Pub Date : 2023-10-27DOI: 10.1097/jp9.0000000000000147
Manyi Hu, Yiting Xu, Yangyang Wang, Cao Chen, Junjun He, Ke Sun, Qi Zhang, Tingbo Liang
Background: Chemotherapy stands as a recommended approach for all stages of pancreatic cancer. However, its efficacy stratification remains obscure. Genomic sequencing is extensively applied across diverse diseases. This study aims to explore the potential genomic markers in relation to the decision-making of chemotherapy. Methods: A total of 140 patients with pancreatic cancer were categorized into chemotherapy-first group and adjuvant chemotherapy group. The genomic alterations were detected from the next-generation sequencing using surgical or fine-needle-biopsy specimens. Chemotherapy response was defined according to objective response based on the RECIST criteria (version 1.1). Results: In the chemotherapy-first group, the patients who harbored higher TMB levels had significant shorter PFS than that with low TMB levels (Hazard ratio [HR] = 30.362, P = 0.002). No independent risk factors were found to be correlated with chemoresistance in patients receiving chemotherapy at first (all P > 0.05). In the adjuvant chemotherapy group, the increased CA125 level of more than 35 U/mL potentially elucidated a shorter period of DFS (HR = 3.695, P = 0.020). Conclusion: Our study indicated that a high level of TMB may predict earlier tumor progression in pancreatic cancer patients received chemotherapy at first. The elevation of CA125 presents itself as a predictive indicator for postoperative chemotherapy patients' tumor recurrence, whereas gene mutations remain unrelated to this phenomenon.
背景:化疗是所有阶段胰腺癌的推荐治疗方法。然而，其疗效分层尚不清楚。基因组测序广泛应用于多种疾病。本研究旨在探索与化疗决策相关的潜在基因组标记。方法:将140例胰腺癌患者分为先化疗组和辅助化疗组。基因组改变是通过手术或细针活检标本从下一代测序中检测到的。化疗反应根据基于RECIST标准(1.1版)的客观反应来定义。结果:先化疗组，TMB水平高的患者PFS明显短于TMB水平低的患者(HR = 30.362, P = 0.002)。首次接受化疗的患者未发现与化疗耐药相关的独立危险因素(P >0.05)。辅助化疗组CA125水平升高大于35 U/mL可能说明DFS时间缩短(HR = 3.695, P = 0.020)。结论:我们的研究表明，高水平的TMB可能预示着首次接受化疗的胰腺癌患者的早期肿瘤进展。CA125升高可作为化疗后患者肿瘤复发的预测指标，而基因突变与此现象无关。
{"title":"Genetic alterations and tumor mutation burden predict chemosensitivity of pancreatic cancer: a retrospective study","authors":"Manyi Hu, Yiting Xu, Yangyang Wang, Cao Chen, Junjun He, Ke Sun, Qi Zhang, Tingbo Liang","doi":"10.1097/jp9.0000000000000147","DOIUrl":"https://doi.org/10.1097/jp9.0000000000000147","url":null,"abstract":"Background: Chemotherapy stands as a recommended approach for all stages of pancreatic cancer. However, its efficacy stratification remains obscure. Genomic sequencing is extensively applied across diverse diseases. This study aims to explore the potential genomic markers in relation to the decision-making of chemotherapy. Methods: A total of 140 patients with pancreatic cancer were categorized into chemotherapy-first group and adjuvant chemotherapy group. The genomic alterations were detected from the next-generation sequencing using surgical or fine-needle-biopsy specimens. Chemotherapy response was defined according to objective response based on the RECIST criteria (version 1.1). Results: In the chemotherapy-first group, the patients who harbored higher TMB levels had significant shorter PFS than that with low TMB levels (Hazard ratio [HR] = 30.362, P = 0.002). No independent risk factors were found to be correlated with chemoresistance in patients receiving chemotherapy at first (all P > 0.05). In the adjuvant chemotherapy group, the increased CA125 level of more than 35 U/mL potentially elucidated a shorter period of DFS (HR = 3.695, P = 0.020). Conclusion: Our study indicated that a high level of TMB may predict earlier tumor progression in pancreatic cancer patients received chemotherapy at first. The elevation of CA125 presents itself as a predictive indicator for postoperative chemotherapy patients' tumor recurrence, whereas gene mutations remain unrelated to this phenomenon.","PeriodicalId":92925,"journal":{"name":"Journal of pancreatology","volume":"10 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-10-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"136234223","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 : 2023-10-21DOI: 10.1097/jp9.0000000000000146
Ruining Gong, Yonglu Hu, Qian Yu, Lin Fang, He Ren
Pancreatic ductal adenocarcinoma (PDAC) is the prototypical aggressive cancer that develops in nutrient-deficient and hypoxic microenvironment. PDAC overcomes these restrictions by employing unconventional tactics for the procurement and usage of fuel sources. The substantial reprogramming of PDAC cells metabolism is driven by oncogene-mediated cell-autonomous pathways. PDAC cells use glucose, glutamine, and lipids for energy and depend on autophagy and macropinocytosis for survival and growth. They also interact metabolically with non-cancerous cells, aiding tumor progression. Many clinical trials focusing on altered metabolism are ongoing. Understanding the metabolic regulation of PDAC cells will not only help to increase understanding of the mechanisms of disease progression, but also provide insights for the development of new diagnostic and therapeutic approaches.
{"title":"Metabolic Signatures in Pancreatic Ductal Adenocarcinoma: Diagnostic and Therapeutic Implications","authors":"Ruining Gong, Yonglu Hu, Qian Yu, Lin Fang, He Ren","doi":"10.1097/jp9.0000000000000146","DOIUrl":"https://doi.org/10.1097/jp9.0000000000000146","url":null,"abstract":"Pancreatic ductal adenocarcinoma (PDAC) is the prototypical aggressive cancer that develops in nutrient-deficient and hypoxic microenvironment. PDAC overcomes these restrictions by employing unconventional tactics for the procurement and usage of fuel sources. The substantial reprogramming of PDAC cells metabolism is driven by oncogene-mediated cell-autonomous pathways. PDAC cells use glucose, glutamine, and lipids for energy and depend on autophagy and macropinocytosis for survival and growth. They also interact metabolically with non-cancerous cells, aiding tumor progression. Many clinical trials focusing on altered metabolism are ongoing. Understanding the metabolic regulation of PDAC cells will not only help to increase understanding of the mechanisms of disease progression, but also provide insights for the development of new diagnostic and therapeutic approaches.","PeriodicalId":92925,"journal":{"name":"Journal of pancreatology","volume":"27 4","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-10-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135510720","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 ductal adenocarcinoma (PDAC) is a highly progressive lethal malignancy, with chemotherapy being the primary treatment modality. This article provides a review of the initial chemotherapy options for PDAC patients with adequate performance status, comparing FOLFIRINOX (oxaliplatin, irinotecan, 5-fluorouracil, and leucovorin) or modified FOLFIRINOX and gemcitabine plus nab-paclitaxel (GEM-NabP) regimens. The availability of limited evidence from randomized trials restricts a direct comparison between the two regimens. Based on our review, (m)FOLFIRINOX yields superior survival outcomes compared to GEM-NabP in metastatic PDAC. For locally advanced PDAC, either (m)FOLFIRINOX or GEM-NabP can be considered initial chemotherapy. In the neoadjuvant setting for borderline resectable PDAC, both regimens have demonstrated promising results in achieving feasible resection rates. However, mFOLFIRINOX remains the preferred choice for adjuvant chemotherapy. The selection of initial chemotherapy for PDAC depends on the disease stage, patients' performance status, and tumor molecular alterations. Further research and clinical trials are necessary to optimize treatment approaches for PDAC patients.
{"title":"Initial chemotherapy option for Pancreatic ductal adenocarcinoma in patients with adequate performance status","authors":"Jiazhang Xing, Yuping Ge, Xiaolei Gong, Yuan Liu, Yuejuan Cheng","doi":"10.1097/jp9.0000000000000144","DOIUrl":"https://doi.org/10.1097/jp9.0000000000000144","url":null,"abstract":"Pancreatic ductal adenocarcinoma (PDAC) is a highly progressive lethal malignancy, with chemotherapy being the primary treatment modality. This article provides a review of the initial chemotherapy options for PDAC patients with adequate performance status, comparing FOLFIRINOX (oxaliplatin, irinotecan, 5-fluorouracil, and leucovorin) or modified FOLFIRINOX and gemcitabine plus nab-paclitaxel (GEM-NabP) regimens. The availability of limited evidence from randomized trials restricts a direct comparison between the two regimens. Based on our review, (m)FOLFIRINOX yields superior survival outcomes compared to GEM-NabP in metastatic PDAC. For locally advanced PDAC, either (m)FOLFIRINOX or GEM-NabP can be considered initial chemotherapy. In the neoadjuvant setting for borderline resectable PDAC, both regimens have demonstrated promising results in achieving feasible resection rates. However, mFOLFIRINOX remains the preferred choice for adjuvant chemotherapy. The selection of initial chemotherapy for PDAC depends on the disease stage, patients' performance status, and tumor molecular alterations. Further research and clinical trials are necessary to optimize treatment approaches for PDAC patients.","PeriodicalId":92925,"journal":{"name":"Journal of pancreatology","volume":"10 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-09-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135477065","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 : 2023-09-27DOI: 10.1097/jp9.0000000000000145
Saira Rafaqat, Aqsa Sattar, Farhan Anjum, Mahrukh Gilani, Sana Rafaqat
Pancreatitis is an inflammatory condition affecting the pancreas and is classified into two types, acute and chronic, which can manifest in various forms. This review article summarizes the role of predictive and prognostic values of inflammatory markers in the pathogenesis of acute pancreatitis, mainly focused on preclinical and clinical studies. It includes serum amyloid A, monocyte chemotactic protein-1, erythrocyte sedimentation rate, interleukin-6(IL-6), C-reactive protein, interleukin 10(IL-10), myeloperoxidase, pentraxin 3 and plasminogen activator inhibitor 1. SAA3 plays a crucial role in developing acute pancreatitis by triggering a receptor-interacting protein 3-dependent necroptosis pathway in acinar cells. Targeting SAA3 could be a potential strategy for treating acute pancreatitis. The recruitment of monocytes/macrophages and the activation of the systemic monocyte chemotactic protein-1 (MCP-1) signaling pathway play a role in the progression of pancreatitis, and blocking MCP-1 may have a suppressive effect on the development of pancreatic fibrosis. The erythrocyte sedimentation rate (ESR) can predict severe acute pancreatitis with slightly lower accuracy than C-reactive protein (CRP). When ESR and CRP levels are combined at 24 hours, they predict severe acute pancreatitis accurately. IL-6 plays a crucial role in activating the Janus kinase/signal transducers and activators of the transcription pathway, exacerbating pancreatitis and contributing to the initiation and progression of pancreatic cancer. Endogenous interleukin-10 plays a crucial role in controlling the regenerative phase and limiting the severity of fibrosis and glandular atrophy induced by repeated episodes of acute pancreatitis in mice. The predictive and diagnostic roles of these inflammatory factors in pancreatitis were introduced in detail in this review.
{"title":"THE ROLE OF PREDICTIVE AND PROGNOSTIC VALUES OF INFLAMMATORY MARKERS IN ACUTE PANCREATITIS: A NARRATIVE REVIEW","authors":"Saira Rafaqat, Aqsa Sattar, Farhan Anjum, Mahrukh Gilani, Sana Rafaqat","doi":"10.1097/jp9.0000000000000145","DOIUrl":"https://doi.org/10.1097/jp9.0000000000000145","url":null,"abstract":"Pancreatitis is an inflammatory condition affecting the pancreas and is classified into two types, acute and chronic, which can manifest in various forms. This review article summarizes the role of predictive and prognostic values of inflammatory markers in the pathogenesis of acute pancreatitis, mainly focused on preclinical and clinical studies. It includes serum amyloid A, monocyte chemotactic protein-1, erythrocyte sedimentation rate, interleukin-6(IL-6), C-reactive protein, interleukin 10(IL-10), myeloperoxidase, pentraxin 3 and plasminogen activator inhibitor 1. SAA3 plays a crucial role in developing acute pancreatitis by triggering a receptor-interacting protein 3-dependent necroptosis pathway in acinar cells. Targeting SAA3 could be a potential strategy for treating acute pancreatitis. The recruitment of monocytes/macrophages and the activation of the systemic monocyte chemotactic protein-1 (MCP-1) signaling pathway play a role in the progression of pancreatitis, and blocking MCP-1 may have a suppressive effect on the development of pancreatic fibrosis. The erythrocyte sedimentation rate (ESR) can predict severe acute pancreatitis with slightly lower accuracy than C-reactive protein (CRP). When ESR and CRP levels are combined at 24 hours, they predict severe acute pancreatitis accurately. IL-6 plays a crucial role in activating the Janus kinase/signal transducers and activators of the transcription pathway, exacerbating pancreatitis and contributing to the initiation and progression of pancreatic cancer. Endogenous interleukin-10 plays a crucial role in controlling the regenerative phase and limiting the severity of fibrosis and glandular atrophy induced by repeated episodes of acute pancreatitis in mice. The predictive and diagnostic roles of these inflammatory factors in pancreatitis were introduced in detail in this review.","PeriodicalId":92925,"journal":{"name":"Journal of pancreatology","volume":"40 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-09-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135477063","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}
Malignant insulinomas are rare neuroendocrine tumors that require management for both symptomatic control and tumor reduction. It is clinically challenging to optimize treatment strategies for refractory malignant insulinoma. We report a case of metastatic grade 3 insulinoma presented with recurrent hypoglycemia in a 23-year-old female with RAD51D p.Q192 germline mutation. During the disease course of 5 years, the tumor has continuously progressed despite locoregional therapy and multiple lines of systemic treatment. However, oxaliplatin-based chemotherapy achieved a partial response, which was maintained for two years. The hypoglycemic symptoms were controlled after the treatment response and did not recur. Platinum-based regimen could be a feasible therapeutic strategy for malignant insulinoma. The relationship between germline mutation in the DNA damage repair pathway and treatment response to platinum-based regimens in neuroendocrine tumors warrants further investigation.
{"title":"Platinum-based chemotherapy for metastatic insulinoma harboring germline mutation in DNA damage repair pathway: A case report","authors":"Kaili Yang, Hongyan Ying, Mei Guan, Lina Wang, Jia Xu, Yuejuan Cheng","doi":"10.1097/jp9.0000000000000143","DOIUrl":"https://doi.org/10.1097/jp9.0000000000000143","url":null,"abstract":"Malignant insulinomas are rare neuroendocrine tumors that require management for both symptomatic control and tumor reduction. It is clinically challenging to optimize treatment strategies for refractory malignant insulinoma. We report a case of metastatic grade 3 insulinoma presented with recurrent hypoglycemia in a 23-year-old female with RAD51D p.Q192 germline mutation. During the disease course of 5 years, the tumor has continuously progressed despite locoregional therapy and multiple lines of systemic treatment. However, oxaliplatin-based chemotherapy achieved a partial response, which was maintained for two years. The hypoglycemic symptoms were controlled after the treatment response and did not recur. Platinum-based regimen could be a feasible therapeutic strategy for malignant insulinoma. The relationship between germline mutation in the DNA damage repair pathway and treatment response to platinum-based regimens in neuroendocrine tumors warrants further investigation.","PeriodicalId":92925,"journal":{"name":"Journal of pancreatology","volume":"16 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-09-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"136313192","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 : 2023-08-29DOI: 10.1097/jp9.0000000000000142
Bin Zhou, Zusen Wang, Caiyan Yu, Shuxiang Jin, Tengfei Qu
The incidence rate of pancreatic tuberculosis (PT) is low, and it is difficult to distinguish from pancreatic malignant tumor before operation. We present three patients diagnosed after surgical treatment. All three cases involved female patients who were admitted due to primary manifestation of abdominal pain. These patients did not exhibit symptoms such as jaundice or back pain, and their tumor markers were within normal range. The surgical interventions employed included partial resection of the tumor in one case, mass resection in another, and pancreaticoduodenectomy in the third. Preoperative puncture biopsy is essential for diagnosing pancreatic tuberculosis, and it should be actively conducted on patients with suspected cases. We summarize several common manifestations of pancreatic tuberculosis to find the possibility of tuberculosis during preoperative evaluation and avoid misdiagnosis and unnecessary surgery.
{"title":"Pancreatic tuberculosis misdiagnosed for surgical treatment: Clinical analysis","authors":"Bin Zhou, Zusen Wang, Caiyan Yu, Shuxiang Jin, Tengfei Qu","doi":"10.1097/jp9.0000000000000142","DOIUrl":"https://doi.org/10.1097/jp9.0000000000000142","url":null,"abstract":"The incidence rate of pancreatic tuberculosis (PT) is low, and it is difficult to distinguish from pancreatic malignant tumor before operation. We present three patients diagnosed after surgical treatment. All three cases involved female patients who were admitted due to primary manifestation of abdominal pain. These patients did not exhibit symptoms such as jaundice or back pain, and their tumor markers were within normal range. The surgical interventions employed included partial resection of the tumor in one case, mass resection in another, and pancreaticoduodenectomy in the third. Preoperative puncture biopsy is essential for diagnosing pancreatic tuberculosis, and it should be actively conducted on patients with suspected cases. We summarize several common manifestations of pancreatic tuberculosis to find the possibility of tuberculosis during preoperative evaluation and avoid misdiagnosis and unnecessary surgery.","PeriodicalId":92925,"journal":{"name":"Journal of pancreatology","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-08-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"44101197","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 : 2023-08-24DOI: 10.1097/jp9.0000000000000141
Y. Chi, Liming Jiang, S. Shi, S. He, C. Bai, D. Cao, Qichen Chen, Xiao Chen, Yiqiao Deng, S. Du, Zhen Huang, Li Huo, Yuan Ji, Jie Li, W. Lou, Jie Luo, Xueying Shi, Lijie Song, Bei Sun, H. Tan, Feng Wang, Xuan Wang, Zhewen Wei, Wenming Wu, D. Xiu, Jianming Xu, Huadan Xue, Yi Yang, Fei Yin, Jiangyuan Yu, C. Yuan, Ye‐fan Zhang, Weixun Zhou, Dongbing Zhao, Hong Zhao
Many management strategies are available for pancreatic neuroendocrine neoplasms with liver metastases. However, a lack of biological, molecular, and genomic information and an absence of data from rigorous trials limit the validity of these strategies. This review presents the viewpoints from an international conference consisting of several expert working groups. The working groups reviewed a series of questions of particular interest to clinicians taking care of patients with pancreatic neuroendocrine neoplasms with liver metastases by reviewing the existing management strategies and literature, evaluating the evidence on which management decisions were based, developing internationally acceptable recommendations for clinical practice, and making recommendations for clinical and research endeavors. The review for each question will be followed by recommendations from the panel.
{"title":"Chinese Expert Consensus on Multidisciplinary Diagnosis and Treatment of Pancreatic Neuroendocrine Liver Metastases","authors":"Y. Chi, Liming Jiang, S. Shi, S. He, C. Bai, D. Cao, Qichen Chen, Xiao Chen, Yiqiao Deng, S. Du, Zhen Huang, Li Huo, Yuan Ji, Jie Li, W. Lou, Jie Luo, Xueying Shi, Lijie Song, Bei Sun, H. Tan, Feng Wang, Xuan Wang, Zhewen Wei, Wenming Wu, D. Xiu, Jianming Xu, Huadan Xue, Yi Yang, Fei Yin, Jiangyuan Yu, C. Yuan, Ye‐fan Zhang, Weixun Zhou, Dongbing Zhao, Hong Zhao","doi":"10.1097/jp9.0000000000000141","DOIUrl":"https://doi.org/10.1097/jp9.0000000000000141","url":null,"abstract":"Many management strategies are available for pancreatic neuroendocrine neoplasms with liver metastases. However, a lack of biological, molecular, and genomic information and an absence of data from rigorous trials limit the validity of these strategies. This review presents the viewpoints from an international conference consisting of several expert working groups. The working groups reviewed a series of questions of particular interest to clinicians taking care of patients with pancreatic neuroendocrine neoplasms with liver metastases by reviewing the existing management strategies and literature, evaluating the evidence on which management decisions were based, developing internationally acceptable recommendations for clinical practice, and making recommendations for clinical and research endeavors. The review for each question will be followed by recommendations from the panel.","PeriodicalId":92925,"journal":{"name":"Journal of pancreatology","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-08-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41507031","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 : 2023-08-17DOI: 10.1097/jp9.0000000000000140
Meijing Wu, A-Fang Zhu, Le Shen
Pancreatic cancer related pain (PCRP) gains widespread attention for its high prevalence, extreme complexity, poor prognosis and decreased survival rate. Current treatment of PCRP remains unsatisfactory, since the underlying mechanism is not clear. The occurrence of PCRP is mainly related to the neurotropic nature of pancreatic cancer, and perineural invasion, neural remodeling and plasticity play important roles. Upon the understanding of PCRP mechanism, the management of PCRP is a multidisciplinary and multifaceted strategy. Traditional pain medications, invasive or intervention treatment, psychological support, integrative therapy and palliative care are all the potential aspects for the management of PCRP.
{"title":"Pancreatic Cancer Related Pain: Mechanism and Management","authors":"Meijing Wu, A-Fang Zhu, Le Shen","doi":"10.1097/jp9.0000000000000140","DOIUrl":"https://doi.org/10.1097/jp9.0000000000000140","url":null,"abstract":"Pancreatic cancer related pain (PCRP) gains widespread attention for its high prevalence, extreme complexity, poor prognosis and decreased survival rate. Current treatment of PCRP remains unsatisfactory, since the underlying mechanism is not clear. The occurrence of PCRP is mainly related to the neurotropic nature of pancreatic cancer, and perineural invasion, neural remodeling and plasticity play important roles. Upon the understanding of PCRP mechanism, the management of PCRP is a multidisciplinary and multifaceted strategy. Traditional pain medications, invasive or intervention treatment, psychological support, integrative therapy and palliative care are all the potential aspects for the management of PCRP.","PeriodicalId":92925,"journal":{"name":"Journal of pancreatology","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-08-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"44187760","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 : 2023-08-10DOI: 10.1097/jp9.0000000000000139
Wenming Wu, S. Cai, Rufu Chen, D. Fu, C. Ge, C. Hao, J. Hao, Heguang Huang, Z. Jian, G. Jin, Fei Li, Hai-ming Li, Sheng-ping Li, Weiqin Li, Yixiong Li, T. Liang, Xu-Bao Liu, W. Lou, Y. Miao, Yiping Mou, C. Peng, R. Qin, C. Shao, B. Sun, Guang-xi Tan, Huaizhi Wang, Lei Wang, Wei Wang, Weilin Wang, Junmin Wei, Heshui Wu, Zheng-Ren Wu, Chang-qing Yan, Yinmo Yang, Xiaoyu Yin, Xianjun Yu, C. Yuan, Yupei Zhao
In clinical practice, pancreatic neuroendocrine neoplasms (pNENs) with a diameter smaller than 2cm are commonly referred to as small pNENs. Due to their generally favorable biological characteristics, the diagnosis and treatment of small pNENs differ from other pNENs and are somewhat controversial. In response to this, the Chinese Pancreatic Surgery Association, Chinese Society of Surgery, Chinese Medical Association has developed a consensus on the diagnosis and treatment of small pNENs, which is based on evidence-based medicine and expert opinions. This consensus covers various topics, including concepts, disease assessment, treatment selection, follow-up, and other relevant aspects.
{"title":"Consensus of clinical diagnosis and treatment for non-functional pancreatic neuroendocrine neoplasms with diameter less than 2cm","authors":"Wenming Wu, S. Cai, Rufu Chen, D. Fu, C. Ge, C. Hao, J. Hao, Heguang Huang, Z. Jian, G. Jin, Fei Li, Hai-ming Li, Sheng-ping Li, Weiqin Li, Yixiong Li, T. Liang, Xu-Bao Liu, W. Lou, Y. Miao, Yiping Mou, C. Peng, R. Qin, C. Shao, B. Sun, Guang-xi Tan, Huaizhi Wang, Lei Wang, Wei Wang, Weilin Wang, Junmin Wei, Heshui Wu, Zheng-Ren Wu, Chang-qing Yan, Yinmo Yang, Xiaoyu Yin, Xianjun Yu, C. Yuan, Yupei Zhao","doi":"10.1097/jp9.0000000000000139","DOIUrl":"https://doi.org/10.1097/jp9.0000000000000139","url":null,"abstract":"In clinical practice, pancreatic neuroendocrine neoplasms (pNENs) with a diameter smaller than 2cm are commonly referred to as small pNENs. Due to their generally favorable biological characteristics, the diagnosis and treatment of small pNENs differ from other pNENs and are somewhat controversial. In response to this, the Chinese Pancreatic Surgery Association, Chinese Society of Surgery, Chinese Medical Association has developed a consensus on the diagnosis and treatment of small pNENs, which is based on evidence-based medicine and expert opinions. This consensus covers various topics, including concepts, disease assessment, treatment selection, follow-up, and other relevant aspects.","PeriodicalId":92925,"journal":{"name":"Journal of pancreatology","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-08-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"48013357","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 : 2023-08-10DOI: 10.1097/jp9.0000000000000138
Tao Qian, Kaiquan Huang, Wenqing Chen, X. Bai, Shunliang Gao, Yan Shen, M. Zhang, Jian Wu, Jun Yu, T. Ma, T. Liang
Pancreatic fistula after distal pancreatectomy is a common and potentially lethal complication. The optimal closure method for the pancreatic remnant during minimally invasive distal pancreatectomy (MDP) remains unclear. Data of consecutive patients who underwent MDP in our institution between July 2018 and June 2021 were collected. The outcomes of MDP with stapler and hand-sewn closure were compared. The primary outcome was clinically relevant postoperative pancreatic fistula (CR-POPF) per the International Study Group of Pancreatic Surgery definition. Of the 384 patients (stapler closure, 339; hand-sewn closure, 45) enrolled, 249 developed CR-POPF (grades B and C: 242 and 7 patients, respectively). The rates of grade B and grade C POPF in the stapler group were similar to the corresponding rates in the hand-sewn group (64.6% and 1.5% vs. 51.1% and 4.4%, P = 0.078 and P = 0.223, respectively). No differences between the stapler and hand-sewn groups were observed regarding the median operation time (207 min vs. 222 min, P = 0.139), incidence of major complications (16.5% vs. 20.0%, P = 0.559), and mortality (0.2% vs. 0%, P = 1.000). The independent risk factors of CR-POPF were abdominal abscess, prolonged operation time, and transection site (P = 0.004, 0.006, and 0.001, respectively). The incidence and severity of CR-POPF by stapler closure of the pancreatic stump were comparable to those associated with hand-sewn closure in MDP in this retrospective cohort. Randomized controlled trials are needed to verify this finding.
{"title":"Comparison of Outcomes with Stapler Versus Hand-Sewn Closure of the Pancreatic Stump following Minimally Invasive Distal Pancreatectomy: A Retrospective Cohort Study","authors":"Tao Qian, Kaiquan Huang, Wenqing Chen, X. Bai, Shunliang Gao, Yan Shen, M. Zhang, Jian Wu, Jun Yu, T. Ma, T. Liang","doi":"10.1097/jp9.0000000000000138","DOIUrl":"https://doi.org/10.1097/jp9.0000000000000138","url":null,"abstract":"\u0000 \u0000 Pancreatic fistula after distal pancreatectomy is a common and potentially lethal complication. The optimal closure method for the pancreatic remnant during minimally invasive distal pancreatectomy (MDP) remains unclear.\u0000 \u0000 \u0000 \u0000 Data of consecutive patients who underwent MDP in our institution between July 2018 and June 2021 were collected. The outcomes of MDP with stapler and hand-sewn closure were compared. The primary outcome was clinically relevant postoperative pancreatic fistula (CR-POPF) per the International Study Group of Pancreatic Surgery definition.\u0000 \u0000 \u0000 \u0000 Of the 384 patients (stapler closure, 339; hand-sewn closure, 45) enrolled, 249 developed CR-POPF (grades B and C: 242 and 7 patients, respectively). The rates of grade B and grade C POPF in the stapler group were similar to the corresponding rates in the hand-sewn group (64.6% and 1.5% vs. 51.1% and 4.4%, P = 0.078 and P = 0.223, respectively). No differences between the stapler and hand-sewn groups were observed regarding the median operation time (207 min vs. 222 min, P = 0.139), incidence of major complications (16.5% vs. 20.0%, P = 0.559), and mortality (0.2% vs. 0%, P = 1.000). The independent risk factors of CR-POPF were abdominal abscess, prolonged operation time, and transection site (P = 0.004, 0.006, and 0.001, respectively).\u0000 \u0000 \u0000 \u0000 The incidence and severity of CR-POPF by stapler closure of the pancreatic stump were comparable to those associated with hand-sewn closure in MDP in this retrospective cohort. Randomized controlled trials are needed to verify this finding.\u0000","PeriodicalId":92925,"journal":{"name":"Journal of pancreatology","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-08-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"47631886","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}
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