding surgeon rationale for patient and drug selection. Variable practice patterns amongst surgeons also underscore the importance of generalizability in the design of future clinical trials in order to maximize impact.</div></div>","PeriodicalId":13229,"journal":{"name":"Hpb","volume":"26 10","pages":"Pages 1229-1236"},"PeriodicalIF":2.7,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141395636","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pancreaticoduodenectomy (PD) is a challenging operation because of complex anatomy and difficult and multiple reconstructions. Robot-assisted PD (RPD) is a novel minimally invasive technique, providing equivalent oncological outcomes to open surgery. The aim of this study is to evaluate the results of a single high-volume center series.
Methods
Patients who underwent RPD from 2014 to 2021 in a high-volume center were included. Patient and disease-specific data, operative details, postoperative complications including postoperative pancreatic fistula (POPF), length of stay (LOS) and long-term survival were recorded. Two groups were compared: Group 1: patients operated between 2014–2019 and Group 2 between 2020–2021.
Results
One hundred and forty-six patients had RPD on the study period (99 in Group 1 and 47 in Group 2). Operative time was 320 min (285–360), major complications were observed in 28% and clinically significant POPF in 20% of the cases. Conversion rate was 2.1%. LOS was 14 days (9–22). Postoperative mortality was 4.1%. Clinically significant POPF decreased from 24% in Group 1 to 11% in Group 2 (p = 0.05). LOS decreased from 16(11–26) days in Group 1 to 11(8–14) in Group 2 (p < 0.001).
Conclusion
RPD is safe and feasible. Technique standardization led to better post-operative outcomes, encouraging the dissemination and implementation of the procedure.
{"title":"Short-term results of robot-assisted pancreatoduodeodenectomy: a retrospective cohort study of 146 patients operated in a high-volume center","authors":"Abdallah Iben-khayat , Emanuelle Felli , Baudouin Thebault , Amaury Facques , Haythem Najah , Olivier Saint-Marc","doi":"10.1016/j.hpb.2024.07.402","DOIUrl":"10.1016/j.hpb.2024.07.402","url":null,"abstract":"<div><h3>Background</h3><div>Pancreaticoduodenectomy (PD) is a challenging operation because of complex anatomy and difficult and multiple reconstructions. Robot-assisted PD (RPD) is a novel minimally invasive technique, providing equivalent oncological outcomes to open surgery. The aim of this study is to evaluate the results of a single high-volume center series.</div></div><div><h3>Methods</h3><div>Patients who underwent RPD from 2014 to 2021 in a high-volume center were included. Patient and disease-specific data, operative details, postoperative complications including postoperative pancreatic fistula (POPF), length of stay (LOS) and long-term survival were recorded. Two groups were compared: Group 1: patients operated between 2014–2019 and Group 2 between 2020–2021.</div></div><div><h3>Results</h3><div>One hundred and forty-six patients had RPD on the study period (99 in Group 1 and 47 in Group 2). Operative time was 320 min (285–360), major complications were observed in 28% and clinically significant POPF in 20% of the cases. Conversion rate was 2.1%. LOS was 14 days (9–22). Postoperative mortality was 4.1%. Clinically significant POPF decreased from 24% in Group 1 to 11% in Group 2 (p = 0.05). LOS decreased from 16(11–26) days in Group 1 to 11(8–14) in Group 2 (p < 0.001).</div></div><div><h3>Conclusion</h3><div>RPD is safe and feasible. Technique standardization led to better post-operative outcomes, encouraging the dissemination and implementation of the procedure.</div></div>","PeriodicalId":13229,"journal":{"name":"Hpb","volume":"26 10","pages":"Pages 1270-1279"},"PeriodicalIF":2.7,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141716587","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-10-01DOI: 10.1016/S1365-182X(24)02304-9
{"title":"Highlights in this issue","authors":"","doi":"10.1016/S1365-182X(24)02304-9","DOIUrl":"10.1016/S1365-182X(24)02304-9","url":null,"abstract":"","PeriodicalId":13229,"journal":{"name":"Hpb","volume":"26 10","pages":"Page iii"},"PeriodicalIF":2.7,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142358026","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-10-01DOI: 10.1016/j.hpb.2024.03.1156
{"title":"Corrigendum to “Changes in activity of heat shock protein-70 association with early acute pancreatitis severity” [HPB 25 (Supplement 1) (2023) S176]","authors":"","doi":"10.1016/j.hpb.2024.03.1156","DOIUrl":"10.1016/j.hpb.2024.03.1156","url":null,"abstract":"","PeriodicalId":13229,"journal":{"name":"Hpb","volume":"26 10","pages":"Page 1309"},"PeriodicalIF":2.7,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140269355","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-10-01DOI: 10.1016/j.hpb.2024.09.012
Faruk Koca, Ekaterina Petrova, Hanan El Youzouri, Jan Heil, Michael Heise, Svenja Sliwinski, Wolf O Bechstein, Andreas A Schnitzbauer
Background: The impact of resection margin and lymph node status on survival in patients undergoing resection for perihilar cholangiocarcinoma (pCCA) is controversial. The aim of this study was to investigate the influence of nodal and resection margin status on long-term survival after resection for pCCA.
Methods: Retrospective analysis of patients resected for pCCA at the University Hospital Frankfurt, Germany between 1999 and 2022. The patients were categorized in four groups according to resection margin (R) and nodal status (N). Survival was analyzed with univariable and multivariable Cox regression.
Results: Out of 123 patients, 100 with long-term survival were included in the survival analysis. In the univariable analysis, negative resection margin (p = 0.02) and lower grade (p = 0.004) were the only significant positive prognostic factors, while the difference between N0 and N+ was not statistically significant (p = 0.062). Median survival in the groups R0N0, R0N+, R + N0 and R+N+ groups was 40.1, 29.9, 18.4 and 18.9 months, respectively (p = 0.03). In the multivariable analysis, after adjusting for grade, nodal and resection margin status, only grade and resection margin had prognostic significance.
Conclusion: Patients with negative resection margin after resection for pCCA have a better prognosis, regardless of the presence of lymph node metastases.
{"title":"Prognostic value of resection margin and lymph node status in perihilar cholangiocarcinoma.","authors":"Faruk Koca, Ekaterina Petrova, Hanan El Youzouri, Jan Heil, Michael Heise, Svenja Sliwinski, Wolf O Bechstein, Andreas A Schnitzbauer","doi":"10.1016/j.hpb.2024.09.012","DOIUrl":"https://doi.org/10.1016/j.hpb.2024.09.012","url":null,"abstract":"<p><strong>Background: </strong>The impact of resection margin and lymph node status on survival in patients undergoing resection for perihilar cholangiocarcinoma (pCCA) is controversial. The aim of this study was to investigate the influence of nodal and resection margin status on long-term survival after resection for pCCA.</p><p><strong>Methods: </strong>Retrospective analysis of patients resected for pCCA at the University Hospital Frankfurt, Germany between 1999 and 2022. The patients were categorized in four groups according to resection margin (R) and nodal status (N). Survival was analyzed with univariable and multivariable Cox regression.</p><p><strong>Results: </strong>Out of 123 patients, 100 with long-term survival were included in the survival analysis. In the univariable analysis, negative resection margin (p = 0.02) and lower grade (p = 0.004) were the only significant positive prognostic factors, while the difference between N0 and N+ was not statistically significant (p = 0.062). Median survival in the groups R0N0, R0N+, R + N0 and R+N+ groups was 40.1, 29.9, 18.4 and 18.9 months, respectively (p = 0.03). In the multivariable analysis, after adjusting for grade, nodal and resection margin status, only grade and resection margin had prognostic significance.</p><p><strong>Conclusion: </strong>Patients with negative resection margin after resection for pCCA have a better prognosis, regardless of the presence of lymph node metastases.</p>","PeriodicalId":13229,"journal":{"name":"Hpb","volume":" ","pages":""},"PeriodicalIF":2.7,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142499457","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-10-01DOI: 10.1016/j.hpb.2024.06.006
Background
Three-dimensional reconstruction of the liver offers several advantages to the surgeon before and during liver resection. This review discusses the factors behind the use of liver 3-D reconstruction.
Methods
Systematic electronic search, according to PRISMA criteria, was performed. A literature search of scientific papers was performed until October 2023. Articles were chosen based on reference to 3-D liver reconstruction and their use in liver surgery. GRADE methodology and the modified Newcastle–Ottawa scale were used to assess the quality of the studies.
Results
The research included 47 articles and 7724 patients were analyzed.
Preoperative planning was performed with 3-D liver reconstruction in the 87.2% of the studies.
Most of preoperative 3-D liver reconstructions were performed in the planning of complex or major hepatectomies. Complex hepatectomies were performed in 64.3% patients.
The 55.3% of the studies reported an improved navigation and accuracy during liver resection. Four studies (8.6%) on living donor liver transplant (LDLT) concluded that 3-D liver reconstruction is useful for graft selection and vascular preservation. Nine papers (19.1%) reported an accurate measurement of future liver remnant.
Conclusion
Liver 3-D reconstruction helps surgeons in the planning of liver surgery, especially in liver graft and complex liver resections, increasing the accuracy of the surgical resection.
{"title":"3-D reconstruction in liver surgery: a systematic review","authors":"","doi":"10.1016/j.hpb.2024.06.006","DOIUrl":"10.1016/j.hpb.2024.06.006","url":null,"abstract":"<div><h3>Background</h3><div>Three-dimensional reconstruction of the liver offers several advantages to the surgeon before and during liver resection. This review discusses the factors behind the use of liver 3-D reconstruction.</div></div><div><h3>Methods</h3><div>Systematic electronic search, according to PRISMA criteria, was performed. A literature search of scientific papers was performed until October 2023. Articles were chosen based on reference to 3-D liver reconstruction and their use in liver surgery. GRADE methodology and the modified Newcastle–Ottawa scale were used to assess the quality of the studies.</div></div><div><h3>Results</h3><div>The research included 47 articles and 7724 patients were analyzed.</div><div>Preoperative planning was performed with 3-D liver reconstruction in the 87.2% of the studies.</div><div>Most of preoperative 3-D liver reconstructions were performed in the planning of complex or major hepatectomies. Complex hepatectomies were performed in 64.3% patients.</div><div>The 55.3% of the studies reported an improved navigation and accuracy during liver resection. Four studies (8.6%) on living donor liver transplant (LDLT) concluded that 3-D liver reconstruction is useful for graft selection and vascular preservation. Nine papers (19.1%) reported an accurate measurement of future liver remnant.</div></div><div><h3>Conclusion</h3><div>Liver 3-D reconstruction helps surgeons in the planning of liver surgery, especially in liver graft and complex liver resections, increasing the accuracy of the surgical resection.</div></div>","PeriodicalId":13229,"journal":{"name":"Hpb","volume":"26 10","pages":"Pages 1205-1215"},"PeriodicalIF":2.7,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141497919","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-10-01DOI: 10.1016/j.hpb.2024.07.405
Jiali Yang, Junfeng Zhang, Mingda Tan, Jianyou Gu, Li Tang, Yao Zheng, Qiang Zhou, Xianxing Wang, Renpei Xia, Tao Zhang, Yongjun Yang, Shixiang Guo, Huaizhi Wang
Background
To evaluate long-term quality of life and survival in pancreatic ductal adenocarcinoma (PDAC) patients after pancreatoduodenectomy with extended lymphadenectomy (PDEL) and identify candidates.
Methods
Patients with resectable PDAC with ≥1 examined lymph node (LN) during pancreatoduodenectomy (PD), and were divided into the PD with standard lymphadenectomy (PDSL) and PDEL groups. Perioperative data, long-term quality of life and survival were compared, and the prognostic effect of LNs ± in every peripancreatic station were analysed.
Results
Screening 446 PDAC patients, 237 and 126 were included in the PDSL and PDEL groups, respectively. The PDEL group showed a longer operation time, greater intraoperative blood loss, severe diarrhoea, a higher incidence of grade III complications. Notably, the PDEL patients experienced significant relief from low back pain and diarrhoea, with an obvious survival advantage (p = 0.037), especially in patients with preoperative tumor contact with vascular and pathological N0; however, LNs+ in any station (No. 8p, 12, 14, or 16) were associated with a poorer prognosis. The vascular reconstruction, T and N stage were independent risk factors for survival.
Conclusion
PDEL can relieve symptoms and prolong the survival of PDAC patients with acceptable complications, and EL should be performed regardless of preoperative LN enlargement.
{"title":"Identifying suitable candidates for pancreaticoduodenectomy with extended lymphadenectomy for pancreatic ductal adenocarcinoma","authors":"Jiali Yang, Junfeng Zhang, Mingda Tan, Jianyou Gu, Li Tang, Yao Zheng, Qiang Zhou, Xianxing Wang, Renpei Xia, Tao Zhang, Yongjun Yang, Shixiang Guo, Huaizhi Wang","doi":"10.1016/j.hpb.2024.07.405","DOIUrl":"10.1016/j.hpb.2024.07.405","url":null,"abstract":"<div><h3>Background</h3><div>To evaluate long-term quality of life and survival in pancreatic ductal adenocarcinoma (PDAC) patients after pancreatoduodenectomy with extended lymphadenectomy (PDEL) and identify candidates.</div></div><div><h3>Methods</h3><div>Patients with resectable PDAC with ≥1 examined lymph node (LN) during pancreatoduodenectomy (PD), and were divided into the PD with standard lymphadenectomy (PDSL) and PDEL groups. Perioperative data, long-term quality of life and survival were compared, and the prognostic effect of LNs ± in every peripancreatic station were analysed.</div></div><div><h3>Results</h3><div>Screening 446 PDAC patients, 237 and 126 were included in the PDSL and PDEL groups, respectively. The PDEL group showed a longer operation time, greater intraoperative blood loss, severe diarrhoea, a higher incidence of grade III complications. Notably, the PDEL patients experienced significant relief from low back pain and diarrhoea, with an obvious survival advantage (p = 0.037), especially in patients with preoperative tumor contact with vascular and pathological N0; however, LNs+ in any station (No. 8p, 12, 14, or 16) were associated with a poorer prognosis. The vascular reconstruction, T and N stage were independent risk factors for survival.</div></div><div><h3>Conclusion</h3><div>PDEL can relieve symptoms and prolong the survival of PDAC patients with acceptable complications, and EL should be performed regardless of preoperative LN enlargement.</div></div>","PeriodicalId":13229,"journal":{"name":"Hpb","volume":"26 10","pages":"Pages 1291-1301"},"PeriodicalIF":2.7,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141715413","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-10-01DOI: 10.1016/j.hpb.2024.06.004
Background
CA 19–9 is an extremely useful biomarker for pancreatic ductal adenocarcinomas (PDACs). However, the optimal cut-off and prognostic significance at higher cut-offs are yet to be determined.
Methods
Retrospective analysis included patients with PDAC who underwent curative resection from January 2010 to May 2020 at Tata Memorial Centre, Mumbai. The pretherapy CA 19–9 was dichotomized using various cut-off levels and analysed.
Results
In 244 included patients, the median overall survival (OS) for those with CA19-9 level (IU/ml) < or >78, 200, 500, 1000, and 2000 was 27, 24, 23, 22, 21 months versus 18, 16, 15, 14, 13 months; respectively, and was statistically significant (p-value- 0.002, 0.001, 0.002, 0.002 and 0.004, respectively). The number of recurrences and mortality had significant correlation with CA 19–9 cut-offs. On multivariate analysis, adjuvant treatment completion (p-0.004) and decreasing or stable CA19-9 after Neoadjuvant therapy (NAT) (p- 0.031) were associated with improved OS.
Conclusion
The prognostic significance of CA 19–9 was observed at all the cut-off levels examined, beyond mere elevated value as per the standard cut-off level. In patients with high CA19-9 level, surgery should be offered if technically and conditionally feasible, only when a response in CA19-9 level to NAT is achieved.
{"title":"Differential impact of incrementally elevated CA 19-9 levels on prognosis of resected pancreatic ductal adenocarcinoma","authors":"","doi":"10.1016/j.hpb.2024.06.004","DOIUrl":"10.1016/j.hpb.2024.06.004","url":null,"abstract":"<div><h3>Background</h3><div>CA 19–9 is an extremely useful biomarker for pancreatic ductal adenocarcinomas (PDACs). However, the optimal cut-off and prognostic significance at higher cut-offs are yet to be determined.</div></div><div><h3>Methods</h3><div>Retrospective analysis included patients with PDAC who underwent curative resection from January 2010 to May 2020 at Tata Memorial Centre, Mumbai. The pretherapy CA 19–9 was dichotomized using various cut-off levels and analysed.</div></div><div><h3>Results</h3><div>In 244 included patients, the median overall survival (OS) for those with CA19-9 level (IU/ml) < or >78, 200, 500, 1000, and 2000 was 27, 24, 23, 22, 21 months versus 18, 16, 15, 14, 13 months; respectively, and was statistically significant (p-value- 0.002, 0.001, 0.002, 0.002 and 0.004, respectively). The number of recurrences and mortality had significant correlation with CA 19–9 cut-offs. On multivariate analysis<span>, adjuvant treatment completion (p-0.004) and decreasing or stable CA19-9 after Neoadjuvant therapy (NAT) (p- 0.031) were associated with improved OS.</span></div></div><div><h3>Conclusion</h3><div>The prognostic significance of CA 19–9 was observed at all the cut-off levels examined, beyond mere elevated value as per the standard cut-off level. In patients with high CA19-9 level, surgery should be offered if technically and conditionally feasible, only when a response in CA19-9 level to NAT is achieved.</div></div>","PeriodicalId":13229,"journal":{"name":"Hpb","volume":"26 10","pages":"Pages 1237-1247"},"PeriodicalIF":2.7,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141467617","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-10-01DOI: 10.1016/j.hpb.2024.07.001
Jenny H. Chang, Henry Stitzel, Chase Wehrle, Chao Tu, Robert Naples, Samer A. Naffouje, R. Matthew Walsh, Robert Simon
{"title":"Contrasting concerns: a retrospective cohort study evaluating intraoperative cholangiogram patients with allergies","authors":"Jenny H. Chang, Henry Stitzel, Chase Wehrle, Chao Tu, Robert Naples, Samer A. Naffouje, R. Matthew Walsh, Robert Simon","doi":"10.1016/j.hpb.2024.07.001","DOIUrl":"10.1016/j.hpb.2024.07.001","url":null,"abstract":"","PeriodicalId":13229,"journal":{"name":"Hpb","volume":"26 10","pages":"Pages 1305-1307"},"PeriodicalIF":2.7,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141612275","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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