The detailed mechanisms underlying the development of ischemia-type biliary lesions (ITBLs) in aged donor grafts remain unclear. In the present study we aimed to investigate the impact of aging on the response of the peribiliary gland (PBG) to ischemia–reperfusion injury (IRI) and its temporal changes.
Methods
Experiments were performed using a 90-min partial warm liver ischemia model in male Wistar rats of two age groups: young (7–8 weeks old) and old (52–60 weeks old). Liver tissues were obtained 24, 72, and 168 h after IRI. Histopathological and immunohistochemical assessments of the perihilar bile duct (PHBD), including the PBG, distal to the clip-clamped site were performed.
Results
Young rats showed little change in the bile duct tissues after IRI. However, old rats showed an increased PBG volume in the PHBD and marked PBG cell proliferation 24 h after IRI. Bile duct wall thickening with narrowing of the lumen peaked 72 h after IRI. Mucus production and oxidative stress in the PBG were significantly higher in old than in young rats after IRI. These findings showed a trend toward improvement 168 h after IRI.
Conclusion
Age-dependent differences in the response of the PBG to IRI may be related to differences in ITBL frequency.
背景：高龄供体移植物缺血型胆道病变（ITBLs）发生的详细机制仍不清楚。本研究旨在探讨衰老对胆管周围腺体（PBG）缺血再灌注损伤（IRI）反应的影响及其时间变化：方法：实验采用 90 分钟部分温热肝缺血模型，分别在年轻（7-8 周龄）和年老（52-60 周龄）两组雄性 Wistar 大鼠中进行。分别在 IRI 后 24、72 和 168 小时采集肝组织。对夹闭部位远端包括 PBG 在内的肝周胆管 (PHBD) 进行组织病理学和免疫组化评估：结果：IRI后，年轻大鼠的胆管组织变化不大。结果：IRI 后，年轻大鼠的胆管组织变化不大，但老年大鼠 PHBD 的 PBG 体积增大，且在 IRI 24 小时后 PBG 细胞明显增殖。胆管壁增厚和管腔变窄在 IRI 72 小时后达到高峰。IRI 后，老龄大鼠 PBG 的粘液分泌和氧化应激明显高于年轻大鼠。这些结果表明，在 IRI 168 小时后，情况有改善的趋势：结论：PBG 对 IRI 反应的年龄依赖性差异可能与 ITBL 频率的差异有关。
{"title":"Impact of aging on peribiliary glands in ischemia–reperfusion injury","authors":"Kaoru Katano, Shinichi Nakanuma, Tomokazu Tokoro, Ryohei Takei, Satoshi Takada, Mitsuyoshi Okazaki, Kaichiro Kato, Isamu Makino, Kenichi Harada, Shintaro Yagi","doi":"10.1002/jhbp.12047","DOIUrl":"10.1002/jhbp.12047","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>The detailed mechanisms underlying the development of ischemia-type biliary lesions (ITBLs) in aged donor grafts remain unclear. In the present study we aimed to investigate the impact of aging on the response of the peribiliary gland (PBG) to ischemia–reperfusion injury (IRI) and its temporal changes.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Experiments were performed using a 90-min partial warm liver ischemia model in male Wistar rats of two age groups: young (7–8 weeks old) and old (52–60 weeks old). Liver tissues were obtained 24, 72, and 168 h after IRI. Histopathological and immunohistochemical assessments of the perihilar bile duct (PHBD), including the PBG, distal to the clip-clamped site were performed.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Young rats showed little change in the bile duct tissues after IRI. However, old rats showed an increased PBG volume in the PHBD and marked PBG cell proliferation 24 h after IRI. Bile duct wall thickening with narrowing of the lumen peaked 72 h after IRI. Mucus production and oxidative stress in the PBG were significantly higher in old than in young rats after IRI. These findings showed a trend toward improvement 168 h after IRI.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Age-dependent differences in the response of the PBG to IRI may be related to differences in ITBL frequency.</p>\u0000 </section>\u0000 </div>","PeriodicalId":16056,"journal":{"name":"Journal of Hepato‐Biliary‐Pancreatic Sciences","volume":"31 10","pages":"705-715"},"PeriodicalIF":3.2,"publicationDate":"2024-07-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141620171","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}
Mirang Lee, Yoon Soo Chae, Seulah Park, Won-Gun Yun, Hye-Sol Jung, Youngmin Han, Wooil Kwon, Joon Seong Park, Jin-Young Jang
Background
Advances in chemotherapy have led to increasing major vascular resection during pancreatectomy which has been contraindicated due to high morbidity. This study aimed to verify the safety and oncological outcomes of vascular resection during pancreatectomy in the era of neoadjuvant therapy.
Methods
Data from patients who underwent surgery for pancreatic cancer at Seoul National University Hospital between 2001 and 2021 were reviewed. Clinicopathological outcomes were analyzed according vessel resection. A propensity-score-matched (PSM) analysis was performed to evaluate survival outcomes.
Results
Of 1596 patients, the proportion of those who underwent vascular resection increased from 9.2% to 23.4% over time divided into 5-year intervals. There were no differences in major complications (15.6% vs. 13.0%; p = .266) and 30-day mortality rate (0.3% vs. 0.6%; p = .837) between the vascular and nonvascular resection groups. After PSM, the vascular resection group demonstrated comparable survival outcome with the nonvascular resection group (5 year-survival-rate 20.4 vs. 23.7%; p = .194). Arterial resection yielded comparable survival outcome with nonvascular resection (5 year-survival-rate 38.1% vs. 23.7%; p = .138).
Conclusions
Appropriate vascular resection―even arterial―is safe and effective in patients carefully selected for radical surgery in the era of neoadjuvant therapy. Further studies are needed to determine the optimal indication and method for vascular resection in patients with pancreatic cancer.
背景：化疗的进展导致胰腺切除术中的主要血管切除术越来越多，但由于高发病率，这一直是禁忌症。本研究旨在验证新辅助治疗时代胰腺切除术中血管切除的安全性和肿瘤学结果：方法：研究人员回顾了 2001 年至 2021 年期间在首尔大学医院接受胰腺癌手术的患者数据。根据血管切除情况分析临床病理结果。进行倾向分数匹配（PSM）分析以评估生存结果：结果：在1596名患者中，接受血管切除术的比例从9.2%上升到23.4%，间隔时间为5年。血管切除组和非血管切除组在主要并发症（15.6% 对 13.0%；P = .266）和 30 天死亡率（0.3% 对 0.6%；P = .837）方面没有差异。PSM 后，血管切除组与非血管切除组的生存结果相当（5 年生存率为 20.4% vs. 23.7%；p = .194）。动脉切除术与非血管切除术的生存率相当（5年生存率为38.1% vs. 23.7%; p = .138）：结论：在新辅助治疗时代，对于精心挑选的根治性手术患者，适当的血管切除--即使是动脉切除--也是安全有效的。需要进一步研究确定胰腺癌患者血管切除的最佳适应症和方法。
{"title":"Re-evaluation of risk and oncological outcomes of resection of veins and arteries in the resection of pancreatic cancer","authors":"Mirang Lee, Yoon Soo Chae, Seulah Park, Won-Gun Yun, Hye-Sol Jung, Youngmin Han, Wooil Kwon, Joon Seong Park, Jin-Young Jang","doi":"10.1002/jhbp.12048","DOIUrl":"10.1002/jhbp.12048","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Advances in chemotherapy have led to increasing major vascular resection during pancreatectomy which has been contraindicated due to high morbidity. This study aimed to verify the safety and oncological outcomes of vascular resection during pancreatectomy in the era of neoadjuvant therapy.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Data from patients who underwent surgery for pancreatic cancer at Seoul National University Hospital between 2001 and 2021 were reviewed. Clinicopathological outcomes were analyzed according vessel resection. A propensity-score-matched (PSM) analysis was performed to evaluate survival outcomes.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Of 1596 patients, the proportion of those who underwent vascular resection increased from 9.2% to 23.4% over time divided into 5-year intervals. There were no differences in major complications (15.6% vs. 13.0%; <i>p</i> = .266) and 30-day mortality rate (0.3% vs. 0.6%; <i>p</i> = .837) between the vascular and nonvascular resection groups. After PSM, the vascular resection group demonstrated comparable survival outcome with the nonvascular resection group (5 year-survival-rate 20.4 vs. 23.7%; <i>p</i> = .194). Arterial resection yielded comparable survival outcome with nonvascular resection (5 year-survival-rate 38.1% vs. 23.7%; <i>p</i> = .138).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Appropriate vascular resection―even arterial―is safe and effective in patients carefully selected for radical surgery in the era of neoadjuvant therapy. Further studies are needed to determine the optimal indication and method for vascular resection in patients with pancreatic cancer.</p>\u0000 </section>\u0000 </div>","PeriodicalId":16056,"journal":{"name":"Journal of Hepato‐Biliary‐Pancreatic Sciences","volume":"31 9","pages":"671-679"},"PeriodicalIF":3.2,"publicationDate":"2024-07-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141616662","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}
The adjuvant S-1 trial affirmed adjuvant chemotherapy for biliary tract cancer but excluded pT1N0 distal cholangiocarcinoma (DCC) according to the seventh edition of the American Joint Committee on Cancer (AJCC) classification. The introduction of tumor depth of invasion (DOI) for T-classification in the eighth edition complicates identifying DCC patients less likely to benefit from adjuvant chemotherapy.
Methods
Our cohort consisted of 185 patients with DCC who underwent pancreaticoduodenectomy between 2002 and 2019. We compared clinicopathological factors and survival outcomes between pT1N0 patients in the seventh edition and those in the eighth edition. New DOI cutoffs for subdividing pT1N0 (8th edition) patients were evaluated to identify patients less likely to benefit from adjuvant chemotherapy.
Results
Transitioning to the eighth edition increased in pT1N0 cases from eight to 46. The 5-year cumulative recurrence rates of them were 14.3% for the seventh edition and 28.3% for the eighth edition. We proposed a DOI cutoff of <2 mm, at which the 5-year cumulative recurrence rate was 11.5%.
Conclusion
The eighth AJCC classification revealed that a significant proportion of pT1N0 DCC patients were at risk for recurrence. A DOI cutoff of <2 mm may be considered to potentially improve patient selection for adjuvant chemotherapy.
{"title":"Subdivision of pT1N0 (American Joint Committee on Cancer 8th edition) distal cholangiocarcinoma for adjuvant chemotherapy consideration","authors":"Shimpei Otsuka, Teiichi Sugiura, Ryo Ashida, Katsuhisa Ohgi, Mihoko Yamada, Yoshiyasu Kato, Kageyama Yumiko, Nobuyuki Ohike, Takashi Sugino, Katsuhiko Uesaka","doi":"10.1002/jhbp.12010","DOIUrl":"10.1002/jhbp.12010","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>The adjuvant S-1 trial affirmed adjuvant chemotherapy for biliary tract cancer but excluded pT1N0 distal cholangiocarcinoma (DCC) according to the seventh edition of the American Joint Committee on Cancer (AJCC) classification. The introduction of tumor depth of invasion (DOI) for T-classification in the eighth edition complicates identifying DCC patients less likely to benefit from adjuvant chemotherapy.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Our cohort consisted of 185 patients with DCC who underwent pancreaticoduodenectomy between 2002 and 2019. We compared clinicopathological factors and survival outcomes between pT1N0 patients in the seventh edition and those in the eighth edition. New DOI cutoffs for subdividing pT1N0 (8th edition) patients were evaluated to identify patients less likely to benefit from adjuvant chemotherapy.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Transitioning to the eighth edition increased in pT1N0 cases from eight to 46. The 5-year cumulative recurrence rates of them were 14.3% for the seventh edition and 28.3% for the eighth edition. We proposed a DOI cutoff of <2 mm, at which the 5-year cumulative recurrence rate was 11.5%.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>The eighth AJCC classification revealed that a significant proportion of pT1N0 DCC patients were at risk for recurrence. A DOI cutoff of <2 mm may be considered to potentially improve patient selection for adjuvant chemotherapy.</p>\u0000 </section>\u0000 </div>","PeriodicalId":16056,"journal":{"name":"Journal of Hepato‐Biliary‐Pancreatic Sciences","volume":"31 8","pages":"559-568"},"PeriodicalIF":3.2,"publicationDate":"2024-06-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141468612","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}
Treatment of common bile duct stones or anastomotic stenosis is challenging in patients with surgically altered anatomy (SAA). Although the clinical outcomes of balloon enteroscopy-assisted endoscopic retrograde cholangiopancreatography (BE-ERCP) have been improving in these patients,1-3 stacked stones are still difficult to remove in some cases. There are also cases in which electrohydraulic lithotripsy (EHL) is required for the removal of stacked stones in patients with SAA.4
The patient in this case was an 89-year-old man who had undergone Roux-en Y reconstruction after resection of gastric cancer. He was admitted to our hospital for treatment of cholangitis due to stacked common bile duct stones. BE-ERCP was attempted for bile duct drainage, but the papilla could not be identified and percutaneous transhepatic biliary drainage was performed. Then rendezvous BE-ERCP using the percutaneous transhepatic drainage route was performed (Figure 1). Although the papilla could be identified, the stacked stones were difficult to remove, and EHL was planned for the next session. Unfortunately, a peroral direct digital cholangioscope (SpyDS; Boston Scientific, Natick, Massachusetts, USA) with a caliber of 3.3 mm was not available for BE-ERCP because of the limited diameter of the accessory channel (3.2 mm). Therefore, ERCP was performed using a colonoscope (CF-XZ1200; Olympus Medical, Tokyo, Japan), in which the cholangioscope can be inserted via the accessory channel (3.7 mm).
The cholangioscope was inserted into the common bile duct via the CF-XZ1200 and showed that the common bile duct was filled with stacked stones. The stacked stones were crushed by EHL and cholangiography showed that the stones were reduced in size. The stones were completely removed using a mechanical lithotripter and basket catheter. The patient had a favorable course and was discharged (Figure 2).
This case demonstrates that stacked stones can be safely and effectively removed by EHL and other tools with the CF-XZ1200 in a patient with SAA.
Conception and design: Noriyuki Hirakawa, Katsuya Kitamura and Takao Itoi. Manuscript preparation: Noriyuki Hirakawa. Endoscopic procedures: Noriyuki Hirakawa and Katsuya Kitamura.
{"title":"A case of complete removal of stacked common bile duct stones by peroral direct digital cholangioscopy in a patient with surgically altered anatomy","authors":"Noriyuki Hirakawa, Katsuya Kitamura, Takao Itoi","doi":"10.1002/jhbp.12013","DOIUrl":"10.1002/jhbp.12013","url":null,"abstract":"<p>Treatment of common bile duct stones or anastomotic stenosis is challenging in patients with surgically altered anatomy (SAA). Although the clinical outcomes of balloon enteroscopy-assisted endoscopic retrograde cholangiopancreatography (BE-ERCP) have been improving in these patients,<span><sup>1-3</sup></span> stacked stones are still difficult to remove in some cases. There are also cases in which electrohydraulic lithotripsy (EHL) is required for the removal of stacked stones in patients with SAA.<span><sup>4</sup></span></p><p>The patient in this case was an 89-year-old man who had undergone Roux-en Y reconstruction after resection of gastric cancer. He was admitted to our hospital for treatment of cholangitis due to stacked common bile duct stones. BE-ERCP was attempted for bile duct drainage, but the papilla could not be identified and percutaneous transhepatic biliary drainage was performed. Then rendezvous BE-ERCP using the percutaneous transhepatic drainage route was performed (Figure 1). Although the papilla could be identified, the stacked stones were difficult to remove, and EHL was planned for the next session. Unfortunately, a peroral direct digital cholangioscope (SpyDS; Boston Scientific, Natick, Massachusetts, USA) with a caliber of 3.3 mm was not available for BE-ERCP because of the limited diameter of the accessory channel (3.2 mm). Therefore, ERCP was performed using a colonoscope (CF-XZ1200; Olympus Medical, Tokyo, Japan), in which the cholangioscope can be inserted via the accessory channel (3.7 mm).</p><p>The cholangioscope was inserted into the common bile duct via the CF-XZ1200 and showed that the common bile duct was filled with stacked stones. The stacked stones were crushed by EHL and cholangiography showed that the stones were reduced in size. The stones were completely removed using a mechanical lithotripter and basket catheter. The patient had a favorable course and was discharged (Figure 2).</p><p>This case demonstrates that stacked stones can be safely and effectively removed by EHL and other tools with the CF-XZ1200 in a patient with SAA.</p><p>Conception and design: Noriyuki Hirakawa, Katsuya Kitamura and Takao Itoi. Manuscript preparation: Noriyuki Hirakawa. Endoscopic procedures: Noriyuki Hirakawa and Katsuya Kitamura.</p>","PeriodicalId":16056,"journal":{"name":"Journal of Hepato‐Biliary‐Pancreatic Sciences","volume":"31 9","pages":"e53-e55"},"PeriodicalIF":3.2,"publicationDate":"2024-06-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/jhbp.12013","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141419488","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Prevention of postoperative splenic infarction in the robotic Warshaw technique requires rigorous evaluation of blood flow to the spleen. Shibuya and colleagues recommend checking: (1) conventional splenic color change, (2) intrasplenic artery waveform by ultrasound Doppler examination, (3) blood flow using indocyanine green, and (4) pulsatile regurgitation from the splenic artery.
{"title":"Robotic Warshaw technique with special attention to prevent postoperative splenic infarction preserving splenic blood flow","authors":"Makoto Shibuya, Takeyuki Misawa, Kana Tsukiyama, Makoto Watanabe, Rie Kondo, Kunihiko Takahashi, Masahiko Kainuma, Keiji Sano","doi":"10.1002/jhbp.12007","DOIUrl":"10.1002/jhbp.12007","url":null,"abstract":"<p>Prevention of postoperative splenic infarction in the robotic Warshaw technique requires rigorous evaluation of blood flow to the spleen. Shibuya and colleagues recommend checking: (1) conventional splenic color change, (2) intrasplenic artery waveform by ultrasound Doppler examination, (3) blood flow using indocyanine green, and (4) pulsatile regurgitation from the splenic artery.\u0000 <figure>\u0000 <div><picture>\u0000 <source></source></picture><p></p>\u0000 </div>\u0000 </figure></p>","PeriodicalId":16056,"journal":{"name":"Journal of Hepato‐Biliary‐Pancreatic Sciences","volume":"31 8","pages":"e44-e46"},"PeriodicalIF":3.2,"publicationDate":"2024-06-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141419489","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}
Min Kyu Sung, Jihyun Chun, Yejong Park, Bong Jun Kwak, Woohyung Lee, Ki Byung Song, Jae Hoon Lee, Song Cheol Kim, Seung Mo Hong, Dae Wook Hwang
Background/Purpose
Extranodal extension (ENE) is an established prognostic factor in various malignancies, affecting survival in pancreatic head cancer (PHC). However, its significance in pancreatic body/tail cancer (PBTC) remains unclear. Therefore, we aimed to investigate the impact of ENE on PTBC prognosis.
Methods
We analyzed data collected from electronic medical records of patients with PBTC who underwent distal pancreatectomy at a single center between January 2011 and December 2015. The patients were categorized based on ENE presence and prognostic implications were evaluated using Kaplan–Meier survival curves and Cox proportional hazards model.
Results
PBTC cases involving lymph node (LN) metastasis and ENE exhibited significantly lower disease-free (DFS) and overall survival (OS) rates compared to cases without LN metastasis or ENE (median DFS; N0, 23 months; LN+/ENE−, 10 months; LN+/ENE+, 5 months; p < .001). No statistically significant difference was observed in DFS and OS rates between patients with N1/N2 in the group without ENE and those with ENE+. Multivariate analysis confirmed ENE as a significant adverse prognostic factor.
Conclusions
ENE significantly predicts poor prognosis in PBTC, particularly in cases with nodal metastasis. The current cancer staging system for PBTC should incorporate ENE status. Moreover, different staging systems should be considered for PHC and PBTC.
{"title":"Extranodal extension influences prognosis in pancreatic body/tail cancer: A retrospective cohort study","authors":"Min Kyu Sung, Jihyun Chun, Yejong Park, Bong Jun Kwak, Woohyung Lee, Ki Byung Song, Jae Hoon Lee, Song Cheol Kim, Seung Mo Hong, Dae Wook Hwang","doi":"10.1002/jhbp.12008","DOIUrl":"10.1002/jhbp.12008","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background/Purpose</h3>\u0000 \u0000 <p>Extranodal extension (ENE) is an established prognostic factor in various malignancies, affecting survival in pancreatic head cancer (PHC). However, its significance in pancreatic body/tail cancer (PBTC) remains unclear. Therefore, we aimed to investigate the impact of ENE on PTBC prognosis.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We analyzed data collected from electronic medical records of patients with PBTC who underwent distal pancreatectomy at a single center between January 2011 and December 2015. The patients were categorized based on ENE presence and prognostic implications were evaluated using Kaplan–Meier survival curves and Cox proportional hazards model.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>PBTC cases involving lymph node (LN) metastasis and ENE exhibited significantly lower disease-free (DFS) and overall survival (OS) rates compared to cases without LN metastasis or ENE (median DFS; N0, 23 months; LN+/ENE−, 10 months; LN+/ENE+, 5 months; <i>p</i> < .001). No statistically significant difference was observed in DFS and OS rates between patients with N1/N2 in the group without ENE and those with ENE+. Multivariate analysis confirmed ENE as a significant adverse prognostic factor.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>ENE significantly predicts poor prognosis in PBTC, particularly in cases with nodal metastasis. The current cancer staging system for PBTC should incorporate ENE status. Moreover, different staging systems should be considered for PHC and PBTC.</p>\u0000 </section>\u0000 </div>","PeriodicalId":16056,"journal":{"name":"Journal of Hepato‐Biliary‐Pancreatic Sciences","volume":"31 8","pages":"569-580"},"PeriodicalIF":3.2,"publicationDate":"2024-06-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/jhbp.12008","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141317538","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Daisuke Fukumori, Christoph Tschuor, Takashi Hamada, Luit Penninga, Jens Hillingsø, Lars Bo Svendsen, Peter Nørgaard Larsen
Background
The incidence of liver tumors requiring surgical treatment continues to increase in elderly patients. This study compared the short-term results of robotic liver surgery (RLS) versus open liver surgery (OLS) for liver tumors in elderly patients.
Methods
A prospective database including all patients undergoing liver surgery at Copenhagen University Hospital between July 2019 and July 2022 was managed retrospectively. Short-term surgical outcomes of the two main cohorts (OLS and RLS) and subgroups were compared using propensity score matching (PSM) in elderly patients (age ≥ 70 years) with liver tumors.
Results
A total of 42 matched patients from each group were investigated: the RLS group had significantly larger tumor diameters, less blood loss (821.2 vs. 155.2 mL, p < .001), and shorter hospital stays (6.6 vs. 3.4 days, p < .001). Overall morbidity was comparable, while operative times were longer in the RLS group. The advantages observed with the robotic approach were replicated in the subgroup of minor liver resections.
Conclusions
In patients ≥70 years, RLS for liver tumors results in significantly less blood loss and shorter hospital stays than OLS. RLS, especially minor liver resection, is safe and feasible in elderly patients with liver tumors.
{"title":"Efficacy and safety of robotic liver surgery for the elderly: A propensity-score matched analysis of short-term outcomes with open liver surgery at a single center in Denmark","authors":"Daisuke Fukumori, Christoph Tschuor, Takashi Hamada, Luit Penninga, Jens Hillingsø, Lars Bo Svendsen, Peter Nørgaard Larsen","doi":"10.1002/jhbp.12015","DOIUrl":"10.1002/jhbp.12015","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>The incidence of liver tumors requiring surgical treatment continues to increase in elderly patients. This study compared the short-term results of robotic liver surgery (RLS) versus open liver surgery (OLS) for liver tumors in elderly patients.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>A prospective database including all patients undergoing liver surgery at Copenhagen University Hospital between July 2019 and July 2022 was managed retrospectively. Short-term surgical outcomes of the two main cohorts (OLS and RLS) and subgroups were compared using propensity score matching (PSM) in elderly patients (age ≥ 70 years) with liver tumors.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>A total of 42 matched patients from each group were investigated: the RLS group had significantly larger tumor diameters, less blood loss (821.2 vs. 155.2 mL, <i>p</i> < .001), and shorter hospital stays (6.6 vs. 3.4 days, <i>p</i> < .001). Overall morbidity was comparable, while operative times were longer in the RLS group. The advantages observed with the robotic approach were replicated in the subgroup of minor liver resections.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>In patients ≥70 years, RLS for liver tumors results in significantly less blood loss and shorter hospital stays than OLS. RLS, especially minor liver resection, is safe and feasible in elderly patients with liver tumors.</p>\u0000 </section>\u0000 </div>","PeriodicalId":16056,"journal":{"name":"Journal of Hepato‐Biliary‐Pancreatic Sciences","volume":"31 9","pages":"625-636"},"PeriodicalIF":3.2,"publicationDate":"2024-06-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/jhbp.12015","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141310844","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
De novo malignancies (DNMs) are a major adverse event after solid organ transplantation; however, their characteristics and recent trends after living-donor liver transplantation (LDLT) remain unclear.
Methods
We retrospectively reviewed 1781 primary LDLT recipients (1990–2020) and annually calculated standardized incidence ratios (SIRs) of DNMs compared to the age-adjusted Japanese general population.
Results
After 21 845 person-years follow-up, 153 DNM lesions (8.6%) were identified in 131 patients (7.4%). The incidence was 0.007 person-years. DNMs included 81 post-transplant lymphoproliferative disorders (PTLDs), 14 colorectal, 12 lung, and 12 gastric cancers, and so on. Comorbid DNMs significantly worsened recipient survival than those without (p < .001). The 5- and 10-year recipient survival after DNM diagnosis were 65% and 58%, respectively. Notably, SIR1993–1995: 8.12 (95% CI: 3.71–15.4, p < .001) and SIR1996–1998: 3.11 (1.34–6.12, p = .01) were significantly high, but had decreased time-dependently to SIR2005–2007: 1.31 (0.68–2.29, p = .42) and SIR2008–2010: 1.34 (0.75–2.20, p = .33), indicating no longer significant difference in DNMs development. Currently, however, SIR2014–2016: 2.27 (1.54–3.22, p < .001) and SIR2017–2019: 2.07 (1.40–2.96, p < .001) have become significantly higher again, reflecting recent aging of recipients (>50 years) and resultant increases in non-PTLD DNMs. Furthermore, characteristically in LDLT, the fewer the donor-recipient HLA-mismatches, the less the post-transplant DNMs development.
Conclusion
DNM development after LDLT was significantly higher than in the general population due to higher PTLD incidence (1993-1998), but once became equivalent (2005-2013), then significantly increased again (2014-2019) due to recent recipient aging and resultant increase in solid cancers.
{"title":"Chronological alterations in de novo malignancies after living-donor liver transplantation: A cohort study of 1781 recipients using annual comparisons of standardized incidence ratios","authors":"Tetsuya Tajima, Koichiro Hata, Kosuke Tanaka, Naomi Iyama, Jiro Kusakabe, Shoichi Kageyama, Eri Ogawa, Tatsuya Okamoto, Hironori Haga, Shinji Uemoto, Etsuro Hatano","doi":"10.1002/jhbp.12002","DOIUrl":"10.1002/jhbp.12002","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>De novo malignancies (DNMs) are a major adverse event after solid organ transplantation; however, their characteristics and recent trends after living-donor liver transplantation (LDLT) remain unclear.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We retrospectively reviewed 1781 primary LDLT recipients (1990–2020) and annually calculated standardized incidence ratios (SIRs) of DNMs compared to the age-adjusted Japanese general population.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>After 21 845 person-years follow-up, 153 DNM lesions (8.6%) were identified in 131 patients (7.4%). The incidence was 0.007 person-years. DNMs included 81 post-transplant lymphoproliferative disorders (PTLDs), 14 colorectal, 12 lung, and 12 gastric cancers, and so on. Comorbid DNMs significantly worsened recipient survival than those without (<i>p</i> < .001). The 5- and 10-year recipient survival after DNM diagnosis were 65% and 58%, respectively. Notably, SIR<sub>1993–1995</sub>: 8.12 (95% CI: 3.71–15.4, <i>p</i> < .001) and SIR<sub>1996–1998</sub>: 3.11 (1.34–6.12, <i>p</i> = .01) were significantly high, but had decreased time-dependently to SIR<sub>2005–2007</sub>: 1.31 (0.68–2.29, <i>p</i> = .42) and SIR<sub>2008–2010</sub>: 1.34 (0.75–2.20, <i>p</i> = .33), indicating no longer significant difference in DNMs development. Currently, however, SIR<sub>2014–2016</sub>: 2.27 (1.54–3.22, <i>p</i> < .001) and SIR<sub>2017–2019</sub>: 2.07 (1.40–2.96, <i>p</i> < .001) have become significantly higher again, reflecting recent aging of recipients (>50 years) and resultant increases in non-PTLD DNMs. Furthermore, characteristically in LDLT, the fewer the donor-recipient HLA-mismatches, the less the post-transplant DNMs development.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>DNM development after LDLT was significantly higher than in the general population due to higher PTLD incidence (1993-1998), but once became equivalent (2005-2013), then significantly increased again (2014-2019) due to recent recipient aging and resultant increase in solid cancers.</p>\u0000 </section>\u0000 </div>","PeriodicalId":16056,"journal":{"name":"Journal of Hepato‐Biliary‐Pancreatic Sciences","volume":"31 7","pages":"455-467"},"PeriodicalIF":3.2,"publicationDate":"2024-06-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/jhbp.12002","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141283919","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Endoscopic retrograde cholangiography (ERC)-related procedures, usually performed before biliary tract cancer (BTC) surgery, are associated with increased risk for various complications, which can cause sarcopenia. No study has previously elucidated the relationship between preoperative ERC-related procedures and sarcopenia/skeletal muscle mass loss.
Methods
Patients with BTC who underwent radical surgical resection following ERC-related procedures were included. Skeletal muscle mass was evaluated using the psoas muscle mass index (PMI), which was determined using computed tomography images, and the change in PMI before the initial pre-ERC and surgery (ΔPMI) was calculated. Risk factors for advanced skeletal muscle mass loss, defined as a large ΔPMI, were evaluated.
Results
The study cohort included 90 patients with a median age of 72 (interquartile range, 65–75) years. The median PMI pre-ERC and surgery was 4.40 and 4.15 cm2/m2, respectively (p < .01). The median ΔPMI was −6.2% (interquartile range, −10.9% to 0.5%). By multivariate analysis, post-ERC pancreatitis and cholangitis before surgery were independent predictive factors for large PMI loss (odds ratio, 4.57 and 3.18, respectively; p = .03 and p = .02, respectively).
Conclusions
Skeletal muscle mass decreases preoperatively in most patients with BTC undergoing ERC. Post-ERC pancreatitis and cholangitis before surgery were independent risk factors for large skeletal muscle mass loss.
{"title":"Preoperative risk factors for skeletal muscle mass loss in patients with biliary tract cancer","authors":"Ryo Sugiura, Masaki Kuwatani, Kazumichi Kawakubo, Kazuma Kishi, Hiroki Yonemura, Shunichiro Nozawa, Masatsugu Ohara, Takehiro Noji, Satoshi Hirano, Naoya Sakamoto","doi":"10.1002/jhbp.12006","DOIUrl":"10.1002/jhbp.12006","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Endoscopic retrograde cholangiography (ERC)-related procedures, usually performed before biliary tract cancer (BTC) surgery, are associated with increased risk for various complications, which can cause sarcopenia. No study has previously elucidated the relationship between preoperative ERC-related procedures and sarcopenia/skeletal muscle mass loss.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Patients with BTC who underwent radical surgical resection following ERC-related procedures were included. Skeletal muscle mass was evaluated using the psoas muscle mass index (PMI), which was determined using computed tomography images, and the change in PMI before the initial pre-ERC and surgery (ΔPMI) was calculated. Risk factors for advanced skeletal muscle mass loss, defined as a large ΔPMI, were evaluated.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>The study cohort included 90 patients with a median age of 72 (interquartile range, 65–75) years. The median PMI pre-ERC and surgery was 4.40 and 4.15 cm<sup>2</sup>/m<sup>2</sup>, respectively (<i>p</i> < .01). The median ΔPMI was −6.2% (interquartile range, −10.9% to 0.5%). By multivariate analysis, post-ERC pancreatitis and cholangitis before surgery were independent predictive factors for large PMI loss (odds ratio, 4.57 and 3.18, respectively; <i>p</i> = .03 and <i>p</i> = .02, respectively).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Skeletal muscle mass decreases preoperatively in most patients with BTC undergoing ERC. Post-ERC pancreatitis and cholangitis before surgery were independent risk factors for large skeletal muscle mass loss.</p>\u0000 </section>\u0000 </div>","PeriodicalId":16056,"journal":{"name":"Journal of Hepato‐Biliary‐Pancreatic Sciences","volume":"31 8","pages":"549-558"},"PeriodicalIF":3.2,"publicationDate":"2024-06-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141283920","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}
Liver metastasis is the most frequently observed distant metastasis of colorectal cancer, and the residual liver recurrence rate after hepatic resection is still high. To explore the mechanism of liver metastasis to discover potential new treatments, we assessed the relationship between the expression of differentially expressed genes (DEGs) and prognosis in patients with colorectal cancer liver metastasis (CRLM).
Methods
The gene expression dataset was extracted from The Cancer Genome Atlas and the Gene Expression Omnibus. Significance analysis of DEGs between tumor and normal samples of colorectum, liver, and lung was conducted. A total of 80 CRLM patients were studied to assess the expression of RPS15, characteristics, and outcomes. We examined the relationships of RPS15 expression to cell viability and apoptosis in vitro and vivo.
Results
Significance analysis identified 33 DEGs. In our cohorts, the overall survival rates were significantly lower in the high-RPS15-expression group, and high expression of RPS15 was an independent and unfavorable prognostic factor in recurrence-free survival and overall survival. Knockdown of RPS15 expression reduced the proliferative capacity of colorectal cancer cells and increased BAX-induced apoptotic cell death.
Conclusions
RPS15 expression is an independent prognostic factor for CRLM patients and might be a novel therapeutic target for CRLM.
{"title":"Clinical significance of ribosomal protein S15 expression in patients with colorectal cancer liver metastases","authors":"Yoshihiro Sakano, Daijiro Matoba, Takehiro Noda, Shogo Kobayashi, Daisaku Yamada, Yoshito Tomimaru, Hidenori Takahashi, Mamoru Uemura, Yuichiro Doki, Hidetoshi Eguchi","doi":"10.1002/jhbp.12012","DOIUrl":"10.1002/jhbp.12012","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Liver metastasis is the most frequently observed distant metastasis of colorectal cancer, and the residual liver recurrence rate after hepatic resection is still high. To explore the mechanism of liver metastasis to discover potential new treatments, we assessed the relationship between the expression of differentially expressed genes (DEGs) and prognosis in patients with colorectal cancer liver metastasis (CRLM).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>The gene expression dataset was extracted from The Cancer Genome Atlas and the Gene Expression Omnibus. Significance analysis of DEGs between tumor and normal samples of colorectum, liver, and lung was conducted. A total of 80 CRLM patients were studied to assess the expression of <i>RPS15</i>, characteristics, and outcomes. We examined the relationships of RPS15 expression to cell viability and apoptosis in vitro and vivo.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Significance analysis identified 33 DEGs. In our cohorts, the overall survival rates were significantly lower in the high-RPS15-expression group, and high expression of RPS15 was an independent and unfavorable prognostic factor in recurrence-free survival and overall survival. Knockdown of RPS15 expression reduced the proliferative capacity of colorectal cancer cells and increased BAX-induced apoptotic cell death.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>RPS15 expression is an independent prognostic factor for CRLM patients and might be a novel therapeutic target for CRLM.</p>\u0000 </section>\u0000 </div>","PeriodicalId":16056,"journal":{"name":"Journal of Hepato‐Biliary‐Pancreatic Sciences","volume":"31 9","pages":"611-624"},"PeriodicalIF":3.2,"publicationDate":"2024-06-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/jhbp.12012","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141260267","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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