Journal of Hepato‐Biliary‐Pancreatic Sciences最新文献

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.

Background/purpose: Preoperative diagnosis of para-aortic lymph node (PALN) metastasis, particularly at station 16b1-a contraindication to pancreatic ductal adenocarcinoma (PDAC) resection-remains challenging. We investigated whether the distance from the root of the splenic artery (SPA) to the tumor (DST) is an objective predictor of PALN metastasis.

Methods: We retrospectively analyzed 130 patients who underwent distal pancreatectomy with PALN sampling for PDAC from 2012 to 2022. DST was measured using preoperative contrast-enhanced computed tomography. Receiver operating characteristic (ROC) analysis was performed, and clinicopathological factors were analyzed.

Results: PALN metastasis occurred in 7/130 (5.4%) patients. DST was significantly shorter in the PALN-positive group (median: 12.0 vs. 18.0 mm, p = 0.0001). ROC analysis indicated that the optimal cutoff value was 20.0 mm. In univariate and multivariate analyses, DST ≤ 20.0 mm was the only factor significantly associated with PALN metastasis (p = 0.0042 and p = 0.0093, respectively). All PALN-positive cases had DST ≤ 20.0 mm.

Conclusions: DST is a clinically useful metric for predicting PALN metastasis in left-sided PDAC. In patients with DST > 20 mm, the likelihood of PALN involvement appeared extremely low, suggesting that intraoperative lymph node sampling may be omitted in selected patients.

Background: In anatomical segment 7 (S7) segmentectomy, the inferior right hepatic vein (IRHV) can be a useful landmark to identify the portal branch of segment 7 (P7); however, the positional relationship between the IRHV and the posterior portal branch has not been investigated.

Patients and methods: We reviewed 203 patients who underwent preoperative multi-detector CT at Jichi Saitama Medical Center from 2022 to 2024. We processed 3D images and evaluated the running patterns concerning the IRHV, and the posterior portal vein and the right hepatic vein (RHV). The IRHV was classified as S6 (IRHV running inside S6 only), S7 (IRHV running inside S7 only), or S6/S7 (the vein courses along the intersegmental plane separating P6 and P7).

Results: IRHVs were present in 44.8% of patients and were classified as S6 in 11.0%, S7 in 17.6%, and S6/S7 in 71.4%. Among patients with IRHVs, 92.3% had either an IRHV or an RHV running along the intersegmental plane separating P6 and P7, compared with 24.1% of patients without IRHVs (p < 0.01).

Conclusions: Most IRHVs were classified as S6/S7. When the IRHV does not serve as a landmark, the RHV may provide an alternative anatomical landmark for identifying P7 during anatomical S7 segmentectomy.

Background: The safety and efficacy of minimally invasive pancreatoduodenectomy (MIPD) for pancreatic ductal adenocarcinoma (PDAC) remain controversial. This study evaluated the surgical and oncological outcomes of MIPD versus open pancreatoduodenectomy (OPD) after overcoming the MIPD learning curve.

Methods: Between April 2014 and July 2022, 357 patients underwent pancreatoduodenectomy for resectable (RPC) or borderline resectable (BRPC) PDAC. After excluding early-phase MIPD cases, 112 patients underwent MIPD and 245 underwent OPD. Propensity score matching was performed. Subgroup analysis assessed outcomes in patients undergoing PD without vascular resection (type 0).

Results: MIPD was associated with longer operation time (p = 0.002), but similar estimated blood loss and intraoperative transfusion volumes. Rates of clinically relevant postoperative fistula and delayed gastric emptying were comparable. Disease-free survival (DFS) and overall survival (OS) did not differ significantly between MIPD and OPD groups (p = 0.670 and p = 0.179, respectively). In type 0 resections, OS was equivalent, but DFS was significantly better in the MIPD group.

Conclusions: MIPD is a safe and feasible option for RPC and BRPC PDAC, with oncologic outcomes comparable to OPD. Type 0 tumors, not requiring vascular resection, may represent an optimal indication for MIPD.

Background and aims: Contrast-enhanced endoscopic ultrasonography (CE-EUS) provides clearer visualization of wall layer structures in gallbladder nodules than B-mode EUS. This study aimed to compare the diagnostic performance of B-mode EUS and CE-EUS in differentiating benign from malignant gallbladder lesions.

Methods: Patients who underwent both B-mode EUS and CE-EUS for gallbladder nodules with available pathological diagnoses were retrospectively analyzed. The diagnostic findings of each modality were evaluated by univariate and multivariate analyses.

Results: Eighty-six patients were included (31 malignant, 55 benign). On B-mode EUS, a pedunculated shape and presence of a Rokitansky-Aschoff sinus were associated with benignity, whereas diameter ≥ 20 mm and an unclear or disrupted wall layer structure were associated with malignancy. On CE-EUS, unclear or disrupted wall layer structure was strongly associated with malignancy, whereas enhancement patterns showed only univariate significance. Multivariate analysis identified unclear or disrupted wall layer structure on CE-EUS and diameter ≥ 20 mm as independent predictors of malignancy. Diagnostic accuracy was significantly higher with CE-EUS evaluation of wall layer structure (93%) than with B-mode EUS evaluation of maximum diameter (78%, p < 0.001).

Conclusion: CE-EUS, particularly assessment of wall layer structure, improves differentiation between benign and malignant gallbladder nodules and complements B-mode EUS.

Background/purpose: The introduction of oligo-recurrence (OR) as a subtype of metastasis offered new hope, suggesting that local therapies may lead to prolonged survival/cure in selected cases. This study compared the genomic alterations between primary tumors and matched OR lesions in patients with pancreatic ductal adenocarcinoma (PDAC) and cholangiocarcinoma (CCA).

Methods: Eight patients with OR of PDAC or CCA were eligible. Genomic DNA was extracted from the tissue samples of primary tumors and matched OR lesions. Comprehensive genomic profiling (CGP) was performed using a panel of 216 cancer-related genes. The genomic profiles of the two groups were compared.

Results: Among 17 tumor samples from eight patients, 32 genomic mutations were identified in nine genes. A total of 48 copy number alterations were found across 31 distinct genes. Driver genomic mutations were concordant between the primary tumors and OR lesions in all cases, whereas differences in passenger mutations were observed in two cases. Five of the eight patients remained recurrence-free, including two pancreatic cancer cases who remained recurrence-free for > 4 years after surgery.

Conclusions: The genomic mutation statuses of primary tumors and OR lesions were concordant, and patients' prognosis was significantly better than that of patients with other Stage IV cancers.