Language：English  

DOI： 10.1097/SLA.0000000000007033

PubMed

Language：English   Publisher：Journal of Hepato Biliary Pancreatic Sciences  

Background/Purpose: Major hepatopancreatoduodenectomy (HPD) is associated with a high risk of postoperative mortality, often due to pancreatic fistula formation and liver failure. We evaluated the impact of the functional reserve of the remnant liver on postoperative pancreatic fistula (POPF) formation and mortality. Methods: Patients who underwent resection of ≥ 3 hepatic segments with pancreatoduodenectomy were retrospectively analyzed. The association of the future liver remnant-to-body weight ratio (FLR/BW) with POPF formation and mortality was assessed. With receiver operating characteristic (ROC) curve analysis, the optimal cutoff values were determined. Underlying pancreatic conditions were also examined. Results: POPFs occurred in 64% of 177 patients. The predictors of POPFs included a high BMI, low pancreatic CT attenuation, and small pancreatic duct diameter. The FLR/BW was not associated with POPF formation. Postoperative mortality occurred in 6% of patients, mostly due to Grade C postpancreatectomy hemorrhage. An FLR/BW < 0.8% was an independent predictor of mortality (OR 15.79); patients with a ratio below 0.8% had a 14% mortality rate. Conclusions: Poor remnant liver functional reserve is not associated with POPF formation but significantly increases mortality after major HPD. Ensuring sufficient liver reserve, perhaps through more proactive use of portal vein embolization or parenchyma-sparing procedures, may improve outcomes.

DOI： 10.1002/jhbp.70026

Web of Science

Scopus

PubMed

Language：English   Publisher：Cancer Science  

Pancreatic cancer remains a highly lethal disease, largely attributed to the rapid development of resistance against standard chemotherapy regimens. Although an acidic tumor microenvironment (TME) has been implicated in this resistance, the molecular mechanisms involved are not fully understood. In this study, we identified Family with Sequence Similarity 111 Member B (FAM111B) as significantly upregulated in pancreatic cancer cells under acidic conditions through RNA sequencing and validated. Functional analyses revealed that FAM111B regulates intracellular pH (pHi). Moreover, combining gemcitabine with α-cyano-4-hydroxycinnamic acid, a lactate transporter inhibitor known to decrease pHi, markedly suppressed pancreatic cancer cell viability compared to gemcitabine alone, thereby enhancing the sensitivity under acidic conditions in both in vitro and in mouse xenograft models. Clinically, elevated FAM111B expression correlated with significantly poorer overall survival in pancreatic cancer patients receiving gemcitabine-based chemotherapy (median OS: 2.05 vs. 3.66 years, p = 0.038). Multivariate analysis identified FAM111B expression as an independent predictor of poor prognosis (HR = 3.05, p = 0.032). These findings highlight the crucial role of FAM111B in maintaining pHi homeostasis under acidic TME conditions and contributing to gemcitabine resistance. Targeting FAM111B may represent a novel therapeutic strategy to overcome chemotherapy resistance and improve clinical outcomes in pancreatic cancer.

DOI： 10.1111/cas.70212

Open Access

Web of Science

Scopus

PubMed

Language：English   Publisher：HPB  

Background: The impact of preoperative mood on complications remains poorly understood in hepato-biliary-pancreatic (HBP) surgery. Methods: This prospective cohort study included patients who underwent resection for pancreatic ductal carcinoma and cholangiocarcinoma. Preoperative positive mood were measured by Vigor-Activity score according to Profile of Mood States, 2nd edition. The primary outcome was the whole burden of complications, represented by the comprehensive complication index (CCI). Patients were divided into low- and high-positive mood groups by the median Vigor-Activity score. The impact of mood state on CCI was assessed by restricted cubic spline regression. Results: Between July 2021 and June 2022, 127 consecutive patients were enrolled. Preoperative findings and surgical procedures did not significantly differ between the low-positive (n = 64) and high-positive (n = 63) mood groups. The high-positive mood group had a significantly lower median CCI than the low-positive mood group (41.1 vs. 48.2, P = 0.026). The Vigor-Activity score had a nearly linear negative correlation with CCI and independently decreased CCI (P = 0.034). Conclusion: Patients with preoperative high-positive mood had a lower CCI than those with low-positive mood after major HBP surgery. A patient's preoperative mood could affect the total burden of postoperative complications.

DOI： 10.1016/j.hpb.2025.07.015

Web of Science

Scopus

PubMed

Language：English   Publisher：In Vivo  

Background/Aim: Despite advances in critical care, postoperative liver failure remains a substantial complication of liver resection, with high mortality rates. Adipose-derived stem cells (ADSCs) have demonstrated potential in various regenerative applications; however, their precise mechanisms in liver repair remain unclear. This study investigated the effects of ADSC sheets on the vascular and cellular responses in a mouse model of partial hepatectomy. Materials and Methods: Human ADSCs were cultured with magnetic nanoparticle-containing liposomes and formed multilayered cell sheets. Following partial hepatectomy in BALB/c nude mice, ADSC or collagen control sheets were attached to liver resection sites. Immunohistochemical analysis assessed angiogenesis (CD31), hepatic stellate cell activation (α-SMA), and cellular origin. Mice were sacrificed on postoperative days 4 and 7. Statistical analysis was conducted using Bonferroni’s method (p<0.05). Results: Compared to cell-free collagen sheets (control), ADSC sheets demonstrated significantly enhanced neovascularization, with higher CD31 expression on postoperative days 4 and 7. Immunohistochemical analysis revealed that these CD31-positive cells were predominantly of mouse origin, rather than differentiated from transplanted human ADSCs, indicating host cell migration into the sheets. Additionally, ADSC sheets significantly increased α-SMA expression compared to that with collagen sheets, with expression levels progressively increasing from day 4 to 7, suggesting continuous activation of hepatic stellate cells. These findings indicate that ADSC sheets induce angiogenesis and hepatic stellate cell activation during liver regeneration, likely through paracrine mechanisms that recruit host cells, rather than through direct differentiation of transplanted ADSCs. Conclusion: This study lays the groundwork for the clinical application of ADSC sheets, demonstrating their potential to enhance liver regeneration after hepatectomy by promoting host cell-mediated angiogenesis and hepatic stellate cell activation.

DOI： 10.21873/invivo.14112

Open Access

Web of Science

Scopus

PubMed

Language：English   Publisher：Journal of Hepato Biliary Pancreatic Sciences  

Background: Overexpression of human epidermal growth factor receptor 2 (HER2) is a recognized prognostic marker and therapeutic target in oncology. However, its clinical significance in intraductal papillary neoplasm of the bile duct (IPNB) remains unclear. Methods: This retrospective study reviewed patients who underwent resection for IPNB between 1998 and 2011. HER2 overexpression was evaluated by immunohistochemistry and semi-quantitatively categorized into four grades (score 0, 1+, 2+, 3+); the former two and the latter two grades defined HER2-negative and HER2-positive groups, respectively. Results: A total of 184 IPNB cases were analyzed, of which 12 patients (6.5%) were diagnosed with HER2-positive disease. There were no significant differences between the groups in clinicopathologic characteristics such as tumor location, histologic type, or invasion depth, with the exception of superficial extension, which was significantly more frequent in the HER2-positive group. The HER2-positive group demonstrated significantly worse overall survival than the HER2-negative group (25% vs. 49% at 5 years, p = 0.030). In multivariable analysis, HER2 positivity, age ≥ 70, percutaneous transhepatic biliary drainage, nodal metastasis, and positive margin status were identified as independent prognostic factors. Conclusion: HER2 overexpression is an independent biologic marker for unfavorable survival, though infrequent in IPNB.

DOI： 10.1002/jhbp.70000

Web of Science

Scopus

PubMed

Language：English  

DOI： 10.1097/SLA.0000000000006957

PubMed

Language：English   Publisher：Anticancer Research  

Background/Aim: Total neoadjuvant therapy has been widespread over the past years and the multimodal treatment strategy involving administration of neoadjuvant chemotherapy (NAC) gradually increases for patients with locally advanced rectal cancer. However, the necessity of adjuvant chemotherapy (AC) following NAC remains controversial. The aim of this study was to investigate the impact of AC on survival outcomes and the influence of perioperative chemotherapy on treatment efficacy in patients with locally advanced rectal cancer (LARC) who received NAC followed by surgery. Patients and Methods: We retrospectively analyzed 107 patients with LARC who received NAC using propensity score matching (PSM) with covariates of clinical N stage, anus-preserving status, presence of severe complications (≥ Clavien-Dindo 3). All patients were planned and treated for three months with oxaliplatin-based doublet chemotherapy preoperatively. Results: There were no significant differences between AC and Non-AC groups in 50 patients of the PSM cohort. At a median follow-up of 85.6 months, the 5-year overall survival was 88.0% and the 5-year relapse-free survival (RFS) was 81.3% for the entire cohort. The 5-year RFS was significantly better in the AC than in the non-AC group (87.3% vs. 79.8%, p=0.033). Multivariate analysis demonstrated that non-AC and lateral lymph node metastasis were poor prognostic factors of RFS in patients with LARC [non-AC: Hazard ratio (HR)=4.089, 95% confidence interval (CI)=1.217-13.735, p=0.023; lateral lymph node metastasis: HR=9.04, 95%CI=1.737-47.040, p=0.009]. Conclusion: AC could improve RFS in patients with LARC following NAC.

DOI： 10.21873/anticanres.1779

Open Access

Web of Science

Scopus

PubMed

Language：English   Publisher：Medical Principles and Practice  

Objective: Clinical value of screening colonoscopy (SC) has been widely accepted; however, its clinical utility remains controversial in patients who undergo laparoscopic cholecystectomy (LC). The aim of this study was to evaluate the clinical value of medical care costs for SC before LC. Subject and Methods: Of the 509 patients who underwent LC, 335 underwent preoperative SC before LC. The electronic medical records were retrospectively reviewed, and the technical fees of SC and endoscopic and/or surgical resection for colorectal neoplasia (CRN) were analyzed. Results: In the 335 patients with SC before LC, the rate of CRN requiring resection, including advanced adenoma and adenocarcinoma, was 13.1%. The detected rate of CRN requiring resection in the age-groups of <45, 44–55, 55–65, 65–75, ≥75 years was 5.3%, 3.8%, 9.8%, 17.4%, and 22.9%, respectively. Of the 174 patients without SC before LC, 4 patients were diagnosed with resectable colorectal carcinomas after LC. The total technical fees of SC and/or treatment of CRNs among the 335 patients with SC before LC and surgical procedures among the 4 patients with resectable colorectal carcinoma were United States dollar (USD) 84,700 and USD 32,000 USD, respectively. Regarding the technical fee per person, the former group (USD 250) had much economic advantage compared to the latter group (USD 8,000). Conclusion: Scheduling LC is recognized as an important chance to undergo SC. For the patients aged ≥55 years, colonoscopy is no longer a screening option but a clinical necessity due to the high detected rates of CRN requiring resection.

DOI： 10.1159/000545322

Open Access

Web of Science

Scopus

PubMed

Language：English   Publisher：Anticancer Research  

Background/Aim: Total neoadjuvant therapy (TNT) is promising in reducing distant metastasis and facilitating nonoperative management (NOM) in locally advanced rectal cancer. However, concerns arise regarding the quality of total mesorectal excision (TME) and local regrowth after NOM. This study investigated the feasibility of a response-guided strategy centered on induction chemotherapy to enhance patient selection and outcomes. Patients and Methods: From 2020 to 2023, patients with clinical Stage II/III lower rectal cancer, located within 10 cm from the anal verge, were enrolled. Induction chemotherapy used either an oxaliplatin-based doublet or triplet regimen over three months. Long-course chemoradiotherapy was administered selectively based on multidisciplinary evaluations, targeting either NOM or minimizing local recurrence for patients with mesorectal fascia (MRF) involvement. Results: Eighteen consecutive patients were enrolled. At first restaging, 39% (seven patients) achieved a complete or near-complete response. Consequently, five patients underwent NOM after chemoradiotherapy, achieving a 100% TME-free survival rate. R0 resections were successful in all 13 surgical cases, including two patients with residual tumor who underwent TNT and one patient with MRF involvement even after TNT, as well as 10 patients without MRF involvement treated solely with induction chemotherapy, omitting chemoradiotherapy. Conclusion: Induction chemotherapy effectively filters suitable candidates for NOM in locally advanced rectal cancer, suggesting a potential to omit routine radiotherapy. This approach highlights personalized treatment strategies and aims to enhance patients' quality of life by reducing unnecessary surgeries and preserving rectal function.

DOI： 10.21873/anticanres.17700

Open Access

Web of Science

Scopus

PubMed

Publisher：南江堂  

DOI： 10.15106/j_geka87_889

CiNii Research

Language：English   Publisher：Asian Journal of Endoscopic Surgery  

Background: According to the Tokyo Guidelines 2018 (TG-18), delayed laparoscopic cholecystectomy (DLC) after recovering from acute cholecystitis (AC) is recommended for patients with poor status. Moreover, DLC for patients with good status remains controversial, and TG-18 does not include clinical questions regarding fluorescent cholangiography (FC). In this study, we evaluated the clinical value and safety of FC during DLC. Methods: We performed DLC in 226 patients after recovering from AC. The electronic medical records of these patients were retrospectively reviewed, focusing on preoperative assessment and intraoperative and postoperative outcomes. Biliary and/or arterial injuries were treated as intraoperative complications. Results: Of the study patients, 144 underwent DLC with FC. Among the remaining 82 patients who underwent DLC without FC, the rate of intraoperative complications was 7.3% (n = 6), which was significantly higher than in those who underwent DLC with FC (0%) (p = 0.002). The rate of conversion to open cholecystectomy during DLC with FC (1.4%) was significantly lower than that during DLC without FC (15.9%). The mean operative time was not significantly different between the patients who underwent DLC with and without FC (p = 0.503). The mean blood loss and postoperative complications in patients who underwent DLC with FC were significantly lower than those who underwent DLC without FC (p = 0.041 and p = 0.002, respectively). Conclusions: Utilizing FC can reduce intraoperative and postoperative complications, the conversion rate, and blood loss during DLC; therefore, DLC with FC is recognized as a safe procedure for patients with AC.

DOI： 10.1111/ases.70092

Open Access

Web of Science

Scopus

PubMed

Language：English   Publisher：Journal of Hepato Biliary Pancreatic Sciences  

Background: Lymph node metastases beyond the hepatoduodenal ligament are sometimes encountered in locally limited T2 gallbladder cancer (GBCA). However, the incidence and impact on prognosis remain unclear. Methods: This was a retrospective multi-institutional study of patients who underwent surgical resection for GBCA from 2002 to 2022. The eighth edition of the Union for International Cancer Control staging was used for tumor-node-metastasis categorization. The lymph node location was classified as follows: (A) along the hepatoduodenal ligament and common hepatic artery; (B) posterior side of the pancreatic head; and (C) others. Metastasis to regions A, B, and C nodes was denoted as Na, Nb, and Nc, respectively. Results: Data for 379 patients (pT1, 29; pT2, 162: pT3, 141; and pT4, 47) were evaluated; none with pT1 GBCA had node metastasis. For N1/2 GBCA, the proportion of patients with N2 disease increased with increasing T grade (p =.001), while the proportions of patients with Na, Nb, and Nc disease were comparable between pT2 (61%, 26%, and 13%), pT3 (63%, 26%, and 12%), and pT4 (50%, 38%, and 12%) disease (p =.681), respectively. Overall survival for pT2N1/2 disease (5 years, 43.8%) was comparable to that for pT3/4N0 disease (5 years, 37.2%; p =.192). Among patients with node-positive pT2 disease, overall survival was comparable for Na, Nb, and Nc disease, with 5-year survivals of 46%, 43%, and 31%, respectively (p =.346). Conclusion: Region B or C node metastasis was not rare even in pT2 GBCA. Regarding survival outcomes, pT2 node-positive GBCA should be considered advanced disease irrespective of the extent of node metastasis.

DOI： 10.1002/jhbp.12140

Open Access

Web of Science

Scopus

PubMed

Language：Japanese   Publisher：Japan Biliary Association  

<p>The bile ducts are anatomically located in close proximity to the hepatic artery and portal vein, and advanced biliary tract cancers are likely to involve these hepatic inflow vessels. In perihilar cholangiocarcinoma surgery combined with portal vein resection, forms of resection and reconstruction of the portal vein varies depending on the extent and location of the portal vein involvement. In most of cases, segmental resection followed by direct end-to-end anastomosis is applied; however, in cases where direct anastomosis is unfeasible, reconstruction utilizing grafts is considered. Autologous venous grafts are typically employed, with the external iliac vein being the preferred choice due to its optimal characteristics. The paper focuses on the technical aspects of portal vein interpositional graft reconstruction for perihilar cholangiocarcinoma.</p>

DOI： 10.11210/tando.39.259

Open Access

CiNii Research

Language：English   Publisher：Nagoya Journal of Medical Science  

Combination regimen consisting of gemcitabine, cisplatin, and durvalumab (GCD) has been employed for unresectable biliary tract cancer (BTC) since the end of 2022 in Japan. Here, we summarize our experience with GCD to demonstrate the clinical outcomes in a practical setting. Patients who underwent GCD for unresectable/recurrent BTC between January and December 2023 were investigated retrospectively. Data for maximal response rate (RR), disease control rate (DCR), and adverse events (AEs) were collected. Progression-free survival (PFS) and overall survival (OS) curves were generated using the Kaplan-Meyer method. Fifty (initially unresectable, n = 32; recurrence after surgery, n = 18) consecutive patients were enrolled, 19 of whom started GCD as second-line therapy or later. Overall RR was 24.0% including complete response in 1 (2%) patient and partial response in 11 (22%) patients; DCR was 68.0%. The median PFS and OS were 7.1 months and not reached, respectively. During a median follow-up period of 8.5 months, 8 (16%) patients underwent surgical resection. A total of 36 (72%) patients suffered Grade 3–5 AE, and 3 immune-related AE were controlled with injection of corticosteroid or observation. The efficacy of GCD for unresectable/recurrent BTC was confirmed in the practical setting, with acceptable toxicity, prolonged survival, and potential probability of resection.

DOI： 10.18999/nagjms.87.2.254

Open Access

Web of Science

Scopus

PubMed

Language：English   Publisher：Annals of Surgery  

Objective: To reappraise whether preoperative autologous blood donation reduces post-hepatectomy liver failure (PHLF) in major hepatectomy for perihilar malignancy. Summary Background Data: Autologous blood storage and transfusion are carried out to reduce the use of allogeneic blood transfusion during hepatectomy and prevent postoperative complications. However, the clinical benefit of major hepatectomy has been controversial. Methods: This randomized clinical trial included patients who underwent major hepatectomy with extrahepatic bile duct resection for perihilar malignancy. Eligible patients were randomly assigned (1:1) to undergo surgery with or without the use of autologous blood transfusion. The primary outcome was the incidence of clinically relevant PHLF (grade B/C according to the International Study Group of Liver Surgery definition). Results: Between February 6, 2019, and May 12, 2023, 138 consecutive patients were enrolled in the study (blood storage group n = 68, non-storage group n = 70). Twenty-five patients who did not undergo resection were excluded; the remaining 113 patients were investigated as the full analysis set (blood storage group n = 60, non-storage group n = 53). Surgical procedures, operative time, and blood loss were not significantly different between the 2 groups. The incidence of PHLF was comparable [blood storage group n = 10 (17%), non-storage group n = 10 (19%); P = 0.760]. There were also no between-group differences in other postoperative outcomes, including the incidence of Clavien-Dindo Grade Ⅲ or higher (72% vs 72%, P = 0.997) and median duration of hospital stay (25 vs 29 days, P = 0.277). Conclusions: Autologous blood storage did not contribute to reducing the incidence of PHLF in patients undergoing major hepatectomy.

DOI： 10.1097/SLA.0000000000006547

Web of Science

Scopus

PubMed

Publisher：金原出版  

DOI： 10.18888/op.0000004420

CiNii Research

Language：English   Publisher：HPB  

Background: A histologically involved surgical margin (R1) is often observed after resection for cholangiocarcinoma. Compared with a negative margin (R0), R1 with invasive carcinoma (R1inv) markedly worsens survival, whereas the prognostic effect of R1 with carcinoma in situ (R1cis) remains controversial. Methods: Patients who underwent resection for perihilar cholangiocarcinoma between 2002 and 2019 were retrospectively reviewed. According to the pathological assessment, the duct margin was classified as R0, R1cis, or R1inv; radial margin positivity was treated as R1inv. Recurrence and survival were compared. Results: Among the 681 patients, 457 had R0, 69 had R1cis, and 155 had R1inv. The overall five-year recurrence rate was 82.8 % with R1inv, 67.8 % with R1cis, and 47.6 % with R0 (P < 0.001); the local recurrence rate also significantly differed among these groups (P < 0.001). The five-year survival rate was significantly worse with R1cis than with R0 (37.3 % vs. 56.7 %, P < 0.001) and better than that with R1inv (20.9 %, P = 0.007). Multivariate analysis revealed that R1cis was an independent predictor of survival (hazard ratio, 1.65; P < 0.001). Conclusion: Compared with R0, R1cis significantly deteriorated overall survival in the whole resection subset of patients with perihilar cholangiocarcinoma. However, the prognostic impact of R1cis was milder than that of R1inv.

DOI： 10.1016/j.hpb.2024.12.005

Open Access

Web of Science

Scopus

PubMed

Language：English   Publisher：Cancer Genomics and Proteomics  

Background/Aim: Bile tract cancer (BTC) is a malignant tumor with a poor prognosis. Recent studies have reported the heterogeneity of the genomic background and gene alterations in BTC, but its genetic heterogeneity and molecular profiles remain poorly understood. Whole-genome sequencing may enable the identification of novel actionable gene mutations involved in BTC carcinogenesis, malignant progression, and treatment resistance. Patients and Methods: We performed whole-genome sequencing of six BTC samples to elucidate its genetic heterogeneity and identify novel actionable gene mutations. Somatic mutations, structural variations, copy number alterations, and their associations with clinical factors were analyzed. Results: The average number of somatic mutations detected in each case was 53,705, with SNVs accounting for most of these mutations (85.02%). None of the 331 mutations related to BTC in The Cancer Genome Atlas (TCGA) database were found in the mutations identified in our study. A higher prevalence of gene mutations was observed in samples without vascular invasion than in those with vascular invasion. Several genes with differences in mutation accumulation between groups were identified, including ADAMTS7, AHNAK2, and CAPN10. Conclusion: Our study provides novel insights into the genomic landscape of BTC and highlights the potential of whole-genome sequencing analysis to identify actionable gene mutations and understand the molecular mechanisms underlying this malignancy. The high mutational burden, structural variations, and copy number alterations observed in BTC samples in this study underscore the genetic complexity and heterogeneity of this disease.

DOI： 10.21873/cgp.20484

Open Access

Web of Science

Scopus

PubMed

Language：English   Publisher：International Psychogeriatrics  

Objectives: To clarify the characteristics of Japanese patients with frontotemporal dementia (FTD), we have established a nationwide multicenter registry named the Frontiers of Time course and Living specimen registry and Disease-modifying therapy development in Japanese patients with FTLD (FTLD-J). To ensure diagnostic consistency, we implemented case review meetings in the registry and evaluated their utility. Methods: Between February 2016 and August 2024, 269 patients with behavioral variant FTD (bvFTD), semantic dementia (SD), or progressive nonfluent aphasia (PNFA) were registered. Fifteen case review meetings, open to all participating facilities, were held, where the clinical course, neuropsychiatric-neuropsychological evaluations, and neuroimaging analysis of 238 out of 269 cases were presented. Initial diagnoses were approved or revised based on discussions among specialists regarding whether the cases met the diagnostic criteria. We examined the diagnostic stability in participants initially diagnosed with bvFTD, SD, and PNFA. Given the limited number of PNFA cases, we compared the rate of diagnostic changes between bvFTD and SD using the chi-square test. Results: Of the 126 participants enrolled as bvFTD, 75 were confirmed as bvFTD. In the remaining 51 patients, the diagnoses changed during the meeting. Of the 95 participants enrolled as SD, 77 were confirmed as SD, and in 18 cases, the diagnoses changed. Of the 17 participants enrolled as PNFA, 15 were confirmed as PNFA; bvFTD had a predominantly higher rate of diagnostic change than those with SD (p < 0.001). Conclusions: Our results suggested that case review meetings in a multicenter study may improve diagnostic consistency, especially in bvFTD.

DOI： 10.1016/j.inpsyc.2025.100078

Open Access

Scopus

PubMed

Language：English   Publisher：Japan Surgical Society  

<p><b>INTRODUCTION:</b> Pembrolizumab has been introduced to solid cancers with microsatellite instability (MSI)-high cases; however, its clinical experience for cholangiocarcinoma remains very limited. Here, we present a case who successfully underwent conversion surgery following pembrolizumab treatment for MSI-high perihilar cholangiocarcinoma, which pathologically exhibited complete response.</p><p><b>CASE PRESENTATION:</b> A 69-year-old male with Bismuth IV perihilar cholangiocarcinoma with bulky lymphadenopathy was referred, who initially required left hepatic trisectionectomy, caudate lobectomy, bile duct resection, and portal vein resection and reconstruction (H123458-B-PV). During the waiting period after preoperative portal vein embolization, the right hepatic artery was involved by rapid tumor progression, needing a modification of the initially scheduled surgical procedure to additional hepatic artery resection and reconstruction (H123458-B-PV-HA). We revised the surgical decision of resectable to locally unresectable disease. He received systemic chemotherapy with gemcitabine and cisplatin as first-line, showing the best effect of stable disease followed by slight tumor progression and re-elevation of tumor marker after 5 courses of treatment. Cancer multi-gene panel analysis using percutaneous biopsy specimen showed the nature of MSI-high. Therefore, he received pembrolizumab treatment as second-line therapy, leading to a drastic downsize >30% in tumor diameter and normalization of the tumor marker as well after only 2 cycles of administration. After confirmation of keeping tumor shrinkage during 22 courses of pembrolizumab treatment without any severe adverse events, we decided to perform conversion surgery and performed left trisectionectomy, caudate lobectomy, and bile duct resection with portal vein resection (H123458-B-PV). Although the right hepatic artery was extensively fibrotic, there was no evidence of malignancy by frozen section histologic diagnosis. The pathological findings showed pathological complete response with no residual tumor cells. The patient is under periodical checkup without adjuvant chemotherapy, and no tumor recurrence was observed at 4 months postoperatively.</p><p><b>CONCLUSIONS:</b> We experienced clinical partial response but pathological complete response after second-line pembrolizumab treatment for unresectable locally advanced perihilar cholangiocarcinoma with a biologic nature of MSI-high. Conversion surgery may be considered as a promising option for such effective case, whereas there is a possibility to avoid resection in the MSI-high setting.</p>

DOI： 10.70352/scrj.cr.25-0025

Open Access

Web of Science

PubMed

CiNii Research

Language：English   Publisher：Annals of Surgery  

Objective: To propose a shared T classification system for biliary cancers located around the cystic duct junction. Summary Background Data: These cancers include perihilar cholangiocarcinoma (PCC), distal cholangiocarcinoma (DCC), and cystic duct carcinoma (CDC), which are staged according to discrete tumor classification. Methods: From 2011 to 2019, patients with biliary cancers that clinically invaded the junction (junctional cholangiocarcinoma [JCC]) were classified as having PCC, DCC, CDC, or unclassifiable tumor (UT) based on topologic predominance. The prognostic stratifying ability of the specific American Joint Committee on Cancer T system and depth-based classification were compared between patients with JCC and UT. Results: Among 191 patients with JCC, 63, 20, and 20 had PCC, DCC, and CDC, respectively; the remaining 88 (46%) had UT. The DCC group showed a better survival rate of 70% at 5 years than the other groups (48% for UT, 36% for PCC, and 29% for CDC). Specific tumor classifications of PCC, DCC, and CDC significantly stratified survival in 88 patients with UT, with c-indices of 0.611, 0.613, and 0.563, respectively. Stratified by depth-based classification (T1, ≤1 mm; T2, >1-5; T3, 6-10; and T4, >10 mm), the 5-year survival rates were 83%, 67%, 44%, and 0% in the UT cohort (P<0.001, C-index, 0.654) and 88%, 60%, 41%, and 24% in the entire JCC cohort (P<0.001, C-index, 0.632), respectively. Conclusions: The depth-based T classification significantly stratified survival in the clinical category of JCC and histologically defined UT. Cholangiocarcinoma and CDC in this region can be grouped under the banner of the JCC.

DOI： 10.1097/SLA.0000000000006672

Scopus

PubMed

Publisher：金原出版  

DOI： 10.18888/op.0000004147

CiNii Research

Language：English   Publisher：Asian Journal of Endoscopic Surgery  

A 21-year-old man was diagnosed with segmental adenomyomatosis of the gallbladder based on ultrasonography and computed tomography images. Computed tomography with drip infusion cholangiography revealed that the cystic duct joined the infraportal type of the left lateral bile duct (IPLLBD), which runs caudal to the umbilical portion, and that the left medial bile duct joined the right hepatic duct without forming the left hepatic duct. We planned a single-incision laparoscopic cholecystectomy with fluorescent cholangiography. The fluorescent cholangiography visualized the anatomic variant of the biliary system, and the cystic duct was divided safely. Fluorescent cholangiography is a suitable procedure to depict complex biliary anatomic variations in this patient. IPLLBD without the formation of the left hepatic duct is potentially hazardous during cholecystectomy.

DOI： 10.1111/ases.13404

Open Access

Web of Science

Scopus

PubMed

Web of Science

Publisher：株式会社医学書院  

DOI： 10.11477/mf.1407214706

CiNii Research

Language：English   Publisher：Surgery Today  

Purposes: We performed a conversation analysis of the speech conducted among the surgical team during three-dimensional (3D)-printed liver model navigation for thrice or more repeated hepatectomy (TMRH). Methods: Seventeen patients underwent 3D-printed liver navigation surgery for TMRH. After transcription of the utterances recorded during surgery, the transcribed utterances were coded by the utterer, utterance object, utterance content, sensor, and surgical process during conversation. We then analyzed the utterances and clarified the association between the surgical process and conversation through the intraoperative reference of the 3D-printed liver. Results: In total, 130 conversations including 1648 segments were recorded. Utterance coding showed that the operator/assistant, 3D-printed liver/real liver, fact check (F)/plan check (Pc), visual check/tactile check, and confirmation of planned resection or preservation target (T)/confirmation of planned or ongoing resection line (L) accounted for 791/857, 885/763, 1148/500, 1208/440, and 1304/344 segments, respectively. The utterance’s proportions of assistants, F, F of T on 3D-printed liver, F of T on real liver, and Pc of L on 3D-printed liver were significantly higher during non-expert surgeries than during expert surgeries. Confirming the surgical process with both 3D-printed liver and real liver and performing planning using a 3D-printed liver facilitates the safe implementation of TMRH, regardless of the surgeon’s experience. Conclusions: The present study, using a unique conversation analysis, provided the first evidence for the clinical value of 3D-printed liver for TMRH for anatomical guidance of non-expert surgeons.

DOI： 10.1007/s00595-024-02835-9

Open Access

Web of Science

Scopus

PubMed

Language：English   Publisher：HPB  

Background: The standard procedure for middle-third cholangiocarcinoma (MCC) is pancreaticoduodenectomy (PD); hepatopancreaticoduodenectomy (HPD) is often performed despite its high risk. There is no clear selection guidance for these procedures. Methods: Patients with MCC who underwent HPD or PD were retrospectively evaluated. The conventional PD was modified (mPD) to transect the bile duct beyond or close to the cranial level of the portal bifurcation. Results: The mPD group (n = 55) was characterized by older age, shorter operation time, less blood loss, and less frequent complications than were observed in the HPD group (n = 34). The median grossly tumor-free margin of the proximal bile duct (GM) was 13 mm vs 20 mm (P = 0.006). Overall survival did not differ significantly between groups (48% vs 53% at 5 years, P = 0.399). Multivariate analysis identified positive surgical margin as a sole independent prognostic factor (hazard ratio, 1.89; P = 0.043), which was statistically associated with GM length. Five-year survival for mPD patients with GM ≥15 mm was significantly better than that for those who had GM <15 mm (69% vs 33%, P = 0.011) and comparable to that of HPD patients (53%, P = 0.450). Conclusion: The mPD may be recommended in patients with MCC, provided that GM ≥15 mm is expected from the preoperative radiological imaging. Otherwise, HPD should be considered.

DOI： 10.1016/j.hpb.2023.12.008

Web of Science

Scopus

PubMed

Language：English   Publisher：Surgery United States  

Background: Previous studies have suggested the utility of an indocyanine green plasma clearance rate of the future liver remnant (FLR) (ICGK-F) ≥0.05 in hepatobiliary resection to reduce the surgical risk. The present study aimed to verify whether future liver remnant size rather than ICGK-F matters in extended hepatobiliary resection. Methods: Between 2004 and 2021, patients who underwent right hepatic trisectionectomy with bile duct resection were included. The effect of the FLR volume-to-body weight ratio (FLR/BW) and ICGK-F on posthepatectomy liver failure was evaluated along with other parameters. Results: Among 91 study patients, the median ICGK-F, FLR, and FLR/BW were 0.057 (range, 0.027–0.099), 392 mL (145–705), and 0.78% (0.40–1.37), respectively. Posthepatectomy liver failure occurred in 23 patients. The incidence was 10 (40%) in 25 patients with an ICGK-F <0.05 and 12 (18%) in 65 patients with an ICGK-F ≥0.05 (P = .053); 13 (52%) in 25 patients with a FLR/BW <0.65% and 10 (15%) in 66 patients with a FLR/BW ≥0.65% (P = .001). Multivariate analysis showed that a FLR/BW <0.65% (odds ratio, 11.7; P = .005), age ≥65 years (odds ratio, 31.7; P < .001), and blood loss ≥25 mL/kg (odds ratio, 22.1; P = .004) were independent predictors of posthepatectomy liver failure, but ICGK-F <0.05 was not (P = .499). According to the meeting number of 3 factors, posthepatectomy liver failure incidence was 0 of 22 (0%) in patients with 0 factors, 6 of 43 (14%) in patients with 1, and 17 of 26 (65%) in patients with 2 or 3 (P < .001). Conclusion: A FLR/BW ≥0.65% may serve as a volumetric basis to reduce posthepatectomy liver failure after extended hepatobiliary resection.

DOI： 10.1016/j.surg.2023.09.037

Web of Science

Scopus

PubMed

Language：English   Publisher：Annals of Surgery  

Objective: This study aims at establishing benchmark values for best achievable outcomes following open major anatomic hepatectomy for liver tumors of all dignities. Background: Outcomes after open major hepatectomies vary widely lacking reference values for comparisons among centers, indications, types of resections, and minimally invasive procedures. Methods: A standard benchmark methodology was used covering consecutive patients, who underwent open major anatomic hepatectomy from 44 high-volume liver centers from 5 continents over a 5-year period (2016-2020). Benchmark cases were low-risk non-cirrhotic patients without significant comorbidities treated in high-volume centers (≥30 major liver resections/year). Benchmark values were set at the 75th percentile of median values of all centers. Minimum follow-up period was 1 year in each patient. Results: Of 8044 patients, 2908 (36%) qualified as benchmark (low-risk) cases. Benchmark cutoffs for all indications include R0 resection ≥78%; liver failure (grade B/C) ≤10%; bile leak (grade B/C) ≤18%; complications ≥grade 3 and CCI^® ≤46% and ≤9 at 3 months, respectively. Benchmark values differed significantly between malignant and benign conditions so that reference values must be adjusted accordingly. Extended right hepatectomy (H1, 4-8 or H4-8) disclosed a higher cutoff for liver failure, while extended left (H1-5,8 or H2-5,8) were associated with higher cutoffs for bile leaks, but had superior oncologic outcomes, when compared to formal left hepatectomy (H1-4 or H2-4). The minimal follow-up for a conclusive outcome evaluation following open anatomic major resection must be 3 months. Conclusion: These new benchmark cutoffs for open major hepatectomy provide a powerful tool to convincingly evaluate other approaches including parenchymal-sparing procedures, laparoscopic/robotic approaches, and alternative treatments, such as ablation therapy, irradiation, or novel chemotherapy regimens.

DOI： 10.1097/SLA.0000000000006012

Web of Science

Scopus

PubMed

Language：English   Publisher：Surgery Today  

Retroperitoneal liposarcoma (RPLS) is a rare but challenging neoplasm, which is frequently associated with iliac vessel invasion. We describe how we used a two-step arterial reconstruction technique to perform en bloc resection of a large RPLS involving the iliac arteries in three patients. A temporal long in situ graft bypass was established using a prosthetic vascular graft during dissection of the tumor. This bypass provided an unobscured surgical field, while maintaining blood flow in the lower limb during the operation. After removal of the tumor and washing out the abdominal cavity, the new prosthetic vascular graft of a suitable length was placed. No graft-related complications, including vascular graft infection or graft occlusion, occurred during the follow-up period. This novel technique appears to provide a safe and effective way to remove large RPLSs involving the retroperitoneal major vessels.

DOI： 10.1007/s00595-023-02684-y

Web of Science

Scopus

PubMed

Publisher：南江堂  

DOI： 10.15106/j_geka85_1198

CiNii Research

Language：English   Publisher：Radiology  

Background: Percutaneous transhepatic portal vein (PV) embolization (PVE) is a standard preoperative procedure for advanced biliary cancer when the future liver remnant (FLR) is insufficient, yet the effect of this procedure on portal hemodynamics is still unclear. Purpose: To assess whether four-dimensional (4D) MRI flowmetry can be used to estimate FLR volume and to identify the optimal time for this measurement. Materials and Methods: This prospective single-center study enrolled consecutive adult patients with biliary cancer who underwent percutaneous transhepatic PVE for the right liver between June 2020 and November 2022. Portal hemodynamics were assessed using 4D flow MRI before PVE and within 1 day (0-day group) or 3-4 days (3-day group) after PVE. FLR volume was measured using CT before PVE and after PVE but before surgery. Blood flow changes were analyzed with the Wilcoxon signed rank test, and correlations with Spearman rank correlation. Results: The 0-day group included 24 participants (median age, 72 years [IQR, 69-77 years]; 17 male participants), and the 3-day group included 13 participants (median age, 71 years [IQR, 68-78 years]; eight male participants). Both groups showed increased left PV (LPV) flow rate after PVE (0-day group: from median 3.72 mL/sec [IQR, 2.83-4.55 mL/sec] to 9.48 mL/sec [IQR, 8.12-10.7 mL/sec], P < .001; 3-day group: from median 3.65 mL/sec [IQR, 2.14-3.79 mL/sec] to 8.16 mL/sec [IQR, 6.82-8.98 mL/sec], P < .001). LPV flow change correlated with FLR volume change relative to the number of days from PVE to presurgery CT only in the 3-day group (ρ = 0.62, P = .02; 0-day group, P = .11). The output of the regression equation for estimating presurgery FLR volume correlated with CT-measured volume (ρ = 0.78; P = .002). Conclusion: Four-dimensional flow MRI demonstrated increased blood flow in residual portal branches 3-4 days after PVE, offering insights for estimating presurgery FLR volume.

DOI： 10.1148/radiol.230709

Open Access

Web of Science

Scopus

PubMed

Language：English   Publisher：Journal of Gastroenterology  

Background: Based on the Japan Adjuvant Study Group of Pancreatic Cancer-01 results, S-1 adjuvant chemotherapy has been the standard in resected pancreatic ductal adenocarcinoma (PDAC) patients in Japan and elsewhere, initiated within 10 weeks after surgery. To assess the clinical impact of this timing, we conducted a secondary analysis of a nationwide survey by the Japan Pancreas Society. Methods: A total of 3361 patients were divided into two groups: 2681 (79.8%) initiating the therapy within 10 weeks after surgery (standard) and 680 (20.2%) after 10 weeks (delayed). We compared recurrence-free survival (RFS) and overall survival (OS) using the log-rank test and Cox proportional hazards model with conditional landmark analysis between the groups. Results were verified by adjustment with inverse-probability-of-treatment weighting (IPTW) analysis. Results: The median timing of S-1 adjuvant chemotherapy initiation was 50 days (interquartile range: 38–66). In the standard group, 5-year RFS and OS rates were 32.3–48.7%, respectively, compared with 25.0–38.7% in the delayed group. Hazard ratios (HRs) and 95% confidence intervals were 0.84 (0.76–0.93) for RFS (p < 0.001) and 0.77 (0.69–0.87) for OS (p < 0.001). The IPTW analysis yielded 5-year RFS rates of 32.1% and 25.3% in the standard versus delayed group, respectively [HR = 0.86 (0.77–0.96), p < 0.001] and 5-year OS rates of 48.3% and 39.8%, respectively [HR = 0.81 (0.71–0.92), p < 0.001]. Conclusions: Initiation of S-1 adjuvant chemotherapy in resected PDAC patients within 10 weeks after surgery may offer survival benefit over later initiation.

DOI： 10.1007/s00535-023-01988-7

Open Access

Web of Science

Scopus

PubMed

Publisher：南江堂  

DOI： 10.15106/j_geka85_909

CiNii Research

Language：English   Publisher：Journal of Hepato Biliary Pancreatic Sciences  

Background: The necessity of a specific T classification for extrahepatic intraductal papillary neoplasm of the bile duct (IPNB) type 2, one of the precursors of cholangiocarcinoma (CC), remains unclear. Methods: Patients who underwent resection for extrahepatic biliary tumors were reviewed. Relapse-free survival (RFS) was compared between IPNB type 2 and CC, stratified by T classification. Results: The cohort involved 443 patients with IPNB type 2 (n = 57) and CC (n = 386). In 342 patients with perihilar tumors, 5-year RFS of IPNB type 2 and CC group was 49.8% versus 34.5% (p =.012), respectively. The RFS was 54.6% versus 47.2% (p =.110) for pT1-2 tumors and 28.6% versus 22.7% (p =.436) for pT3-4 tumors, respectively. In 92 patients with distal tumors, 5-year RFS was 47.4% versus 42.1% (p =.678). The RFS was 68.2% versus 49.6% (p =.422) for pT1 tumors and 18.8% versus 38.3% (p =.626) for pT2-3 tumors, respectively. Multivariate analysis identified that poor histologic grade (HR, 2.105; p <.001), microscopic venous invasion (HR, 1.568; p =.002), and nodal metastasis (HR, 1.547; p <.001) were independent prognostic deteriorators, while tumor type (IPNB type 2 vs. CC) was not. Conclusions: Prognostic impact of IPNB type 2 was limited, suggesting unnecessity of a specific T classification for IPNB type 2 with invasive carcinoma.

DOI： 10.1002/jhbp.1269

Web of Science

Scopus

PubMed

Publisher：金原出版  

DOI： 10.18888/op.0000003349

CiNii Research

Language：English   Publisher：International Journal of Colorectal Disease  

Purpose: Combined resection of primary colorectal cancer and associated liver metastases is increasingly common. This study compares peri-operative and oncological outcomes according to surgical approach. Methods: The study was registered with PROSPERO. A systematic search was performed for all comparative studies describing outcomes in patients that underwent laparoscopic versus open simultaneous resection of colorectal primary tumours and liver metastases. Data was extracted and analysed using a random effects model via Rev Man 5.3 Results: Twenty studies were included with a total of 2168 patients. A laparoscopic approach was performed in 620 patients and an open approach in 872. There was no difference in the groups for BMI (mean difference: 0.04, 95% CI: 0.63–0.70, p = 0.91), number of difficult liver segments (mean difference: 0.64, 95% CI:0.33–1.23, p = 0.18) or major liver resections (mean difference: 0.96, 95% CI: 0.69–1.35, p = 0.83). There were fewer liver lesions per operation in the laparoscopic group (mean difference 0.46, 95% CI: 0.13–0.79, p = 0.007). Laparoscopic surgery was associated with shorter length of stay (p < 0.00001) and less overall postoperative complications (p = 0.0002). There were similar R0 resection rates (p = 0.15) but less disease recurrence in the laparoscopic group (mean difference: 0.57, 95% CI:0.44–0.75, p < 0.0001). Conclusion: Synchronous laparoscopic resection of primary colorectal cancers and liver metastases is a feasible approach in selected patients and does not demonstrate inferior peri-operative or oncological outcomes.

DOI： 10.1007/s00384-023-04375-z

Open Access

Web of Science

Scopus

PubMed

Language：Japanese   Publisher：Japan Biliary Association  

<p>A 78-year-old man had undergone magnetic compression anastomosis (Yamanouchi method) against iatrogenic hilar bile stricture after partial hepatectomy (segment 4) for liver metastasis from rectal primary neuroendocrine tumor. He was referred to our clinic with relapse of liver tumor and hilar biliary stricture. An abdominal CT and cholangiography showed a new tumor, 13mm in diameter, located between the segment 4 and 1, atrophy of the right anterior sector, and bilateral biliary dilataton. As definitive surgery for the both problems, he underwent hepatic central bisectionectomy plus caudate lobectomy for liver tumor and biliary bypass for biliary stricture. In the latter, two side-to-side bilio-digestive anastomoses were made on the left lateral inferior duct and the right posterior sectoral duct. The stenotic hilar bile duct, which exhibited extensive fibrosis, were left in situ to avoid major vessel injury.</p>

DOI： 10.11210/tando.37.108

Open Access

CiNii Research

Language：English   Publisher：Cancer  

Background: Based on the Japan Adjuvant Study Group of Pancreatic Cancer 01 study, the standard duration of adjuvant chemotherapy with S-1 (an oral 5-fluorouracil prodrug consisting of tegafur, gimeracil, and oteracil) in patients with resected pancreatic ductal adenocarcinoma (PDAC) was considered to be 6 months, but the impact of increasing its duration on postoperative survival was unknown. Here, the authors investigated this question by reviewing real-world data from a large cohort of patients with PDAC. Methods: In total, 3949 patients who underwent surgery for PDAC during the study period followed by S-1 adjuvant chemotherapy in board-certified institutions were included. Based on the duration of S-1 chemotherapy, two subgroups were defined: a standard-duration group that included patients who were treated for 180 ± 30 days and a longer duration group that included patients who received treatment for >210 days. Results: The median duration of S-1 chemotherapy was 167 days, with a mean ± standard deviation of 200 ± 193 days. After excluding patients who had a recurrence within 210 days after the initiation of adjuvant chemotherapy, postoperative recurrence-free survival (RFS) and overall survival (OS) in the standard-duration group (n = 1473) and the longer duration group (n = 975) were compared. RFS and OS did not differ significantly between the standard-duration and longer duration groups (5-year RFS: 37.8% vs. 36.2% respectively; p =.6186; 5-year OS: 52.8% vs. 53.4%, respectively; p =.5850). The insignificant difference was verified by multivariate analysis and propensity-score matching analysis. Conclusions: The current findings suggest that extending S-1 adjuvant chemotherapy beyond 6 months has no significant additional effect on survival in patients with PDAC. This could be useful in determining whether to extend S-1 chemotherapy in patients who have completed the standard 6-month treatment.

DOI： 10.1002/cncr.34580

Web of Science

Scopus

PubMed

Language：English   Publisher：International Journal of Clinical Oncology  

Background: Survival in patients with retroperitoneal liposarcoma (RPLS) depends on the surgical management of the dedifferentiated foci. The present study investigated the diagnostic yield of contrast-enhanced CT, ¹⁸F-fluorodeoxyglucose positron emission tomography (PET), and diffusion-weighted MRI in terms of dedifferentiated foci within the RPLS. Methods: Patients treated with primary or recurrent RPLS who underwent the above imaging between January 2010 and December 2021 were retrospectively reviewed. The diagnostic accuracy of the three modalities for histologic subtype of dedifferentiated liposarcoma (DDLS) and French Federation of Cancer Center (FNCLCC) grade 2/3 were compared using receiver operating characteristic curves and areas under the curves (AUCs). Results: The cohort involved 32 patients with 53 tumors; 30 of which exhibited DDLS and 31 of which did FNCLCC grades 2/3. The optimal thresholds for predicting DDLS were mean CT value of 31 Hounsfield Unit (HU) (AUC = 0.880, 95% CI 0.775–0.984; p < 0.001), maximum standardized uptake value (SUVmax) of 2.9 (AUC = 0.865 95% CI 0.792–0.980; p < 0.001), while MRI failed to differentiate DDLS. The cutoff values for distinguishing FNCLCC grades 1 and 2/3 were a mean CT value of 24 HU (AUC = 0.858, 95% CI 0.731–0.985; p < 0.001) and SUVmax of 2.9 (AUC = 0.885, 95% CI 0.792–0.978; p < 0.001). MRI had no sufficient power to separate these grades. Conclusions: Contrast-enhanced CT and PET were useful for predicting DDLS and FNCLCC grade 2/3, while MRI was inferior to these two modalities.

DOI： 10.1007/s10147-022-02287-6

Open Access

Web of Science

Scopus

PubMed

Publisher：南江堂  

DOI： 10.15106/j_geka85_145

CiNii Research

Language：English   Publisher：HPB  

Background: No studies to date have determined the impact of pancreatic fat infiltration on postoperative pancreatic fistula (POPF) occurrence in patients undergoing invagination pancreaticojejunostomy (IV-PJ). Methods: The medical records of patients with a soft pancreas who underwent pancreatoduodenectomy followed by IV-PJ were reviewed . The pancreatic fat ratio on computed tomography (CT) images (I-PFR) was determined using preoperative CT and verified by histologic examination. The relationship between the I-PFR and POPF occurrence was determined. Patients were classified into 2 groups based on I-PFR value (fatty and non-fatty pancreas). Postoperative outcomes were compared between the two groups, and specifically among patients who developed POPF. Results: Of 221 patients, POPF occurred in 67 (30.3%). I-PFR was positively correlated with histologic-calculated fat ratio (ρ = 0.517, p < 0.001). This index was shown to be an independent predictor of POPF. Based on an I-PFR cut-off value of 3.2%, 92 patients were classified in the fatty pancreas group. Subgroup analysis of the patients who developed POPF showed that incidence of abscess formation and hemorrhage tended to be higher in patients with fatty pancreas than in those with non-fatty pancreas. Conclusions: Pancreatic fat infiltration is highly associated with POPF and possibly causes subsequent serious complications in patients undergoing IV-PJ.

DOI： 10.1016/j.hpb.2022.08.013

Web of Science

Scopus

PubMed

Publisher：金原出版  

DOI： 10.18888/op.0000003012

CiNii Research

Authorship：Lead author   Language：English   Publisher：Annals of Surgical Oncology  

Background: The prognostic significance of peritoneal lavage cytology (PLC) in patients with pancreatic ductal adenocarcinoma (PDAC) remains controversial. The purpose of this study was to evaluate the prognostic impact of PLC status in PDAC patients. Methods: Patients intending to undergo resection for PDAC between 2007 and 2020 were included. Survival was compared among patients who underwent resection with negative or positive PLC status and those who did not undergo resection. Univariable and multivariable analyses were conducted to evaluate the prognostic impact of positive PLC status. A systematic literature review was performed to evaluate the correlation between prognosis and the positive PLC rate. Results: A total of 480 patients formed the study cohort and were divided as follows: 438 in the negative PLC group, 18 in the positive PLC group, and 24 in the no resection group. Although the median survival time significantly differed between the negative and positive PLC groups (35.7 vs. 13.6 months, P < 0.001), it did not significantly differ between the positive PLC and no resection groups (13.6 vs. 12.2 months, P = 0.605). Multivariable analyses demonstrated that positive PLC status (hazard ratio = 3.54, 95% confidence interval = 1.97–6.38, P < 0.001) was the strongest poor prognostic factor. Based on statistical analyses for the systematic review, the prognostic impact of positive PLC status weakened significantly as the institutional positive PLC rate increased (P = 0.044). Conclusions: Resection did not improve the prognosis of patients with positive PLC status in our cohort. The institutional positive PLC rate may be a good reference for surgical indication in these patients.

DOI： 10.1245/s10434-022-11722-x

Web of Science

Scopus

PubMed

Authorship：Lead author   Language：English   Publisher：Annals of Surgical Oncology  

DOI： 10.1245/s10434-022-11747-2

Web of Science

Scopus

PubMed

Authorship：Lead author  

DOI： 10.1245/s10434-022-11781-0

Web of Science

PubMed