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Chen L, Huang Z, Tian Q, Zha Q, Zhang S, Chen Z, Dong Z, Zhou Y, Zhang M, Wei X. Construction of individualised care programmes for patients with pancreatic cancer with postoperative weight-loss control based on the Delphi method: a cross-sectional study in China. JOURNAL OF HEALTH, POPULATION, AND NUTRITION 2024; 43:36. [PMID: 38429793 PMCID: PMC10908084 DOI: 10.1186/s41043-024-00525-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/06/2023] [Accepted: 02/09/2024] [Indexed: 03/03/2024]
Abstract
BACKGROUND At present, clinical nutritional care for patients with pancreatic cancer focuses more on the observation of the effect of enteral parenteral nutrition, and there is a lack of personalised care plans for weight-loss control. We used the Delphi method to construct a set of personalised nursing programmes to effectively control the rate of postoperative weight loss in patients with pancreatic cancer. METHODS This study was a cross-sectional investigation. Through literature analysis, literature review and data review, a personalised nursing plan for the postoperative weight-loss control in patients with pancreatic cancer was preliminarily developed. From October to December 2022, the Delphi method was adopted to conduct two questionnaires for 32 experts working in fields related to pancreatic diseases in Grade-A tertiary hospitals from four different departments. After statistical processing, the personalised nursing plan was determined according to the perceived level of importance, coefficient of variation, full score rate and recognition rate of the indicators. RESULTS The recovery rates of the two rounds of consultation were 93.75% and 100%, respectively, and the overall authority coefficient of the experts was 0.918, which represented 'authoritative'. In terms of importance, the coefficient of variation was 0-0.137; in terms of feasibility, the coefficient of variation ranged from 0.09 to 0.194. Finally, a scheme consisting of 36 entries in 8 dimensions was built. This programme is comprehensive in content, meets the nutritional diagnosis and treatment needs of patients in the stage of postoperative rehabilitation, provides relatively comprehensive nutritional assessment and support and has a robust system and feasibility. CONCLUSIONS The individualised nursing plan for patients with pancreatic cancer with postoperative weight-loss control based on the Delphi method is highly scientific and reliable and has positive significance.
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Affiliation(s)
- Leying Chen
- Department of Pancreatic Surgery, Shanghai Ruijin Hospital Affiliated of Jiaotong University, No. 197 of Ruijin No. 2 Street, Huangpu District, Shanghai, 200025, China
| | - Zhongyan Huang
- Department of Pancreatic Surgery, Shanghai Ruijin Hospital Affiliated of Jiaotong University, No. 197 of Ruijin No. 2 Street, Huangpu District, Shanghai, 200025, China
| | - Qiuju Tian
- Department of Nurse Management, Shanghai Ruijin Hospital Affiliated of Jiaotong University, Shanghai, 200025, China
| | - Qinghua Zha
- Department of Nurse Management, Shanghai Ruijin Hospital Affiliated of Jiaotong University, Shanghai, 200025, China
| | - Shiyu Zhang
- Department of Nurse Management, Shanghai Ruijin Hospital Affiliated of Jiaotong University, Shanghai, 200025, China
| | - Zhe Chen
- Department of Pancreatic Surgery, Shanghai Ruijin Hospital Affiliated of Jiaotong University, No. 197 of Ruijin No. 2 Street, Huangpu District, Shanghai, 200025, China
| | - Ziyun Dong
- Department of Pancreatic Surgery, Shanghai Ruijin Hospital Affiliated of Jiaotong University, No. 197 of Ruijin No. 2 Street, Huangpu District, Shanghai, 200025, China
| | - Yuqing Zhou
- Department of Pancreatic Surgery, Shanghai Ruijin Hospital Affiliated of Jiaotong University, No. 197 of Ruijin No. 2 Street, Huangpu District, Shanghai, 200025, China
| | - Ming Zhang
- Department of Pancreatic Surgery, Shanghai Ruijin Hospital Affiliated of Jiaotong University, No. 197 of Ruijin No. 2 Street, Huangpu District, Shanghai, 200025, China.
| | - Xiaoyan Wei
- Department of Pancreatic Surgery, Shanghai Ruijin Hospital Affiliated of Jiaotong University, No. 197 of Ruijin No. 2 Street, Huangpu District, Shanghai, 200025, China.
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Vouros D, Bramis K, Alexakis N, Kotsarinis V, Antonakis P, Memos N, Konstadoulakis M, Toutouzas K. Completion Pancreatectomy. Indications and Outcomes: A Systematic Review. Am Surg 2023; 89:6134-6146. [PMID: 37295804 DOI: 10.1177/00031348231183121] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
BACKGROUND/OBJECTIVE (S) Completion pancreatectomy (C.P.) is one acceptable treatment of choice in clinical scenarios such as management of post-pancreatectomy complications and recurrence in the pancreatic remnant. Studies referring to completion pancreatectomy as a distinct operation are limited, without emphasizing at the operation itself, rather reporting completion pancreatectomy as a possible option for treatment of various diseases. The identification of indications of CP in various pathologies and the clinical outcomes are therefore mandatory. METHODS A systematic literature search was performed in the Pubmed and Scopus Databases (February 2020),guided by the PRISMA protocol, for all studies reporting CP as a surgical procedure with reference at indications for performing it combined with postoperative morbidity and/or mortality. RESULTS Out of 1647 studies, 32 studies from 10 countries with 2775 patients in total, of whom 561 (20.2%) CPs met the inclusion criteria and were included in the analysis. Inclusion year ranged from 1964 to 2018 and were published from 1992 until 2019. 17 studies with a total number of 249 CPs were performed for post-pancreatectomy complications. Mortality rate was 44.5% (111 out of 249). Morbidity rate was (72.6%). 12 studies with 225 CPs were performed for isolated local recurrence after initial resection with a morbidity rate of 21.5% and 0% mortality rate in the early postoperative period. Two studies with a total number of 12 patients reported CP as a treatment option for recurrent neuroendocrine neoplasms. The mortality in those studies was 8% (1/12) and the mean morbidity rate was 58.3% (7/12). Finally, CP for refractory chronic pancreatitis was presented in one study with morbidity and mortality rates of 19% and 0%, respectively. CONCLUSION Completion pancreatectomy is a distinct treatment option for various pathologies. Morbidity and mortality rates depend on the indications of performing CP, the status performance of the patients and whether the operation is performed electively or urgently.
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Affiliation(s)
- Dimitrios Vouros
- 1st Department of Propaedeutic Surgery, Athens Medical School, National and Kapodistrian University of Athens, Hippocration General Athens Hospital, Athens, Greece
| | - Konstantinos Bramis
- 2nd Department of Surgery, School of Medicine, Aretaieion Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Nikolaos Alexakis
- 1st Department of Propaedeutic Surgery, Athens Medical School, National and Kapodistrian University of Athens, Hippocration General Athens Hospital, Athens, Greece
| | - Vasileios Kotsarinis
- 1st Department of Propaedeutic Surgery, Athens Medical School, National and Kapodistrian University of Athens, Hippocration General Athens Hospital, Athens, Greece
| | - Pantelis Antonakis
- 2nd Department of Surgery, School of Medicine, Aretaieion Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Nikolaos Memos
- 2nd Department of Surgery, School of Medicine, Aretaieion Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Manousos Konstadoulakis
- 2nd Department of Surgery, School of Medicine, Aretaieion Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Konstantinos Toutouzas
- 1st Department of Propaedeutic Surgery, Athens Medical School, National and Kapodistrian University of Athens, Hippocration General Athens Hospital, Athens, Greece
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Kim SH. Metachronous pancreatic cancer 18 years after resection of common bile duct cancer: A case report. Front Surg 2022; 9:851524. [PMID: 36090324 PMCID: PMC9448957 DOI: 10.3389/fsurg.2022.851524] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2022] [Accepted: 07/20/2022] [Indexed: 11/13/2022] Open
Abstract
We report an extremely rare case of metachronous double cancers of the bile duct and pancreas in a single patient who underwent successful curative resections consecutively. At the age of 57, a woman underwent pylorus-preserving pancreaticoduodenectomy for a lesion that was pathologically diagnosed as moderately differentiated adenocarcinoma of the distal common bile duct. Eighteen years later, a pancreatic mass was detected during a follow-up examination. Abdominal computed tomography showed a bigger 2.3 cm lesion at the remnant pancreas body, which suggested a diagnosis of primary pancreatic cancer or metastasis. After admission and further work-up confirming no other lesions, completion total pancreatectomy was performed. The pathological diagnosis of the resected specimen was moderately differentiated pancreatic ductal adenocarcinoma, and this case highlights the occurrence of metachronous double primary cancers developed in both the distal bile duct and the pancreas with an interval of 18 years. This is the first report on the metachronous primary cancers of the bile duct and pancreas with a long interval within an English review of the literature in the MEDLINE. This case serves as another data point to guide surgeons that they should be vigilant for the postoperative long-term surveillance of patients with pancreatobiliary cancer.
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Safi SA, Lehwald-Tywuschik N, Rehders A, Fluegen G, Haeberle L, Keitel V, Knoefel WT. Site of relapse of ductal adenocarcinoma of the pancreas affects survival after multimodal therapy. BMC Surg 2021; 21:110. [PMID: 33658016 PMCID: PMC7931536 DOI: 10.1186/s12893-021-01082-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2020] [Accepted: 02/01/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Ductal adenocarcinoma of the pancreas (PDAC) remains one of the most lethal malignancies. To date, no guidelines exists for isolated resectable metachronous disease. It is still unknown, which patients may benefit from relapse surgery. The aim of our study was to compare disease free survival (DFS) and post relapse survival (PRS) in patients with isolated local recurrence, metachronous hepatic or pulmonary metastases. METHODS Patients with isolated resectable local recurrence, metachronous hepatic or pulmonary metastases were included for survival analyses. PRS of surgically treated patients (local (n = 11), hepatic (n = 6) and pulmonary metastases (n = 9)) was compared to conservatively treated patients (local (n = 17), hepatic (n = 37) and pulmonary metastases (n = 8)). RESULTS Resected PDAC patients suffering from isolated metachronous hepatic metastases initially had a higher T-stage and venous invasion (V1) compared to the other patients. DFS in the metachronous pulmonary metastases group was longer compared to DFS of the hepatic metastases and local recurrence groups. Surgical resection significantly improved PRS in patients with local recurrence and pulmonary metastases, when compared to patients receiving chemotherapy alone. Very-long term survivors (> 5 years) were detected following secondary resection of local recurrence and 45% of these patients were still alive at the end of our study period. CONCLUSION Although DFS in PDAC patients suffering from isolated local recurrence was dismal and comparable to that of patients with isolated hepatic metastases, very-long term survivors were present only in this group. These results indicate that a surgical approach for isolated local recurrence, if anatomically possible, should be considered.
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Affiliation(s)
- S A Safi
- Department of Surgery (A), Medical Faculty, Heinrich-Heine-University and University Hospital, Duesseldorf, Germany
| | - N Lehwald-Tywuschik
- Department of Surgery (A), Medical Faculty, Heinrich-Heine-University and University Hospital, Duesseldorf, Germany
| | - A Rehders
- Department of Surgery (A), Medical Faculty, Heinrich-Heine-University and University Hospital, Duesseldorf, Germany
| | - G Fluegen
- Department of Surgery (A), Medical Faculty, Heinrich-Heine-University and University Hospital, Duesseldorf, Germany
| | - L Haeberle
- Institute of Pathology, Medical Faculty, Heinrich-Heine-University and University Hospital, Duesseldorf, Germany
| | - V Keitel
- Department of Gastroenterology, Hepatology and Infectious Diseases, Medical Faculty, Heinrich-Heine-University and University Hospital, Duesseldorf, Germany
| | - W T Knoefel
- Department of Surgery (A), Medical Faculty, Heinrich-Heine-University and University Hospital, Duesseldorf, Germany.
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Repeated Pancreatectomy for Isolated Local Recurrence in the Remnant Pancreas Following Radical Pancreatectomy for Pancreatic Ductal Adenocarcinoma: A Pooled Analysis. J Clin Med 2020; 9:jcm9123945. [PMID: 33291378 PMCID: PMC7762026 DOI: 10.3390/jcm9123945] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2020] [Revised: 11/29/2020] [Accepted: 12/01/2020] [Indexed: 02/07/2023] Open
Abstract
The mainstream treatment for recurrent pancreatic cancer is potent chemotherapy or chemoradiotherapy. However, recent clinical investigations have suggested a potential oncologic role of local resection of recurrent pancreatic cancer. This systemic review with a pooled analysis aimed to assess the potential role of local repeated pancreatectomy with respect to the survival outcomes for patients with recurrent pancreatic ductal adenocarcinoma (PDAC) in the remnant pancreas. The PubMed database was searched, and 15 articles reporting on repeated pancreatectomy for local recurrence of PDAC in the remnant pancreas were identified. The pooled individual data were examined for the clinical outcomes of repeated pancreatectomy for recurrent PDAC. The survival analysis was performed using the Kaplan–Meier method. In the pooled analysis, the mean time interval from initial pancreatectomy to repeated pancreatectomy was 41.3 months (standard deviation (SD), 29.09 months). Completion total pancreatectomy was most commonly performed as repeated pancreatectomy (46 patients, 92.0%), and partial pancreatic resection was performed for only 4 (10.3%) patients. Twenty (40.9%) patients received postoperative chemotherapy following repeated pancreatectomy. The median overall survival was 60 months (95% confidential interval (CI): 45.99–74.01) after repeated pancreatectomy for isolated local recurrence in the remnant pancreas. Overall survival was markedly longer considering the timing of the initial pancreatectomy for pancreatic cancer (median, 107 months (95% CI: 80.37–133.62). The time interval between the initial and subsequent repeated pancreatectomy for pancreatic cancer was not associated with long-term oncologic outcomes (p = 0.254). Repeated pancreatectomy cannot completely replace adjuvant chemotherapy but should be considered for patients with isolated local recurrent PDAC in the remnant pancreas.
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D'Haese JG, Renz BW, Ilmer M, Werner J. [Surgery for isolated local recurrence and metachronous oligometastasis in pancreatic cancer]. Chirurg 2020; 91:628-635. [PMID: 32424598 DOI: 10.1007/s00104-020-01190-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
BACKGROUND Most patients with pancreatic cancer suffer a relapse, which occurs either locally or systemically in the sense of liver and the lung metastases. Surgery for pancreatic cancer has become more radical due to the increased use of multimodal treatment concepts; however, the role of surgery in cases of recurrence remains controversial. OBJECTIVE This review summarizes the surgical treatment options for isolated local recurrence and metachronous oligometastatic pancreatic cancer. MATERIAL AND METHODS A selective literature search was carried out and the current evidence for surgical treatment is summarized. RESULTS There are currently no randomized studies on surgery for metastatic pancreatic cancer. Currently available data, however, show that after surgery long-term survival of up to 32-47 months after metastasectomy can be achieved, especially in patients with local recurrence or isolated pulmonary metastases with low morbidity and mortality. Individualized treatment concepts including surgical resection after initial systemic therapy seem promising even for liver metastases. The greatest survival benefits are consistently shown for all localizations in patients with a long as possible disease-free interval after the first operation. CONCLUSION The treatment of isolated local recurrence or metachronous oligometastatic pancreatic cancer is an interdisciplinary challenge that should be performed in specialized pancreatic treatment centers only. Surgical resection embedded in a multimodal treatment concept can be meaningful in selected cases.
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Affiliation(s)
- J G D'Haese
- Klinik für Allgemein, Viszeral- und Transplantationschirurgie, Klinikum der Universität München, Standort Großhadern, Marchioninistr. 15, 81377, München, Deutschland.
| | - B W Renz
- Klinik für Allgemein, Viszeral- und Transplantationschirurgie, Klinikum der Universität München, Standort Großhadern, Marchioninistr. 15, 81377, München, Deutschland
| | - M Ilmer
- Klinik für Allgemein, Viszeral- und Transplantationschirurgie, Klinikum der Universität München, Standort Großhadern, Marchioninistr. 15, 81377, München, Deutschland
| | - J Werner
- Klinik für Allgemein, Viszeral- und Transplantationschirurgie, Klinikum der Universität München, Standort Großhadern, Marchioninistr. 15, 81377, München, Deutschland
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Miyagawa Y, Kitazawa M, Kitahara H, Karasawa Y, Orii T, Soejima Y. Three Curative Pancreatectomies for the Metachronous Appearance of Pancreatic Invasive Ductal Adenocarcinoma. Case Rep Oncol 2020; 13:392-397. [PMID: 32355495 PMCID: PMC7184847 DOI: 10.1159/000506732] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2020] [Accepted: 02/20/2020] [Indexed: 11/19/2022] Open
Abstract
We report a rare case of a patient who underwent 3 successful curative operations for the metachronous appearance of pancreatic cancer. In July 2007, a 54-year-old woman underwent pylorus-preserving pancreaticoduodenectomy. In March 2010, a tumor measuring 9 mm in diameter was detected in the tail of the pancreas on computed tomography (CT) and magnetic resonance imaging. The pancreas tail was subsequently resected while preserving the pancreatic body. In February 2011, CT revealed a cystic tumor measuring 2.5 cm in diameter in the remnant pancreatic body without any metastasis; therefore, total resection of the residual pancreas was performed in April 2011. The first resected tumor was histopathologically diagnosed as undifferentiated adenocarcinoma with osteoclast-like giant cells. Additionally, the third resected tumor had similar undifferentiated components. Contrarily, the second resected tumor was diagnosed as a well-differentiated tubular adenocarcinoma. We consider that the tumor from the third operation was an intra-pancreatic metastasis of the primary cancer and that the tumor from the second operation was the second primary cancer. The patient responded well with good control of surgical diabetes for 92 months since the last pancreatectomy. This case suggested that aggressive repeated resection for recurrent pancreatic invasive ductal adenocarcinoma is beneficial in limited cases.
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Affiliation(s)
- Yusuke Miyagawa
- Department of Surgery, Shinshu University School of Medicine, Matsumoto City, Japan
| | - Masato Kitazawa
- Department of Surgery, Shinshu University School of Medicine, Matsumoto City, Japan
| | - Hiroe Kitahara
- Department of Surgery, Showa-Inan General Hospital, Komagane, Japan
| | | | - Takashi Orii
- Department of Surgery, Showa-Inan General Hospital, Komagane, Japan
| | - Yuji Soejima
- Department of Surgery, Shinshu University School of Medicine, Matsumoto City, Japan
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Miyasaka Y, Ohtsuka T, Matsuda R, Mori Y, Nakata K, Ohuchida K, Nakamura M. High-risk lesions in the remnant pancreas: fate of the remnant pancreas after pancreatic resection for pancreatic cancer and intraductal papillary mucinous neoplasms. Surg Today 2019; 50:832-840. [PMID: 31346809 DOI: 10.1007/s00595-019-01852-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2019] [Accepted: 07/01/2019] [Indexed: 02/06/2023]
Abstract
Progress in diagnostic modalities, surgical procedures, and multidisciplinary treatment for pancreatic diseases has increased the number of long-term survivors after pancreatic resection. Several reports have focused on high-risk lesions (HRLs), including high-grade pancreatic intraepithelial neoplasia (PanIN), pancreatic ductal adenocarcinoma, high-grade intraductal papillary mucinous neoplasm (IPMN), and IPMN with an associated invasive carcinoma, in the remnant pancreas after partial pancreatic resection for pancreatic cancer or IPMN. The etiology of HRLs in the remnant pancreas is thought to be either isolated local recurrence of the initial lesion in the remnant pancreas or a newly developed primary lesion. Although it is difficult to distinguish between local recurrence and a new primary lesion, comparison of genetic alterations between two lesions may help with this distinction. Early detection of HRLs in the remnant pancreas may improve the prognosis of patients, and several investigators have proposed predictive factors for HRLs in the remnant pancreas after partial pancreatic resection for pancreatic cancer or IPMN. The reported short- and long-term outcomes of surgical resection of HRLs in the remnant pancreas are relatively favorable. Life-long surveillance of the remnant pancreas is recommended after partial pancreatic resection for pancreatic cancer or IPMN.
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Affiliation(s)
- Yoshihiro Miyasaka
- Department of Surgery and Oncology, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan.,Department of Surgery, Fukuoka University Chikushi Hospital, Chikushino, Japan
| | - Takao Ohtsuka
- Department of Surgery and Oncology, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan
| | - Ryota Matsuda
- Department of Surgery and Oncology, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan
| | - Yasuhisa Mori
- Department of Surgery and Oncology, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan
| | - Kohei Nakata
- Department of Surgery and Oncology, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan
| | - Kenoki Ohuchida
- Department of Surgery and Oncology, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan
| | - Masafumi Nakamura
- Department of Surgery and Oncology, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan.
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Surgery for Recurrent Pancreatic Cancer: Is It Effective? Cancers (Basel) 2019; 11:cancers11070991. [PMID: 31315222 PMCID: PMC6679234 DOI: 10.3390/cancers11070991] [Citation(s) in RCA: 42] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2019] [Revised: 07/10/2019] [Accepted: 07/12/2019] [Indexed: 02/06/2023] Open
Abstract
Despite improvements to surgical procedures and novel combinations of drugs for adjuvant and neoadjuvant therapies for pancreatic adenocarcinoma, the recurrence rate after radical surgery is still high. Little is known about the role of surgery in the treatment of isolated recurrences of pancreatic cancer. The aim of this study was to review the current literature dealing with surgery for recurrent pancreatic cancer in order to examine its feasibility and effectiveness. An extensive literature review was conducted according to the 2009 Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines and 14 articles dealing with re-resections for recurrent pancreatic adenocarcinoma were analyzed, focusing on the characteristics of the primary neoplasm and its recurrence, the surgical procedures used, and patient outcomes. Data were retrieved on a total of 301 patients. The interval between surgery for primary pancreatic cancer and the detection of a recurrence ranged from 2 to 120 months. The recurrence was local or regional in 230 patients, and distant in 71. The median overall survival was 68.9 months (range 3–152) after resection of the primary tumor, and 26.0 months (range 0–112) after surgery for recurrent disease. The disease-free interval after the resection of recurrences was 14.2 months (range 4–29). Although data analysis was performed on a heterogeneous and limited number of patients, some of these may benefit from surgery for isolated recurrence of pancreatic adenocarcinoma. Further studies are needed to identify these cases.
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Pancreatic cancer arising from the remnant pancreas after pancreatectomy: a multicenter retrospective study by the Kyushu Study Group of Clinical Cancer. J Gastroenterol 2019; 54:437-448. [PMID: 30515563 DOI: 10.1007/s00535-018-01535-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2018] [Accepted: 11/28/2018] [Indexed: 02/07/2023]
Abstract
BACKGROUND After initial pancreatic resection, local recurrence of pancreatic cancer (PC) or new primary PC can develop in the remnant. There are limited data available regarding this so-called remnant PC. The aim of this retrospective study was to clarify the clinical features and establish a treatment strategy for remnant PC. METHODS A multicenter retrospective study with the Kyushu Study Group of Clinical Cancer was carried out. Clinical data from 50 patients who developed remnant PC were analyzed. RAS mutation analysis of the initial tumor and of remnant PC was performed in 17 cases. RESULTS The initial pancreatic resections were performed for 37 invasive ductal carcinomas, and for 13 other tumors. Thirty-seven patients underwent a second pancreatectomy for remnant PC (resected group), while thirteen patients were not operated (unresected group). The median overall survival times were 42.2 months in the resected group and 12.3 months in the unresected group (HR 0.374; 95% CI 0.17-0.83). In RAS mutation analysis, 14 cases had at least 1 missense variant of KRAS, HRAS, or NRAS in the initial pancreatic tumor and/or remnant PC. The same missense variants between the initial tumor and remnant PC were discovered only in KRAS of one patient, and in HRAS of one patient. No case had completely consistent missense variants between the initial tumor and remnant PC. CONCLUSIONS This study found that repeated pancreatectomy for remnant PC can prolong patient survival, and RAS mutation analysis indicated that many remnant PCs are developed from metachronous multifocal origins.
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Kling SM, Tannouri S, Jiang W, Yeo CJ. Pancreatic Mass in a Patient with a History of Resected Renal Cell Carcinoma and Resected Adenocarcinoma of the Ampulla of Vater: A Case Report. J Pancreat Cancer 2018; 4:41-44. [PMID: 30631857 PMCID: PMC6145538 DOI: 10.1089/pancan.2018.0001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Background: Metastases of renal cell carcinoma (RCC) to the pancreas are rare, whereas recurrence of pancreatic ductal adenocarcinoma (PDA) or a primary periampullary cancer is far more common. The time elapsed between a primary tumor and a new mass can aid in differentiation between the two. Presentation: A 70-year-old man with a history of RCC status after left nephrectomy and ampullary adenocarcinoma status after pancreaticoduodenectomy presents with an incidentally found mass in his remnant pancreas. Resection of the mass via completion pancreatectomy yielded pathology consistent with metastatic RCC. Conclusions: Metastases of RCC to the pancreas often present many years after a primary resection. Conversely, recurrent PDA often presents within 5 years of resection. Resection of RCC metastases yields better survival than resection of recurrent PDA, which is controversial. We recommend resection of suspected isolated pancreatic RCC metastases due to known favorable outcomes.
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Affiliation(s)
- Sarah M. Kling
- Department of Surgery, Sidney Kimmel Medical College at Thomas Jefferson University Hospital, Philadelphia, Pennsylvania
| | - Sami Tannouri
- Department of Surgery, Sidney Kimmel Medical College at Thomas Jefferson University Hospital, Philadelphia, Pennsylvania
| | - Wei Jiang
- Department of Surgery, Sidney Kimmel Medical College at Thomas Jefferson University Hospital, Philadelphia, Pennsylvania
| | - Charles J. Yeo
- Department of Surgery, Sidney Kimmel Medical College at Thomas Jefferson University Hospital, Philadelphia, Pennsylvania
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Yamada S, Kobayashi A, Nakamori S, Baba H, Yamamoto M, Yamaue H, Fujii T. Resection for recurrent pancreatic cancer in the remnant pancreas after pancreatectomy is clinically promising: Results of a project study for pancreatic surgery by the Japanese Society of Hepato-Biliary-Pancreatic Surgery. Surgery 2018; 164:1049-1056. [PMID: 30068484 DOI: 10.1016/j.surg.2018.05.050] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2018] [Revised: 05/25/2018] [Accepted: 05/31/2018] [Indexed: 01/12/2023]
Abstract
BACKGROUND A therapeutic strategy has not been established for recurrent pancreatic cancer in the remnant pancreas. The purpose of this multicenter survey was to clarify the clinical features of remnant pancreatic cancer and to assess the appropriate operative indications. METHODS Clinical data from 114 patients with remnant pancreatic cancer after initial pancreatectomy were collected retrospectively. Clinicopathologic factors and overall survival curves were analyzed, and multivariate Cox proportional hazard models were evaluated. RESULTS Variate analysis revealed that age (≥65 years), body mass index (<20 kg/m2), tumor size (≥20 mm), distance from the pancreatic stump (<10 mm), and resection of the remnant pancreatic cancer were significant prognostic factors. The median survival times of the resected (n = 90) and the nonresected group (n = 24) were 26 and 14 months, respectively (hazard ratio: 0.56; P = .012). When the patients were classified based on recurrence patterns after a second pancreatectomy, the median survival times were 30.5 months in the no recurrence group, 32.0 in the local recurrence group, and 23.0 in the distant metastasis group. A total of 8.9% of the patients had a postoperative complication of Clavien-Dindo classification III or higher, and the 90-day mortality rate was 1.1%. CONCLUSION Resection of the remnant pancreatic cancer could offer a favorable outcome and a chance for a cure. In particular, a young and healthy patient with a relatively small tumor at least 10 mm away from the pancreatic stump appears to be the best candidate for reoperation. Furthermore, the safety profile of resection is acceptable.
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MESH Headings
- Age Factors
- Aged
- Carcinoma, Pancreatic Ductal/diagnostic imaging
- Carcinoma, Pancreatic Ductal/mortality
- Carcinoma, Pancreatic Ductal/pathology
- Carcinoma, Pancreatic Ductal/surgery
- Disease-Free Survival
- Female
- Follow-Up Studies
- Humans
- Japan/epidemiology
- Male
- Middle Aged
- Neoplasm Recurrence, Local/diagnostic imaging
- Neoplasm Recurrence, Local/mortality
- Neoplasm Recurrence, Local/pathology
- Neoplasm Recurrence, Local/surgery
- Neoplasm, Residual
- Pancreas/diagnostic imaging
- Pancreas/pathology
- Pancreas/surgery
- Pancreatectomy/adverse effects
- Pancreatectomy/methods
- Pancreatic Neoplasms/diagnostic imaging
- Pancreatic Neoplasms/mortality
- Pancreatic Neoplasms/pathology
- Pancreatic Neoplasms/surgery
- Patient Selection
- Postoperative Complications/epidemiology
- Postoperative Complications/etiology
- Prognosis
- Reoperation/adverse effects
- Reoperation/methods
- Retrospective Studies
- Survival Analysis
- Tomography, X-Ray Computed
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Affiliation(s)
- Suguru Yamada
- Department of Gastroenterological Surgery (Surgery II), Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Akira Kobayashi
- Department of Surgery, Shinshu University School of Medicine, Matsumoto, Japan
| | - Shoji Nakamori
- Department of Hepato-Biliary-Pancreatic Surgery, National Hospital Organization Osaka National Hospital, Osaka, Japan
| | - Hideo Baba
- Department of Gastroenterological Surgery, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan
| | - Masakazu Yamamoto
- Department of Surgery, Institute of Gastroenterology, Tokyo Women's Medical University, Tokyo, Japan
| | - Hiroki Yamaue
- Second Department of Surgery, Wakayama Medical University, Wakayama, Japan
| | - Tsutomu Fujii
- Department of Surgery and Science, Graduate School of Medicine and Pharmaceutical Sciences, University of Toyama, Toyama, Japan.
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13
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Suzuki S, Shimoda M, Shimazaki J, Maruyama T, Nishida K. Clinical Outcome of Resected Remnant Pancreatic Cancer After Resection of the Primary Pancreatic Cancer. J INVEST SURG 2018; 32:670-678. [PMID: 29589962 DOI: 10.1080/08941939.2018.1452995] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
Purpose: Pancreatic cancer (PC) has high morbidity and mortality rates, with a poor prognosis and frequent recurrence. The postresection survival rate has increased but remains low, and remnant PC is becoming more common. This review evaluates the current literature pertaining to the clinical outcomes of patients with resected remnant PC. Material and Methods: We reviewed publications on remnant PC that included repeated and completion pancreatectomy. Clinicophysiological data were analyzed, and survival rates were calculated using the Kaplan-Meier method. Remnant PC was defined by negative margins at the initial operation, a cancer-free interval >1 year, and presence in the remnant pancreas. Results: Forty-nine cases of remnant PC selected from the literature were examined. Primary and remnant PCs had the same histopathological features in 29 of 45 patients (64.4%). The median disease-free interval was 44.3 months (12-143 months). The 1- and 3-year survival rates after repeat pancreatectomy were 81.5% and 50%, respectively, and the median survival time was 32 months. The age of the patient at the time of the first operation independently predicted survival in a multivariate analysis. Conclusion: In long-term survivors after curative resection for PC, resectable remnant PCs should be aggressively removed to improve prognosis.
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Affiliation(s)
- Shuji Suzuki
- Department of Gastroenterological Surgery, Ibaraki Medical Center, Tokyo Medical University , Ibaraki , Japan
| | - Mitsugi Shimoda
- Department of Gastroenterological Surgery, Ibaraki Medical Center, Tokyo Medical University , Ibaraki , Japan
| | - Jiro Shimazaki
- Department of Gastroenterological Surgery, Ibaraki Medical Center, Tokyo Medical University , Ibaraki , Japan
| | - Tsunehiko Maruyama
- Department of Gastroenterological Surgery, Ibaraki Medical Center, Tokyo Medical University , Ibaraki , Japan
| | - Kiyotaka Nishida
- Department of Gastroenterological Surgery, Ibaraki Medical Center, Tokyo Medical University , Ibaraki , Japan
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14
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Efficacy of completion pancreatectomy for recurrence of adenocarcinoma in the remnant pancreas. J Surg Res 2018; 221:15-23. [DOI: 10.1016/j.jss.2017.07.016] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2017] [Revised: 06/16/2017] [Accepted: 07/14/2017] [Indexed: 02/07/2023]
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15
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Kanno A, Masamune A, Hanada K, Maguchi H, Shimizu Y, Ueki T, Hasebe O, Ohtsuka T, Nakamura M, Takenaka M, Kitano M, Kikuyama M, Gabata T, Yoshida K, Sasaki T, Serikawa M, Furukawa T, Yanagisawa A, Shimosegawa T. Multicenter study of early pancreatic cancer in Japan. Pancreatology 2018; 18:61-67. [PMID: 29170051 DOI: 10.1016/j.pan.2017.11.007] [Citation(s) in RCA: 139] [Impact Index Per Article: 23.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/09/2017] [Revised: 10/21/2017] [Accepted: 11/16/2017] [Indexed: 12/11/2022]
Abstract
BACKGROUND/OBJECTIVES The diagnosis of early-stage pancreatic ductal adenocarcinoma (PDAC) is still challenging. We conducted a multicenter study to clarify the clinical features of early-stage PDAC in Japan. METHODS We collected patients with stage 0 and stage I PDAC according to the sixth edition of the Japanese Classification of Pancreatic Carcinoma. We retrospectively analyzed the clinical profiles including opportunities for medical examination, imaging modalities and findings, methods of cytological diagnosis, and prognosis according to the stages at diagnosis. RESULTS Two hundred cases with Stage 0 and stage I PDAC were reported from 14 institutions, which accounted for approximately 0.7% and 3% of all PDAC cases, respectively. Overall, 20% of the early-stage PDAC cases were symptomatic. Indirect imaging findings such as dilatation of the main pancreatic duct were useful to detect early-stage PDAC. In particular, local fatty changes may be specific to early-stage PDAC. For preoperative pathologic diagnosis, cytology during endoscopic retrograde cholangiopancreatography was more commonly applied than endoscopic ultrasound fine-needle aspiration. Although the overall prognosis was favorable, new PDAC lesions developed in the remnant pancreas in 11.5% cases. CONCLUSIONS This multicenter study revealed several key points concerning the diagnosis and management of early-stage PDAC, including screening of asymptomatic cases, importance of indirect imaging findings, application of cytology during endoscopic retrograde cholangiopancreatography, and the risk of carcinogenesis in the remnant pancreas.
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Affiliation(s)
- Atsushi Kanno
- Division of Gastroenterology, Tohoku University, Graduate School of Medicine, Japan.
| | - Atsushi Masamune
- Division of Gastroenterology, Tohoku University, Graduate School of Medicine, Japan
| | - Keiji Hanada
- Department of Gastroenterology, JA Onomichi General Hospital, Japan
| | | | - Yasuhiro Shimizu
- Department of Gastroenterological Surgery, Aichi Cancer Center Hospital, Japan
| | - Toshiharu Ueki
- Department of Gastroenterology, Fukuoka University Chikushi Hospital, Japan
| | - Osamu Hasebe
- Department of Gastroenterology, Nagano Municipal Hospital, Japan
| | - Takao Ohtsuka
- Department of Surgery and Oncology, Graduate School of Medical Sciences, Kyushu University, Japan
| | - Masafumi Nakamura
- Department of Surgery and Oncology, Graduate School of Medical Sciences, Kyushu University, Japan
| | - Mamoru Takenaka
- Department of Gastroenterology and Hepatology, Kindai University, Faculty of Medicine, Japan
| | - Masayuki Kitano
- Second Department of Internal Medicine, Wakayama Medical University, School of Medicine, Japan
| | | | | | - Koji Yoshida
- Department of Interventional Bilio-Pancreatology, Kawasaki Medical School, Japan
| | - Tamito Sasaki
- Department of Gastroenterology, Hiroshima Prefectural Hospital, Japan
| | - Masahiro Serikawa
- Department of Gastroenterology and Metabolism, Hiroshima University Hospital, Japan
| | - Toru Furukawa
- Institute for Integrated Medical Sciences, Tokyo Women's Medical University, Japan; Department of Histopathology, Tohoku University, Graduate School of Medicine, Japan
| | - Akio Yanagisawa
- Department of Pathology, Kyoto Prefectural University of Medicine, Japan
| | - Tooru Shimosegawa
- Division of Gastroenterology, Tohoku University, Graduate School of Medicine, Japan
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16
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Abstract
Local recurrence of pancreatic cancer (PC) can occur in the pancreatic remnant. In addition, new primary PC can develop in the remnant. There are limited data available regarding this so-called remnant PC. The aim of this review was to describe the characteristics and therapeutic strategy regarding remnant PC. A literature search was performed using Medline published in English according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. The incidence of remnant PC has been reported to be 3% to 5%. It is difficult to distinguish local recurrence from new primary PC. Genetic diagnosis such as Kirsten rat sarcoma viral oncogene homolog mutation may resolve this problem. For patients with remnant PC, repeated pancreatectomy can be performed. Residual total pancreatectomy is the most common procedure. Recent studies have described the safety of the operation because of recent surgical progress and perioperative care. The patients with remnant PC without distant metastasis have shown good long-term outcomes, especially those who underwent repeated pancreatectomy. Adjuvant chemotherapy may contribute to longer survival. In conclusion, this review found that both local recurrence and new primary PC can develop in the pancreatic remnant. Repeated pancreatectomy for the remnant PC is a feasible procedure and can prolong patient survival.
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17
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Groot VP, van Santvoort HC, Rombouts SJE, Hagendoorn J, Borel Rinkes IHM, van Vulpen M, Herman JM, Wolfgang CL, Besselink MG, Molenaar IQ. Systematic review on the treatment of isolated local recurrence of pancreatic cancer after surgery; re-resection, chemoradiotherapy and SBRT. HPB (Oxford) 2017; 19:83-92. [PMID: 28065427 DOI: 10.1016/j.hpb.2016.11.001] [Citation(s) in RCA: 67] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/17/2016] [Revised: 10/31/2016] [Accepted: 11/07/2016] [Indexed: 02/06/2023]
Abstract
BACKGROUND The majority of patients who have undergone a pancreatic resection for pancreatic cancer develop disease recurrence within two years. In around 30% of these patients, isolated local recurrence (ILR) is found. The aim of this study was to systematically review treatment options for this subgroup of patients. METHODS A systematic search was performed in PubMed, Embase and the Cochrane Library. Studies reporting on the treatment of ILR after initial curative-intent resection of primary pancreatic cancer were included. Primary endpoints were morbidity, mortality and survival after ILR treatment. RESULTS After screening 1152 studies, 18 studies reporting on 313 patients undergoing treatment for ILR were included. Treatment options for ILR included surgical re-resection (8 studies, 100 patients), chemoradiotherapy (7 studies, 153 patients) and stereotactic body radiation therapy (SBRT) (4 studies, 60 patients). Morbidity and mortality were reported for re-resection (29% and 1%, respectively), chemoradiotherapy (54% and 0%) and SBRT (3% and 1%). Most patients had a prolonged disease-free interval before recurrence. Median survival after treatment of ILR of up to 32, 19 and 16 months was reported for re-resection, chemoradiotherapy and SBRT, respectively. CONCLUSION In selected patients, treatment of ILR following pancreatic resection for pancreatic cancer seems safe, feasible and associated with relatively good survival.
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Affiliation(s)
- Vincent P Groot
- Dept. of Surgery, University Medical Center Utrecht Cancer Center, The Netherlands; Dept. of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Hjalmar C van Santvoort
- Dept. of Surgery, St. Antonius Hospital Nieuwegein, The Netherlands; Dept. of Surgery, Academic Medical Center Amsterdam, The Netherlands
| | - Steffi J E Rombouts
- Dept. of Surgery, University Medical Center Utrecht Cancer Center, The Netherlands
| | - Jeroen Hagendoorn
- Dept. of Surgery, University Medical Center Utrecht Cancer Center, The Netherlands
| | | | - Marco van Vulpen
- Dept. of Radiation Oncology, University Medical Center Utrecht Cancer Center, The Netherlands
| | - Joseph M Herman
- Dept. of Radiation Oncology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | | | - Marc G Besselink
- Dept. of Surgery, Academic Medical Center Amsterdam, The Netherlands
| | - I Quintus Molenaar
- Dept. of Surgery, University Medical Center Utrecht Cancer Center, The Netherlands.
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18
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KANNO A, MASAMUNE A, HANADA K, MAGUCHI H, SHIMIZU Y, UEKI T, HASEBE O, OHTSUKA T, NAKAMURA M, TAKENAKA M, KITANO M, KIKUYAMA M, GABATA T, YOSHIDA K, SASAKI T, SERIKAWA M, FURUKAWA T, YANAGISAWA A, SHIMOSEGAWA T. The present situation of early diagnosis for pancreatic cancer. ACTA ACUST UNITED AC 2017. [DOI: 10.2958/suizo.32.16] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Affiliation(s)
- Atsushi KANNO
- Division of Gastroenterology, Tohoku University Graduate School of Medicine
- The Study Group on the Early Detection of Pancreatic Cancer
| | - Atsushi MASAMUNE
- Division of Gastroenterology, Tohoku University Graduate School of Medicine
| | - Keiji HANADA
- Department of Gastroenterology, JA Onomichi General Hospital
- The Study Group on the Early Detection of Pancreatic Cancer
| | - Hiroyuki MAGUCHI
- Center for Gastroenterology, Teine-Keijinkai Hospital
- The Study Group on the Early Detection of Pancreatic Cancer
| | - Yasuhiro SHIMIZU
- Department of Gastroenterological Surgery, Aichi Cancer Center Hospital
- The Study Group on the Early Detection of Pancreatic Cancer
| | - Toshiharu UEKI
- Department of Gastroenterology, Fukuoka University Chikushi Hospital
- The Study Group on the Early Detection of Pancreatic Cancer
| | - Osamu HASEBE
- Department of Gastroenterology, Nagano Municipal Hospital
- The Study Group on the Early Detection of Pancreatic Cancer
| | - Takao OHTSUKA
- Department of Surgery and Oncology, Graduate School of Medical Sciences, Kyushu University
- The Study Group on the Early Detection of Pancreatic Cancer
| | - Masashi NAKAMURA
- Department of Surgery and Oncology, Graduate School of Medical Sciences, Kyushu University
| | - Mamoru TAKENAKA
- Department of Gastroenterology and Hepatology, Kindai University Faculty of Medicine
- The Study Group on the Early Detection of Pancreatic Cancer
| | - Masayuki KITANO
- Second Department of Internal Medicine, Wakayama Medical University School of Medicine
- The Study Group on the Early Detection of Pancreatic Cancer
| | - Masataka KIKUYAMA
- Division of Gastroenterology, Shizuoka General Hospital
- The Study Group on the Early Detection of Pancreatic Cancer
| | - Toshifumi GABATA
- Department of Radiology, Kanazawa University
- The Study Group on the Early Detection of Pancreatic Cancer
| | - Koji YOSHIDA
- Department of Interventional Bilio-Pancreatology, Kawasaki Medical School
- The Study Group on the Early Detection of Pancreatic Cancer
| | - Tamito SASAKI
- Department of Gastroenterology, Hiroshima Prefectural Hospital
- The Study Group on the Early Detection of Pancreatic Cancer
| | - Masahiro SERIKAWA
- Department of Gastroenterology and Metabolism, Hiroshima University Hospital
- The Study Group on the Early Detection of Pancreatic Cancer
| | - Toru FURUKAWA
- Institute for Integrated Medical Sciences, Tokyo Women's Medical University
- The Study Group on the Early Detection of Pancreatic Cancer
| | - Akio YANAGISAWA
- Department of Pathology, Kyoto Prefectural University of Medicine
- The Study Group on the Early Detection of Pancreatic Cancer
| | - Tooru SHIMOSEGAWA
- Division of Gastroenterology, Tohoku University Graduate School of Medicine
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19
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Zhou Y, Song A, Wu L, Si X, Li Y. Second pancreatectomy for recurrent pancreatic ductal adenocarcinoma in the remnant pancreas: A pooled analysis. Pancreatology 2016; 16:1124-1128. [PMID: 27717684 DOI: 10.1016/j.pan.2016.09.015] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2016] [Revised: 09/13/2016] [Accepted: 09/29/2016] [Indexed: 12/11/2022]
Abstract
OBJECTIVES The aim of this study was to examine the outcomes of second pancreatectomy for the treatment of recurrent pancreatic ductal adenocarcinoma (PDAC) in the remnant pancreas. METHOD Search of the PubMed database was undertaken to identify relevant English language studies. Pooled individually data were examined for clinical outcomes after second pancreatectomy for recurrent PDAC. RESULTS A total of 19 articles involving 55 patients were eligible for inclusion. The median disease-free interval after initial resection was 33 (range 7-143) months. Of the 55 patients reported, 52 (94.5%) patients underwent completion total pancreatectomy in the second operation for recurrences, including 15 patients who developed recurrences more than 5 years after the initial operation. There was no perioperative death. The 1-, 3- and 5-year overall survival rate after the second pancreatectomy was 82.2%, 49.2% and 40.6% respectively. CONCLUSION Second pancreatectomy for recurrent PDAC can be performed safely with long-term survival in selected patients.
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Affiliation(s)
- Yanming Zhou
- Department of Hepatobiliary & Pancreatovascular Surgery, First Affiliated Hospital of Xiamen University, Xiamen, China; Department of General Surgery, Second Hospital of Lanzhou University, Lanzhou, China
| | - Ailing Song
- Department of General Surgery, Second Hospital of Lanzhou University, Lanzhou, China
| | - Lupeng Wu
- Department of Hepatobiliary & Pancreatovascular Surgery, First Affiliated Hospital of Xiamen University, Xiamen, China
| | - Xiaoying Si
- Department of Hepatobiliary & Pancreatovascular Surgery, First Affiliated Hospital of Xiamen University, Xiamen, China
| | - Yumin Li
- Department of General Surgery, Second Hospital of Lanzhou University, Lanzhou, China.
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20
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Ishida J, Toyama H, Matsumoto I, Asari S, Goto T, Terai S, Nanno Y, Yamashita A, Mizumoto T, Ueda Y, Kido M, Ajiki T, Fukumoto T, Ku Y. Second primary pancreatic ductal carcinoma in the remnant pancreas after pancreatectomy for pancreatic ductal carcinoma: High cumulative incidence rates at 5 years after pancreatectomy. Pancreatology 2016; 16:615-20. [PMID: 27237099 DOI: 10.1016/j.pan.2016.05.003] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2016] [Revised: 03/08/2016] [Accepted: 05/06/2016] [Indexed: 12/11/2022]
Abstract
OBJECTIVES The aim of this study was to determine the incidence rate and clinical features of second primary pancreatic ductal carcinoma (SPPDC) in the remnant pancreas after pancreatectomy for pancreatic ductal carcinoma (PDC). METHODS Data of patients undergoing R0 resection for PDC at a single high-volume center were reviewed. SPPDC was defined as a tumor in the remnant pancreas after R0 resection for PDC, and SPPDC met at least one of the following conditions: 1) the time interval between initial pancreatectomy and development of a new tumor was 3 years or more; 2) the new tumor was not located in contact with the pancreatic stump. We investigated the clinical features and treatment outcomes of patients with SPPDC. RESULTS This study included 130 patients who underwent surgical resection for PDC between 2005 and 2014. Six (4.6%) patients developed SPPDC. The cumulative 3- and 5-year incidence rates were 3.1% and 17.7%, respectively. Four patients underwent remnant pancreatectomy for SPPDC. They were diagnosed with the disease in stage IIA or higher and developed recurrence within 6 months after remnant pancreatectomy. One patient received carbon ion radiotherapy and survived 45 months. One patient refused treatment and died 19 months after the diagnosis of SPPDC. CONCLUSIONS The incidence rate of SPPDC is not negligible, and the cumulative 5-year incidence rate of SPPDC is markedly high. Post-operative surveillance of the remnant pancreas is critical for the early detection of SPPDC, even in long-term survivors after PDC resection.
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Affiliation(s)
- Jun Ishida
- Division of Hepato-Biliary-Pancreatic Surgery, Department of Surgery, Kobe University Graduate School of Medicine, 7-5-2 Kusunoki-cho, Chuo-ku, Kobe 650-0017, Japan
| | - Hirochika Toyama
- Division of Hepato-Biliary-Pancreatic Surgery, Department of Surgery, Kobe University Graduate School of Medicine, 7-5-2 Kusunoki-cho, Chuo-ku, Kobe 650-0017, Japan.
| | - Ippei Matsumoto
- Department of Surgery, Kinki University Faculty of Medicine, 377-2 Onohigashi, Osakasayama 589-8511, Japan
| | - Sadaki Asari
- Division of Hepato-Biliary-Pancreatic Surgery, Department of Surgery, Kobe University Graduate School of Medicine, 7-5-2 Kusunoki-cho, Chuo-ku, Kobe 650-0017, Japan
| | - Tadahiro Goto
- Division of Hepato-Biliary-Pancreatic Surgery, Department of Surgery, Kobe University Graduate School of Medicine, 7-5-2 Kusunoki-cho, Chuo-ku, Kobe 650-0017, Japan
| | - Sachio Terai
- Division of Hepato-Biliary-Pancreatic Surgery, Department of Surgery, Kobe University Graduate School of Medicine, 7-5-2 Kusunoki-cho, Chuo-ku, Kobe 650-0017, Japan
| | - Yoshihide Nanno
- Division of Hepato-Biliary-Pancreatic Surgery, Department of Surgery, Kobe University Graduate School of Medicine, 7-5-2 Kusunoki-cho, Chuo-ku, Kobe 650-0017, Japan
| | - Azusa Yamashita
- Division of Hepato-Biliary-Pancreatic Surgery, Department of Surgery, Kobe University Graduate School of Medicine, 7-5-2 Kusunoki-cho, Chuo-ku, Kobe 650-0017, Japan
| | - Takuya Mizumoto
- Division of Hepato-Biliary-Pancreatic Surgery, Department of Surgery, Kobe University Graduate School of Medicine, 7-5-2 Kusunoki-cho, Chuo-ku, Kobe 650-0017, Japan
| | - Yuki Ueda
- Division of Hepato-Biliary-Pancreatic Surgery, Department of Surgery, Kobe University Graduate School of Medicine, 7-5-2 Kusunoki-cho, Chuo-ku, Kobe 650-0017, Japan
| | - Masahiro Kido
- Division of Hepato-Biliary-Pancreatic Surgery, Department of Surgery, Kobe University Graduate School of Medicine, 7-5-2 Kusunoki-cho, Chuo-ku, Kobe 650-0017, Japan
| | - Tetsuo Ajiki
- Division of Hepato-Biliary-Pancreatic Surgery, Department of Surgery, Kobe University Graduate School of Medicine, 7-5-2 Kusunoki-cho, Chuo-ku, Kobe 650-0017, Japan
| | - Takumi Fukumoto
- Division of Hepato-Biliary-Pancreatic Surgery, Department of Surgery, Kobe University Graduate School of Medicine, 7-5-2 Kusunoki-cho, Chuo-ku, Kobe 650-0017, Japan
| | - Yonson Ku
- Division of Hepato-Biliary-Pancreatic Surgery, Department of Surgery, Kobe University Graduate School of Medicine, 7-5-2 Kusunoki-cho, Chuo-ku, Kobe 650-0017, Japan
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