Pub Date : 2021-12-01DOI: 10.1097/JP9.0000000000000081
Dipesh Kumar Yadav, Xing Huang, Qi Zhang, Gang Zhang, X. Bai, T. Liang
Supplemental Digital Content is available in the text Abstract To analyze a long-term survival outcome of an auto-intestine transplantation (aINTx) for the patients with locally advanced pancreatic tumor and identify the potential prognostic factors, databases were carefully searched for the studies reporting the patients with a locally advanced pancreatic tumor which typically underwent aINTx. We performed a database search using PubMed, the Cochrane Library, EMBASE, and MEDLINE to identify multiple case series of the patients who had pancreatic tumors with mesenteric root involvement and underwent aINTx, to evaluate the treatment outcomes, and calculated the patient survival using the Kaplan–Meier method and Cox proportional hazard regression analysis to properly identify an independent predictor of the survival. A total of 9 retrospective studies with a total of 29 patients were included in our study. The calculated 1-, 2-, and 3-year survival rates for the patients with pancreatic cancer and benign or low grade pancreatic tumors were 49.64%, 22.06%, and 0% versus 100%, 100%, and 80%, respectively. The corresponding median survival time was 13.4 months and 84 months, respectively. Moreover, when stratifying the pancreatic cancer patients undergoing aINTx on the basis of neoadjuvant chemotherapy (aINTx + neoadjuvant vs aINTx - neoadjuvant) there was a significant difference in the survival (P = .01). The 1- and 2-year survival rates were 75% and 75% versus 34.1% and 0%, respectively. Corresponding median survival times were 24 months and 10 months, respectively. Our analysis shows the long-term survival benefit with acceptable morbidity and mortality of pancreatoduodenectomy and aINTx for the pancreatic tumors with the mesenteric root involvement that are otherwise unresectable by the conventional surgical techniques. However, from an oncological point of view, a larger study with the control group is required to determine its safety compared to less aggressive surgical treatment.
{"title":"Auto-intestine transplantation for pancreatic tumors with mesenteric root involvement: a systematic review and survival-based analysis","authors":"Dipesh Kumar Yadav, Xing Huang, Qi Zhang, Gang Zhang, X. Bai, T. Liang","doi":"10.1097/JP9.0000000000000081","DOIUrl":"https://doi.org/10.1097/JP9.0000000000000081","url":null,"abstract":"Supplemental Digital Content is available in the text Abstract To analyze a long-term survival outcome of an auto-intestine transplantation (aINTx) for the patients with locally advanced pancreatic tumor and identify the potential prognostic factors, databases were carefully searched for the studies reporting the patients with a locally advanced pancreatic tumor which typically underwent aINTx. We performed a database search using PubMed, the Cochrane Library, EMBASE, and MEDLINE to identify multiple case series of the patients who had pancreatic tumors with mesenteric root involvement and underwent aINTx, to evaluate the treatment outcomes, and calculated the patient survival using the Kaplan–Meier method and Cox proportional hazard regression analysis to properly identify an independent predictor of the survival. A total of 9 retrospective studies with a total of 29 patients were included in our study. The calculated 1-, 2-, and 3-year survival rates for the patients with pancreatic cancer and benign or low grade pancreatic tumors were 49.64%, 22.06%, and 0% versus 100%, 100%, and 80%, respectively. The corresponding median survival time was 13.4 months and 84 months, respectively. Moreover, when stratifying the pancreatic cancer patients undergoing aINTx on the basis of neoadjuvant chemotherapy (aINTx + neoadjuvant vs aINTx - neoadjuvant) there was a significant difference in the survival (P = .01). The 1- and 2-year survival rates were 75% and 75% versus 34.1% and 0%, respectively. Corresponding median survival times were 24 months and 10 months, respectively. Our analysis shows the long-term survival benefit with acceptable morbidity and mortality of pancreatoduodenectomy and aINTx for the pancreatic tumors with the mesenteric root involvement that are otherwise unresectable by the conventional surgical techniques. However, from an oncological point of view, a larger study with the control group is required to determine its safety compared to less aggressive surgical treatment.","PeriodicalId":92925,"journal":{"name":"Journal of pancreatology","volume":"4 1","pages":"153 - 163"},"PeriodicalIF":0.0,"publicationDate":"2021-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"46070402","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 : 2021-12-01DOI: 10.1097/JP9.0000000000000077
Taiping Zhang, Wenming Wu, Yinmo Yang, Yupei Zhao
Abstract Aiming to keep pace with the renewal of international guidelines and refine the domestic treatment system of pancreatic cancer, the Chinese Pancreatic Surgery Association, Chinese Medical Association and Pancreatic Disease Committee of China Research Hospital Association launched this Chinese guidelines for neoadjuvant therapy of pancreatic cancer (2020 edition). Based on the Grading of Recommendations Assessment, Development, and Evaluation system, the guidelines have conducted a discussion on the indication, regimen selection, therapeutic effect evaluation, pathological diagnosis, surgery strategy, etc. The guidelines have quantified the evidence level of the current clinical researches and provided recommendations for the clinical practice in neoadjuvant therapy of pancreatic cancer. The guidelines have highlighted the role of multiple disciplinary team and represented the conversion of treatment concepts in pancreatic cancer. Neoadjuvant therapy has prolonged the survival of part of pancreatic cancer patients. However, more high-quality clinical researches are in urgent need to improve the level of evidence, optimize the clinical practice, and improve the survival of patients.
{"title":"The Chinese guidelines for neoadjuvant therapy of pancreatic cancer (2020)","authors":"Taiping Zhang, Wenming Wu, Yinmo Yang, Yupei Zhao","doi":"10.1097/JP9.0000000000000077","DOIUrl":"https://doi.org/10.1097/JP9.0000000000000077","url":null,"abstract":"Abstract Aiming to keep pace with the renewal of international guidelines and refine the domestic treatment system of pancreatic cancer, the Chinese Pancreatic Surgery Association, Chinese Medical Association and Pancreatic Disease Committee of China Research Hospital Association launched this Chinese guidelines for neoadjuvant therapy of pancreatic cancer (2020 edition). Based on the Grading of Recommendations Assessment, Development, and Evaluation system, the guidelines have conducted a discussion on the indication, regimen selection, therapeutic effect evaluation, pathological diagnosis, surgery strategy, etc. The guidelines have quantified the evidence level of the current clinical researches and provided recommendations for the clinical practice in neoadjuvant therapy of pancreatic cancer. The guidelines have highlighted the role of multiple disciplinary team and represented the conversion of treatment concepts in pancreatic cancer. Neoadjuvant therapy has prolonged the survival of part of pancreatic cancer patients. However, more high-quality clinical researches are in urgent need to improve the level of evidence, optimize the clinical practice, and improve the survival of patients.","PeriodicalId":92925,"journal":{"name":"Journal of pancreatology","volume":"4 1","pages":"135 - 145"},"PeriodicalIF":0.0,"publicationDate":"2021-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"47057749","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 : 2021-12-01DOI: 10.1097/JP9.0000000000000080
Nuerabula Wujimaimaiti, Yi Wu, J. Yuan, Jikuan Jin, Hebin Wang, Shizhen Li, Hang Zhang, Min Wang, R. Qin
Abstract Pancreatic surgery is one of the most complex and challenging fields in abdominal surgery associated with extensive surgical trauma, damage to adjacent organs, a long operation time and a high incidence of postoperative complications. Since the early 1990s, laparoscopic techniques have been applied to a growing number of pancreas surgeries, and great progress has been achieved in laparoscopic pancreaticoduodenectomy. As surgeons become proficient in laparoscopic pancreaticoduodenectomy techniques, laparoscopic techniques are gradually used in other pancreatic surgeries, such as laparoscopic distal pancreatectomies and laparoscopic duodenum-preserving pancreatic head resection (LDPPHR), which may benefit patients by reducing postoperative pain and hospital stays and providing a quick recovery to normal activity. Recently, a great number of literature have introduced LDPPHR. It is a good surgical method for benign and low-grade malignant tumors of the pancreatic head. Although LDPPHR is technically feasible, it is not yet generally practicable and limited to highly skilled endoscopic surgeons, and the long-term results after LDPPHR are still not well defined. This article aims to provide a literature review of LDPPHR to assess its feasibility, safety, postoperative recovery, and future outlook according to early experiences of this technique.
{"title":"Laparoscopic duodenum-preserving pancreatic head resection: a narrative review","authors":"Nuerabula Wujimaimaiti, Yi Wu, J. Yuan, Jikuan Jin, Hebin Wang, Shizhen Li, Hang Zhang, Min Wang, R. Qin","doi":"10.1097/JP9.0000000000000080","DOIUrl":"https://doi.org/10.1097/JP9.0000000000000080","url":null,"abstract":"Abstract Pancreatic surgery is one of the most complex and challenging fields in abdominal surgery associated with extensive surgical trauma, damage to adjacent organs, a long operation time and a high incidence of postoperative complications. Since the early 1990s, laparoscopic techniques have been applied to a growing number of pancreas surgeries, and great progress has been achieved in laparoscopic pancreaticoduodenectomy. As surgeons become proficient in laparoscopic pancreaticoduodenectomy techniques, laparoscopic techniques are gradually used in other pancreatic surgeries, such as laparoscopic distal pancreatectomies and laparoscopic duodenum-preserving pancreatic head resection (LDPPHR), which may benefit patients by reducing postoperative pain and hospital stays and providing a quick recovery to normal activity. Recently, a great number of literature have introduced LDPPHR. It is a good surgical method for benign and low-grade malignant tumors of the pancreatic head. Although LDPPHR is technically feasible, it is not yet generally practicable and limited to highly skilled endoscopic surgeons, and the long-term results after LDPPHR are still not well defined. This article aims to provide a literature review of LDPPHR to assess its feasibility, safety, postoperative recovery, and future outlook according to early experiences of this technique.","PeriodicalId":92925,"journal":{"name":"Journal of pancreatology","volume":"4 1","pages":"146 - 152"},"PeriodicalIF":0.0,"publicationDate":"2021-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42289442","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 : 2021-12-01DOI: 10.1097/JP9.0000000000000082
Amon B. Hackney, W. Chung, J. Isherwood, A. Dennison, N. Martin
Abstract Objective: Pancreatic cancer (PC) is an aggressive cancer with ineffective treatment. Inhibition of stearoyl-CoA desaturase 1 (SCD1) suppresses cancer proliferation and might act as a novel chemotherapy supplement, but this has not been investigated in PC. Here, the effects of SCD1 inhibitor CAY10566 supplemented with gemcitabine treatment (gemcitabine+CAY10566) on PC cell viability, apoptosis, phenotype, fatty acid content, platelet-derived growth factor release, and cell size were investigated. Methods: Human PC cell line (PANC-1) was treated with SCD1 inhibitor CAY10566 with or without gemcitabine. Cell viability was assayed using 3-[4,5-dimethylthiazol-2-yl]-2,5 diphenyl tetrazolium bromide and apoptosis and phenotype were determined using flow cytometry. Fatty acid content and platelet-derived growth factor release were measured by enzyme-linked immunosorbent assay. Cell size was determined using scanning electron microscopy. Results: Half-maximal inhibitory concentration of gemcitabine or CAY10566 significantly reduced PANC-1 viability compared to gemcitabine alone (P < .0001). No significant differences in the phenotype of phosphatidylserine, tissue factor or basigin expression were detected at therapeutic doses (P > .05). Apoptosis was significantly increased following incubation with CAY10566 (P < .05). Fatty acid content of cells was significantly higher following gemcitabine treatment compared to CAY10566 alone or gemcitabine+CAY10566 (P < .05). Platelet-derived growth factor released by gemcitabine-treated cells was significantly increased compared to 142 nM CAY10566 alone or gemcitabine+CAY10566 (P < .01). CAY10566 did not affect the size of isolated tumor cells but gemcitabine+CAY10566 significantly increased the size compared to the control (P < .05). Cell viability decreased significantly after the treatment with gemcitabine+CAY10566 compared with CAY10566 alone (P < .05) and gemcitabine alone (P < .01). However, when cycles of chemotherapy were mimicked and treatment was removed, the number of cell viability was significantly reduced (P < .05). Conclusion: This study suggests that CAY10566 may be a suitable supplement for gemcitabine chemotherapy for PC.
{"title":"Stearoyl-CoA desaturase 1 inhibitor supplemented with gemcitabine treatment reduces the viability and fatty acid content of pancreatic cancer cells in vitro","authors":"Amon B. Hackney, W. Chung, J. Isherwood, A. Dennison, N. Martin","doi":"10.1097/JP9.0000000000000082","DOIUrl":"https://doi.org/10.1097/JP9.0000000000000082","url":null,"abstract":"Abstract Objective: Pancreatic cancer (PC) is an aggressive cancer with ineffective treatment. Inhibition of stearoyl-CoA desaturase 1 (SCD1) suppresses cancer proliferation and might act as a novel chemotherapy supplement, but this has not been investigated in PC. Here, the effects of SCD1 inhibitor CAY10566 supplemented with gemcitabine treatment (gemcitabine+CAY10566) on PC cell viability, apoptosis, phenotype, fatty acid content, platelet-derived growth factor release, and cell size were investigated. Methods: Human PC cell line (PANC-1) was treated with SCD1 inhibitor CAY10566 with or without gemcitabine. Cell viability was assayed using 3-[4,5-dimethylthiazol-2-yl]-2,5 diphenyl tetrazolium bromide and apoptosis and phenotype were determined using flow cytometry. Fatty acid content and platelet-derived growth factor release were measured by enzyme-linked immunosorbent assay. Cell size was determined using scanning electron microscopy. Results: Half-maximal inhibitory concentration of gemcitabine or CAY10566 significantly reduced PANC-1 viability compared to gemcitabine alone (P < .0001). No significant differences in the phenotype of phosphatidylserine, tissue factor or basigin expression were detected at therapeutic doses (P > .05). Apoptosis was significantly increased following incubation with CAY10566 (P < .05). Fatty acid content of cells was significantly higher following gemcitabine treatment compared to CAY10566 alone or gemcitabine+CAY10566 (P < .05). Platelet-derived growth factor released by gemcitabine-treated cells was significantly increased compared to 142 nM CAY10566 alone or gemcitabine+CAY10566 (P < .01). CAY10566 did not affect the size of isolated tumor cells but gemcitabine+CAY10566 significantly increased the size compared to the control (P < .05). Cell viability decreased significantly after the treatment with gemcitabine+CAY10566 compared with CAY10566 alone (P < .05) and gemcitabine alone (P < .01). However, when cycles of chemotherapy were mimicked and treatment was removed, the number of cell viability was significantly reduced (P < .05). Conclusion: This study suggests that CAY10566 may be a suitable supplement for gemcitabine chemotherapy for PC.","PeriodicalId":92925,"journal":{"name":"Journal of pancreatology","volume":"4 1","pages":"170 - 177"},"PeriodicalIF":0.0,"publicationDate":"2021-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42478623","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 : 2021-09-17DOI: 10.1097/jp9.0000000000000076
Xiaofan Guo, S. Gao, Zekun Li, J. Hao
{"title":"The role of biomarker in pancreatic neuroendocrine tumor","authors":"Xiaofan Guo, S. Gao, Zekun Li, J. Hao","doi":"10.1097/jp9.0000000000000076","DOIUrl":"https://doi.org/10.1097/jp9.0000000000000076","url":null,"abstract":"","PeriodicalId":92925,"journal":{"name":"Journal of pancreatology","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-09-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"48871601","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 : 2021-09-16DOI: 10.1097/jp9.0000000000000074
Wen Xie, Huaiyu Liang, Yan Guo, S. Xiao
{"title":"Update on mucinous cystic neoplasm of the pancreas","authors":"Wen Xie, Huaiyu Liang, Yan Guo, S. Xiao","doi":"10.1097/jp9.0000000000000074","DOIUrl":"https://doi.org/10.1097/jp9.0000000000000074","url":null,"abstract":"","PeriodicalId":92925,"journal":{"name":"Journal of pancreatology","volume":"1 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-09-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"47679073","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 : 2021-09-01DOI: 10.1097/JP9.0000000000000075
G. Krishnamurthy, P. Radhakrishna, Aswin Khanna, K. Damodaran
Abstract Severe acute pancreatitis is commonly associated with pancreatic and extrapancreatic necrosis (EPN). Progressive EPN leading to necrotizing fasciitis of the retroperitoneum and abdominal wall has been reported. However, extension of retroperitoneal necrosis to the scrotum causing Fournier's gangrene is uncommon. We present a case of 39-year-old male admitted with severe acute pancreatitis requiring prolonged mechanical ventilation. He was managed with percutaneous drainage and culture specific antibiotics during the 1st month of hospital stay. During the 3rd month of hospital stay, the patient started developing pain and ulceration over the scrotum. He was diagnosed with Fournier's gangrene based on clinical examination and was planned for debridement. During surgery, the track extending up to the deep inguinal ring was widened and drain was placed into the right lateral pelvic wall through the deep ring via a separate stab incision to reduce further scrotal wound contamination. The case highlights a rare but potentially fatal complication of Fournier's gangrene following severe acute necrotizing pancreatitis and the importance of measures to prevent further contamination of scrotum after surgical debridement. Concomitant management of two potentially fatal conditions poses numerous challenges.
{"title":"Fournier's gangrene complicating severe acute pancreatitis: a case report and literature review","authors":"G. Krishnamurthy, P. Radhakrishna, Aswin Khanna, K. Damodaran","doi":"10.1097/JP9.0000000000000075","DOIUrl":"https://doi.org/10.1097/JP9.0000000000000075","url":null,"abstract":"Abstract Severe acute pancreatitis is commonly associated with pancreatic and extrapancreatic necrosis (EPN). Progressive EPN leading to necrotizing fasciitis of the retroperitoneum and abdominal wall has been reported. However, extension of retroperitoneal necrosis to the scrotum causing Fournier's gangrene is uncommon. We present a case of 39-year-old male admitted with severe acute pancreatitis requiring prolonged mechanical ventilation. He was managed with percutaneous drainage and culture specific antibiotics during the 1st month of hospital stay. During the 3rd month of hospital stay, the patient started developing pain and ulceration over the scrotum. He was diagnosed with Fournier's gangrene based on clinical examination and was planned for debridement. During surgery, the track extending up to the deep inguinal ring was widened and drain was placed into the right lateral pelvic wall through the deep ring via a separate stab incision to reduce further scrotal wound contamination. The case highlights a rare but potentially fatal complication of Fournier's gangrene following severe acute necrotizing pancreatitis and the importance of measures to prevent further contamination of scrotum after surgical debridement. Concomitant management of two potentially fatal conditions poses numerous challenges.","PeriodicalId":92925,"journal":{"name":"Journal of pancreatology","volume":"4 1","pages":"130 - 133"},"PeriodicalIF":0.0,"publicationDate":"2021-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"46358792","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 : 2021-06-15DOI: 10.1097/JP9.0000000000000088
Chaobin He, Jun Wang, Y. Mao, X. Lao, Sheng-ping Li
Abstract Objective: Irreversible electroporation (IRE) is emerging as a new therapy for locally advanced pancreatic cancer (LAPC). We aimed to conduct survival and safety analyses in LAPC patients after treatment with IRE combined with chemotherapy. Methods: A total of 64 patients with LAPC who had received IRE and chemotherapy were retrospectively collected from August 2015 to March 2019 at Sun Yat-sen University Cancer Center. Overall survival (OS) and progression-free survival (PFS) were evaluated using Kaplan-Meier method and compared by the log-rank test. A multivariate Cox regression model was used to determine the prognostic factors of survival. The perioperative complications of IRE were also evaluated. The study was approved by the Institutional Review Board of Sun Yat-sen University Cancer Center (approval No. C2021-003). Results: The median survival of all included patients were 24.63 (95% confidence interval: 21.78–27.49) for overall survival and 13.00 (95% confidence interval: 8.81–17.19) months for progression-free survival, with 96.8%, 51.9%, 18.3%; and 52.3%, 21.5%, 7.9% as the 1-, 2- and 3-year OS and PFS rates, respectively. Tumor size [OS, hazard ratio (HR)=1.768, P = 0.048; PFS, HR = 0.304, P = 0.010], neoadjuvant chemotherapy (OS, HR = 0.338, P = 0.030; PFS, HR = 0.358, P = 0.034), carbohydrate antigen 19-9 variation after IRE (OS, HR = 19.320, P = 0.003; PFS, HR = 14.591, P = 0.021) and tumor response after neoadjuvant chemotherapy (OS, HR = 8.779, P = 0.033; PFS, HR = 5.562, P = 0.008) were predictive factors of survival in patients with LAPC after IRE. Complications were observed in 20.3% of patients. Grade B pancreatic fistula was the most common complication. The complication rates of the late treatment group (6.1%) were significantly lower than those of the first 15 patients after IRE treatment (66.7%). The median length of hospital stay of late treatment group was 8.6 days, which was also shorter than that of the early treatment group (10.0 days). Conclusions: IRE combined with chemotherapy could improve survival of LAPC patients with acceptable complication rates. Therefore, it may be a suitable method for LAPC but should be validated in prospective randomized trials.
{"title":"An evaluation of safety and survival for patients with locally advanced pancreatic cancer treated with irreversible electroporation combined with chemotherapy: a retrospectively observational study","authors":"Chaobin He, Jun Wang, Y. Mao, X. Lao, Sheng-ping Li","doi":"10.1097/JP9.0000000000000088","DOIUrl":"https://doi.org/10.1097/JP9.0000000000000088","url":null,"abstract":"Abstract Objective: Irreversible electroporation (IRE) is emerging as a new therapy for locally advanced pancreatic cancer (LAPC). We aimed to conduct survival and safety analyses in LAPC patients after treatment with IRE combined with chemotherapy. Methods: A total of 64 patients with LAPC who had received IRE and chemotherapy were retrospectively collected from August 2015 to March 2019 at Sun Yat-sen University Cancer Center. Overall survival (OS) and progression-free survival (PFS) were evaluated using Kaplan-Meier method and compared by the log-rank test. A multivariate Cox regression model was used to determine the prognostic factors of survival. The perioperative complications of IRE were also evaluated. The study was approved by the Institutional Review Board of Sun Yat-sen University Cancer Center (approval No. C2021-003). Results: The median survival of all included patients were 24.63 (95% confidence interval: 21.78–27.49) for overall survival and 13.00 (95% confidence interval: 8.81–17.19) months for progression-free survival, with 96.8%, 51.9%, 18.3%; and 52.3%, 21.5%, 7.9% as the 1-, 2- and 3-year OS and PFS rates, respectively. Tumor size [OS, hazard ratio (HR)=1.768, P = 0.048; PFS, HR = 0.304, P = 0.010], neoadjuvant chemotherapy (OS, HR = 0.338, P = 0.030; PFS, HR = 0.358, P = 0.034), carbohydrate antigen 19-9 variation after IRE (OS, HR = 19.320, P = 0.003; PFS, HR = 14.591, P = 0.021) and tumor response after neoadjuvant chemotherapy (OS, HR = 8.779, P = 0.033; PFS, HR = 5.562, P = 0.008) were predictive factors of survival in patients with LAPC after IRE. Complications were observed in 20.3% of patients. Grade B pancreatic fistula was the most common complication. The complication rates of the late treatment group (6.1%) were significantly lower than those of the first 15 patients after IRE treatment (66.7%). The median length of hospital stay of late treatment group was 8.6 days, which was also shorter than that of the early treatment group (10.0 days). Conclusions: IRE combined with chemotherapy could improve survival of LAPC patients with acceptable complication rates. Therefore, it may be a suitable method for LAPC but should be validated in prospective randomized trials.","PeriodicalId":92925,"journal":{"name":"Journal of pancreatology","volume":"5 1","pages":"27 - 35"},"PeriodicalIF":0.0,"publicationDate":"2021-06-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43072682","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 : 2021-06-15DOI: 10.1097/JP9.0000000000000084
Lili Wu, Yaolin Xu, Z. Zeng, Yixing Chen, Yuhong Zhou, Dansong Wang, J. Sun, M. Lv, S. Du, W. Lou
Abstract Objective: It remains unclear whether adjuvant chemoradiotherapy (CRT) improves survival outcome of pancreatic ductal adenocarcinoma (PDAC) patients after surgery. This study aimed to investigate the efficacy and safety of tegafur/gimeracil/oteracil (S-1)-based adjuvant concurrent chemoradiotherapy in resected PDAC patients with defined high-risk pathological features. Methods: We conducted a single-arm, prospective, and interventional study at Zhongshan Hospital Fudan University from December 2012 to December 2019 and the last follow-up was conducted in December 2021. This study was approved by the Ethics Committee of Zhongshan Hospital Fudan University on December 27, 2012 (approval No. B2012-139). Resected PDAC patients with high-risk pathological features, including positive resection margin, pathological T3-4N1-2M0 disease, peripancreatic fat invasion, microvascular invasion, and perineural invasion, were recruited. Primary endpoint was overall survival and secondary endpoints were disease-free survival, treatment toxicity, and 2-, 5-year survival rates. Results: A total of 54 patients were recruited. Mean age was 63.6 years old (±7.2). The distribution of T and N stages were 24.1% for T1, 46.3% for T2, 27.8% for T3, 1.9% for T4, 33.3% for N1, and 11.1% for N2. Seven patients had R1 resection. The median overall survival and disease-free survival were 27.1 and 13.7 months, respectively, while no fatal adverse events were recorded. Subgroup analyses showed differences in survival outcomes among patients with microvascular invasion, different N stages, and preoperative CA 19-9 levels. Further, a Cox proportional hazard model demonstrated associations of lymph node metastases, CA 19-9 level, and microvascular invasion with overall survival and disease-free survival. Conclusion: S-1-based adjuvant CRT showed promising efficacy and manageable toxicity in resected PDAC patients with high-risk pathological features.
{"title":"Efficacy and safety of S-1 based adjuvant chemoradiotherapy for resected pancreatic ductal adenocarcinoma with high-risk pathological feature: a prospective, single-arm, interventional study","authors":"Lili Wu, Yaolin Xu, Z. Zeng, Yixing Chen, Yuhong Zhou, Dansong Wang, J. Sun, M. Lv, S. Du, W. Lou","doi":"10.1097/JP9.0000000000000084","DOIUrl":"https://doi.org/10.1097/JP9.0000000000000084","url":null,"abstract":"Abstract Objective: It remains unclear whether adjuvant chemoradiotherapy (CRT) improves survival outcome of pancreatic ductal adenocarcinoma (PDAC) patients after surgery. This study aimed to investigate the efficacy and safety of tegafur/gimeracil/oteracil (S-1)-based adjuvant concurrent chemoradiotherapy in resected PDAC patients with defined high-risk pathological features. Methods: We conducted a single-arm, prospective, and interventional study at Zhongshan Hospital Fudan University from December 2012 to December 2019 and the last follow-up was conducted in December 2021. This study was approved by the Ethics Committee of Zhongshan Hospital Fudan University on December 27, 2012 (approval No. B2012-139). Resected PDAC patients with high-risk pathological features, including positive resection margin, pathological T3-4N1-2M0 disease, peripancreatic fat invasion, microvascular invasion, and perineural invasion, were recruited. Primary endpoint was overall survival and secondary endpoints were disease-free survival, treatment toxicity, and 2-, 5-year survival rates. Results: A total of 54 patients were recruited. Mean age was 63.6 years old (±7.2). The distribution of T and N stages were 24.1% for T1, 46.3% for T2, 27.8% for T3, 1.9% for T4, 33.3% for N1, and 11.1% for N2. Seven patients had R1 resection. The median overall survival and disease-free survival were 27.1 and 13.7 months, respectively, while no fatal adverse events were recorded. Subgroup analyses showed differences in survival outcomes among patients with microvascular invasion, different N stages, and preoperative CA 19-9 levels. Further, a Cox proportional hazard model demonstrated associations of lymph node metastases, CA 19-9 level, and microvascular invasion with overall survival and disease-free survival. Conclusion: S-1-based adjuvant CRT showed promising efficacy and manageable toxicity in resected PDAC patients with high-risk pathological features.","PeriodicalId":92925,"journal":{"name":"Journal of pancreatology","volume":"5 1","pages":"18 - 26"},"PeriodicalIF":0.0,"publicationDate":"2021-06-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41558659","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 : 2021-06-15DOI: 10.1097/JP9.0000000000000085
Hassam Ali, Swethaa Manickam, R. Pamarthy, M. Farooq, W. Leland
Abstract Objective: Acute pancreatitis (AP) results in systemic inflammatory responses and activates coagulation pathways. We intend to investigate the risk and hospital outcomes of acute venous thromboembolisms (VTE) in patients with AP. Methods: We retrospectively analyzed patients with AP from 2016 to 2019 using the National Inpatient Sample database. Primary outcome was the effect of VTE on the length of stay, inpatient costs, and mortality. Hierarchical multivariate logistic regression models were built using univariate screens. Results: The study included 909,354 weighted discharges with AP. 2.1% of cases had an acute VTE. The length of stay was 5.9 days longer in the hospital of AP patients with VTE compared to AP with no VTE (P < 0.001). Total hospital charge per patient was $71,914 in patients with VTE compared to AP with no VTE (P < 0.001). Mortality was higher in AP patients with VTE compared to AP with no VTE (adjusted odds ratio [AOR] 4.2, 95% confidence interval [CI]: 3.4–5.3, P < 0.001). AP was associated with an increased VTE risk during inpatient stay (AOR 1.06, 95% CI 1.04–1.1, P < 0.001) There was an increased association of lower and upper extremity deep venous thrombosis with AP without necrosis (AOR 6.9, 95% CI 6.4–7.4, P < 0.001) and AP with infected necrosis (AOR 12.2, 95% CI 10.6–14.1, P < 0.001) but not in AP without necrosis (AOR 0.77, 95% CI 0.74–0.81, P < 0.001). Conclusion: VTE in AP increases length of stay and inpatient costs. The prognosis is poor in such patients, with increased inpatient mortality compared to no VTE. AP with necrosis can increase chances of all VTE subtypes; however, AP without necrosis does not increase upper and lower extremity VTE risk.
摘要目的:急性胰腺炎(AP)引起全身炎症反应并激活凝血途径。我们打算调查AP患者急性静脉血栓栓塞(VTE)的风险和医院结局。方法:我们使用国家住院患者样本数据库对2016年至2019年的AP患者进行回顾性分析。主要结局是静脉血栓栓塞对住院时间、住院费用和死亡率的影响。采用单变量筛选建立分层多元逻辑回归模型。结果:该研究纳入了909354例AP加权出院患者，2.1%的患者发生急性静脉血栓栓塞。有VTE的AP患者住院时间比无VTE的AP患者长5.9天(P < 0.001)。与没有VTE的AP患者相比，VTE患者的每位患者总住院费用为71,914美元(P < 0.001)。合并VTE的AP患者死亡率高于未合并VTE的AP(校正优势比[AOR] 4.2, 95%可信区间[CI]: 3.4-5.3, P < 0.001)。AP与住院期间VTE风险增加相关(AOR 1.06, 95% CI 1.04-1.1, P < 0.001)。无坏死AP (AOR 6.9, 95% CI 6.4-7.4, P < 0.001)和AP合并感染性坏死(AOR 12.2, 95% CI 10.6-14.1, P < 0.001)与下肢和上肢深静脉血栓形成的相关性增加，但与无坏死AP无相关性(AOR 0.77, 95% CI 0.74-0.81, P < 0.001)。结论:静脉血栓栓塞增加了AP患者的住院时间和住院费用。这些患者的预后较差，与无静脉血栓栓塞患者相比，住院死亡率增加。AP伴坏死可增加所有静脉血栓栓塞亚型发生的机会;然而，没有坏死的AP不会增加上肢和下肢静脉血栓栓塞的风险。
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