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}
Pub Date : 2023-08-10DOI: 10.1097/jp9.0000000000000137
Sana Rafaqat, Ramsha Hafeez, Rida Mairaj, Abeer Saleem, Saira Rafaqat
Diabetes mellitus refers to a group of diseases that cause high blood sugar levels. The most common type is type 2 diabetes, which is caused by insulin resistance and inadequate insulin production. However, diabetes can also result from conditions affecting the exocrine pancreas. Both type 1 and type 2 diabetes patients may experience changes in their pancreatic exocrine function, leading to reduced levels of fecal elastase-1 in many cases. This review paper focuses on the role of specific pancreatic biomarkers in diabetes mellitus, including cholecystokinin, trypsin, chymotrypsin, carboxypeptidase, amylase, lipase, secretin, elastase-1, and retinol-binding protein 4 about recent advances and discoveries, significant gaps in the literature, current debates, and potential directions for future research related to these biomarkers about diabetes mellitus. This review article discusses various biomarkers related to pancreatic exocrine and endocrine function and their implications in diabetes. It suggests that gut cholecystokinin may play a role in lowering glucose synthesis through a neural network and resistance to it could contribute to hyperglycemia in diabetic patients. It also discusses the use of various markers such as serum trypsin concentration, amylase and lipase levels, pancreatic elastase levels, and fasting secretin levels to assess pancreatic exocrine function. Additionally, the article explores the role of carboxypeptidase E in the endocrine and neurological systems and its association with disorders. Moreover, it also highlights the involvement of retinol-binding protein 4 in the development of type 2 diabetes and insulin resistance.
{"title":"PANCREATIC BIOMARKERS: ROLE IN DIABETES MELLITUS","authors":"Sana Rafaqat, Ramsha Hafeez, Rida Mairaj, Abeer Saleem, Saira Rafaqat","doi":"10.1097/jp9.0000000000000137","DOIUrl":"https://doi.org/10.1097/jp9.0000000000000137","url":null,"abstract":"Diabetes mellitus refers to a group of diseases that cause high blood sugar levels. The most common type is type 2 diabetes, which is caused by insulin resistance and inadequate insulin production. However, diabetes can also result from conditions affecting the exocrine pancreas. Both type 1 and type 2 diabetes patients may experience changes in their pancreatic exocrine function, leading to reduced levels of fecal elastase-1 in many cases. This review paper focuses on the role of specific pancreatic biomarkers in diabetes mellitus, including cholecystokinin, trypsin, chymotrypsin, carboxypeptidase, amylase, lipase, secretin, elastase-1, and retinol-binding protein 4 about recent advances and discoveries, significant gaps in the literature, current debates, and potential directions for future research related to these biomarkers about diabetes mellitus. This review article discusses various biomarkers related to pancreatic exocrine and endocrine function and their implications in diabetes. It suggests that gut cholecystokinin may play a role in lowering glucose synthesis through a neural network and resistance to it could contribute to hyperglycemia in diabetic patients. It also discusses the use of various markers such as serum trypsin concentration, amylase and lipase levels, pancreatic elastase levels, and fasting secretin levels to assess pancreatic exocrine function. Additionally, the article explores the role of carboxypeptidase E in the endocrine and neurological systems and its association with disorders. Moreover, it also highlights the involvement of retinol-binding protein 4 in the development of type 2 diabetes and insulin resistance.","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":"46022594","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 : 2023-08-04DOI: 10.1097/jp9.0000000000000136
Amina Ehsan
Endoscopic retrograde cholangiopancreatography is a diagnostic and therapeutic procedure for various gastrointestinal problems. Pancreatitis is a severe complication of the procedure. The main objective of this study was to address if post-ERCP pancreatitis can be prevented and what are the various pharmacological and non-pharmacological options along with their efficacy. Keywords ‘post-ERCP’ and ‘pancreatitis’ were used to search articles in Pubmed. Randomized controlled trials on patients undergoing ERCP due to any disease using pharmacological or non-pharmacological intervention published in the last seven years were included. Observational studies, descriptive studies, reviews, and studies with no full access were excluded. The primary outcome in the trials was a frequency of post-ERCP pancreatitis. NSAIDs were the most effective drugs in reducing the incidence of pancreatitis. The preferred route was rectal. After NSAIDs, intravenous hydration and sublingual nitrate showed promising outcomes, especially when combined with rectal NSAIDs. Other drugs like magnesium sulfate and nafamostat mesilate did reduce the incidence, but the results were not statistically significant. Epinephrine spray on duodenal papilla showed no benefits and instead had a risk of increasing the incidence. Stent placement also reduced the incidence of pancreatitis. In conclusion, rectal NSAIDs alone or combined with IV hydration and sublingual nitrate significantly reduced the incidence of pancreatitis, and stent placement was comparable to pharmacological interventions. Thus, regular use of pharmacological interventions before the procedure can help to reduce the incidence of this grave complication.
{"title":"Pharmacological and Non-pharmacological Prophylaxis in the Prevention of Post-Endoscopic Retrograde Cholangiopancreatography Pancreatitis; A Narrative Review","authors":"Amina Ehsan","doi":"10.1097/jp9.0000000000000136","DOIUrl":"https://doi.org/10.1097/jp9.0000000000000136","url":null,"abstract":"Endoscopic retrograde cholangiopancreatography is a diagnostic and therapeutic procedure for various gastrointestinal problems. Pancreatitis is a severe complication of the procedure. The main objective of this study was to address if post-ERCP pancreatitis can be prevented and what are the various pharmacological and non-pharmacological options along with their efficacy. Keywords ‘post-ERCP’ and ‘pancreatitis’ were used to search articles in Pubmed. Randomized controlled trials on patients undergoing ERCP due to any disease using pharmacological or non-pharmacological intervention published in the last seven years were included. Observational studies, descriptive studies, reviews, and studies with no full access were excluded. The primary outcome in the trials was a frequency of post-ERCP pancreatitis. NSAIDs were the most effective drugs in reducing the incidence of pancreatitis. The preferred route was rectal. After NSAIDs, intravenous hydration and sublingual nitrate showed promising outcomes, especially when combined with rectal NSAIDs. Other drugs like magnesium sulfate and nafamostat mesilate did reduce the incidence, but the results were not statistically significant. Epinephrine spray on duodenal papilla showed no benefits and instead had a risk of increasing the incidence. Stent placement also reduced the incidence of pancreatitis. In conclusion, rectal NSAIDs alone or combined with IV hydration and sublingual nitrate significantly reduced the incidence of pancreatitis, and stent placement was comparable to pharmacological interventions. Thus, regular use of pharmacological interventions before the procedure can help to reduce the incidence of this grave complication.","PeriodicalId":92925,"journal":{"name":"Journal of pancreatology","volume":"260 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-08-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"136118872","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 : 2023-07-14DOI: 10.1097/jp9.0000000000000135
Xuqing Shi, Hangqi Liu, Zhiyong Liang
Pancreatic ductal adenocarcinoma (PDAC) is one of the most lethal solid tumors and is characterized by dense desmoplasia and immune desert. Regulatory T cells (Tregs) are critical components of the immune tumor microenvironment (TIME) of PDAC. Treg-induced immune evasion presents a significant hurdle in enhancing the efficacy of conventional and emerging therapeutic strategies. Nonetheless, Treg deficiency alone led to inconsistent outcomes. To unveil the underlying potential reasons for these results and to determine the role of Tregs in other therapeutic strategies, in-depth insights into the crosstalk between Tregs and other cells in PDAC are indispensable and currently lacking. Therefore, in this review, we comprehensively delineate the direct and indirect interplay between Tregs and various cellular constituents ranging from cancer cells and immune cells to stromal cells in PDAC in an attempt to uncover potential leads for the development of Treg-associated therapies.
{"title":"Cellular crosstalk of regulatory T cells in pancreatic ductal adenocarcinoma","authors":"Xuqing Shi, Hangqi Liu, Zhiyong Liang","doi":"10.1097/jp9.0000000000000135","DOIUrl":"https://doi.org/10.1097/jp9.0000000000000135","url":null,"abstract":"Pancreatic ductal adenocarcinoma (PDAC) is one of the most lethal solid tumors and is characterized by dense desmoplasia and immune desert. Regulatory T cells (Tregs) are critical components of the immune tumor microenvironment (TIME) of PDAC. Treg-induced immune evasion presents a significant hurdle in enhancing the efficacy of conventional and emerging therapeutic strategies. Nonetheless, Treg deficiency alone led to inconsistent outcomes. To unveil the underlying potential reasons for these results and to determine the role of Tregs in other therapeutic strategies, in-depth insights into the crosstalk between Tregs and other cells in PDAC are indispensable and currently lacking. Therefore, in this review, we comprehensively delineate the direct and indirect interplay between Tregs and various cellular constituents ranging from cancer cells and immune cells to stromal cells in PDAC in an attempt to uncover potential leads for the development of Treg-associated therapies.","PeriodicalId":92925,"journal":{"name":"Journal of pancreatology","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-07-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43158095","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 : 2023-06-29DOI: 10.1097/jp9.0000000000000134
Lei Jiang, Y. Miao, Jishu Wei
{"title":"Isolated myeloid sarcoma of the pancreas: A case report","authors":"Lei Jiang, Y. Miao, Jishu Wei","doi":"10.1097/jp9.0000000000000134","DOIUrl":"https://doi.org/10.1097/jp9.0000000000000134","url":null,"abstract":"","PeriodicalId":92925,"journal":{"name":"Journal of pancreatology","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-06-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"48183278","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 : 2023-06-26DOI: 10.1097/jp9.0000000000000133
Tianxing Zhou, Jingrui Yan, J. Hao, Jun Yu
{"title":"Pancreatic Adenocarcinoma and Ageing: Understanding the Menace for Better Management","authors":"Tianxing Zhou, Jingrui Yan, J. Hao, Jun Yu","doi":"10.1097/jp9.0000000000000133","DOIUrl":"https://doi.org/10.1097/jp9.0000000000000133","url":null,"abstract":"","PeriodicalId":92925,"journal":{"name":"Journal of pancreatology","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-06-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43524570","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 : 2023-06-26DOI: 10.1097/jp9.0000000000000132
C. Pang, Z. Fan, Pengli Su, H. Zhan
{"title":"An unrecognized undifferentiated tumor of the pancreas: A case report","authors":"C. Pang, Z. Fan, Pengli Su, H. Zhan","doi":"10.1097/jp9.0000000000000132","DOIUrl":"https://doi.org/10.1097/jp9.0000000000000132","url":null,"abstract":"","PeriodicalId":92925,"journal":{"name":"Journal of pancreatology","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-06-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43554977","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 : 2023-06-16DOI: 10.1097/JP9.0000000000000130
Lingyu Zhu, S. Gao, Xinqian Wu, Bo Li, Xiaohan Shi, Xiaoyi Yin, Huan Wang, Meilong Shi, Penghao Li, Yikai Li, Chaoliang Zhong, Chuanqi Teng, Jiawei Han, Y. Ren, Jian Wang, Zhendong Fu, Xinyu Liu, Kai-lian Zheng, Shiwei Guo, G. Jin
Objective: To evaluate the survival outcomes of patients who underwent conversion surgery for metastatic pancreatic ductal adenocarcinoma (mPDAC) after neoadjuvant therapy (NAT) and to identify potential candidates that may benefit from this treatment strategy. Background: The role and eligibility population of conversion surgery for mPDAC remains controversial in the era of NAT. Methods: A consecutive cohort of patients diagnosed with mPDAC and treated with NAT followed by conversion surgery between 2019 and 2021 were confirmed from a prospective database maintained by the Department of Pancreatic Hepatobiliary Surgery of Changhai Hospital. In accordance with residual metastases and technical resectability after NAT, patients were classified as the complete pathological response of metastases (ypM0) resection group, residual metastases (ypM1) resection group, and exploration group. Median overall survival (mOS) was calculated using the Kaplan-Meier method, uni- and multivariable cox regression was performed to identify clinicopathological predictors of OS. Results: A total of 244 patients with mPDAC were identified from the prospective database, with 19 (7.8%) patients who underwent ypM0 resection, 22 (9.0%) underwent ypM1 resection, and 23 (9.4%) underwent explorative laparotomy. The mOS was 32.6 months for ypM0 resected patients, 15.1 months for ypM1 resected patients, and 13.4 months for those who underwent explorative laparotomy (P < .001). Univariable and multivariable Cox regression analyses confirmed that ypM0 resection, normalization of preoperative CA19-9 levels, and continued adjuvant therapy were independent prognostic factors of conversion surgery for mPDAC after NAT. Subgroup analyses revealed that oligometastases and continued adjuvant therapy were associated with improved prognosis in the ypM1 resection group. Conclusion: In patients with mPDAC who underwent NAT followed by conversion surgery, the complete pathological response of metastases, normalization of preoperative CA19-9 levels, and continued adjuvant therapy were independent risk factors for prognosis. Patients with residual oligometastases after treatment were expected to prolong survival through resection. These patients may benefit from conversion surgery and should be potential candidates for this treatment strategy.
{"title":"Survival outcomes of conversion surgery for metastatic pancreatic ductal adenocarcinoma after neoadjuvant therapy","authors":"Lingyu Zhu, S. Gao, Xinqian Wu, Bo Li, Xiaohan Shi, Xiaoyi Yin, Huan Wang, Meilong Shi, Penghao Li, Yikai Li, Chaoliang Zhong, Chuanqi Teng, Jiawei Han, Y. Ren, Jian Wang, Zhendong Fu, Xinyu Liu, Kai-lian Zheng, Shiwei Guo, G. Jin","doi":"10.1097/JP9.0000000000000130","DOIUrl":"https://doi.org/10.1097/JP9.0000000000000130","url":null,"abstract":"Objective: To evaluate the survival outcomes of patients who underwent conversion surgery for metastatic pancreatic ductal adenocarcinoma (mPDAC) after neoadjuvant therapy (NAT) and to identify potential candidates that may benefit from this treatment strategy. Background: The role and eligibility population of conversion surgery for mPDAC remains controversial in the era of NAT. Methods: A consecutive cohort of patients diagnosed with mPDAC and treated with NAT followed by conversion surgery between 2019 and 2021 were confirmed from a prospective database maintained by the Department of Pancreatic Hepatobiliary Surgery of Changhai Hospital. In accordance with residual metastases and technical resectability after NAT, patients were classified as the complete pathological response of metastases (ypM0) resection group, residual metastases (ypM1) resection group, and exploration group. Median overall survival (mOS) was calculated using the Kaplan-Meier method, uni- and multivariable cox regression was performed to identify clinicopathological predictors of OS. Results: A total of 244 patients with mPDAC were identified from the prospective database, with 19 (7.8%) patients who underwent ypM0 resection, 22 (9.0%) underwent ypM1 resection, and 23 (9.4%) underwent explorative laparotomy. The mOS was 32.6 months for ypM0 resected patients, 15.1 months for ypM1 resected patients, and 13.4 months for those who underwent explorative laparotomy (P < .001). Univariable and multivariable Cox regression analyses confirmed that ypM0 resection, normalization of preoperative CA19-9 levels, and continued adjuvant therapy were independent prognostic factors of conversion surgery for mPDAC after NAT. Subgroup analyses revealed that oligometastases and continued adjuvant therapy were associated with improved prognosis in the ypM1 resection group. Conclusion: In patients with mPDAC who underwent NAT followed by conversion surgery, the complete pathological response of metastases, normalization of preoperative CA19-9 levels, and continued adjuvant therapy were independent risk factors for prognosis. Patients with residual oligometastases after treatment were expected to prolong survival through resection. These patients may benefit from conversion surgery and should be potential candidates for this treatment strategy.","PeriodicalId":92925,"journal":{"name":"Journal of pancreatology","volume":"6 1","pages":"110 - 118"},"PeriodicalIF":0.0,"publicationDate":"2023-06-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"45798999","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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