[Collision Lung Cancer Consisting of Squamous Cell Carcinoma and Adenocarcinoma which Showed Identical Epidermal Growth Factor Receptor Mutation;Report of a Case].

We report a 79-year-old woman with collision cancer in the right middle lobe of the lung. She had a persistent abnormal shadow after treatment for pneumonia pointed out in right middle lung field on chest radiogram, and referred to our hospital. On examination, the chest computed tomography showed a pure-solid mass of 7.6 cm in diameter in right middle lobe of the lung which was thought to invade the superior pulmonary vein. She underwent a successful right pneumonecomty, and the postoperative course was uneventful. The tumor proved to be a collision cancer consisting of poor differentiated squamous cell carcinoma and invasive adenocarcinoma, lepidic predominanat by pathological examination. Epidermal growth factor receptor mutations (L858R) were found in both squamous cell carcinoma and adenocarcinoma of the tumor, possibly suggesting the same origin of both histological types.

The modified Glasgow Prognostic Score (mGPS) is a good predictor of indication for palliative bypass surgery in patients with unresectable pancreatic and biliary cancers.

BACKGROUND: Patients with unresectable pancreatic and biliary cancers sometimes need decompression due to obstruction of the gastrointestinal tract and/or biliary tract. The aim of this study was to determine the prognostic factors associated with an indication for palliative bypass surgery in patients with unresectable pancreatic and biliary cancers. METHODS: Between April 2005 and September 2011, 37 patients with unresectable pancreatic and biliary cancers underwent palliative bypass surgery. Prognostic factors were searched for among clinical characteristics, operation-related factors, and tumor-related factors using a prospective database. RESULTS: The median survival time (MST) of these patients was 4.6 months, with a 6-month survival rate of 40.5 %. A multivariate Cox proportional hazards regression analysis revealed that mGPS >2 was the only independent prognostic factor for bypass surgery. Patients with an mGPS of 2 had an MST of 1.7 months, and they had a significantly worse prognosis than mGPS 0-1 patients with an MST of 6.3 months. CONCLUSIONS: The mGPS is useful for predicting survival after surgical decompression due to gastrointestinal obstruction in patients with unresectable pancreatic and biliary cancers. Patients with a poor mGPS may not be indicated for palliative bypass surgery.

Carcinogenesis of intraductal papillary mucinous neoplasm of the pancreas: loss of microRNA-101 promotes overexpression of histone methyltransferase EZH2.

BACKGROUND: The mechanisms of IPMN carcinogenesis are as yet unclear. This study aimed to determine whether expression of EZH2 promotes neoplastic progression of IPMN and PDCA, and to elucidate regulation of EZH2 expression by miR-101. METHODS: EZH2 mRNA and protein expression were investigated in 8 human pancreatic cancer cell lines by PCR and western blotting. Pre-miR-101 and anti-miR-101 were transfected into pancreatic cancer cells to elucidate EZH2 regulation by miR-101. To evaluate whether EZH2 modulates malignant progression of IPMN, EZH2 expression in IPMN was examined by immunohistochemistry. Next, we collected malignant and benign cells from FFPE samples of IPMNs using laser capture microdissection and extracted the RNA. miR-101 expression in IPMN was assessed using real-time PCR. RESULTS: All pancreatic cancer cell lines expressed EZH2 mRNA and protein. The induction of miR-101 by transfection of pre-miR-101 in MIA PaCa-2 was closely related to a reduction in EZH2 protein production compared with control, whereas there was little difference in the expression of EZH2 mRNA. Anti-miR-101 transfected pancreatic cancer cells showed an increase in EZH2 protein, while the level of EZH2 mRNA was not elevated. Immunohistochemistry revealed that the expression of EZH2 was significantly higher in malignant than benign IPMN. Expression of miR-101 was significantly lower in malignant IPMN than benign IPMN. CONCLUSIONS: MiR-101 targets EZH2 at the posttranscriptional level, and loss of miR-101 could be a trigger for the adenomacarcinoma sequence of IPMN by upregulation of EZH2. This study suggests miR-101-EZH2 blockade as a potential therapeutic target in IPMN carcinogenesis.

An autopsy study to clarify characteristics of local recurrence after extended pancreatectomy with intraoperative radiation therapy in patients with pancreatic cancer.

PURPOSE: Local relapses frequently occur even after curative resection of pancreatic cancer. To control local recurrence, we adopted extended radical resection combined with intraoperative radiation therapy. METHODS: A retrospective review was conducted on 41 patients who underwent extended radical pancreatectomy combined with intraoperative radiation therapy for pancreatic cancer. Fourteen patients underwent autopsies. We took en bloc specimens of the abdominal aorta with surrounding connective tissue to evaluate histological characteristics of local status at autopsies. RESULTS: Autopsies disclosed microscopic local recurrence in five (36%) of the 14 patients, although no evidence of local relapse was observed in either follow-up images or macroscopic findings at autopsy. Of the three patients with R1 resection, two had no local recurrence microscopically at autopsy. Histological features of local recurrence in autopsy samples showed small numbers of cancer cells surrounded by thick connective tissue without mass formation. CONCLUSIONS: The autopsy study revealed that a characteristic of local recurrence after this treatment was tiny cancer cells scattered in dense connective tissue; these cells were undetected by follow-up imaging.

Perioperative intra-arterial and systemic chemotherapy for pancreatic cancer.

BACKGROUND: Even after curative resection of pancreatic cancer, there is a high probability of systemic recurrence. This indicates that subclinical metastases are already present at the time of operation. The purpose of this study was to assess the feasibility and outcomes of patients who received a novel multimodality therapy combining pancreatic resection and intraoperative radiation therapy (IORT) with pre- and postoperative chemotherapy for pancreatic cancer. METHODS: For eligible patients with pancreatic cancer, 5-FU was administered at a dose of 125 mg/m(2)/day on days 1-5 every week as a continuous pancreatic and hepatic arterial infusion, and gemcitabine was infused intravenously at a dose of 800 mg/m(2) per day once per week for 2 weeks for preoperative chemotherapy. Pancreatic resection combined with IORT was performed 1 week after preoperative chemotherapy. Postoperative chemotherapy was performed in the same way as preoperative chemotherapy. We performed an intention-to-treat analysis for all enrolled patients. RESULTS: This study enrolled 44 patients. The most common toxicities were hematological and gastrointestinal events. Grade 3/4 hematological toxicities were observed during preoperative chemotherapy, although there were no grade 3/4 nonhematological events. Postoperative chemotherapy-related toxicities were more critical and frequent than preoperative ones. There were no pre- or postoperative chemotherapy-associated deaths. Median overall survival was 36.5 months with 30.5% overall 5-year survival. CONCLUSIONS: This multimodality therapy is feasible and promises to contribute to survival. It should be evaluated in a phase III setting.

Adenocarcinoma of the minor duodenal papilla: report of a case.

We report a case of adenocarcinoma of the minor duodenal papilla, a rare type of duodenal neoplasm. A 76-year-old man with a history of surgery for rectal cancer and gastric cancer was referred to us after a follow-up upper gastrointestinal endoscopy revealed an abnormal elevation in the minor duodenal papilla. The pathological diagnosis of a biopsy specimen was adenocarcinoma. Preoperative examination of other organs revealed a tumor in the ascending colon, which was also identified as adenocarcinoma. We performed synchronous pancreatoduodenectomy and ileocecal resection with lymph node dissection. Histopathological examination of the resected specimen revealed that the papilla tumor arose from the duodenal mucosa and infiltrated the submucosa of the duodenal wall, but not the pancreatic parenchyma. Based on these findings, we diagnosed primary adenocarcinoma of the minor duodenal papilla. To our knowledge, this is only the sixth such case reported in the English-language literature, and we review all six cases after this case report.

Clinical significance of dihydropyrimidine dehydrogenase and thymidylate synthase expression in patients with pancreatic cancer.

BACKGROUND: Little is known about the clinical significance of TS and DPD in pancreatic cancer. We aimed to evaluate TS and DPD expression levels in not only pancreatic cancer but also surrounding normal pancreatic tissues to assess the clinical implications of the expression of TS and DPD in this study. PATIENTS AND METHODS: Pancreatic cancer and normal pancreatic tissues were obtained from 18 patients with pancreatic cancer who underwent pancreatic resection to measure TS and DPD activities. The TS and DPD activities were determined by enzyme-linked immunosorbent assay using non-fixed fresh-frozen specimens. RESULTS: Pancreatic cancer tissues had significantly higher DPD and TS enzyme activities than surrounding normal tissue. Anaplastic ductal carcinoma had higher DPD and TS activities than the other histological types. Patients with high DPD in this study demonstrated poorer prognosis than those with low DPD. On the other hand, there was no statistically significant difference in survival between the high and the low TS groups. CONCLUSIONS: The efficacy of 5-FU may be lower in pancreatic cancer tissue than in normal tissue because DPD activity is upregulated in pancreatic cancer tissue compared to normal pancreatic tissue. It is necessary to develop an effective 5-FU delivery system and/or 5-FU combined with an inhibitor for DPD that can be used when 5-FU must be administered to patients with pancreatic cancer. High DPD activity may be a prognostic factor in patients with pancreatic cancer.

Small solid pseudopapillary tumor of the pancreas in a 32-year-old man: report of a case.

A solid pseudopapillary tumor (SPT) of the pancreas is a rare neoplasm that mainly occurs in young women. We herein report the case of a small SPT arising from the head of the pancreas in an asymptomatic 32-year-old man, plus a literature review of this tumor. A 32-year-old man was admitted to our department at Kumamoto University Hospital for the evaluation of a pancreatic mass. The tumor had central necrosis, which was poorly perfused on contrast-enhanced computed tomography (CT) and which had a high intensity on T2-weighted magnetic resonance imaging (MRI). Histology revealed the lesion to be a solid pseudopapillary tumor of the pancreas, with the characteristic pseudopapilla formation and central degeneration. However, no capsule formation was observed. The tumor was positive for CD56, CD10, alpha1-antitrypsin, alpha1-antichymotrypsin, beta-catenin, and progesterone receptor. However, the tumor was negative for pancreatic hormones, chromogranin-A, carcinoembryonic antigen, and carbohydrate antigen 19-9. We diagnosed the patient to have an SPT based on these histological findings. Small-sized solid pseudopapillary tumors of the pancreas are being increasingly recognized because of the recent advances in CT and MRI. We should also consider SPT even if it occurs in a male when the tumor contains necrosis-suspected areas which are poorly perfused on contrast-enhanced CT with a high intensity on T2-weighted MRI.

Cancer cells spread through lymph vessels in the submucosal layer of the common bile duct in gallbladder carcinoma.

INTRODUCTION: In the present study, we performed immunohistochemical staining with a lymphatic epithelium-specific marker, D2-40, to analyze the status of lymphatic spreading in the hepatoduodenal ligament in T2 gallbladder carcinoma (GC). METHODS: One hundred and eighty-six paraffin-embedded specimens from 15 T2 GC patients were reviewed. RESULTS: Lymph vessels lined with D2-40 were visualized in the submucosal layer of the common bile duct in all cases. In 3 of 15 patients, clusters of cancer cells were identified in the submucosal lymph vessels of the extrahepatic bile duct, and this lymphatic invasion of cancer cells failed to be detected with only conventional hematoxylin-eosin staining. The frequency of the invasion to the submucosal lymph vessels in T2 GC correlated with presence of microscopic invasion to hepatoduodenal ligament and perineural invasion. CONCLUSION: There were lymph vessels in the submucosal layer of the common bile duct, and cancer cells can spread through these channels in addition to the large lymph vessels in subserosal layer around the extrahepatic bile duct in GC. The present results would support the concept of en bloc resection of the extrahepatic bile duct in curative resection for T2 GC.

Oxysterol binding protein-related protein-5 is related to invasion and poor prognosis in pancreatic cancer.

In previous studies, the gene expression profiles of two hamster pancreatic cancer cells with different potentials for invasion and metastasis were analyzed. In the present study, we identified that one of the genes expressed strongly in the highly metastatic cell line is hamster oxysterol binding protein-related protein (ORP)-5. The aim of the present study was to clarify the relationship between ORP5 and invasion and poor prognosis of human pancreatic cancer. Invasion assays were carried out in both hamster and human pancreatic cancer cells by suppressing the ORP5 gene with short interfering RNA or inducing its expression by introducing an expression vector. To evaluate the relationship between ORP5 and the characteristics of human pancreatic cancer, 56 pancreatic cancer tissue specimens were analyzed and the ORP5 expression in each pancreatic cancer tissue specimen was analyzed by immunohistochemistry. In both the hamster and human pancreatic cancer cells, suppression of ORP5 significantly reduced the invasion rate of the cells and induction of ORP5 significantly enhanced the invasion rate of the cells. In the clinical sample, the median survival times of the patients with ORP5-positive (n = 33) and ORP5-negative (n = 23) cancer were 8.3 and 17.2 months, respectively (P = 0.02). Also, the 1-year survival rates of patients with ORP5-positive and ORP5-negative cancer were 36.4 and 73.9%, respectively (P = 0.005). The ORP5 expression level was related to both invasion and poor prognosis in human pancreatic cancer. These findings suggest that the expression of ORP5 may induce cancer cell invasion, resulting in the poor prognosis of pancreatic cancer.

Efficacy of radiotherapy for PV and IVC tumor thrombosis in unresectable HCC.

BACKGROUND/AIMS: The purpose of this study is to evaluate the effect of radiation therapy (RT) for tumor thrombosis (TT) in the major portal vein (PV) or inferior vena cava (IVC) from unresectable hepatocellular carcinoma. METHODOLOGY: Fifteen HCC patients with main PVTT (n = 10) and IVCTT (n 5) were treated with three-dimensional conformal RT between 2001 and 2004. The mean dose was 38.5 Gy (range 28 to 54Gy). The concurrent therapies to intrahepatic tumor included transcatheter arterial chemoembolization (TACE) in 7, TACE + hepatic arterial infusion in 2 and systemic chemotherapy in 1 patient. The therapeutic effect was assessed by tumor regression for TT. RESULTS: An objective response was observed in 3 of 15 patients (20%). There were no patients with progressive disease. The median survival time was 10 months. In 12 cases with stable disease, time to progression (TTP) estimated above 6 months were 42% (5/12 cases). In univariate analysis, therapeutic effect and TTP were affected to survival time. All patients did not have severe deterioration of liver function. CONCLUSIONS: In the current study, we concluded that RT was superior treatment in terms of local control capability and was useful to continue further treatment because RT did not make liver function worse.

[A 42-month disease free survival case of combined hepatocellular-cholangiocarcinoma with lymph node metastases treated with multimodal therapy].

Combined hepatocellular and cholangiocarcinoma (HCC-CC) is a rare type of liver cancer. We herein report a case of HCC-CC with lymph node metastases treated by multimodality therapy. The patient has been alive for more than 42 months. A 52-year-old man with a 9 cm diameter mass lesion in the liver was admitted to our hospital. The tumor was diagnosed as peripheral type of cholangiocarcinoma. Preoperative transhepatic arterial chemoenbolization (TACE) was performed. An accumulation pattern of lipiodol after TACE and an increase of serum alpha-fetoprotein led us to diagnosis of combined HCC-CC. A three segmentectomies of the liver and dissection of the local lymph nodes were performed. A histological examination of the resected specimen showed combined HCC-CC with lymph node metastases. Alpha fetoprotein, cytokeratins 7 and 19 were partially positive with immunohistochemical staining. The final diagnosis was a mixed type of combined HCC-CC. To improve a poor prognosis of combined HCC-CC, adjuvant chemotherapy with CDDP, 5 FU and radiation therapy were achieved. Fortunately, the patient is alive without any recurrence for 42 months after the operation.

[A long-term survival case of liver and mediastinal LN metastases from colon cancer treated with intensive multimodal therapy].

A 50-year-old man with multiple liver and mediastinal LN metastases from sigmoid colon cancer was admitted to our hospital in May 2005. In October 2002, a radical resection of the original tumor and liver metastases were performed at a previous hospital. Histologically, the tumor was diagnosed as Stage IV. He was treated with an oral anticancer agent as an adjuvant therapy. In January 2005, the CEA level was increased to 3.2 ng/ml and CT scan revealed a solitary liver metastasis. Partial resection of the liver was performed. On admission to our hospital, a systemic chemotherapy by FOLFOX4 was begun. The liver metastases showed 61% reduction in size and were judged to be PR. However, the intrathoracic lymph node size was not changed. Therefore, VATS extirpation of the mediastinal lymph node was performed. After 10 courses of FOLFOX4, abdominal CT revealed liver metastases remained to be almost the same size. In January 2006, radio frequency ablation (RFA) and partial hepatectomy were enforced and then, the tumor marker returned to normal. There were no serious adverse events or postoperative complications. He has been alive without any sign of recurrence for 42 months from the initial treatment. In conclusion, intensive combination therapies for remote metastases of colon cancer might be promising to obtain a long-term survival without ruining QOL.

[Thoracoscopic radio-frequency ablation therapy for liver surface tumor located under the diaphragm].

It is necessary to select a proper method for radio-frequency ablation (RFA) therapy of the liver tumor. Especially, treating the tumor under the diaphragm is usually difficult to approach by percutaneous puncture. We have done thoracoscopic RFA in 48 cases (43 HCC, 1 adenomatous hyperplasia, and 4 metastatic liver tumors) to treat the tumor located on the surface of the liver under the diaphragma since January 1st, 2000. The average operation time was 237 minutes, the average blood loss was 29.0 ml and the average tumor diameter were 2.6 cm, and the average frequency of coagulation was 4.5 times. The cases which thoracoscopic RFA was possible with diaphragm incision were 27 cases (56%). However, there were 15 cases in which diaphragm incision was difficult by the adhesion under the diaphragm. Moreover, there were six cases with severe adhesion that was impossible by the thoracoscopic operation to convert an open chest method. There were 25 cases, which had some adhesion either in the chest or under the diaphragm, and those adhesions were considered to be related to the previous treatments such as the operation, ablation, and chemotherapy. The average length of the hospital stay post operation was 9.7 days. Only 3 cases (6%) needed additional treatments for tumor where the severe postoperative complication did not occur. Therefore, thoracoscopic RFA for tumor on the liver surface located under the diaphragm is suggested to be a feasible technique. On the other hand, it is necessary to pay attention to two kinds of adhesion taking a critical role for thoracoscopic operation procedures.

[A long term survival case of advanced intrahepatic cholangiocarcinoma treated with multidisciplinary treatment].

A 56-year-old man was admitted to our hospital for liver tumor of 7 cm in diameter, located mainly in the anterior segment. He underwent a hepatic resection of anterior and median segment of the liver in January 2002. Pathologically, the tumor was moderately differentiated intrahepatic cholangiocarcinoma (ICC) with vascular invasion. Hepatic arterial chemotherapy as a neoadjuvant therapy was performed. In December 2002, bone metastases in the 12th thoracic spine and iliac bone were found. Therefore, he received radiotherapy (total of 30 Gy) and a monthly bisphosphonate infusion. In May 2003, multiple intrahepatic recurrences were diagnosed. Transarterial chemoembolization for twice and an additional radio-frequency ablation were performed. Four months later, lung metastases were found, thus, he was administered TS-1. He has been alive with PS 0 for 4 and half years after the hepatic resection. No new intrahepatic recurrences were found and bone and lung metastases remained to be stable. Although only a hepatic resection is a useful therapy for ICC, such a multidisciplinary treatment may have an effect to improve the prognosis of patients with ICC.

Metastatic gastric tumor secondary to pancreatic adenocarcinoma.

Metastatic disease, from the pancreas, involving the stomach is an unusual clinical event. Local recurrence, liver metastases, and peritoneal spread are the most common recurrent patterns after curative resection of pancreatic cancer. We report a patient who suffered from gastric metastasis secondary to pancreatic adenocarcinoma 1 year after pancreatectomy. A 49-year-old woman underwent distal pancreatectomy with intraoperative radiation therapy for cancer of the body of the pancreas in October 2002. The histological diagnosis was well-differentiated adenocarcinoma of the pancreas, stage IIB; T1N1M0. Multiple liver metastases were detected on computed tomography (CT) in March 2003. Combination chemotherapy of 5-fluorouracil hepatic arterial continuous infusion and systemic gemcitabine administration led to the disappearance of the liver metastases on CT in September 2003. One month later, she complained of epigastric pain and underwent gastric endoscopy, which revealed a submucosal tumor in the fornix posterior wall. Histological diagnosis of the biopsy specimen was well-differentiated adenocarcinoma, and immunohistochemical studies, using anti-cytokeratin 7 and -20 monoclonal antibodies, were compatible with gastric metastasis from pancreatic carcinoma. A F-18-fluorodeoxyglucose positron emission tomography (FDG-PET) scan revealed a high-uptake lesion, which coincided with the gastric tumor. No other abnormal uptake could be found. Histopatholoical examination of the resected specimen revealed submucosal growth of the metastatic cancer (well-differentiated adenocarcinoma).

[A new approach to local ablation therapy for hepatocellular carcinoma--hand-assisted laparoscopic radio-frequency ablation].

We have developed a radio-frequency ablation using hand-assisted laparoscopic surgery (HALS-RFA) for hepatocellular carcinoma, and it applied for 10 patients who were difficult to be treated by common laparoscopic surgery (LS) from November 2001. The reasons for selection of HALS-RFA were severe adhesions in 3 patients, anatomical location at the hepatic dome in 3 patients, lesions adjacent to other organs or vasculatures in 3 patients, and co-operation for another organ in 1 patient. We compared efficacies of HALS to other ablation therapeutic techniques with LS and open surgery (OS). The average amount of bleeding was 85 ml in HALS, 14 ml in LS and 319 ml in OS. The amount of HALS was lesser than that of OS, but not significant. Post operative maximal CRP level was 3.2 mg/dl, 4.9 mg/dl and 10.5 mg/dl in HALS, LS, and OS, respectively, with a statistical significance between HALS and OS. Complications occurred in 2 out of 10 cases (20%) in HALS, 2 out of 62 cases (3.2%) in LS and 3 out of 9 cases (33%) in OS. Recurrence in the treated site was encountered in 1 out of 10 cases (10%) in HALS, 2 out of 62 cases (3.2%) in LS and none (0%) of OS. Based on these findings, we conclude that HALS-RFA seems to be a minimally invasive and highly effective treatment.

[A long-term survival of the patient with hepatocellular carcinoma and advanced portal vein and bile duct tumor thrombosis successfully treated with multimodal treatments].

We reported a 60-year-old male patient with hepatocellular carcinoma (HCC) of 5cm in diameter with advanced tumor thrombosis in the left main trunk of portal vein and bile duct. He was treated with multimodal treatments resulting in a long-term survival of more than 4 years. At first, he was treated with transcatheter arterial chemoembolization (TACE) in April 1999, but the therapeutic effect was insufficient. Therefore, we performed an extended left hepatic lobectomy in July. Since six HCCs appeared in a posterior segment in January 2000, we achieved microwave coagulation therapy under laparotomy. Because of diffuse relapse of HCCs in the same segment of the liver, we performed hepatic arterial chemotherapy (HAC) using low-dose CDDP and 5-FU. As a result, complete disappearance of the tumors was observed. A new lesion appeared in S7 in January 2001. We performed TACE, but relapsed in June, so we selected percutaneous radio-frequency ablation under CO2 angiography. Since a recurrent tumor was detected at the same therapeutic site with invasion to the diaphragm in September 2002, we performed a partial liver resection with synchronous excision of the diaphragm. We continued TACE and systemic chemotherapy for relapses in and out of the liver. Accordingly, he lived for over four years. We conclude that a long-term survival in this patient can be attributable to appropriate treatment selections and timing, such as hepatic resection, TACE, HAC and ablation therapies based on changes in diagnostic imaging and tumor markers. In addition, we have to pay attention to keep good hepatic reserve in order to continue treatment for recurrences of HCC.

[Hand-assisted laparoscopic adrenalectomy to a solitary adrenal metastasis from lung cancer].

A 75-year-old man with right chest pain was diagnosed with primary lung cancer in the right apical portion, and was treated with chemoradiotherapy because of a synchronous left adrenal tumor of 1.6 cm. Since the adrenal tumor did not increase in size for three months and there were no other relapses, the right upper lobectomy of the lung with the excision of the chest wall was performed. Afterward, an enlargement of the left adrenal tumor was encountered; he was admitted to our hospital for an operation. For the metastatic adrenal tumor from lung cancer, we performed a hand-assisted laparoscopic adrenalectomy. He recovered rapidly and returned to the previous hospital in two weeks after the operation. After the first report in 1992, the laparoscopic adrenalectomy has been established as the curative operation to adrenal benign tumor. The indication is being expanded to the malignancy because of the improvement of operation techniques and advancement of the operation equipments. We conclude that the laparoscopic adrenalectomy for malignant tumor is a safe, curative, and clinically useful surgical technique.

Pancreatic liver metastases after curative resection combined with intraoperative radiation for pancreatic cancer.

BACKGROUND/AIMS: A high proportion of patients even after curative resection for pancreatic cancer suffer from hepatic metastases. The aim of this study was to identify clinicopathological predictors of liver metastases after surgery, retrospectively. METHODOLOGY: Forty-one patients underwent extended radical pancreatectomy combined with intraoperative radiotherapy, which is one of the best local control methods for ductal cell carcinoma of the pancreas. Of the 41 patients, twenty-one patients regarded as being in a cancer free state after this combined therapy were studied to analyze clinicopathological predictors of hepatic metastases. Odds ratios and their 95% confidence intervals were calculated from data using logistic regression analysis. Statistical difference was considered significant at p<0.05. RESULTS: Liver metastases after curative resection occurred in 11 patients. Preoperative biliary drainage, jaundice, elevated preoperative serum tumor-associated carbohydrate antigens levels, microscopic distal bile duct invasion, duodenal wall invasion, extrapancreatic nerve plexuses invasion were factors influencing postoperative liver metastases. CONCLUSIONS: We found clinicopathological predictors of postoperative liver metastases. Patients with these factors require consideration in careful follow-up and perioperative adjuvant therapy for prevention of postoperative liver metastases.