Journal of Hepato‐Biliary‐Pancreatic Sciences最新文献

Pancreaticogastrostomy (PG) emerged as a reconstructive option after pancreaticoduodenectomy (PD) due to its reported lower incidence of postoperative pancreatic fistula (POPF), but its superiority over pancreaticojejunostomy (PJ) remains unclear. We provide a narrative review that summarizes its evolution, technical variations, and comparative outcomes versus PJ. A narrative review from a comprehensive literature search was conducted using electronic databases of Medline/PubMed, EMBASE, and the Cochrane Library to identify relevant studies addressing surgical techniques, outcomes, and comparative analyses. PG offers anatomical, physiological advantages, including tension-free anastomosis and gastric acid inactivation of pancreatic enzymes. Early RCTs showed similar clinically relevant POPF rates. Later trials supported PG for soft glands and small ducts, showing fewer intraperitoneal collections but more hemorrhage. Despite similar short-term outcomes, long-term randomized follow-up shows worse exocrine function after PG than PJ, with higher fecal fat, lower fecal elastase-1, and greater pancreatic atrophy. PG is an effective reconstruction option after PD, particularly in POPF high-risk cases. However, it has higher bleeding rates and worse long-term exocrine function than PJ. Reconstruction should prioritize pancreatic function, favoring PJ for most patients and reserving PG for selected soft, small-duct, or high-risk glands based on institutional expertise.

Background: Gallstones are a common digestive disorder linked to a bile composition imbalance. Uric acid (UA) and high-density lipoprotein cholesterol (HDL-C) are key metabolic markers associated with gallstone risk.

Objective: To investigate the association between the uric acid to HDL-C ratio (UHR) and gallstone risk.

Methods: Using 2017-2020 NHANES data, we included participants with complete UHR and gallstone information. Analyses included weighted multivariate logistic regression, restricted cubic splines (RCS) for nonlinearity, subgroup/interaction tests, and sensitivity analysis using multiple imputation.

Results: Among 6354 participants, UHR was positively associated with gallstones. The fully adjusted model revealed that for every 1-unit increase in UHR, the incidence of gallstones increased by 4% (OR = 1.04, 95% CI: 1.00-1.08, p = 0.045). RCS indicated a nonlinear relationship (P_nonlinear < 0.001) with an inflection at 14.6: risk increased significantly below 14.6 but weakened above it. Subgroup analysis revealed a remarkable interaction within the asthma subgroup (P_{forinteraction} = 0.017). Sensitivity analysis corroborated the robustness of these findings.

Conclusion: UHR, a novel inflammatory and metabolic marker, is closely related to gallstone risk. Its predictive value is particularly high in the lower range (< 14.6), offering a new reference for screening high-risk populations for gallstones.

Background/purpose: Intrahepatic cholangiocarcinoma (iCCA) and extrahepatic cholangiocarcinoma (eCCA) are clinically and genetically distinct. However, the classification of perihilar cholangiocarcinoma (phCCA) with an intrahepatic tumor mass remains unclear. This study aimed to position phCCA near the hilar plate (hCCA) within an extrahepatic-intrahepatic framework using pathological and molecular analyses.

Methods: Among 357 resected invasive CCAs, 100 hCCAs were histologically classified as either hCCA with (hCCA-M) or hCCA without (hCCA-NM) a grossly evident intrahepatic mass. Transcriptomic comparison of 9 typical eCCAs and 39 mass-forming iCCAs identified three contextual markers, which were examined by immunohistochemistry in 309 additional cases.

Results: Among 100 hCCAs, 85 were hCCA-NM and 15 hCCA-M. Claudin 18 (CLDN18) and mesothelin (MSLN) were identified as extrahepatic contextual markers, and serpin family A member 1 (SERPINA1) as an intrahepatic contextual marker. SERPINA1 was more highly expressed in hCCA-M than in hCCA-NM, regardless of microscopic liver parenchymal invasion, whereas CLDN18 and MSLN were similarly expressed in both. Cluster analysis revealed that hCCA-NM clustered with eCCA, whereas hCCA-M clustered with iCCA.

Conclusions: Gross intrahepatic mass formation indicates an intrahepatic contextual profile and provides a useful criterion for subclassifying hCCA. This contextual framework shows that hCCA-M and hCCA-NM represent biologically distinct tumor groups.

Background: Neoadjuvant chemotherapy (NAC) with gemcitabine and S-1 (GS) is the standard regimen for resectable pancreatic cancer (PC) in Japan. However, its efficacy in elderly patients and those with impaired renal function remains unclear.

Methods: We retrospectively analyzed patients with resectable PC who received NAC GS. Patients were classified as elderly (≥ 75 years) or non-elderly (< 75 years). The primary endpoint was relative dose intensity (RDI) of NAC. Secondary endpoints included adverse events (AEs), perioperative outcomes, RDI of adjuvant chemotherapy (AC), recurrence-free survival (RFS), and overall survival (OS).

Results: A total of 185 patients were included (non-elderly: 148, elderly: 37). Median creatinine clearance (CCr) was lower in elderly patients (64.2 vs. 84.5 mL/min, p < 0.001). Mean RDI of GS was significantly lower in elderly patients and those with CCr < 50 mL/min, particularly when both factors coexisted. Severe hematologic AEs were more frequent in these groups, though perioperative outcomes were similar. While initiation of AC was delayed and RDI of adjuvant S-1 was lower in elderly patients, RFS and OS did not significantly differ between groups.

Conclusions: NAC GS appears feasible in elderly patients with resectable PC, though caution is needed in those with impaired renal function.