Pub Date : 2024-06-18DOI: 10.1097/jp9.0000000000000184
Haoqi Zhang, Chunlu Tan, Xubao Liu, Xing Wang
Parenchyma-sparing resections (PSRs) are increasingly used for small pancreatic neuroendocrine neoplasms (PNENs) to preserve the function of the gland. However, the data are extremely limited due to the rarity of this tumor. This study sought to describe the indications, operative technique, short and long-term outcomes of PSRs for PNENs, with a focus on postoperative pancreatic fistula (POPF) and oncologic outcomes. From 2008 to 2018, data collected retrospectively from 113 PNENs that underwent PSRs (113/421, 27%) were reviewed. A comparison was conducted of PSRs of PNENs without (group1, n=101) or with pancreatic transection (group 2, n=12). Of the 113 patients, the most common indication for PSRs was insulinoma (80%), followed by NF-PNEN (20%). The majority of lesions were WHO G1 grade (80/113, 71%). The mean maximum diameter of the tumors was 19 mm. Patients who underwent PSRs had a low rate of severe postoperative morbidity (7/113, 6%). Pancreatic endocrine and exocrine insufficiency occurred in only 1% and 7% of patients respectively. And there was no evidence of tumor recurrence after PSRs detected during follow-up. Age was identified as the only independent positive risk factor of POPF in group 1. Patients in group 2 had significantly higher rates of POPF (p=0.002), overall morbidity (p=0.002), severe morbidity (p=0.026) and readmission (p=0.004). PSRs of PNENs appear to be feasible and safe, preserving the endocrine and exocrine function of the gland with no increased risk of recurrence or metastasis. In contrast, PSRs involving transection of the pancreas should be performed more cautiously.
为了保留腺体的功能，越来越多的小型胰腺神经内分泌肿瘤（PNENs）采用了保留实质的切除术（PSRs）。然而，由于这种肿瘤的罕见性，相关数据极为有限。 本研究试图描述PNENs PSR的适应症、手术技术、短期和长期疗效，重点关注术后胰瘘（POPF）和肿瘤学疗效。 从 2008 年到 2018 年，回顾性收集了 113 例接受 PSR 的 PNEN（113/421，27%）的数据。对未进行 PSR 的 PNEN（第 1 组，人数=101）或进行了胰腺横切的 PNEN（第 2 组，人数=12）进行了比较。 在 113 名患者中，最常见的 PSR 适应症是胰岛素瘤（80%），其次是 NF-PNEN（20%）。大多数病变为 WHO G1 级（80/113，71%）。肿瘤的平均最大直径为 19 毫米。接受 PSR 的患者术后严重发病率较低（7/113，6%）。分别只有1%和7%的患者出现胰腺内分泌和外分泌功能不全。在随访过程中也没有发现 PSR 后肿瘤复发的证据。在第一组中，年龄被确定为 POPF 的唯一独立阳性风险因素。 第二组患者的 POPF 发生率（P=0.002）、总发病率（P=0.002）、严重发病率（P=0.026）和再入院率（P=0.004）均显著较高。 PNENs的PSR似乎是可行和安全的，它保留了腺体的内分泌和外分泌功能，不会增加复发或转移的风险。相比之下，涉及胰腺横切的 PSR 应更加谨慎。
{"title":"Reappraisal of the Parenchyma-Sparing Resections for Pancreatic Neuroendocrine Tumors: A Chinese High-volume Center Experience","authors":"Haoqi Zhang, Chunlu Tan, Xubao Liu, Xing Wang","doi":"10.1097/jp9.0000000000000184","DOIUrl":"https://doi.org/10.1097/jp9.0000000000000184","url":null,"abstract":"\u0000 \u0000 Parenchyma-sparing resections (PSRs) are increasingly used for small pancreatic neuroendocrine neoplasms (PNENs) to preserve the function of the gland. However, the data are extremely limited due to the rarity of this tumor.\u0000 \u0000 \u0000 \u0000 This study sought to describe the indications, operative technique, short and long-term outcomes of PSRs for PNENs, with a focus on postoperative pancreatic fistula (POPF) and oncologic outcomes.\u0000 \u0000 \u0000 \u0000 From 2008 to 2018, data collected retrospectively from 113 PNENs that underwent PSRs (113/421, 27%) were reviewed. A comparison was conducted of PSRs of PNENs without (group1, n=101) or with pancreatic transection (group 2, n=12).\u0000 \u0000 \u0000 \u0000 Of the 113 patients, the most common indication for PSRs was insulinoma (80%), followed by NF-PNEN (20%). The majority of lesions were WHO G1 grade (80/113, 71%). The mean maximum diameter of the tumors was 19 mm. Patients who underwent PSRs had a low rate of severe postoperative morbidity (7/113, 6%). Pancreatic endocrine and exocrine insufficiency occurred in only 1% and 7% of patients respectively. And there was no evidence of tumor recurrence after PSRs detected during follow-up. Age was identified as the only independent positive risk factor of POPF in group 1. Patients in group 2 had significantly higher rates of POPF (p=0.002), overall morbidity (p=0.002), severe morbidity (p=0.026) and readmission (p=0.004).\u0000 \u0000 \u0000 \u0000 PSRs of PNENs appear to be feasible and safe, preserving the endocrine and exocrine function of the gland with no increased risk of recurrence or metastasis. In contrast, PSRs involving transection of the pancreas should be performed more cautiously.\u0000","PeriodicalId":92925,"journal":{"name":"Journal of pancreatology","volume":"32 10","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-06-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141334779","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-06-04DOI: 10.1097/jp9.0000000000000185
Lijuan Wang, Pengxue Li, Yifu Hu, Bo Cheng, Lei Li, Lili Ding, Jinghai Song, Junmin Wei, Jingyong Xu
The aim of this study is to elucidate the correlation between phase angle and malnutrition, and to determine the malnutrition cut-off points based on phase angle in patients undergoing major pancreatic and biliary surgery. This is a cross-sectional study analyzing the prospective database of the Department of Hepatopancreatobiliary Surgery at Beijing Hospital, China, from December 2020 to September 2023. Basal data, diet surveys, anthropometry, and body composition were recorded. Phase angle was measured with the InBody 720. The GLIM criteria were used to diagnose malnutrition. Subgroup analyses were conducted by stratifying age and pancreatic cancer. A total of 185 consecutive cases were included, with a mean age of 63.66;±11.96 years. 63.8% (118/185) of the participants were aged 60 years or older, and 43.8% (81/185) were diagnosed with pancreatic cancer. The prevalence of malnutrition was 62.2% among all subjects, 67.8% among the elderly, and 69.1% among pancreatic cancer patients. Phase angle was significantly lower in the malnourished group than in the normal group. Positive correlations were found between phase angle and BMI, ASMI, FFMI, fat-free mass, total energy intake, grip strength, calf circumference, 6-meter timed walk speed, total protein, albumin, and prealbumin. Among all the subjects, participants with a lower phase angle were significantly more likely to suffer from malnutrition than their control group, with a 1.611 times higher risk (95% CI 1.013-2.562, P=0.044). The cut-off points of the phase angle for determining malnutrition were 4.82 in men (sensitivity 0.744, specificity 0.571, area under the curve 0.667, 95% CI 0.567-0.766, P = 0.003), and 4.54 in women (sensitivity 0.750, specificity 0.711, area under the curve 0.757, 95% CI 0.644-0.869, P < 0.001). In the subgroup analyses of elderly and pancreatic cancer patients, we obtained consistent results with statistical significance and identified corresponding cut-off points. The present study suggests that the phase angle could be a valid, useful, and simple indicator of malnutrition in patients undergoing major pancreatic and biliary surgery.
{"title":"Phase angle is an indicator of GLIM-diagnosed malnutrition in patients undergoing major pancreatic and biliary surgery: a cross-sectional study","authors":"Lijuan Wang, Pengxue Li, Yifu Hu, Bo Cheng, Lei Li, Lili Ding, Jinghai Song, Junmin Wei, Jingyong Xu","doi":"10.1097/jp9.0000000000000185","DOIUrl":"https://doi.org/10.1097/jp9.0000000000000185","url":null,"abstract":"\u0000 \u0000 The aim of this study is to elucidate the correlation between phase angle and malnutrition, and to determine the malnutrition cut-off points based on phase angle in patients undergoing major pancreatic and biliary surgery.\u0000 \u0000 \u0000 \u0000 This is a cross-sectional study analyzing the prospective database of the Department of Hepatopancreatobiliary Surgery at Beijing Hospital, China, from December 2020 to September 2023. Basal data, diet surveys, anthropometry, and body composition were recorded. Phase angle was measured with the InBody 720. The GLIM criteria were used to diagnose malnutrition. Subgroup analyses were conducted by stratifying age and pancreatic cancer.\u0000 \u0000 \u0000 \u0000 A total of 185 consecutive cases were included, with a mean age of 63.66;±11.96 years. 63.8% (118/185) of the participants were aged 60 years or older, and 43.8% (81/185) were diagnosed with pancreatic cancer. The prevalence of malnutrition was 62.2% among all subjects, 67.8% among the elderly, and 69.1% among pancreatic cancer patients. Phase angle was significantly lower in the malnourished group than in the normal group. Positive correlations were found between phase angle and BMI, ASMI, FFMI, fat-free mass, total energy intake, grip strength, calf circumference, 6-meter timed walk speed, total protein, albumin, and prealbumin. Among all the subjects, participants with a lower phase angle were significantly more likely to suffer from malnutrition than their control group, with a 1.611 times higher risk (95% CI 1.013-2.562, P=0.044). The cut-off points of the phase angle for determining malnutrition were 4.82 in men (sensitivity 0.744, specificity 0.571, area under the curve 0.667, 95% CI 0.567-0.766, P = 0.003), and 4.54 in women (sensitivity 0.750, specificity 0.711, area under the curve 0.757, 95% CI 0.644-0.869, P < 0.001). In the subgroup analyses of elderly and pancreatic cancer patients, we obtained consistent results with statistical significance and identified corresponding cut-off points.\u0000 \u0000 \u0000 \u0000 The present study suggests that the phase angle could be a valid, useful, and simple indicator of malnutrition in patients undergoing major pancreatic and biliary surgery.\u0000","PeriodicalId":92925,"journal":{"name":"Journal of pancreatology","volume":"93 11","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-06-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141268029","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-04-25DOI: 10.1097/jp9.0000000000000183
Jie Chen, Wenming Wu, Chunmei Bai, Yihebali Chi, Li Huo, Liming Jiang, Yuan Ji, Jie Luo, Jie Li, Jingnan Li, W. Lou, Chenghao Shao, Lin Shen, Feng Wang, Yu Wang, Ling Xue, Jin Xu, Chunhui Yuan, Xianjun Yu, Xiaoyu Yin, Hong Zhao, Xiongzeng Zhu, Yupei Zhao
The World Health Organization (WHO) 2017 classifications for neuroendocrine neoplasms (NENs) subdivided grade 3 pancreatic neoplasms (pNENs) into G3 well-differentiated pancreatic neuroendocrine tumors (G3 pNETs) and poorly-differentiated pancreatic neuroendocrine carcinomas (pNECs), according to the mitotic count, Ki-67 index and cell differentiation. As a new category, G3 pNETs remains a challenging group of tumors to manage by lacking large randomized trials and consensus to support its clinical practice. Therefore, the Chinese Pancreatic Surgery Association, Chinese Society of Surgery, Chinese Medical Association gathered experts in this field to formulate this consensus for the diagnosis and treatment of G3 pNETs.
{"title":"Consensus on the Clinical Diagnosis and Treatment of Grade 3 Pancreatic Neuroendocrine Tumors","authors":"Jie Chen, Wenming Wu, Chunmei Bai, Yihebali Chi, Li Huo, Liming Jiang, Yuan Ji, Jie Luo, Jie Li, Jingnan Li, W. Lou, Chenghao Shao, Lin Shen, Feng Wang, Yu Wang, Ling Xue, Jin Xu, Chunhui Yuan, Xianjun Yu, Xiaoyu Yin, Hong Zhao, Xiongzeng Zhu, Yupei Zhao","doi":"10.1097/jp9.0000000000000183","DOIUrl":"https://doi.org/10.1097/jp9.0000000000000183","url":null,"abstract":"The World Health Organization (WHO) 2017 classifications for neuroendocrine neoplasms (NENs) subdivided grade 3 pancreatic neoplasms (pNENs) into G3 well-differentiated pancreatic neuroendocrine tumors (G3 pNETs) and poorly-differentiated pancreatic neuroendocrine carcinomas (pNECs), according to the mitotic count, Ki-67 index and cell differentiation. As a new category, G3 pNETs remains a challenging group of tumors to manage by lacking large randomized trials and consensus to support its clinical practice. Therefore, the Chinese Pancreatic Surgery Association, Chinese Society of Surgery, Chinese Medical Association gathered experts in this field to formulate this consensus for the diagnosis and treatment of G3 pNETs.","PeriodicalId":92925,"journal":{"name":"Journal of pancreatology","volume":"14 3","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-04-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140656167","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-04-17DOI: 10.1097/jp9.0000000000000181
Siyao Zeng, Yue Li, Lianghe Wen, Yunlong Li, Zhipeng Yao, Yang Cao, Ming Li, Hongliang Wang, Junbo Zheng
For severe acute pancreatitis (SAP), the combination of urinastatin and octreotide (OCT) is increasingly used. This meta-analysis assesses whether the combination therapy of urinastatin and OCT is more effective than using sole OCT in treating SAP. After searching 12 databases in English and Chinese as well as two clinical trial centers up to October 7, 2023, we compared the combination of urinastatin and OCT with sole OCT in treating SAP. Statistical measures utilized include risk ratios (RR), weighted mean difference (WMD), and 95% confidence intervals (95% CI). We summarized 145 studies from 145 hospitals in 26 provinces, municipalities, and autonomous regions of China, including 13,605 patients. It was found that for SAP, using urinastatin combined with OCT compared to using sole OCT can improve the total effective rate (I 2 = 0%; RR: 1.22; 95% CI: 1.19-1.24; P < 0.01), reduce mortality rate (I 2 = 0%; RR: 0.21; 95% CI: 0.09-0.46; P < 0.01), and reduce the overall incidence rate of complications (I 2 = 0%; RR: 0.28; 95% CI: 0.23-0.34; P < 0.01). In addition, combination therapy reduced in-hospital length of stay, abdominal pain relief time, time for blood and urine amylase to return to normal, inflammatory markers, and improved oxidative stress indicators, immune function indicators, and hemorheology indicators. Low-quality evidence suggests that for SAP, the combined use of urinastatin and OCT may be associated with better improvement in patients' symptoms, signs, CT imaging manifestations, and laboratory indicators such as inflammatory markers, oxidative stress markers, immune function indicators, and hemorheological indicators compared to using OCT alone. Additionally, the combination therapy compared to monotherapy may also be associated with lower mortality, a reduced incidence rate of complications, and a shorter in-hospital length of stay. Future research calls for multicenter, high-quality, well-designed studies to validate our findings.
{"title":"Urinastatin combined with octreotide versus sole octreotide in severe acute pancreatitis: a meta-analysis","authors":"Siyao Zeng, Yue Li, Lianghe Wen, Yunlong Li, Zhipeng Yao, Yang Cao, Ming Li, Hongliang Wang, Junbo Zheng","doi":"10.1097/jp9.0000000000000181","DOIUrl":"https://doi.org/10.1097/jp9.0000000000000181","url":null,"abstract":"\u0000 \u0000 For severe acute pancreatitis (SAP), the combination of urinastatin and octreotide (OCT) is increasingly used. This meta-analysis assesses whether the combination therapy of urinastatin and OCT is more effective than using sole OCT in treating SAP.\u0000 \u0000 \u0000 \u0000 After searching 12 databases in English and Chinese as well as two clinical trial centers up to October 7, 2023, we compared the combination of urinastatin and OCT with sole OCT in treating SAP. Statistical measures utilized include risk ratios (RR), weighted mean difference (WMD), and 95% confidence intervals (95% CI).\u0000 \u0000 \u0000 \u0000 We summarized 145 studies from 145 hospitals in 26 provinces, municipalities, and autonomous regions of China, including 13,605 patients. It was found that for SAP, using urinastatin combined with OCT compared to using sole OCT can improve the total effective rate (I\u0000 \u0000 2\u0000 = 0%; RR: 1.22; 95% CI: 1.19-1.24; P < 0.01), reduce mortality rate (I\u0000 \u0000 2\u0000 = 0%; RR: 0.21; 95% CI: 0.09-0.46; P < 0.01), and reduce the overall incidence rate of complications (I\u0000 \u0000 2\u0000 = 0%; RR: 0.28; 95% CI: 0.23-0.34; P < 0.01). In addition, combination therapy reduced in-hospital length of stay, abdominal pain relief time, time for blood and urine amylase to return to normal, inflammatory markers, and improved oxidative stress indicators, immune function indicators, and hemorheology indicators.\u0000 \u0000 \u0000 \u0000 Low-quality evidence suggests that for SAP, the combined use of urinastatin and OCT may be associated with better improvement in patients' symptoms, signs, CT imaging manifestations, and laboratory indicators such as inflammatory markers, oxidative stress markers, immune function indicators, and hemorheological indicators compared to using OCT alone. Additionally, the combination therapy compared to monotherapy may also be associated with lower mortality, a reduced incidence rate of complications, and a shorter in-hospital length of stay. Future research calls for multicenter, high-quality, well-designed studies to validate our findings.\u0000","PeriodicalId":92925,"journal":{"name":"Journal of pancreatology","volume":"156 2","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-04-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140693541","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-04-16DOI: 10.1097/jp9.0000000000000180
Yuzhi Liu, Fei Xu, Anyi Jiang, Jie Ding, Chungao Li, Ming Quan
Pancreatic ductal adenocarcinoma (PDAC) is a highly malignant tumor that responds poorly to immunotherapy. The pivotal influence of CD8 + T-cell infiltration on immunotherapy has been documented in various solid tumors. However, the specific contribution of CD8 + T cell-associated immune genes (TIGs) to the tumor immune microenvironment remains unclear. We obtained CD8 + T cell-related immune genes from the INNATE and IMMPORT databases. Univariate analysis and lasso regression analysis were utilized to screen hub TIGs and develop a prognostic signature, the TIGs score. This score was used to evaluate prognosis, immunocyte infiltration, cancer-associated signaling pathways, and the potential responsiveness of immunotherapy. The transcriptomic data and single-cell data from the GSE183795 and GE212966 datasets are employed to validate the reliability of the findings. Our findings suggest that patients with low TIGs scores have stronger immune effector functions and immune checkpoint activation, resulting in a more favorable response to PD-L1 inhibitors. TIGs scores were significantly correlated with various molecular characteristics and clinical outcomes, such as tumor mutation burden, multiple tumor-associated pathways, and chemotherapeutic drug sensitivity. PSME2 was identified as a potential prognostic biomarker for predicting survival in patients with PDAC. This study elucidates the intricate regulatory mechanisms of TIGs within the tumor immune microenvironment of pancreatic cancer. Our findings strongly suggest that the TIGs score is a robust prognostic marker for prognosis and immunotherapy responsiveness. Additionally, targeting PSME2 may offer a novel avenue for enhancing the effectiveness of immunotherapy in pancreatic cancer.
{"title":"Integrated analysis of single-cell and bulk RNA sequencing to construct a CD8 + T cell-related immune gene signature in pancreatic cancer","authors":"Yuzhi Liu, Fei Xu, Anyi Jiang, Jie Ding, Chungao Li, Ming Quan","doi":"10.1097/jp9.0000000000000180","DOIUrl":"https://doi.org/10.1097/jp9.0000000000000180","url":null,"abstract":"\u0000 \u0000 Pancreatic ductal adenocarcinoma (PDAC) is a highly malignant tumor that responds poorly to immunotherapy. The pivotal influence of CD8 + T-cell infiltration on immunotherapy has been documented in various solid tumors. However, the specific contribution of CD8 + T cell-associated immune genes (TIGs) to the tumor immune microenvironment remains unclear.\u0000 \u0000 \u0000 \u0000 We obtained CD8 + T cell-related immune genes from the INNATE and IMMPORT databases. Univariate analysis and lasso regression analysis were utilized to screen hub TIGs and develop a prognostic signature, the TIGs score. This score was used to evaluate prognosis, immunocyte infiltration, cancer-associated signaling pathways, and the potential responsiveness of immunotherapy. The transcriptomic data and single-cell data from the GSE183795 and GE212966 datasets are employed to validate the reliability of the findings.\u0000 \u0000 \u0000 \u0000 Our findings suggest that patients with low TIGs scores have stronger immune effector functions and immune checkpoint activation, resulting in a more favorable response to PD-L1 inhibitors. TIGs scores were significantly correlated with various molecular characteristics and clinical outcomes, such as tumor mutation burden, multiple tumor-associated pathways, and chemotherapeutic drug sensitivity. PSME2 was identified as a potential prognostic biomarker for predicting survival in patients with PDAC.\u0000 \u0000 \u0000 \u0000 This study elucidates the intricate regulatory mechanisms of TIGs within the tumor immune microenvironment of pancreatic cancer. Our findings strongly suggest that the TIGs score is a robust prognostic marker for prognosis and immunotherapy responsiveness. Additionally, targeting PSME2 may offer a novel avenue for enhancing the effectiveness of immunotherapy in pancreatic cancer.\u0000","PeriodicalId":92925,"journal":{"name":"Journal of pancreatology","volume":"352 13","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-04-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140698050","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
With the accumulation of experience and evidence, guidelines for invasive intervention for acute pancreatitis (AP) have continuously evolved, followed in Peking Union Medical College Hospital (PUMCH). We aimed to review AP case series to help understand the impact of guideline evolution on the management and prognosis of AP in real-world practice. This was a single-center study of AP patients who had received invasive interventions from 1988 to 2022. Patient demographics, baseline severity, imaging findings, and the indication, timing, and specific modalities of invasive interventions were collected. The composite primary endpoint was death during hospitalization or major complications after intervention. Other endpoints included pancreatic fistula, incision infection, number of interventions, length of intensive care stay, length of hospitalization, and total medical cost. A total of 195 patients were included. The most common indication for invasive intervention was suspected infection, followed by persistent symptoms. The step-up and delayed strategies reduced the incidence of major complications or death. Over 35 years, the number of patients requiring surgery has gradually declined, and more patients need only minimally invasive procedures for remission. The incidence of the primary outcome decreased as well as the duration of hospitalization. The management of AP patients at PUMCH in the last 35 years has undergone therapeutic guideline changes that support the efficacy and safety of the deferred step-up strategy in real-world practice.
{"title":"Real-world Insights for the Evolving Intervention Strategy for non-Mild Acute Pancreatitis: 35-Year Experience in a Chinese Tertiary Center","authors":"Xiaxiao Yan, Jingya Zhou, Jian Cao, Qiang Xu, Xianlin Han, Duan Wang, Shengyu Zhang, Dong Wu","doi":"10.1097/jp9.0000000000000179","DOIUrl":"https://doi.org/10.1097/jp9.0000000000000179","url":null,"abstract":"\u0000 \u0000 With the accumulation of experience and evidence, guidelines for invasive intervention for acute pancreatitis (AP) have continuously evolved, followed in Peking Union Medical College Hospital (PUMCH). We aimed to review AP case series to help understand the impact of guideline evolution on the management and prognosis of AP in real-world practice.\u0000 \u0000 \u0000 \u0000 This was a single-center study of AP patients who had received invasive interventions from 1988 to 2022. Patient demographics, baseline severity, imaging findings, and the indication, timing, and specific modalities of invasive interventions were collected. The composite primary endpoint was death during hospitalization or major complications after intervention. Other endpoints included pancreatic fistula, incision infection, number of interventions, length of intensive care stay, length of hospitalization, and total medical cost.\u0000 \u0000 \u0000 \u0000 A total of 195 patients were included. The most common indication for invasive intervention was suspected infection, followed by persistent symptoms. The step-up and delayed strategies reduced the incidence of major complications or death. Over 35 years, the number of patients requiring surgery has gradually declined, and more patients need only minimally invasive procedures for remission. The incidence of the primary outcome decreased as well as the duration of hospitalization.\u0000 \u0000 \u0000 \u0000 The management of AP patients at PUMCH in the last 35 years has undergone therapeutic guideline changes that support the efficacy and safety of the deferred step-up strategy in real-world practice.\u0000","PeriodicalId":92925,"journal":{"name":"Journal of pancreatology","volume":"5 41","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-04-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140712383","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-04-12DOI: 10.1097/jp9.0000000000000182
Chloe Lahoud, Zeina Morcos, Ryan Njeim, Mark Tawfik, Taimur Aslam, Suzanne El-Sayegh
Acute pancreatitis (AP) is a common disease with defined diagnostic criteria, radiological findings, and management guidelines. Patients with end-stage renal disease (ESRD) are at an increased risk of developing AP. The diagnosis of AP in ESRD is challenging, and the clinical presentation may mimic other pathologies. Moreover, the impact of AP on the overall morbidity and mortality in ESRD patients warrants a tailored therapeutic approach. We conducted a literature search for published manuscripts on AP and ESRD up to November 2023 in several databases such as Google Scholar and PubMed, and employed the following search terms: “acute pancreatitis”, “pancreatitis”, “end-stage renal disease”, “hemodialysis”, “peritoneal dialysis”, “diagnostic criteria”, “etiology”, “presentation”, “management”, “complication”, “prognosis”, “mortality”. Qualitative and quantitative data were both extracted. This manuscript reviews current evidence-based literature about the etiology and clinical presentation of AP in ESRD. It sheds the light on the current clinical studies that reflect beneficial management strategies as well as complications of AP in ESRD. Patients with ESRD are more likely to develop AP and subsequently severe pancreatitis with high mortality rates compared to the general population. The etiology of AP in ESRD is multifactorial and management is focused on pain control, early nutritional support and most importantly maintaining a fluid balance. While existing research has shed light on certain aspects of AP in ESRD, additional literature focused on this topic is required to foster a deeper and broader understanding of AP in ESRD.
急性胰腺炎（AP）是一种常见疾病，有明确的诊断标准、放射学检查结果和治疗指南。终末期肾病（ESRD）患者罹患急性胰腺炎的风险更高。ESRD 患者 AP 的诊断具有挑战性，其临床表现可能与其他病症相似。此外，由于 AP 会影响 ESRD 患者的总体发病率和死亡率，因此需要采取有针对性的治疗方法。我们在谷歌学术（Google Scholar）和PubMed等多个数据库中检索了截至2023年11月发表的有关急性胰腺炎和ESRD的文献，并使用了以下检索词："急性胰腺炎"、"胰腺炎"、"终末期肾病"、"血液透析"、"腹膜透析"、"诊断标准"、"病因"、"表现"、"处理"、"并发症"、"预后"、"死亡率"。同时提取了定性和定量数据。本手稿回顾了目前有关 ESRD 中 AP 病因学和临床表现的循证文献。它揭示了当前的临床研究，这些研究反映了 ESRD 中 AP 的有益管理策略和并发症。与普通人群相比，ESRD 患者更容易发生 AP，继而发展为重症胰腺炎，且死亡率较高。ESRD 患者胰腺炎的病因是多因素的，治疗重点是控制疼痛、早期营养支持，最重要的是保持体液平衡。虽然现有研究已经揭示了 ESRD 患者胰腺炎的某些方面，但还需要更多关注这一主题的文献，以促进对 ESRD 患者胰腺炎更深入、更广泛的了解。
{"title":"Understanding Acute Pancreatitis in End-Stage Renal Disease: Unraveling etiologies, clinical presentations, management strategies, and complications: a narrative review","authors":"Chloe Lahoud, Zeina Morcos, Ryan Njeim, Mark Tawfik, Taimur Aslam, Suzanne El-Sayegh","doi":"10.1097/jp9.0000000000000182","DOIUrl":"https://doi.org/10.1097/jp9.0000000000000182","url":null,"abstract":"Acute pancreatitis (AP) is a common disease with defined diagnostic criteria, radiological findings, and management guidelines. Patients with end-stage renal disease (ESRD) are at an increased risk of developing AP. The diagnosis of AP in ESRD is challenging, and the clinical presentation may mimic other pathologies. Moreover, the impact of AP on the overall morbidity and mortality in ESRD patients warrants a tailored therapeutic approach.\u0000 We conducted a literature search for published manuscripts on AP and ESRD up to November 2023 in several databases such as Google Scholar and PubMed, and employed the following search terms: “acute pancreatitis”, “pancreatitis”, “end-stage renal disease”, “hemodialysis”, “peritoneal dialysis”, “diagnostic criteria”, “etiology”, “presentation”, “management”, “complication”, “prognosis”, “mortality”. Qualitative and quantitative data were both extracted.\u0000 This manuscript reviews current evidence-based literature about the etiology and clinical presentation of AP in ESRD. It sheds the light on the current clinical studies that reflect beneficial management strategies as well as complications of AP in ESRD. Patients with ESRD are more likely to develop AP and subsequently severe pancreatitis with high mortality rates compared to the general population. The etiology of AP in ESRD is multifactorial and management is focused on pain control, early nutritional support and most importantly maintaining a fluid balance. While existing research has shed light on certain aspects of AP in ESRD, additional literature focused on this topic is required to foster a deeper and broader understanding of AP in ESRD.","PeriodicalId":92925,"journal":{"name":"Journal of pancreatology","volume":"14 5","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-04-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140711912","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-03-01Epub Date: 2024-01-02DOI: 10.1097/JP9.0000000000000168
Saif Zaman, Fred Gorelick
Acute pancreatitis is a severe inflammatory disorder with limited treatment options. Improved understanding of disease mechanisms has led to new and potential therapies. Here we summarize what we view as some of the most promising new therapies for treating acute pancreatitis, emphasizing the rationale of specific treatments based on disease mechanisms. Targeted pharmacologic interventions are highlighted. We explore potential treatment benefits and risks concerning reducing acute injury, minimizing complications, and improving long-term outcomes. Mechanisms associated with acute pancreatitis initiation, perpetuation, and reconstitution are highlighted, along with potential therapeutic targets and how these relate to new treatments.
{"title":"Acute pancreatitis: pathogenesis and emerging therapies.","authors":"Saif Zaman, Fred Gorelick","doi":"10.1097/JP9.0000000000000168","DOIUrl":"10.1097/JP9.0000000000000168","url":null,"abstract":"<p><p>Acute pancreatitis is a severe inflammatory disorder with limited treatment options. Improved understanding of disease mechanisms has led to new and potential therapies. Here we summarize what we view as some of the most promising new therapies for treating acute pancreatitis, emphasizing the rationale of specific treatments based on disease mechanisms. Targeted pharmacologic interventions are highlighted. We explore potential treatment benefits and risks concerning reducing acute injury, minimizing complications, and improving long-term outcomes. Mechanisms associated with acute pancreatitis initiation, perpetuation, and reconstitution are highlighted, along with potential therapeutic targets and how these relate to new treatments.</p>","PeriodicalId":92925,"journal":{"name":"Journal of pancreatology","volume":"7 1","pages":"10-20"},"PeriodicalIF":0.0,"publicationDate":"2024-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10959536/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140208469","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-02-22DOI: 10.1097/jp9.0000000000000174
C. Pang, Zhiyao Fan, Hanxiang Zhan
Pancreatic ductal adenocarcinoma (PDAC) is a highly malignant tumor, which is mostly solitary in the pancreas. Surgery-based comprehensive treatment with adjuvant chemotherapy is the currently advanced treatment modality, neoadjuvant chemotherapy has achieved satisfactory results, however, due to the high heterogeneity of PDAC, its sensitivity to chemotherapy is also different. A 66-year-old man presented with discomfort in the upper abdomen and Computed Tomography (CT) scans revealed two tumor lesions in the head and tail of the pancreas, respectively. Endoscopic ultrasonoraphy guided fine needle aspiration (EUS-FNA) was performed to clarify the pathology and the patient was recommended to undergo neoadjuvant therapy. Through five courses of neoadjuvant chemotherapy, the two tumors showed different treatment effects, and after evaluation, total pancreatectomy and splenectomy were provided to patients.We report a case of the one patient presenting with two pancreatic cancer lesions, who demonstrated different therapeutic responses after receiving neoadjuvant chemotherapy due to the heterogeneity of PDAC.
{"title":"Different response of two primary neoplastic lesions to neoadjuvant therapy: a case report","authors":"C. Pang, Zhiyao Fan, Hanxiang Zhan","doi":"10.1097/jp9.0000000000000174","DOIUrl":"https://doi.org/10.1097/jp9.0000000000000174","url":null,"abstract":"Pancreatic ductal adenocarcinoma (PDAC) is a highly malignant tumor, which is mostly solitary in the pancreas. Surgery-based comprehensive treatment with adjuvant chemotherapy is the currently advanced treatment modality, neoadjuvant chemotherapy has achieved satisfactory results, however, due to the high heterogeneity of PDAC, its sensitivity to chemotherapy is also different. A 66-year-old man presented with discomfort in the upper abdomen and Computed Tomography (CT) scans revealed two tumor lesions in the head and tail of the pancreas, respectively. Endoscopic ultrasonoraphy guided fine needle aspiration (EUS-FNA) was performed to clarify the pathology and the patient was recommended to undergo neoadjuvant therapy. Through five courses of neoadjuvant chemotherapy, the two tumors showed different treatment effects, and after evaluation, total pancreatectomy and splenectomy were provided to patients.We report a case of the one patient presenting with two pancreatic cancer lesions, who demonstrated different therapeutic responses after receiving neoadjuvant chemotherapy due to the heterogeneity of PDAC.","PeriodicalId":92925,"journal":{"name":"Journal of pancreatology","volume":"9 s2","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-02-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140439209","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pancreatic cancer is one of the most aggressive malignancies, a robust prognostic signature and novel biomarkers are urgently needed for accurate stratification of the patients and optimization of clinical decision-making. A list of bioinformatic analysis were applied in public dataset to construct an immune-related signature. Furthermore, the most pivotal gene in the signature was identified. The potential mechanism of the core gene function was revealed through GSEA, CIBERSORT, ESTIMATE, immunophenoscore algorithm, single cell analysis and functional experiment. An immune-related prognostic signature and associated nomogram were constructed and validated. Among the genes constituting the signature, IL1R2 was identified as the gene occupying the most paramount position in the risk signature. Meanwhile, Knockdown of IL1R2 significantly inhibited the proliferation, invasion and migration ability of pancreatic cancer cells. Additionally, high IL1R2 expression was associated with reduced CD8+ T cell infiltration in pancreatic cancer microenvironment, which may be due to high PD-L1 expression in cancer cells. Finally, the IPS algorithm proved that patients with high IL1R2 expression possessed a higher tumor mutation burden and a higher probability of benefiting from immunotherapy. In conclusion, our study constructed an efficient immune-related prognostic signature and identified the key role of IL1R2 in the development of pancreatic cancer, as well as its potential to serve as a biomarker for immunotherapy efficacy prediction for pancreatic cancer.
{"title":"Immune-related signature identifies IL1R2 as an immunological and prognostic biomarker in pancreatic cancer","authors":"Chengcheng Wang, Yuan Chen, Xinpeng Yin, Ruiyuan Xu, Rexiati Ruze, Jianlu Song, Chenglin Hu, Yupei Zhao","doi":"10.1097/jp9.0000000000000175","DOIUrl":"https://doi.org/10.1097/jp9.0000000000000175","url":null,"abstract":"\u0000 \u0000 Pancreatic cancer is one of the most aggressive malignancies, a robust prognostic signature and novel biomarkers are urgently needed for accurate stratification of the patients and optimization of clinical decision-making.\u0000 \u0000 \u0000 \u0000 A list of bioinformatic analysis were applied in public dataset to construct an immune-related signature. Furthermore, the most pivotal gene in the signature was identified. The potential mechanism of the core gene function was revealed through GSEA, CIBERSORT, ESTIMATE, immunophenoscore algorithm, single cell analysis and functional experiment.\u0000 \u0000 \u0000 \u0000 An immune-related prognostic signature and associated nomogram were constructed and validated. Among the genes constituting the signature, IL1R2 was identified as the gene occupying the most paramount position in the risk signature. Meanwhile, Knockdown of IL1R2 significantly inhibited the proliferation, invasion and migration ability of pancreatic cancer cells. Additionally, high IL1R2 expression was associated with reduced CD8+ T cell infiltration in pancreatic cancer microenvironment, which may be due to high PD-L1 expression in cancer cells. Finally, the IPS algorithm proved that patients with high IL1R2 expression possessed a higher tumor mutation burden and a higher probability of benefiting from immunotherapy.\u0000 \u0000 \u0000 \u0000 In conclusion, our study constructed an efficient immune-related prognostic signature and identified the key role of IL1R2 in the development of pancreatic cancer, as well as its potential to serve as a biomarker for immunotherapy efficacy prediction for pancreatic cancer.\u0000","PeriodicalId":92925,"journal":{"name":"Journal of pancreatology","volume":"33 21","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-02-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140441490","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
京公网安备 11010802042870号
京ICP备2023020795号-1
扫码关注我们
求助内容：
应助结果提醒方式：