Pancreas最新文献

Objectives: To evaluate patient preferences for decision-making role in the management of intraductal papillary mucinous neoplasms (IPMNs) of the pancreas and to identify characteristics associated with those preferences.

Background: Management of IPMNs is rooted in uncertainty with guidelines failing to incorporate patients' preferences.

Materials and methods: A representative sample of participants evaluated a clinical vignette with the option to undergo surgery or surveillance for their IPMN. Their preferred role in decision-making was evaluated using the Control Preference Scale. The relationship between control preference and demographic/psychosocial variables was analyzed.

Results: Of the 520 participants in the study, most preferred an active role (65%), followed by shared (29%), and passive roles (6%) in the decision-making process. Lower health literacy was significantly associated with more passive control preference ( P  = 0.003). Non-active preference was significantly associated with Latino race compared to White race (odds ratio = 0.52, P  = 0.009). We found no significant association between control preference and education level or cancer anxiety.

Conclusions: Most patients prefer an active role in IPMN treatment decisions. Lower health literacy and Latino race were associated with a preference for non-active decision roles. Clinicians should strive to align patient involvement in IPMN treatment decisions with their patient's preferred role.

Objectives: Chronic pancreatitis (CP) is a fibro-inflammatory disorder characterized by abdominal pain and pancreatic insufficiency resulting in significant morbidity. This study evaluates the impact of geospatial parameters assessed using the Social Vulnerability Index (SVI) on CP outcomes.

Materials and methods: We retrospectively analyzed CP patients with available addresses followed at our pancreas center. We reviewed demographics, number of CP flares, local complications, healthcare-resource utilization, and outpatient opioid prescriptions. Regression analysis was performed to assess the association between outcomes and SVI (divided into 4 quartiles [I-IV; IV being most vulnerable]).

Results: Among 324 CP patients followed over 8 years, we noted trends of higher dependence on governmental insurance or no insurance among patients in higher SVI quartiles (III/IV vs I/II) but no differences in demographics, comorbidities, or etiology of CP. Among patients in higher SVI quartiles, we noted significantly higher frequency of hospitalizations for CP flares and reduced opioid use. Rates of exocrine and endocrine pancreatic dysfunction and healthcare-resource utilization were similar across SVI quartiles.

Conclusions: Residence in the most vulnerable neighborhoods may be associated with reduced opioid use and more frequent CP flares, suggesting possible inadequate pain control in these patients. These findings should guide prospective investigation of the impact of geospatial social determinants of health in CP.

Objectives: Pancreatic neuroendocrine tumors (pNETs) are uncommon, comprising 3%-7% of pancreatic tumors. With increasing incidence due to advanced imaging techniques, there is a need for detailed characterization of these tumors. This study aims to describe the clinical features, diagnostic evaluations, and pathology characteristics of pNETs in a large cohort from a single tertiary center, and to compare these findings with other larger cohort studies.

Methods: We conducted a retrospective analysis of 866 patients with pNETs who underwent surgical resection at Mayo Clinic, Rochester, from March 2000 to December 2019. Data on demographics, clinical presentation, laboratory tests, imaging, and pathology were extracted and analyzed. Descriptive statistics were used to summarize the data.

Results: The cohort had a median age of 57 years. Nonfunctional tumors were much more prevalent (77.5%), with functional tumors primarily being insulinomas (75.9%). Common presenting symptoms included gastrointestinal (45.3%) and nongastrointestinal symptoms (30.7%). Chromogranin A levels were elevated in 57.5% of patients. Imaging revealed enhancing lesions in most cases, with computed tomography scans performed in 90.9% of patients. Endoscopic ultrasound (EUS) identified tumors in 98.1% of cases, with EUS-FNA showing a sensitivity of 82%. Ki-67 index, used in 58.1% of cases, indicated grade 2 tumors as the most common (55.9%). Metastasis was observed in 39.4% of patients at the time of diagnosis, predominantly in the liver.

Conclusion: This study provides a comprehensive description of pNET characteristics in a large surgical cohort. Findings highlight the predominance of nonfunctional tumors and the importance of imaging and EUS in diagnosis. The data can aid in inter-institutional comparisons and enhance understanding of pNETs, contributing to improved patient management and future research.

Objectives: Chronic pancreatitis is a debilitating and progressive inflammatory disease with an altered quality of life due to severe abdominal pain. Pancreaticoduodenectomy is a surgical option for patients with bulky disease involving the head of the pancreas, especially when this disease has progressed to stricture of the bile duct, duodenum, or both. A long-term issue associated with this procedure is the stricture of the pancreatic anastomosis. Reoperative and endoscopic interventions are difficult related to difficulty in reaching the anastomosis endoscopically. We describe a variation of this procedure with the potential to lead to longer-term improvement in the drainage of the residual pancreas.

Methods: We reviewed electronic medical records of patients undergoing pancreaticoduodenectomy for chronic pancreatitis performed by 1 surgeon at the University of Minnesota Medical Center, Minneapolis, MN, between 2014 and 2023. Information gathered from the patient's records included preoperative demographics, perioperative outcomes, and postoperative follow-up information.

Results: The described procedure was performed on 8 patients between 2014 and 2023. Three patients have died since surgery at 1.5, 5.5, and 8 years postop, with no deaths related to pancreatitis or surgical complications. Of the remaining 5 patients, the median time from surgery is 7.5 years.

Conclusions: We describe a surgical technique that may reduce the risk of pancreaticojejunal stricture in patients undergoing pancreaticoduodenectomy for chronic pancreatitis. In a small series of patients, this procedure can be performed safely with acceptable results.

Introduction: Pancreatic ductal adenocarcinoma (PDAC) has a distinct genomic profile, with somatic KRAS mutations occurring in 85%-95% of all PDAC cases. This study aimed to measure the prognostic impact of specific KRAS mutations in resected PDAC patients from a large, high-volume center.

Methods: This retrospective study included a cohort of PDAC patients who underwent curative-intent pancreatic resection at our institution between 2016 and 2021. Demographic, histologic, and oncologic outcome data were recorded. KRAS status was assessed via next-generation sequencing. Thirty-six (12.8%) wtKRAS, 109 (38.8%) G12D, 76 (27.0%) G12V, 36 (12.8%) G12R, 11 (3.9%) Q61H.

Results: A total of 281 patients were included with wtKRAS (12.8%), G12D (38.8%), G12V (27.0%), G12R (12.8%), accounting for over 90% of the KRAS genotypes. Kaplan-Meier analysis revealed wild-type KRAS to be associated with improved overall survival (68.5±0 vs. 32.1±2.3 mo, P=0.005), and disease-free survival (35.4±0 vs. 20.3±3.9 mo, P=0.043). Cox regression analysis demonstrated worse overall survival with increased age (HR=1.04/y, P<0.01), neoadjuvant chemotherapy (HR=2.01, P<0.01), the presence of lymphovascular invasion (HR=2.47, P<0.01), G12D or G12V KRAS subtypes (P≤0.05), and lack of adjuvant chemotherapy (HR=0.6, P=0.02).

Conclusions: Next-generation sequencing of the KRAS subtype in resectable PDAC tumors shows that the KRAS G12D/G12V subtypes confer a worse prognosis compared with wild-type KRAS tumors.