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4.
Ann Surg Oncol ; 2021 Dec 20.
Artigo em Inglês | MEDLINE | ID: mdl-34931288

RESUMO

BACKGROUND: Transduodenal ampullectomy (TDA) is performed for adenoma or early cancer of the ampulla of Vater (AoV). This study aimed to analyze the short- and long-term outcomes of TDA (TDA group) when compared with conventional pancreaticoduodenectomy (PD) or pylorus-preserving pancreaticoduodenectomy (PD group). METHODS: Patients who underwent TDA between January 2006 and December 2019, and PD cases performed for AoV malignancy with carcinoma in-situ (Tis) (high-grade dysplasia, HGD) and T1 and T2 stage from January 2010 to December 2019 were reviewed. RESULTS: Forty-six patients underwent TDA; 21 had a benign tumor, and 25 cases with malignant tumors were compared with PD cases (n = 133). Operation time (p < 0.001), estimated blood loss (p < 0.001), length of hospital stays (p = 0.003), and overall complication rate (p < 0.001) were lower in the TDA group than in the PD group. Lymph node metastasis rates were 14.6% in pT1 and 28.9% in pT2 patients. The 5-year disease-free survival and 5-year overall survival rates for HGD/Tis and T1 tumor between the two groups were similar (TDA group vs PD group, 72.2% vs 77.7%, p = 0.550; 85.6% vs 79.2%, p = 0.816, respectively). CONCLUSION: TDA accompanied with lymph node dissection is advisable in HGD/Tis and T1 AoV cancers in view of superior perioperative outcomes and similar long-term survival rates compared with PD.

5.
Artigo em Inglês | MEDLINE | ID: mdl-34907094

RESUMO

A recent successful prospective randomized control study comparing open distal pancreatectomy with laparoscopic distal pancreatectomy (LDP) has shown that LDP is a safe and effective surgical modality in treating left-sided pancreatic pathological conditions requiring surgical extirpation. With the accumulating surgical experiences and improved surgical techniques, we recently reported several cases of successful LDP in advanced pancreatic cancer following neoadjuvant chemotherapy. Herein, we report a case of LDP with celiac axis resection (LDP-CAR) in locally advanced pancreatic cancer (LAPC) following neoadjuvant chemotherapy. A 58-year-old female with LAPC was referred to our institution. Computed tomography (CT) findings revealed a 24-mm mass in the pancreatic body that showed celiac artery (CA), common hepatic artery abutment. There was no abutment with superior mesenteric artery, superior mesenteric vein, and portal vein. From these findings, Neoadjuvant chemotherapy (FORFIRINOX) was performed biweekly. After 8 cycles of chemotherapy, the tumor size was slightly decreased (24 mm to 16 mm), but still abutting to CA. After 14 cycles of chemotherapy, CT revealed the same tumor size (16 mm) still abutting to CA. LDP-CAR was performed. Intraoperative ultrasonography gastric perfusion and hepatic perfusion were confirmed using indocyanine green. The patient recovered without complications and was discharged from the hospital nine days after the surgery.

6.
Artigo em Inglês | MEDLINE | ID: mdl-34840144

RESUMO

Gallbladder cancer has a poor prognosis, especially in peritoneal carcinomatosis related to perforation of the gallbladder followed by bile spillage. Previously, curative-intent treatment was not considered in carcinomatosis from cancer of the biliary tract. A 72-year-old male was referred to the hospital with a perforated gallbladder cancer. Intraoperatively, the tumor was confined to the gallbladder and liver. We presented a case of intention-to-curative resection of perforated gallbladder cancer followed by intraoperative hyperthermic intraperitoneal chemotherapy.

7.
Cell Oncol (Dordr) ; 44(6): 1363-1371, 2021 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-34791637

RESUMO

BACKGROUND: Pancreatic cancer is a devastating disease with a high relapse rate, even in case of resectable pancreatic cancer. Here, we aimed to identify the prognostic significance and therapeutic options of metabolic subtypes of resectable pancreatic cancer. METHOD: Transcriptomic data were obtained from the TCGA-PAAD cohort in the The Cancer Genome Atlas (TCGA) data portal (n = 182). After integrative analysis of transcriptomic data in the discovery cohort, immunohistochemical (IHC) staining was performed in an independent cohort (n = 51) to validate the molecules of interest. Experimental testing for the molecules of interest was performed in vitro using pancreatic cancer cell line models AsPC1, BxPC3, MIA PaCa-2 and PANC-1. RESULTS: Two subtypes showing distinct gene expression patterns in the TCGA-PAAD dataset were identified. Of these, the active glucose metabolism subtype showed a significantly lower survival rate related to relapse after surgical resection. The genes SLC2A1 (GLUT1) and SLC16A3 (MCT4) were highly enriched in this subtype. The validation cohort showed a high MCT4 staining and a high relapse rate (p = 0.01). Several molecular pathways associated with aggressive tumor biology, including cell cycle regulation and Myc and mTOR downstream signaling, were highly enriched in the active glucose metabolism subtype, as well as with distinct responses to immunotherapy. MCT4 inhibition suppressed the in vitro malignant characteristics of pancreatic cancer cells and showed a synergistic effect with gemcitabine treatment. CONCLUSIONS: From our data we conclude that MCT4 may serve as a potential therapeutic target in resectable pancreatic cancer. The precision medicine strategy for resectable pancreatic cancer should be validated in a clinical setting with a prospective study design.

8.
J Proteome Res ; 20(12): 5315-5328, 2021 Dec 03.
Artigo em Inglês | MEDLINE | ID: mdl-34766501

RESUMO

Although plasma complement factor B (CFB, NX_P00751), both alone and in combination with CA19-9 (i.e., the ComB-CAN), previously exhibited a reliable diagnostic ability for pancreatic cancer (PC), its detectability of the early stages and the cancer detection mechanism remained elusive. We first evaluated the diagnostic accuracy of ComB-CAN using plasma samples from healthy donors (HDs), patients with chronic pancreatitis (CP), and patients with different PC stages (I/II vs III/IV). An analysis of the area under the curve (AUC) by PanelComposer using logistic regression revealed that ComB-CAN has a superior diagnostic ability for early-stage PC (97.1.% [95% confidence interval (CI): (97.1-97.2)]) compared with CFB (94.3% [95% CI: 94.2-94.4]) or CA19-9 alone (34.3% [95% CI: 34.1-34.4]). In the comparisons of all stages of patients with PC vs CP and HDs, the AUC values of ComB-CAN, CFB, and CA19-9 were 0.983 (95% CI: 0.983-0.983), 0.950 (95% CI: 0.950-0.951), and 0.873 (95% CI: 0.873-0.874), respectively. We then investigated the molecular mechanism underlying the detection of early-stage PC by using stable cell lines of CFB knockdown and CFB overexpression. A global transcriptomic analysis coupled to cell invasion assays of both CFB-modulated cell lines suggested that CFB plays a tumor-promoting role in PC, which likely initiates the PI3K-AKT cancer signaling pathway. Thus our study establishes ComB-CAN as a reliable early diagnostic marker for PC that can be clinically applied for early PC screening in the general public.

9.
Artigo em Inglês | MEDLINE | ID: mdl-34773395

RESUMO

BACKGROUND: Few studies have compared laparoscopic pancreaticoduodenectomy (LPD) and robotic pancreaticoduodenectomy (RPD) despite emerging use of minimally invasive pancreaticoduodenectomy (MIPD). The present study therefore compares perioperative outcomes of LPD and RPD patients, and evaluates safety and feasibility of MIPD. METHODS: This retrospective multicenter analysis evaluated MIPD patients through June 2020 performed by three experienced pancreatic surgeons at three different institutions. Perioperative outcomes were compared before and after propensity score-matching analyses, and learning curves based on operation time were used for additional matching analysis. RESULTS: Of 362 patients, 282 underwent LPD and 80 underwent RPD. Open conversion rate was significantly higher in LPD (P = .001). There were no significant differences in rates of major complications (Clavien-Dindo ≥III) and clinically relevant postoperative pancreatic fistula (CR-POPF). After matching, operation time (P = .001) and hospital stay (P = .027) were significantly shorter in RPD, but there were no differences in major complications and CR-POPF. Propensity score-matched comparison after learning curve attainment showed shorter operation time (P = .037) and hospital stay (P = .014) in RPD, and no differences in major complications and CR-POPF. CONCLUSION: RPD had several advantages compared with LPD, including shorter operative time and hospital stay, and lower open conversion rate. Postoperative complications including CR-POPF showed comparable results in two groups. Both LPD and RPD seemed to be feasible and safe approaches in experienced hands.

11.
Artigo em Inglês | MEDLINE | ID: mdl-34783176

RESUMO

BACKGROUND: The anatomical structure around the pancreatic head is very complex and it is important to understand its precise anatomy and corresponding anatomical approach to safely perform minimally invasive pancreatoduodenectomy (MIPD). This consensus statement aimed to develop recommendations for elucidating the anatomy and surgical approaches to MIPD. METHODS: Studies identified via a comprehensive literature search were classified using the Scottish Intercollegiate Guidelines Network method. Delphi voting was conducted after experts had drafted recommendations, with a goal of obtaining >75% consensus. Experts discussed the revised recommendations with the validation committee and an international audience of 384 attendees. Finalized recommendations were made after a second round of online Delphi voting. RESULTS: Three clinical questions were addressed, providing six recommendations. All recommendations reached at least a consensus of 75%. Preoperatively evaluating the presence of anatomical variations and superior mesenteric artery (SMA) and superior mesenteric vein (SMV) branching patterns was recommended. Moreover, it was recommended to fully understand the anatomical approach to SMA and intraoperatively confirm the SMA course based on each anatomical landmark before initiating dissection. CONCLUSIONS: MIPD experts suggest that surgical trainees perform resection based on precise anatomical landmarks for safe and reliable MIPD.

12.
Asian J Surg ; 2021 Oct 11.
Artigo em Inglês | MEDLINE | ID: mdl-34649792

RESUMO

INTRODUCTION: With continued technical advances in surgical instruments and growing surgical expertise, many laparoscopic pancreaticoduodenectomies (LPDs) have been safely performed with favorable outcomes, and this approach is being used more frequently. With an increase in the life expectancy, interest in treatments for elderly patients has increased. In this study, we investigated the safety and feasibility of LPD in octogenarians. METHODS: From September 2005 to February 2020, resectable/borderline resectable periampullary tumors (PATs) were diagnosed in 71 octogenarians at Sincheon Severance Hospital and CHA Bundang Medical Center. Patients were divided into two groups: those who underwent surgery (PD, N = 38) and those who did not (NPD, N = 33). The group that underwent surgery was further divided into two groups: those who underwent open PD (OPD, N = 19), and those who underwent LPD (LPD, N = 19). Perioperative outcomes, including long-term survival, were retrospectively compared between these groups. RESULTS: There was no significant difference in age, sex, comorbidities, diagnosis, and chemo-radiotherapy between the surgery and non-surgery groups. The PD group had a better survival rate than the NPD group (p < 0.05). The baseline characteristics and postoperative outcomes were not significantly different between the OPD and LPD groups. Only three and two patients in the OPD and LPD groups had a biochemical leak (p > 0.999). There was no significant difference in overall survival and disease-free survival between the OPD and LPD groups (p = 0.816, p = 0.446, respectively). CONCLUSIONS: LPD is a good alternative for octogenarians with PAT requiring PD.

13.
Artigo em Inglês | MEDLINE | ID: mdl-34717038

RESUMO

BACKGROUND: Pancreatoduodenectomy (PD) is the only curative therapy for distal cholangiocarcinoma (dCC). There has been no study to compare outcomes between minimally invasive pancreatoduodenectomy (MIPD) and open pancreatoduodenectomy (OPD) for dCC. The aim of the study is to compare the two operation types for dCC in terms of postoperative and oncologic outcomes. METHODS: Data from 426 patients who underwent MIPD (n = 91) or OPD (n = 335) for dCC from January 2012 to December 2019 at two tertiary hospitals were retrospectively reviewed. After 1:2 propensity score matching, postoperative and oncologic outcomes were compared. RESULTS: Minimally invasive pancreatoduodenectomy group showed more favorable results than OPD group in terms of blood loss (MIPD vs OPD, 250 [150-400] vs 400 [200-600], mL, P < .001), and length of hospital stay (19.8 ± 11.3 vs 26.6 ± 14.3 days, P < .001). OPD group showed more favorable results than MIPD group in terms of operation time (MIPD vs OPD, 457 ± 70 vs 398 ± 85 min, P < .001) and harvested lymph nodes (14.9 ± 7.8 vs 20.7 ± 11.5, P < .001). There was no statistical difference between the two groups in the R0 resection rate and complications. In long-term survival analysis, there was no significant difference between the two groups. CONCLUSION: Minimally invasive pancreatoduodenectomy showed comparable postoperative complications and long-term oncologic survival with OPD in the treatment of dCC.

14.
Artigo em Inglês | MEDLINE | ID: mdl-34719123

RESUMO

BACKGROUND: Surgical views with high resolution and magnification have enabled us to recognize the precise anatomical structures that can be used as landmarks during minimally invasive distal pancreatectomy (MIDP). This study aimed to validate the usefulness of anatomy-based approaches for MIDP before and during the Expert Consensus Meeting: Precision Anatomy for Minimally Invasive HBP Surgery (February 24, 2021). METHODS: Twenty-five international MIDP experts developed clinical questions regarding surgical anatomy and approaches for MIDP. Studies identified via a comprehensive literature search were classified using Scottish Intercollegiate Guidelines Network methodology. Online Delphi voting was conducted after experts had drafted the recommendations, with the goal of obtaining >75% consensus. Experts discussed the revised recommendations in front of the validation committee and an international audience of 384 attendees. Finalized recommendations were made after a second round of online Delphi voting. RESULTS: Four clinical questions were addressed, resulting in 10 recommendations. All recommendations reached at least a 75% consensus among experts. CONCLUSIONS: The expert consensus on precision anatomy for MIDP has been presented as a set of recommendations based on available evidence and expert opinions. These recommendations should guide experts and trainees in performing safe MIDP and foster its appropriate dissemination worldwide.

15.
Int J Surg ; 93: 106050, 2021 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-34388677

RESUMO

BACKGROUND: or Purpose: Pancreatic ductal adenocarcinoma (PDAC) is a leading cause of mortality in the world with the overall 5-year survival rate of 6%. The survival of patients with PDAC is closely related to recurrence and therefore it is necessary to identify the risk factors for recurrence. This study uses artificial intelligence approaches and multi-center registry data to analyze the recurrence of pancreatic cancer after surgery and its major determinants. METHODS: Data came from 4846 patients enrolled in a multi-center registry system, the Korea Tumor Registry System (KOTUS). The random forest and the Cox proportional-hazards model (the Cox model) were applied and compared for the prediction of disease-free survival. Variable importance, the contribution of a variable for the performance of the model, was used for identifying major predictors of disease-free survival after surgery. The C-Index was introduced as a criterion for validating the models trained. RESULTS: Based on variable importance from the random forest, major predictors of disease-free survival after surgery were tumor size (0.00310), tumor grade (0.00211), TNM stage (0.00211), T stage (0.00146) and lymphovascular invasion (0.00125). The coefficients of these variables were statistically significant in the Cox model (p < 0.05). The C-Index averages of the random forest and the Cox model were 0.6805 and 0.7738, respectively. CONCLUSIONS: This is the first artificial-intelligence study with multi-center registry data to predict disease-free survival after the surgery of pancreatic cancer. The findings of this methodological study demonstrate that artificial intelligence can provide a valuable decision-support system for treating patients undergoing surgery for pancreatic cancer. However, at present, further studies are needed to demonstrate the actual benefit of applying machine learning algorithms in clinical practice.


Assuntos
Carcinoma Ductal Pancreático , Neoplasias Pancreáticas , Inteligência Artificial , Carcinoma Ductal Pancreático/cirurgia , Humanos , Recidiva Local de Neoplasia/epidemiologia , Neoplasias Pancreáticas/cirurgia , Estudos Retrospectivos
16.
Ann Hepatobiliary Pancreat Surg ; 25(3): 390-394, 2021 Aug 31.
Artigo em Inglês | MEDLINE | ID: mdl-34402441

RESUMO

For years, neoadjuvant chemotherapy for locally advanced pancreatic cancer is being investigated and radical surgical resection with laparoscopic approach is getting up to speed. Pathological complete remission is known as a predictive marker for a good prognosis for various carcinomas. Although there are a few case reports about pathological complete remission, there has been no case report of pathological complete remission resulted from successful extensive resection by laparoscopic surgery after a neoadjuvant modified FOLFIRINOX chemotherapy. A 68-year-old male patient was admitted due to a palpable abdominal mass which turned out to be 16-cm-sized huge locally advanced left-sided pancreatic cancer with possible stomach, left adrenal gland, left kidney, and colon invasion. After administration of 10th modified FOLFIRINOX chemotherapy, the tumor had decreased and he underwent laparoscopic radical distal pancreatectomy with splenectomy, left adrenalectomy, wedge resection of stomach, and segmental resection of transverse colon. Although patient had a postoperative micro-abscess around the colon anastomosis site, he was successfully managed with conservative treatment and discharged on 12 days postoperatively. The final pathology reported complete tumor regression. We hereby emphasize the oncologic significance of neoadjuvant chemotherapy in huge left-sided pancreatic cancer and the potential role of laparoscopic conversion surgery.

17.
Yonsei Med J ; 62(9): 836-842, 2021 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-34427070

RESUMO

PURPOSE: The aim of the current study was to evaluate the adverse clinical impact of intraoperative conversion during laparoscopic pancreaticoduodenectomy (LPD). MATERIALS AND METHODS: The medical records of patients who underwent pancreaticoduodenectomy (PD) were retrospectively reviewed. Perioperative clinical variables were compared between patients who underwent converted PD (cPD) and initially planned open PD (OPD) to investigate the clinical impact and predictive factors of intraoperative conversion during LPD. RESULTS: A total of 171 patients were included. Among them, 31 patients (19.3%) were found to have intraoperative conversion during LPD. Failure of progression due to severe adhesion (12 patients, 7%) and major vessel invasion (7 patients, 4%) were the two most frequent reasons for conversion. On multivariate analysis, age [Exp(ß)=1.044, p=0.044] and pancreatic texture [Expa(ß)=2.431, p=0.039) were found to be independent factors for predicting intraoperative conversion during LPD. In comparative analysis with the OPD group, the cPD group had a longer operation time (516.8 min vs. 449.9 min, p=0.001), higher rate of postoperative hemorrhage (12.1% vs. 0.85%, p=0.008), higher reoperation rate (9.1% vs. 0%, p=0.01), and higher cost (21886.4 USD vs. 17168.9 USD, p=0.018). CONCLUSION: Intraoperative conversion during LPD can have an adverse clinical impact on the postoperative course following LPD. Appropriate patients selection and improvement of surgical techniques will be crucial for unnecessary intraoperative conversion and safe LPD.


Assuntos
Laparoscopia , Pancreaticoduodenectomia , Humanos , Laparoscopia/efeitos adversos , Tempo de Internação , Pancreatectomia , Pancreaticoduodenectomia/efeitos adversos , Estudos Retrospectivos
18.
Artigo em Inglês | MEDLINE | ID: mdl-34318617

RESUMO

BACKGROUND: Development of a pragmatic pathologic classifier of pancreatic ductal adenocarcinoma (PDAC) that reflects biological behavior is needed. METHODS: The tumor epithelial and stromal features of PDAC and molecular subtype-related markers were evaluated in three independent cohorts. RESULTS: In the non-neoadjuvant therapy cohort (n = 108), regarding tumor-epithelial feature, non-gland-forming type showed worse prognosis compared to gland-forming type (P < .001). For tumor-stromal feature, in gland-forming type, the prognosis was good in order of inactivated stroma-rich, stroma-poor, and activated stroma-rich (P = .027). Whereas, non-gland-forming type revealed no difference of prognosis according to tumor stroma. Of molecular subtype-related markers, keratin 81 expression was correlated with non-gland-forming type and poor prognosis (P = .005 and P = .021, respectively). Other markers (HNF1A, c-MET, and p53) showed no significant differences in prognosis. In the neoadjuvant therapy cohort (n = 68), non-gland-forming type was correlated with high residual tumor volume (≥20%) (P < .001) and gland-forming/stroma-poor type was not present. In the next-generation sequencing cohort (n = 55), non-gland-forming type was correlated with a higher number of the KRAS, TP53, CDKN2A, and SMAD4 mutations (P = .038). CONCLUSION: Combined tumor epithelial and stromal histopathology with keratin 81 expression is suggested to be useful for predicting prognosis of PDAC.

19.
Gut Liver ; 2021 Jun 22.
Artigo em Inglês | MEDLINE | ID: mdl-34140428

RESUMO

Background/Aims: : Controversy regarding the effectiveness of neoadjuvant therapy for resectable pancreatic ductal adenocarcinoma (PDAC) still exists. Here, we aimed to identify the potential benefits of neoadjuvant therapy followed by surgery for resectable PDAC. Methods: We reviewed radiologically resectable PDAC patients who received resection with curative intent at a tertiary hospital in South Korea between January 2012 and August 2019. A total of 202 patients underwent curative resection for resectable PDAC: 167 underwent surgical resection first during this period, and 35 received neoadjuvant chemotherapy/chemoradiation therapy followed by surgery. Resectable PDAC patients were subdivided, and 1:3 propensity score matching (PSM) was performed to reduce selection bias. Results: Compared with the group that received surgery first, the group that received neoadjuvant treatment followed by surgery had significantly smaller tumors (22.0 mm vs 27.0 mm, p=0.004), a smaller proportion of patients with postoperative pathologic T stage (p=0.026), a smaller proportion of patients with lymphovascular invasion (20.0% vs 40.7%, p=0.022), and a larger proportion of patients with negative resection margins (74.3% vs 51.5%, p=0.049). After PSM, the group that received neoadjuvant therapy had a significantly longer progression-free survival than those in the group that underwent surgery first (29.6 months vs 15.1 months, p=0.002). Overall survival was not significantly different between the two groups after PSM analysis. Conclusions: We observed significantly better surgical outcomes and progression-free survival with the addition of neoadjuvant therapy to the management of resectable PDAC. However, despite PSM, there was still selection bias due to the use of different regimens between the groups receiving surgery first and neoadjuvant therapy. Large homogeneous samples are needed in the future prospective studies.

20.
Ann Hepatobiliary Pancreat Surg ; 25(2): 307-312, 2021 May 31.
Artigo em Inglês | MEDLINE | ID: mdl-34053937

RESUMO

Pancreatic cancer is one of the dismal malignant disease in gastrointestinal tract. However, since the recent literature reporting median survival of FOLFIRINOX (leucovorin clcium, fluorouracil, irinotecan hydrochloride, oxaliplatin) chemotherapy was more than 12 months in metastatic pancreatic cancer was published, the positive attitude toward the treatment of the advanced pancreatic cancer is gradually expanded among the medical and surgical oncologists. Due to multiple combination of potent chemotherapeutic agents, potential adverse side effects should be concerned when considering FOLFIRINOX. Herein, we report a 55-year old male patient with locally advanced pancreatic cancer who successfully underwent curative resection following by laparoscopic division of pancreaticosplenic ligament due to long-term preoperative use of FOLFIRINOX related hepatic toxicity associated with secondary hypersplenism. The present case suggests the extended radical PD with combined major vascular resection following laparoscopic division of pancreaticosplenic ligament containing splenic artery and vein can improve the safety of curative resection and may expand the potential indication of pancreatic cancer in well-selected long-term use of preoperative FOLFIRINOX induced hepatic toxicity associated with secondary hypersplenism.

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