Pancreas最新文献

Objectives: Acute pancreatitis induces systemic inflammation and promotes a prothrombotic environment, which may increase the risk of cardiovascular events. However, the temporal relationship between acute pancreatitis and subsequent cardiovascular events remains unexplored. We aimed to examine whether the risk of acute myocardial infarction and stroke is increased following an episode of acute pancreatitis.

Methods: We conducted a Danish Nationwide population-based cohort study, including all incident cases of acute pancreatitis (≥18 years) from 2002 to 2017. The primary outcome was acute myocardial infarction or stroke. Using a self-controlled case series design, we compared the incidence of myocardial infarction or stroke during a risk interval (90 days following acute pancreatitis discharge) with two control intervals (365 days before and 91-365 days after the acute pancreatitis episode).

Results: Among 33,124 patients with incident acute pancreatitis, 366 cases of myocardial infarction and 624 cases of stroke were identified within one year of the acute pancreatitis episode. The incidence rate ratios (IRR) for myocardial infarction during the 90-day risk interval was 1.87 (95% confidence interval (CI), 1.42-2.47), with the highest risk observed during the first 10 days (IRR, 4.08; 95% CI, 2.58-6.44), followed by a gradual decline. The IRR for stroke during the risk interval was 2.12 (95% CI, 1.74-2.58), peaking in the first 10 days (IRR, 3.40; 95% CI, 2.33-4.96) and gradually declining.

Conclusions: Our study reveals a temporary increase in the risk of myocardial infarction and stroke after hospitalization for a first episode of acute pancreatitis.

Objective: Identify how surgical resection of pancreatic ductal adenocarcinoma (PDAC) affects systemic minimal residual disease (MRD).

Methods: Pancreatic tumors were generated by orthotopic implantation of tumor cells into the pancreas of immunocompetent mice. Tumor resection was carried out via distal pancreatectomy and splenectomy. Liver metastases and microenvironment immune changes were analyzed in resected vs. non-resected mice.

Results: Resection was accompanied by proliferative expansion of liver metastases and an increase in hepatic metastatic burden. Postoperative immune changes predominantly manifested as a time-dependent increase in eosinophils and decrease in neutrophils. The postoperative hepatic eosinophilia was protective of further metastatic progression. The parenchymal findings were detectable in the circulation, and the trends observed in the mouse model modeled those seen in PDAC patients postoperatively.

Conclusion: Collectively, we describe a preclinical resection model that offers a means to investigate MRD. Using this model, we delineated effects of surgical resection on metastatic outgrowth and uncovered a protective link between the postoperative hepatic eosinophilia and further metastatic progression.

Objectives: The prognostic significance of the ABO blood type in patients with advanced pancreatic cancer (APC) receiving nab-paclitaxel plus gemcitabine (AG) remains unknown. Therefore, we investigated the prognostic significance of the ABO blood type in patients with APC receiving AG.

Methods: From January 2015 to May 2023, 90 patients with APC received AG as first-line chemotherapy at Higashiosaka City Medical Center. We analyzed overall survival (OS) based on the ABO blood type using the Kaplan-Meier method and log-rank test, and we retrospectively compared patient characteristics between those with the blood type associated with the worst OS and those with other blood types. Prognostic factors were assessed using Cox regression.

Results: The median OS in the B blood type group was significantly shorter (5.0 months) than that in the non-B blood type group (9.6 months, P=0.012). Patients in the B blood type group had a significantly higher prevalence of sarcopenia than those in the non-B blood type group (P=0.011). However, the AG treatment response, progression-free survival during AG, and residual survival with subsequent anti-cancer treatment after AG did not significantly differ between the two groups. The multivariate analysis revealed that the B blood type was an independent unfavorable prognostic factor of OS.

Conclusions: Patients with the B blood type had a markedly poorer prognosis and a higher prevalence of sarcopenia. Patients who have APC with the B blood type may require additional supportive treatment for sarcopenia.

Background and aims: Pancreatic fat infiltration (PFI) is strongly associated with obesity, insulin resistance, and cardiometabolic risk. However, its impact on pancreatic stiffness remains unclear. This study aimed to evaluate the relationship between PFI, pancreatic stiffness measured by transabdominal 2D-SWE elastography, and cardiometabolic risk factors (CMRF).

Methods: This cross-sectional study included patients with and without PFI, identified by abdominal ultrasound. Exclusion criteria included a history of pancreatic or liver disease and alcohol consumption >20 g/day. CMRFs were assessed, and pancreatic stiffness was measured using transabdominal 2D-SWE elastography. In patients with PFI, additional assessments included hepatic 2D-SWE elastography, attenuation imaging for hepatic fat quantification, and evaluation of insulin resistance.

Results: A total of 205 patients were included, 103 with PFI and 102 without. Patients with PFI were older and had a higher prevalence of CMRFs, including increased waist circumference (84.5%), overweight/obesity (79.6%), hypertriglyceridemia (62.7%), metabolic syndrome (59.4%), and insulin resistance (53.9%). Hepatic steatosis was present in 61% of patients with PFI but absent in those without. Pancreatic stiffness was significantly higher in patients with PFI compared with those without (7.35 KPa [IQR: 6.30-8.79] vs. 5.3 KPa [IQR: 4.5-6.1]; P<0.001). A stiffness threshold of ≥6 KPa demonstrated 85% sensitivity and an 86% negative predictive value for detecting PFI. Among CMRFs, hyperglycemia was significantly associated with increased pancreatic stiffness, and type 2 diabetes (T2D) emerged as the strongest predictor of elevated stiffness.

Conclusions: PFI is a relevant metabolic marker associated with central obesity, insulin resistance, and increased pancreatic stiffness. These findings support the potential of transabdominal 2D-SWE as a non-invasive tool for detecting early pancreatic structural, particularly in patients with T2D. Longitudinal studies are warranted to clarify its role in predicting pancreatic dysfunction and metabolic disease progression.

Objectives: Pain control following surgery for chronic pancreatitis presents a significant challenge. Options like epidurals used in parenchymal preserving pancreatic surgery (PPS) are contraindicated in certain settings such as total pancreatectomy (TP) with islet cell auto-transplantation (IAT). Our aim is to assess the efficacy and safety of ketamine in these patients and compare it to that of epidural analgesia.

Methods: A single-center, cohort study was conducted in patients 16 years or older with chronic pancreatitis from August 2017 to May 2023 who underwent pancreatectomy. Patients were stratified based on ketamine infusion group vs epidural group. Primary outcome was change in morphine milligram equivalent (MME) from preoperative to discharge. Secondary outcomes were pain scores at postoperative day one to five and associated complications.

Results: Sixty-five patients were included (ketamine group 26 (40%) and epidural 39 (60%)). Ninety six percent (25/26) of patients in the ketamine group underwent TPIAT and 87% of patients in the epidural group (34/39) underwent PPS. There was no difference in opioid consumption preoperatively, or at time of discharge [ketamine, median MME 75 (IQR 47-90) vs epidural, median MME 60 (IQR 45-90), P=0.279] and in pain scores. Adverse events were minimal, with hallucinations (n=4) as the most common ketamine related reaction.

Conclusions: Ketamine provided similar opioid sparing analgesia compared to opioid epidurals. Ketamine is a promising adjunctive analgesic in patients with chronic pancreatitis.

Objectives: This study aimed to evaluate whether predictive variables differ by acute pancreatitis (AP) etiology and clinical outcomes.

Methods: This retrospective study included 845 AP patients diagnosed from January 2015 to December 2022 at a tertiary care hospital. Patient characteristics, scoring systems, and biomarkers were assessed to determine AP severity, with regression analysis used to identify predictor-outcome associations.

Results: The predictors of acute biliary pancreatitis severity were creatinine (Cr) (OR=7.157, 95% CI [3.176-16.21], P≤0.0001), procalcitonin (PCT) (OR=6.061, 95% CI [2.575-14.26], P≤0.0001), and the harmless acute pancreatitis score (HAPS) (OR=3.163, 95% CI [1.363-7.340], P≤0.0073). Cr (OR=5.844, 95% CI [2.238-15.25], P≤0.0003) and systemic inflammatory response syndrome (SIRS) (OR=3.708, 95% CI [1.442-9.532], P≤0.0065) were predictors of alcoholic AP severity. SIRS (OR=9.663, 95% CI [1.904-48.74], P≤0.0062) was the sole predictor of hypertriglyceridemic AP severity. Among patients with other etiologic causes of AP, the severity predictors were Cr (OR=8.144, 95% CI [3.337-19.9], P≤0.0001), C-reactive protein (OR=5.808, 95% CI [2.186-15.43], P=0.0004), and age (OR=1.032, 95% CI [1.006-1.059], P=0.0146). The multivariable analysis identified Cr, PCT, HAPS, SIRS, and age as significant predictors of organ failure in AP, yielding and area under the curve of 0.909 with a sensitivity of 0.85 and specificity = 0.85.

Conclusions: This study sheds new light on early-stage AP severity prediction, emphasizing the association between predictors, etiology, and clinical outcomes.

Objectives: In patients with pancreatic ductal adenocarcinoma (PDAC) and portal vein/superior mesenteric vein (PV/SMV) contact, we can often separate the tumor from the PV/SMV and avoid PV/SMV resection (VR) owing to the favorable efficacy of neoadjuvant therapy (NAT). However, there is a risk that tumor cells may remain around the PV/SMV. This study aimed to elucidate whether separating a tumor from a PV/SMV is justified in the NAT setting. Methods: We reviewed patients with PDAC who underwent pancreaticoduodenectomies or total pancreatectomies between 2005 and 2019. We usually attempt the skeletonization of PV/SMV as long as possible. We explored recurrence patterns and overall survival (OS). Results: In total, 248 patients were enrolled and divided based on PV/SMV contact (PVC), NAT, and VR. In the NAT setting, local recurrence around PV the SMV occurred at almost the same rate among the three groups (8.1%, NAT+/PVC-; 11.8%, NAT+/PVC+/VR-; 13.6%, NAT+/PVC+/VR+), while the NAT-/PVC+/VR- had a higher local recurrence rate in upfront surgery (10.0%, NAT-/PVC-; 33.3%, NAT-/PVC+/VR-; 12.2%, NAT-/PVC+/VR+, P=0.021). In addition, the OS in the NAT+/PVC+/VR- was not inferior to that in the NAT+/PVC- (Median survival time: 46.6 months, NAT+/PVC-; 61.1, NAT+/PVC+/VR-; 33.0, NAT+/PVC+/VR+). Conclusions: Separation of the PV/SMV in NAT+/PVC+ patients did not enhance local recurrence or aggravate OS if PV/SMV invasion was not suspected intraoperatively. Therefore, an attempt to separate the PV/SMV is acceptable.