1
|
Nalbant MO, Oner O, Akinci O, Hocaoglu E, Inci E. Analysis of Pancreatobiliary and Intestinal Type Periampullary Carcinomas Using Volumetric Apparent Diffusion Coefficient Histograms. Acad Radiol 2023; 30 Suppl 1:S238-S245. [PMID: 37211479 DOI: 10.1016/j.acra.2023.04.031] [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] [Received: 04/02/2023] [Revised: 04/21/2023] [Accepted: 04/22/2023] [Indexed: 05/23/2023]
Abstract
RATIONALE AND OBJECTIVES Magnetic resonance imaging plays an important role in the evaluation of patients with known or suspected periampullary masses. The utilization of volumetric apparent diffusion coefficient (ADC) histogram evaluation for the entire lesion eradicates the potential for subjectivity in the region of interest placement, thus guaranteeing the accuracy of computation and repeatability. PURPOSE To investigate the value of volumetric ADC histogram analysis in the differentiation of intestinal-type (IPAC) and pancreatobiliary-type periampullary adenocarcinomas (PPAC). MATERIALS AND METHODS This retrospective study included 69 patients with histopathologically confirmed periampullary adenocarcinoma (54 PPAC and 15 IPAC). Diffusion-weighted imaging was obtained at b values of 1000 mm²/s. The histogram parameters of ADC values, comprising the mean, minimum, maximum, 5th, 10th, 25th, 50th, 75th, 90th, and 95th percentiles, as well as skewness, kurtosis, and variance, were calculated independently by two radiologists. Using the interclass correlation coefficient, the interobserver agreement was evaluated. RESULTS The ADC parameters for the PPAC group were all lower than those of the IPAC group. The PPAC group had higher variance, skewness, and kurtosis than the IPAC group. However, the difference between the kurtosis (P = .003), the 5th (P = .032), 10th (P = .043), and 25th (P = .037) percentiles of ADC values was statistically significant. The area under the curve (AUC) of the kurtosis was the highest (AUC=0.752; cut-off value=-0.235; sensitivity=61.1%; specificity=80.0%). CONCLUSION Volumetric ADC histogram analysis with b values of 1000 mm²/s can discriminate subtypes noninvasively before surgery.
Collapse
Affiliation(s)
- Mustafa Orhan Nalbant
- University of Health Sciences, Bakirkoy Dr. Sadi Konuk Training and Research Hospital, Radiology Department, Tevfik Saglam Cad. No: 11, Zuhuratbaba, 34147 Bakırkoy, Istanbul, Turkey.
| | - Ozkan Oner
- University of Health Sciences, Bakirkoy Dr. Sadi Konuk Training and Research Hospital, Radiology Department, Tevfik Saglam Cad. No: 11, Zuhuratbaba, 34147 Bakırkoy, Istanbul, Turkey
| | - Ozlem Akinci
- University of Health Sciences, Bakirkoy Dr. Sadi Konuk Training and Research Hospital, Radiology Department, Tevfik Saglam Cad. No: 11, Zuhuratbaba, 34147 Bakırkoy, Istanbul, Turkey
| | - Elif Hocaoglu
- University of Health Sciences, Bakirkoy Dr. Sadi Konuk Training and Research Hospital, Radiology Department, Tevfik Saglam Cad. No: 11, Zuhuratbaba, 34147 Bakırkoy, Istanbul, Turkey
| | - Ercan Inci
- University of Health Sciences, Bakirkoy Dr. Sadi Konuk Training and Research Hospital, Radiology Department, Tevfik Saglam Cad. No: 11, Zuhuratbaba, 34147 Bakırkoy, Istanbul, Turkey
| |
Collapse
|
2
|
Szor DJ, Tustumi F. The influence of institutional pancreaticoduodenectomy volume on short-term outcomes in the Brazilian public health system: 2008-2021. Rev Col Bras Cir 2023; 50:e20233569. [PMID: 37646727 PMCID: PMC10508654 DOI: 10.1590/0100-6991e-20233569-en] [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] [Received: 04/12/2023] [Accepted: 07/10/2023] [Indexed: 09/01/2023] Open
Abstract
INTRODUCTION pancreaticoduodenectomy is a complex surgical procedure that can result in high rates of complications and morbimortality. Due to its complexity, the establishment of referral centers has increased in recent decades. This study aims to evaluate the influence of the institutional volume of pancreaticoduodenectomy for periampullary cancer on short-term outcomes in the Brazilian public health system. METHODS this study used a population-based approach and investigated the number of pancreaticoduodenectomies performed by institutions within Brazil's public health system between 2008 and 2021. High-volume institutions were defined as those that performed more than two standard deviations above the mean number of procedures per year. Specifically, if a center performed eight or more pancreaticoduodenectomies annually, it was considered a high-volume institution. RESULTS in Brazil, 283 public hospitals performed pancreaticoduodenectomy for cancer between 2008 and 2021. Only ten hospitals performed at least eight pancreaticoduodenectomies per year, accounting for approximately 3.5% of the institutions. High-volume institutions had a significantly lower in-hospital mortality rate than low-volume institutions (8 vs. 17%). No significant differences between groups were observed for length of stay, hospitalizations using the ICU, and ICU length of stay. The linear regression model showed that the number of hospital admissions for pancreaticoduodenectomy and age were significantly associated with hospital mortality. CONCLUSION institutional pancreaticoduodenectomy volume implies a lowering of in-hospital mortality. The findings of this nationwide study can affect how the public health system manages pancreaticoduodenectomy care.
Collapse
Affiliation(s)
- Daniel José Szor
- - Hospital Israelita Albert Einstein, Ciências em Saúde - São Paulo - SP - Brasil
| | - Francisco Tustumi
- - Hospital Israelita Albert Einstein, Ciências em Saúde - São Paulo - SP - Brasil
| |
Collapse
|
3
|
Gregório C, Thakur S, Camara Rivero R, Márcia Dos Santos Machado S, Cuenin C, Carreira C, White V, Cree IA, Vukojevic K, Glavina Durdov M, Bersch Osvaldt A, Ashton-Prolla P, Herceg Z, Talukdar FR. Telomere length assessment and molecular characterization of TERT gene promoter in periampullary carcinomas. Gene 2023; 873:147460. [PMID: 37150235 DOI: 10.1016/j.gene.2023.147460] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2022] [Revised: 04/14/2023] [Accepted: 05/01/2023] [Indexed: 05/09/2023]
Abstract
Genetic and epigenetic alterations of the telomere maintenance machinery like telomere length and telomerase reverse transcriptase (encoded by TERT gene) are reported in several human malignancies. However, there is limited knowledge on the status of the telomere machinery in periampullary carcinomas (PAC) which are rare and heterogeneous groups of cancers arising from different anatomic sites around the ampulla of Vater. In the current study, we investigated the relative telomere length (RTL) and the most frequent genetic and epigenetic alterations in the TERT promoter in PAC and compared it with tumor-adjacent nonpathological duodenum (NDu). We found shorter RTLs (1.27 vs 1.33, P = 0.01) and lower TERT protein expression (p = 0.04) in PAC tissues as compared to the NDu. Although we did not find any mutation at two reactivating hotspot mutation sites of the TERT promoter, we detected polymorphism in 45% (9/20) of the cases at rs2853669 (T > C). Also, we found a hypermethylated region in the TERT promoter of PACs consisting of four CpGs (cg10896616 with Δβ 7%; cg02545192 with Δβ 9%; cg03323598 with Δβ 19%; and cg07285213 with Δβ 15%). In conclusion, we identified shorter telomeres with DNA hypermethylation in the TERT promoter region and lower TERT protein expression in PAC tissues. These results could be used further to investigate molecular pathology and develop theranostics for PAC.
Collapse
Affiliation(s)
- Cleandra Gregório
- Departamento de Genética, Programa de Pós-graduação em Genética e Biologia Molecular, Universidade Federal do Rio Grande do Sul, Porto Alegre, Rio Grande do Sul, Brazil; Laboratório de Medicina Genômica, Centro de Pesquisa Experimental - Hospital de Clínicas de Porto Alegre (HCPA), Porto Alegre, Rio Grande do Sul, Brazil
| | - Shefali Thakur
- International Agency for Research on Cancer, Lyon, France; Faculty of Science, Charles University, Prague, Czech Republic
| | - Raquel Camara Rivero
- Departamento de Patologia, Faculdade de Medicina, Universidade Federal do Rio Grande do Sul, Porto Alegre, Rio Grande do Sul, Brazil; Serviço de Patologia- Hospital de Clínicas de Porto Alegre, Porto Alegre, Rio Grande do Sul, Brazil
| | - Simone Márcia Dos Santos Machado
- Grupo de Vias Biliares e Pâncreas - Cirurgia do Aparelho Digestivo, Hospital de Clínicas de Porto Alegre, Porto Alegre, Rio Grande do Sul, Brazil
| | - Cyrille Cuenin
- International Agency for Research on Cancer, Lyon, France
| | | | - Valerie White
- International Agency for Research on Cancer, Lyon, France
| | - Ian A Cree
- International Agency for Research on Cancer, Lyon, France
| | - Katarina Vukojevic
- Department of Anatomy, Histology and Embryology, School of Medicine, University of Split, Split, Croatia
| | | | - Alessandro Bersch Osvaldt
- Serviço de Patologia- Hospital de Clínicas de Porto Alegre, Porto Alegre, Rio Grande do Sul, Brazil; Programa de Pós-graduação em Medicina: Ciências Cirúrgicas, Universidade Federal do Rio Grande do Sul, Porto Alegre, Rio Grande do Sul, Brazil
| | - Patricia Ashton-Prolla
- Departamento de Genética, Programa de Pós-graduação em Genética e Biologia Molecular, Universidade Federal do Rio Grande do Sul, Porto Alegre, Rio Grande do Sul, Brazil; Laboratório de Medicina Genômica, Centro de Pesquisa Experimental - Hospital de Clínicas de Porto Alegre (HCPA), Porto Alegre, Rio Grande do Sul, Brazil; Serviço de Patologia- Hospital de Clínicas de Porto Alegre, Porto Alegre, Rio Grande do Sul, Brazil
| | - Zdenko Herceg
- International Agency for Research on Cancer, Lyon, France
| | | |
Collapse
|
4
|
Chun J, Kim YW, Seo-Rin J, Cho H, Kim KP, Hwang DW, Hong SM. Prognostic Significance of Extranodal Extension of Nodal Metastasis in Adenocarcinoma of the Ampulla of Vater. Hum Pathol 2023; 137:36-47. [PMID: 37088435 DOI: 10.1016/j.humpath.2023.04.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2023] [Revised: 04/14/2023] [Accepted: 04/17/2023] [Indexed: 04/25/2023]
Abstract
Although nodal metastasis (NM) is an important prognostic factor of ampullary adenocarcinoma, the prognostic implication of extranodal extension (ENE) is not well characterized. NM with ENE status was investigated in 279 surgically resected ampullary adenocarcinoma patients and compared with other clinicopathologic factors, including overall survival (OS) and recurrence-free survival (RFS). Expression of epithelial-mesenchymal transition (EMT) markers, including E-cadherin, Twist, and Snail, was assessed in a subset of the cohort. NM was observed in 94 cases (33.7%), of which ENE was observed in 32 cases (34%). NM with ENE was more frequently associated with tumors with poor differentiation than NM without ENE (P=0.017). The 5-year OS and RFS rates of patients with NM and ENE was significantly worse (13.0% and 6.3%) than those with NM without ENE (37.7% and 21.4%) and those without NM (57.6% and 50.2%, respectively; P<0.001). When pN category was matched, the OS and RFS was worse in patients with ENE than in those without ENE (P<0.05). Moreover, the expression of E-cadherin and Twist was significantly different between NM areas with and without ENE (all, P<0.001). Since ENE was associated with poorly differentiated ampullary adenocarcinomas and showed different expression of EMT markers, EMT could be a possible mechanism of ENE. Ampullary adenocarcinoma patients with ENE had worse OS and RFS than those without ENE. Therefore, evaluation of ENE can provide additional survival information for patients with surgically resected ampullary carcinoma.
Collapse
Affiliation(s)
- Jihyun Chun
- Department of Pathology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Yeon Wook Kim
- Asan Institute for Life Sciences, Asan Medical Center, Seoul, Republic of Korea
| | - Jeong Seo-Rin
- Department of Statistics, Korea University, Seoul, Republic of Korea
| | - HyunhJun Cho
- Department of Statistics, Korea University, Seoul, Republic of Korea
| | - Kyu-Pyo Kim
- Department of Oncology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Dae Wook Hwang
- Division of Hepatobiliary and Pancreatic Surgery, Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Seung-Mo Hong
- Department of Pathology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea.
| |
Collapse
|
5
|
Skórzewska M, Kurzawa P, Ciszewski T, Pelc Z, Polkowski WP. Controversies in the diagnosis and treatment of periampullary tumours. Surg Oncol 2022; 44:101853. [PMID: 36152420 DOI: 10.1016/j.suronc.2022.101853] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2022] [Revised: 08/27/2022] [Accepted: 09/09/2022] [Indexed: 12/01/2022]
Abstract
Most tumours in the head of the pancreas are adenocarcinomas of the exocrine pancreas. However, carcinomas located in the head of the pancreas may originate from the papilla of Vater, the distal part of the common bile duct, or the duodenum. Tumours of that region, within 2 cm of the greater duodenal papilla, have been usually described as periampullary neoplasms. Adenocarcinomas separated from the major duodenal papilla and located in the major pancreatic duct, common bile duct, or duodenum are identified as ductal pancreatic carcinomas, distal bile duct cholangiocarcinomas or duodenal carcinomas. Surgical treatment is the only chance for cure. Pancreatoduodenectomy is the procedure of choice. Regional lymphadenectomy and removal of at least 16 lymph nodes are necessary for optimal long-term outcomes. Indications for adjuvant chemotherapy remain controversial. This review evaluates the available data on the pathological assessment of periampullary tumours and discusses the controversies of therapeutic management, emphasising adjuvant treatment.
Collapse
Affiliation(s)
| | - Paweł Kurzawa
- Department of Clinical Pathology, Poznan University of Medical Sciences, Poznan, Poland; Department of Oncological Pathology, University Hospital of Lord's Transfiguration, Partner of Karol Marcinkowski University of Medical Sciences, Poznan, Poland
| | - Tomasz Ciszewski
- Department of Surgical Oncology, Medical University of Lublin, Poland
| | - Zuzanna Pelc
- Department of Surgical Oncology, Medical University of Lublin, Poland
| | | |
Collapse
|
6
|
Xia MX, Shi ZM, Xing L, Gao DJ, Ye X, Wang TT, Wu J, Qian YW, Qin WH, Hu B. Endoscopic radiofrequency ablation may improve overall survival in patients with inoperable ampullary carcinoma. Dig Endosc 2022; 34:587-595. [PMID: 34233037 DOI: 10.1111/den.14078] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2021] [Revised: 06/25/2021] [Accepted: 07/06/2021] [Indexed: 12/08/2022]
Abstract
OBJECTIVES Patients with advanced ampullary carcinoma (AC) who are unsuitable for surgery are most likely to have poor outcomes. The role of endoscopic radiofrequency ablation (RFA) in this population has not been fully defined. We aimed to assess the short- and long-term outcomes of RFA in a large cohort of AC patients. METHODS In this retrospective study, data of consecutive patients with pathologically proven AC who underwent successful endobiliary RFA and/or stent placement were collected. All patients did not undergo surgical resection. The primary outcome was overall survival (OS). The secondary outcomes included clinical success and adverse events. RESULTS A total of 85 patients, 50 in the RFA plus stenting group and 35 in the stenting alone group, were identified. The median OS was significantly longer in the RFA group than in the stenting alone group (16.9 vs. 9.8 months, P < 0.001). In multivariable Cox analysis, RFA (hazards ratio 0.408; 95% confidence interval 0.235-0.706; P = 0.001) was the only independent OS predictor. Eight patients with stage II tumors, exclusively from the RFA group, survived for more than 3 years. Clinical success was comparable between the two groups (96% vs. 100%, P = 0.231). Early adverse events between the two groups were similar (10% vs. 2.9%, P = 0.206); however, late biliary/pancreatic stenoses occurred in three RFA patients who were successfully managed with endoscopic interventions. CONCLUSIONS Endoscopic RFA appears to prolong patients' survival with acceptable safety; it may therefore be a feasible treatment option for patients with inoperable ampullary cancers.
Collapse
Affiliation(s)
- Ming-Xing Xia
- Departments of, Endoscopy, Eastern Hepatobiliary Hospital, Second Military Medical University, Shanghai, China
| | - Zhi-Mei Shi
- Departments of, Endoscopy, Eastern Hepatobiliary Hospital, Second Military Medical University, Shanghai, China
| | - Ling Xing
- Departments of, Endoscopy, Eastern Hepatobiliary Hospital, Second Military Medical University, Shanghai, China
| | - Dao-Jian Gao
- Departments of, Endoscopy, Eastern Hepatobiliary Hospital, Second Military Medical University, Shanghai, China
| | - Xin Ye
- Departments of, Endoscopy, Eastern Hepatobiliary Hospital, Second Military Medical University, Shanghai, China
| | - Tian-Tian Wang
- Departments of, Endoscopy, Eastern Hepatobiliary Hospital, Second Military Medical University, Shanghai, China
| | - Jun Wu
- Department of Gastroenterology, Third Affiliated Hospital, Second Military Medical University, Shanghai, China
| | - You-Wen Qian
- Department of, Pathology, Eastern Hepatobiliary Hospital, Second Military Medical University, Shanghai, China
| | - Wen-Hao Qin
- Departments of, Endoscopy, Eastern Hepatobiliary Hospital, Second Military Medical University, Shanghai, China
| | - Bing Hu
- Departments of, Endoscopy, Eastern Hepatobiliary Hospital, Second Military Medical University, Shanghai, China.,Department of Gastroenterology, Third Affiliated Hospital, Second Military Medical University, Shanghai, China
| |
Collapse
|
7
|
Attard JA, Al-Sarireh B, Bhogal RH, Farrugia A, Fusai G, Harper S, Hidalgo-Salinas C, Jah A, Marangoni G, Mortimer M, Pizanias M, Prachialias A, Roberts KJ, Sew Hee C, Soggiu F, Srinivasan P, Chatzizacharias NA. Short-term outcomes after pancreatoduodenectomy in octogenarians: multicentre case-control study. Br J Surg 2021; 109:89-95. [PMID: 34750618 DOI: 10.1093/bjs/znab374] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2020] [Accepted: 09/28/2021] [Indexed: 12/18/2022]
Abstract
BACKGROUND Pancreatoduodenectomy (PD) is frequently the surgical treatment indicated for a number of pathologies. Elderly patients may be denied surgery because of concerns over poor perioperative outcomes. The aim of this study was to evaluate postoperative clinical outcomes and provide evidence on current UK practice in the elderly population after PD. METHODS This was a multicentre retrospective case-control study of octogenarians undergoing PD between January 2008 and December 2017, matched with younger controls from seven specialist centres in the UK. The primary endpoint was 90-day mortality. Secondary endpoints were index admission mortality, postoperative complications, and 30-day readmission rates. RESULTS In total, 235 octogenarians (median age 81 (range 80-90) years) and 235 controls (age 67 (31-79) years) were included in the study. Eastern Cooperative Oncology Group performance status (median 0 (range 0-3) versus 0 (0-2); P = 0.010) and Charlson Co-morbidity Index score (7 (6-11) versus 5 (2-9); P = 0.001) were higher for octogenarians than controls. Postoperative complication and 30-day readmission rates were comparable. The 90-day mortality rate was higher among octogenarians (9 versus 3 per cent; P = 0.030). Index admission mortality rates were comparable (4 versus 2 per cent; P = 0.160), indicating that the difference in mortality was related to deaths after hospital discharge. Despite the higher 90-day mortality rate in the octogenarian population, multivariable Cox regression analysis did not identify age as an independent predictor of postoperative mortality. CONCLUSION Despite careful patient selection and comparable index admission mortality, 90-day and, particularly, out-of-hospital mortality rates were higher in octogenarians.
Collapse
Affiliation(s)
- Joseph A Attard
- Hepatopancreatobiliary and Liver Transplant Unit, Queen Elizabeth Hospital, Birmingham, UK
| | | | | | - Alexia Farrugia
- Department of Surgery, University Hospitals Coventry and Warwickshire NHS Trust, Coventry, UK
| | - Giuseppe Fusai
- Hepatopancreatobiliary and Liver Transplant Unit, Royal Free Hospital, London, UK
| | - Simon Harper
- Hepatopancreatobiliary Unit, Cambridge University Hospital, Cambridge, UK
| | | | - Asif Jah
- Hepatopancreatobiliary Unit, Cambridge University Hospital, Cambridge, UK
| | - Gabriele Marangoni
- Department of Surgery, University Hospitals Coventry and Warwickshire NHS Trust, Coventry, UK
| | | | - Michail Pizanias
- Hepatopancreatobiliary Unit, King's College Hospital, London, UK
| | | | - Keith J Roberts
- Hepatopancreatobiliary and Liver Transplant Unit, Queen Elizabeth Hospital, Birmingham, UK
| | - Chloe Sew Hee
- Hepatopancreatobiliary Unit, Cambridge University Hospital, Cambridge, UK
| | - Fiammetta Soggiu
- Hepatopancreatobiliary and Liver Transplant Unit, Royal Free Hospital, London, UK
| | | | | |
Collapse
|
8
|
Coppola A, La Vaccara V, Caggiati L, Carbone L, Spoto S, Ciccozzi M, Angeletti S, Coppola R, Caputo D. Utility of preoperative systemic inflammatory biomarkers in predicting postoperative complications after pancreaticoduodenectomy: Literature review and single center experience. World J Gastrointest Surg 2021; 13:1216-1225. [PMID: 34754389 PMCID: PMC8554715 DOI: 10.4240/wjgs.v13.i10.1216] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2021] [Revised: 05/10/2021] [Accepted: 07/13/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND The role of preoperative inflammatory biomarkers (PIBs) in predicting postoperative morbidity has been assessed in colorectal and otorhinolaryngeal surgery. However, data regarding the role that preoperative inflammatory biomarkers have on morbidity after pancreaticoduodenectomiy (PD) are less consistent.
AIM To assess the utility of PIBs in predicting postoperative complications after pancreaticoduodenectomy.
METHODS A database of 317 consecutive pancreaticoduodenectomies performed from April 2003 to November 2018 has been retrospectively analyzed. Data regarding preoperative neutrophil-to-lymphocyte ratio (NLR), derived NLR and C-reactive protein (CRP), and postoperative complications of 238 cases have been evaluated. Exclusion criteria were: age < 18-years-old, previous neoadjuvant treatment, absence of data about PIBs, concomitant hematological disorders, and presence of active infections at the moment of the surgery. PIBs were compared using Mann-Whitney’s test and receiver operating characteristic (ROC) analysis was performed to define the cutoffs. The positive predictive value (PPV) was computed to evaluate the probability to develop complication. P-values < 0.05 were considered statistically significant.
RESULTS According to the literature findings, only four papers have been published reporting the relation between the inflammatory biomarkers and PD postoperative morbidity. A combination of preoperative and postoperative inflammatory biomarkers in predicting complications after PD and the utility of preoperative NLR in the development of postoperative pancreatic fistula (POPF) have been reported. The combination of PIBs and postoperative day-1 drains amylase has been reported to predict the incidence of POPF. According to our results, CRP values were significantly different between patients who had/did not have postoperative complications and abdominal collections (P < 0.05). Notably, patients with preoperative CRP > 8.81 mg/dL were at higher risk of both overall complications and abdominal collections (respectively P = 0.0037, PPV = 0.95, negative predictive value [NPV] = 0.27 and P = 0.016, PPV = 0.59, NPV = 0.68). Preoperative derived neutrophil-to-lymphocyte ratio (dNLR) (cut off > 1.47) was also a predictor of abdominal collection (P = 0.021, PPV = 0.48, NPV = 0.71). Combining CRP and dNLR, PPV increased to 0.67. NLR (cut off > 1.65) was significantly associated with postoperative hemorrhage (P = 0.016, PPV = 0.17, NPV = 0.98).
CONCLUSION PIBs may predict complications after PD. During postoperative care, PIB levels could influence decisions regarding the timing of drains removal and the selection of patients who might benefit from second level diagnostic exams.
Collapse
Affiliation(s)
- Alessandro Coppola
- Department of Surgery, University Campus Bio-Medico di Roma, Rome 00128, Italy
| | - Vincenzo La Vaccara
- Department of General Surgery, University Campus Bio-Medico di Roma, Rome 00128, Italy
| | - Lorenza Caggiati
- Department of General Surgery, University Campus Bio-Medico di Roma, Rome 00128, Italy
| | - Ludovico Carbone
- Department of General Surgery, University Campus Bio-Medico di Roma, Rome 00128, Italy
| | - Silvia Spoto
- Department of Internal Medicine, University Campus Bio-Medico di Roma, Rome 00128, Italy
| | - Massimo Ciccozzi
- Medical Statistics and Epidemiology Unit, University Campus Bio-Medico di Roma, Rome 00128, Italy
| | - Silvia Angeletti
- Unit of Clinical Laboratory Science, University Campus Bio-Medico di Roma, Rome 00128, Italy
| | - Roberto Coppola
- Department of General Surgery, University Campus Bio-Medico di Roma, Rome 00128, Italy
| | - Damiano Caputo
- Department of General Surgery, University Campus Bio-Medico di Roma, Rome 00128, Italy
| |
Collapse
|
9
|
Long-term survival after minimally invasive resection versus open pancreaticoduodenectomy for periampullary cancers: a systematic review, meta-analysis and meta-regression. HPB (Oxford) 2021; 23:197-205. [PMID: 33077373 DOI: 10.1016/j.hpb.2020.09.023] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2020] [Accepted: 09/29/2020] [Indexed: 12/12/2022]
Abstract
BACKGROUND It remains unclear whether minimally invasive pancreaticoduodenectomy (MIPD) and open pancreaticoduodenectomy (OPD) influences long-term survival in periampullary cancers. This review aims evaluate long-term survival between MIPD and OPD for periampullary cancers. METHODS A systematic review was performed to identify studies comparing long-term survival after MIPD and OPD. The I2 test was used to test for statistical heterogeneity and publication bias using Egger test. Random-effects meta-analysis was performed for all-cause 5-year (main outcome) and 3-year survival, and disease-specific 5-year and 3-year survival. Meta-regression was performed for the 5-year and 3-year survival outcomes with adjustment for study (region, design, case matching), hospital (centre volume), patient (ASA grade, gender, age), and tumor (stage, neoadjuvant therapy, subtype (i.e. ampullary, distal bile duct, duodenal, pancreatic)). Sensitivity analyses performed on studies including pancreatic ductal adenocarcinoma (PDAC) only. RESULTS The review identified 31 relevant studies. Among all 58,622 patients, 8716 (14.9%) underwent MIPD and 49,875 (85.1%) underwent OPD. Pooled analysis revealed similar 5-year overall survival after MIPD compared with OPD (HR: 0.78, 95% CI 0.50-1.22, p = 0.2). Meta-regression indicated case matching, and ASA Grade II and III as confounding covariates. The statistical heterogeneity was limited (I2 = 12, χ2 = 0.26) and the funnel plot was symmetrical both according to visual and statistical testing (Egger test = 0.32). Sensitivity subset analyses for PDAC demonstrated similar 5-year overall survival after MIPD compared with OPD (HR 0.69, 95% CI: 0.32-1.50, p = 0.3). CONCLUSION Long-term survival after MIPD is non-inferior to OPD. Thus, MIPD can be recommended as a standard surgical approach for periampullary cancers.
Collapse
|
10
|
Wang CY, Chao YJ, Chen YL, Wang TW, Phan NN, Hsu HP, Shan YS, Lai MD. Upregulation of peroxisome proliferator-activated receptor-α and the lipid metabolism pathway promotes carcinogenesis of ampullary cancer. Int J Med Sci 2021; 18:256-269. [PMID: 33390794 PMCID: PMC7738964 DOI: 10.7150/ijms.48123] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2020] [Accepted: 10/28/2020] [Indexed: 02/07/2023] Open
Abstract
Ampullary cancer is a rare periampullary cancer currently with no targeted therapeutic agent. It is important to develop a deeper understanding of the carcinogenesis of ampullary cancer. We attempted to explore the characteristics of ampullary cancer in our dataset and a public database, followed by a search for potential drugs. We used a bioinformatics pipeline to analyze complementary (c)DNA microarray data of ampullary cancer and surrounding normal duodenal tissues from five patients. A public database from the National Center for Biotechnology Information Gene Expression Omnibus (NCBI GEO) was applied for external validation. Bioinformatics tools used included the Gene Set Enrichment Analysis (GSEA), Database for Annotation, Visualization and Integrated Discovery (DAVID), MetaCore, Kyoto Encyclopedia of Genes and Genomes (KEGG), Hallmark, BioCarta, Reactome, and Connectivity Map (CMap). In total, 9097 genes were upregulated in the five ampullary cancer samples compared to normal duodenal tissues. From the MetaCore analysis, genes of peroxisome proliferator-activated receptor alpha (PPARA) and retinoid X receptor (RXR)-regulated lipid metabolism were overexpressed in ampullary cancer tissues. Further a GSEA of the KEGG, Hallmark, Reactome, and Gene Ontology databases revealed that PPARA and lipid metabolism-related genes were enriched in our specimens of ampullary cancer and in the NCBI GSE39409 database. Expressions of PPARA messenger (m)RNA and the PPAR-α protein were higher in clinical samples and cell lines of ampullary cancer. US Food and Drug Administration (FDA)-approved drugs, including alvespimycin, trichostatin A (a histone deacetylase inhibitor), and cytochalasin B, may have novel therapeutic effects in ampullary cancer patients as predicted by the CMap analysis. Trichostatin A was the most potent agent for ampullary cancer with a half maximal inhibitory concentration of < 0.3 μM. According to our results, upregulation of PPARA and lipid metabolism-related genes are potential pathways in the carcinogenesis and development of ampullary cancer. Results from the CMap analysis suggested potential drugs for patients with ampullary cancer.
Collapse
Affiliation(s)
- Chih-Yang Wang
- PhD Program for Cancer Molecular Biology and Drug Discovery, College of Medical Science and Technology, Taipei Medical University, Taipei 11031, Taiwan.,Graduate Institute of Cancer Biology and Drug Discovery, College of Medical Science and Technology, Taipei Medical University, Taipei 11031, Taiwan
| | - Ying-Jui Chao
- Department of Surgery, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan 70403, Taiwan.,Institute of Clinical Medicine, College of Medicine, National Cheng Kung University, Tainan 70101, Taiwan
| | - Yi-Ling Chen
- Senior Citizen Service Management, Chia-Nan University of Pharmacy and Science, Tainan 71710, Taiwan
| | - Tzu-Wen Wang
- Department of Surgery, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan 70403, Taiwan
| | - Nam Nhut Phan
- NTT Institute of Hi-Technology, Nguyen Tat Thanh University, Ho Chi Minh City, Vietnam
| | - Hui-Ping Hsu
- Department of Surgery, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan 70403, Taiwan.,Department of Biostatistics, Vanderbilt University Medical Center, Nashville, TN 37232, USA
| | - Yan-Shen Shan
- Department of Surgery, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan 70403, Taiwan
| | - Ming-Derg Lai
- Department of Biochemistry and Molecular Biology, College of Medicine, National Cheng Kung University, Tainan 70101, Taiwan.,Institute of Basic Medical Sciences, National Cheng Kung University, Tainan 70101, Taiwan.,Center for Infectious Diseases and Signaling Research, College of Medicine, National Cheng Kung University, Tainan 70101, Taiwan
| |
Collapse
|
11
|
Survival Benefit of Adjuvant Chemotherapy After Pancreatoduodenectomy for Ampullary Adenocarcinoma: a Propensity-Matched National Cancer Database (NCDB) Analysis. J Gastrointest Surg 2021; 25:1805-1814. [PMID: 33230687 PMCID: PMC8275534 DOI: 10.1007/s11605-020-04879-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2020] [Accepted: 11/10/2020] [Indexed: 01/31/2023]
Abstract
BACKGROUND The benefit of adjuvant chemotherapy (AC) after pancreatoduodenectomy (PD) for ampullary adenocarcinoma is uncertain. We aimed to evaluate the association of AC with survival in patients with resected ampullary adenocarcinoma. METHODS Using the National Cancer Database (NCDB) data from 2004 to 2016, patients with non-metastatic ampullary adenocarcinoma who underwent PD were identified. Patients with neoadjuvant radiotherapy and chemotherapy and survival < 6 months were excluded. Propensity score matching was used to account for treatment selection bias. A multivariable Cox proportional hazards model was then used to analyze the association of AC with survival. RESULTS Of 3186 (43%) AC and 4172 (57%) no AC (noAC) patients, 1720 AC and 1720 noAC patients remained in the cohort after matching. Clinicopathologic variables were well balanced after matching. After matching, AC was associated with improved survival (median 47.5 vs 39.6 months, p = 0.003), which remained after multivariable adjustment (HR: 0.83, CI95%: 0.76-0.91, p < 0.001). Multivariable interaction analyses showed that this benefit was seen irrespective of nodal status: N0 (HR: 0.81, CI95%: 0.68-0.97, p < 0.001), N1 (HR: 0.65, CI95%: 0.61-0.70, p < 0.001), N2 (HR: 0.73, CI95%: 0.59-0.90, p = 0.003), N3 (HR: 0.59, CI95%: 0.44-0.78, p < 0.001); and margin status: R0 (HR: 0.85, CI95%: 0.77-0.94, p < 0.001), R1 (HR: 0.69, CI95%: 0.48-1.00, p < 0.001). Stratified analyses by nodal and margin status demonstrated consistent results. CONCLUSION In this large retrospective cohort study, AC after resected ampullary adenocarcinoma was associated with a survival benefit in patients, including patients with node-negative and margin-negative disease.
Collapse
|
12
|
Kang CM, Lee JH, Choi JK, Hwang HK, Chung JU, Lee WJ, Kwon KH. Can we recommend surgical treatment to the octogenarian with periampullary cancer?: National database analysis in South Korea. Eur J Cancer 2020; 144:81-90. [PMID: 33341449 DOI: 10.1016/j.ejca.2020.10.039] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2020] [Revised: 10/10/2020] [Accepted: 10/20/2020] [Indexed: 12/30/2022]
Abstract
BACKGROUND The incidence of periampullary cancer in the elderly is increasing. Safety and oncologic effectiveness of pancreaticoduodenectomy in elderly patients is still controversial. MATERIALS AND METHODS From 2002 to 2016, patients with periampullary cancer were evaluated. Customised health information data provided by the National Health Insurance Corporation (NHIS-2018-1-157) were used for analysis. Chronological changes in the incidence of periampullary cancer and long-term survival outcomes were estimated according to patients' age. RESULT A total of 148,080 patients were found to have periampullary cancer. Chronologically, the incidence of periampullary cancer increased, and the proportion of elderly patients with periampullary cancer prominently increased (about 2.1 times in patients in their 70s and about 4.7 times in those older than 80 years). The number of patients with pylorus-preserving pancreaticoduodenectomy in their 70s (about 5.6 times, p < 0.001) and over 80 years of age (about 8.9 times, p < 0.001) was much higher than the number of patients aged younger than 50 years (about 1.7 times) and in their 60s (about 2.5 times). Long-term survival was different as per diagnosis (p < 0.001). In addition, it was observed that age was a factor attenuating the survival of patients with resected periampullary cancers (p < 0.001). However, in case of patients older than 80 years, those who underwent surgical treatment showed a higher survival rate than those who did not undergo surgical treatment. CONCLUSION We can recommend surgical treatment for elderly patients with resectable periampullary cancer. The survival data in this study can be useful references especially in making treatment plan for octogenarians diagnosed with periampullary cancer.
Collapse
Affiliation(s)
- Chang M Kang
- Division of HBP Surgery, Department of Surgery, Yonsei University College of Medicine, South Korea; Pancreatobiliary Cancer Center, Yonsei Cancer Center, Severance Hospital, Seoul, South Korea
| | - Jin H Lee
- Department of Surgery, National Health Insurance Service Ilsan Hospital, Goyang, South Korea
| | - Jung K Choi
- Department of Policy Research Affairs, National Health Insurance Service Ilsan Hospital, South Korea
| | - Ho K Hwang
- Division of HBP Surgery, Department of Surgery, Yonsei University College of Medicine, South Korea; Pancreatobiliary Cancer Center, Yonsei Cancer Center, Severance Hospital, Seoul, South Korea
| | - Jae U Chung
- Department of Surgery, National Health Insurance Service Ilsan Hospital, Goyang, South Korea
| | - Woo J Lee
- Division of HBP Surgery, Department of Surgery, Yonsei University College of Medicine, South Korea; Pancreatobiliary Cancer Center, Yonsei Cancer Center, Severance Hospital, Seoul, South Korea
| | - Kuk H Kwon
- Department of Surgery, National Health Insurance Service Ilsan Hospital, Goyang, South Korea.
| |
Collapse
|
13
|
Xu H, Jing C, Zhou J, Min X, Zhao J, Yang L, Ren Y. Clinical efficacy of coil embolization in treating pseudoaneurysm post-Whipple operation. Exp Ther Med 2020; 20:37. [PMID: 32952628 PMCID: PMC7480126 DOI: 10.3892/etm.2020.9164] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2019] [Accepted: 06/24/2020] [Indexed: 02/05/2023] Open
Abstract
The present study aimed to evaluate the clinical efficacy and safety of angiography and coil embolization for pseudoaneurysm post-pancreatoduodenectomy (PD). A total of 17 patients with gastrointestinal or abdominal hemorrhage after PD were included in the present study. Angiography was performed on the celiac artery, common hepatic artery, splenic artery, gastroduodenal artery and superior mesenteric artery to determine the size of the pseudoaneurysm, the parent artery and its collateral branches. A variety of embolization techniques have been applied to embolize pseudoaneurysm, including the sac packing technique, proximal embolization, exclusion technique and sandwich technique. Different techniques with coils were used for embolization and the clinical effects of embolization were analyzed. A total of 18 pseudoaneurysms were identified in 17 patients. In 2 patients, severe technical complications occurred, including migration of the coil and rupture of pseudoaneurysm, and one of them died, which may have been associated with this complication. No serious clinical complications were observed in the other patients. A total of 7 patients had mild clinical complications, including mild abdominal and dorsal pain, which were alleviated after symptomatic management. A total of 15 patients with definite pseudoaneurysm were successfully embolized without re-bleeding and complications. The clinical success rate was 94.1% (16/17). In conclusion, a variety of embolization techniques may be applied for the treatment of pseudoaneurysm after PD, which have high technical and clinical success rates and small trauma. It is recommended in emergency situations, but care should be taken to avoid serious technical complications.
Collapse
Affiliation(s)
- Hao Xu
- Sichuan Key Laboratory of Medical Imaging, Department of Interventional Radiology, Affiliated Hospital of North Sichuan Medical College, Nanchong, Sichuan 637000, P.R. China
| | - Cong Jing
- Sichuan Key Laboratory of Medical Imaging, Department of Interventional Radiology, Affiliated Hospital of North Sichuan Medical College, Nanchong, Sichuan 637000, P.R. China
| | - Jie Zhou
- Department of Hepatobiliary Surgery, Affiliated Hospital of North Sichuan Medical College, Nanchong, Sichuan 637000, P.R. China
| | - Xuli Min
- Sichuan Key Laboratory of Medical Imaging, Department of Interventional Radiology, Affiliated Hospital of North Sichuan Medical College, Nanchong, Sichuan 637000, P.R. China
| | - Jing Zhao
- Sichuan Key Laboratory of Medical Imaging, Department of Interventional Radiology, Affiliated Hospital of North Sichuan Medical College, Nanchong, Sichuan 637000, P.R. China
| | - Lin Yang
- Sichuan Key Laboratory of Medical Imaging, Department of Interventional Radiology, Affiliated Hospital of North Sichuan Medical College, Nanchong, Sichuan 637000, P.R. China
| | - Yongjun Ren
- Sichuan Key Laboratory of Medical Imaging, Department of Interventional Radiology, Affiliated Hospital of North Sichuan Medical College, Nanchong, Sichuan 637000, P.R. China
| |
Collapse
|
14
|
Kim HS, Jang JY, Yoon YS, Park SJ, Kwon W, Kim SW, Han HS, Han SS, Park JS, Yoon DS. Does adjuvant treatment improve prognosis after curative resection of ampulla of Vater carcinoma? A multicenter retrospective study. JOURNAL OF HEPATO-BILIARY-PANCREATIC SCIENCES 2020; 27:721-730. [PMID: 32652820 DOI: 10.1002/jhbp.801] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/18/2020] [Revised: 06/03/2020] [Accepted: 07/05/2020] [Indexed: 12/12/2022]
Abstract
BACKGROUND/PURPOSE Ampulla of Vater (AoV) carcinoma is a rare tumor that accounts for approximately 0.2% of gastrointestinal malignancies. There are no clinical guidelines concerning the treatment of AoV carcinoma. This study aimed to investigate the effectiveness of adjuvant treatment in AoV carcinoma following curative resection and define the "high-risk" group. METHODS Clinical data of patients who underwent curative resection for AoV carcinoma in four hospitals, namely Yonsei Gangnam Severance Hospital, Seoul National University Hospital, Seoul National University Bundang Hospital, and National Cancer Center (n = 651; 2002-2015), were reviewed. Overall survival (OS) and recurrence-free survival (RFS) rates were compared using Kaplan-Meier estimates. RESULTS Data of 651 patients who had undergone curative resection were retrospectively reviewed. Age, T stage, N stage, and differentiation type remained strong and independent risk factors for RFS and OS. In early-stage AoV carcinoma (T1N0, T2N0), the non-adjuvant group had better prognosis based on the RFS and OS than the adjuvant group (P < .001, P = .007). In advanced T stage (T3N0, T4N0), the adjuvant group had better prognosis than the non-adjuvant group, but the difference was not statistically significant (P > .05). In node-positive patients (any T, N1/2), adjuvant treatment did not affect RFS and OS (P > .05). CONCLUSIONS Adjuvant treatment after curative resection of AoV carcinoma is not associated with improved survival. The high-risk group (node-positive or advanced T stage (T3, T4)) treated with adjuvant treatment was not statistically associated with improved survival; however, our study showed that the adjuvant treatment for the high-risk group might help achieve better patient outcome.
Collapse
Affiliation(s)
- Hyung Sun Kim
- Department of Surgery, Pancreatobiliary Cancer Clinic, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Jin-Young Jang
- Department of Surgery, Seoul National University College of Medicine, Seoul, Korea
| | - Yoo-Seok Yoon
- Department of Surgery, Seoul National University Bundang Hospital, Seoul National University, Seoul, Korea
| | - Sang-Jae Park
- Center for Liver Cancer, National Cancer Center, Goyang, Korea
| | - Wooil Kwon
- Department of Surgery, Seoul National University College of Medicine, Seoul, Korea
| | - Sun-Whe Kim
- Center for Liver Cancer, National Cancer Center, Goyang, Korea
| | - Ho Seong Han
- Department of Surgery, Seoul National University Bundang Hospital, Seoul National University, Seoul, Korea
| | - Sung-Sik Han
- Center for Liver Cancer, National Cancer Center, Goyang, Korea
| | - Joon Seong Park
- Department of Surgery, Pancreatobiliary Cancer Clinic, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Dong Sup Yoon
- Department of Surgery, Pancreatobiliary Cancer Clinic, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| |
Collapse
|
15
|
Jung JH, Choi DW, Yoon S, Yoon SJ, Han IW, Heo JS, Shin SH. Three Thousand Consecutive Pancreaticoduodenectomies in a Tertiary Cancer Center: A Retrospective Observational Study. J Clin Med 2020; 9:jcm9082558. [PMID: 32784559 PMCID: PMC7465877 DOI: 10.3390/jcm9082558] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2020] [Revised: 08/05/2020] [Accepted: 08/05/2020] [Indexed: 01/06/2023] Open
Abstract
(1) Aim: To evaluate clinicopathological features and postoperative outcomes including survival in patients who underwent pancreaticoduodenectomy (PD) for periampullary diseases. (2) Methods: We retrospectively reviewed 3078 cases of PD performed in our center for 25 years. Periampullary diseases were divided into benign and malignancy groups. All cases were also classified by location. The time of 25 years was divided to different periods (5 years per period) to compare outcomes. Overall survival was compared between subdivided periods. (3) Results: Hospitalization became significantly shorter from 28.0 days in the 1st period to 13.8 days in the 5th period. Overall complication rate was significantly increased since the 3rd period. The rate without postoperative pancreatic fistula (POPF) was high at 98.7% in the 1st period. This might be because drain amylase on the 3rd day after PD was not routinely checked in the past. Thus, POPF was not detected. In survival analysis of adenocarcinoma of pancreas, bile duct, and ampulla, overall survival was found to be improved significantly in recent years. (4) Conclusions: Our study revealed that outcomes were improved with increasing number of PDs performed. Although POPF and overall complications showed increases more recently, those were detected and managed, resulting in shorter hospitalization and improved outcomes.
Collapse
Affiliation(s)
| | | | | | | | | | | | - Sang Hyun Shin
- Correspondence: ; Tel.: +82-2-3410-1089; Fax: +82-2-3410-6980
| |
Collapse
|
16
|
Cheng LC, Chao YJ, Wang CY, Phan NN, Chen YL, Wang TW, Hsu HP, Lin YJ, Shan YS, Lai MD. Cancer-Derived Transforming Growth Factor-β Modulates Tumor-Associated Macrophages in Ampullary Cancer. Onco Targets Ther 2020; 13:7503-7516. [PMID: 32821120 PMCID: PMC7423398 DOI: 10.2147/ott.s246714] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2020] [Accepted: 07/14/2020] [Indexed: 12/12/2022] Open
Abstract
Purpose Tumor-associated macrophages (TAMs) originate from monocytes and differentiate into mature macrophages. The interaction between cancer cells and TAMs promotes tumor growth and suppresses immunosurveillance. However, this phenomenon has seldom been observed in ampullary cancer. Patients and Methods TAMs in ampullary cancer were investigated using immunohistochemical (IHC) staining of cancer tissues. Bioinformatic analysis of data from the Gene Expression Omnibus (GEO) database revealed transforming growth factor-beta (TGF-β) signaling in ampullary cancer. The complementary DNA microarray of cancer was compared with adjacent normal duodenum and enzyme-linked immunosorbent assay of serum was used to verify TGF-β signaling in patients. The THP-1 cell line was activated in vitro to imitate M2 TAMs. ClueGo and CluePedia software were operated to simulate TGF-β-related networks in ampullary cancer. Results The IHC study revealed that the majority of TAMs inside ampullary cancer were cluster of differentiation (CD)163+ cells and that the expression of mature CD68+ macrophages was correlated with advanced cancer stage. Bioinformatics analysis revealed that TGF-β and its downstream signaling were significantly upregulated. To verify our bioinformatics-derived predictions, we performed several experiments and demonstrated that increased TGF-β expression was detected in the cDNA microarray. Higher serum levels of TGF-β were correlated with fewer CD68+ and more inducible nitric oxide synthase macrophages in ampullary cancer. Treatment with TGF-β induced modulation of THP-1-derived macrophages. Conclusion The present study demonstrates that TGF-β modulates macrophage activity in ampullary cancer. Targeting TGF-β could be an approach to activating immunosurveillance.
Collapse
Affiliation(s)
- Li-Chin Cheng
- Division of Colorectal Surgery, Department of Surgery, Chi-Mei Medical Center, Tainan 71004, Taiwan
| | - Ying-Jui Chao
- Department of Surgery, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan 70403, Taiwan.,Institute of Clinical Medicine, College of Medicine, National Cheng Kung University, Tainan 70101, Taiwan
| | - Chih-Yang Wang
- Department of Biochemistry and Molecular Biology, College of Medicine, National Cheng Kung University, Tainan 70101, Taiwan.,Institute of Basic Medical Sciences, College of Medicine, National Cheng Kung University, Tainan 70101, Taiwan.,Program for Cancer Molecular Biology and Drug Discovery, College of Medical Science and Technology, Taipei Medical University, Taipei 11031, Taiwan.,Graduate Institute of Cancer Biology and Drug Discovery, College of Medical Science and Technology, Taipei Medical University, Taipei 11031, Taiwan
| | - Nam Nhut Phan
- NTT Institute of Hi-Technology, Nguyen Tat Thanh University, Ho Chi Minh City, Vietnam
| | - Yi-Ling Chen
- Senior Citizen Service Management, Chia-Nan University of Pharmacy and Science, Tainan 71710, Taiwan
| | - Tzu-Wen Wang
- Department of Surgery, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan 70403, Taiwan
| | - Hui-Ping Hsu
- Department of Surgery, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan 70403, Taiwan.,Department of Biostatistics, Vanderbilt University Medical Center, Nashville, TN 37232, USA
| | - Yih-Jyh Lin
- Department of Surgery, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan 70403, Taiwan
| | - Yan-Shen Shan
- Department of Surgery, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan 70403, Taiwan.,Institute of Clinical Medicine, College of Medicine, National Cheng Kung University, Tainan 70101, Taiwan
| | - Ming-Derg Lai
- Department of Biochemistry and Molecular Biology, College of Medicine, National Cheng Kung University, Tainan 70101, Taiwan.,Institute of Basic Medical Sciences, College of Medicine, National Cheng Kung University, Tainan 70101, Taiwan
| |
Collapse
|
17
|
A systematic review and network meta-analysis of phase III randomised controlled trials for adjuvant therapy following resection of pancreatic ductal adenocarcinoma (PDAC). HPB (Oxford) 2020; 22:649-659. [PMID: 31894014 DOI: 10.1016/j.hpb.2019.12.001] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2019] [Revised: 11/28/2019] [Accepted: 12/02/2019] [Indexed: 02/06/2023]
Abstract
BACKGROUND Several randomised controlled trials (RCTs) have reported various systemic adjuvant therapy regimens following resection of pancreatic ductal adenocarcinoma (PDAC). The most commonly applied include modified FOLFRINOX (mFFX), Gemcitabine/Capecitabine (GemCap) and S1, usually compared to gemcitabine (Gem) alone. However, many of these regimens have not been directly compared in RCTs. This network meta-analysis aims to characterise the impact of adjuvant therapies on overall and disease-free survival in patients having resection of PDAC. METHODS A systematic review was conducted using MEDLINE, EMBASE, Cochrane Central and American Society of Clinical Oncology (ASCO) abstracts to identify published phase III RCTs articles up to 9th May 2019 that examined adjuvant systemic therapy in resected pancreatic cancer. Data including study characteristics and outcomes including overall survival (OS) and disease-free survival (DFS) were extracted. Indirect comparisons of all regimens were simultaneously compared using random-effects network meta-analyses (NMA) which maintains randomisation within trials. RESULTS Twelve phase III RCTs involving 4947 patients and nine different regimens (5-Flourouracil/Folinic acid (5-FU/FA), Gemcitabine, Gemcitabine/Erlotinib (GemErl), GemCap), mFFX, S1, chemoradiotherapy (CRT), CRT with either 5-FU or Gemcitabine) were identified. S1 was ranked best for overall and disease-free survival followed by mFFX. Whilst there were no significant difference between S1 and mFFX for overall survival (mean difference: 1.6 months, p = 0.8), S1 had significantly longer disease-free survival than mFFX (mean difference: 2.8 months, p < 0.001). Furthermore, S1 was ranked best for lowest overall and haematological grade 3/4 toxicities. CONCLUSION This network meta-analysis demonstrates that chemotherapy with S1 or mFFX is superior to GemCap for adjuvant treatment for PDAC, improves survival after surgical resection and should be considered as reasonable standard treatment options in the adjuvant setting and as control arm for future adjuvant clinical trials.
Collapse
|
18
|
A systematic review and network meta-analysis of different surgical approaches for pancreaticoduodenectomy. HPB (Oxford) 2020; 22:329-339. [PMID: 31676255 DOI: 10.1016/j.hpb.2019.09.016] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2019] [Revised: 09/16/2019] [Accepted: 09/29/2019] [Indexed: 02/07/2023]
Abstract
BACKGROUND Minimally invasive pancreaticoduodenectomy (MIPD) is a demanding surgical procedure, thus explaining its slow expansion and limited popularity amongst Hepato-Pancreatico-Biliary (HPB) surgeons. However, three main advantages of robotic assisted pancreaticoduodenectomy (PD) including improved dexterity, 3D vision less surgical fatigue, may overcome some of the hurdles and ultimately lead to a wider adoption. This systematic review and network meta-analysis aims to evaluate the current literature on open and MIPD. METHODS A systematic literature search was conducted for studies reporting robotic, laparoscopic and open surgery for PD. Network meta-analysis of intraoperative (operating time, blood loss, transfusion rate), postoperative (overall and major complications, pancreatic fistula, delayed gastric emptying, length of hospital stay) and oncological outcomes (R0 resection, lymphadenectomy) were performed. RESULTS Sixty-one studies including 62,529 patients were included in the network meta-analysis, of which 3% (n = 2131) were totally robotic (TR) and 10% (n = 6514) were totally laparoscopic (TL). There were no significant differences between surgical techniques for major complications, overall and grade B/C fistula, biliary leak, mortality and R0 resections. Transfusion rates were significantly lower in TR compared to TL and open. Operative time for TR was longer compared with open and TL. Both TL and TR were associated with significantly lower rates of wound infections, pulmonary complications, shorter length of stay and higher lymph nodes examined when compared to open. TR was associated with significantly lower conversion rates than TL. CONCLUSION In summary, this network meta-analysis highlights the variability in techniques within MIPD and compares other variations to the conventional open PD. Current evidence appears to demonstrate MIPD, both laparoscopic and robotic techniques are associated with improved rates of surgical site infections, pulmonary complications, and a shorter hospital stay, with no compromise in oncological outcomes for cancer resections.
Collapse
|
19
|
Adjuvant therapy for true ampullary cancer: a systematic review. Clin Transl Oncol 2020; 22:1407-1413. [PMID: 31927720 DOI: 10.1007/s12094-019-02278-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2019] [Accepted: 12/19/2019] [Indexed: 12/17/2022]
Abstract
BACKGROUND Given the lack of evidence on the best adjuvant approach, this review closely examines optimal adjuvant management for resected true ampullary cancer and its histological subtypes. MATERIALS AND METHODS A comprehensive literature search of PubMed was performed to identify studies on resected true ampullary cancers, published between January 2010 and December 2018. Data including the use of radiation, chemotherapy or chemoradiation and the outcomes were extracted. RESULTS A total of 116 records were identified, of which 65 screened were selected. Finally, nine studies were included. Only two of the studies reported separately the outcomes of pancreatobiliary and intestinal subtypes. Patients in the selected studies were treated with a pancreaticoduodenectomy with negative margins. Patients treated with adjuvant therapy were more likely to be pT3-4 and have positive nodes; median survival ranged from 30 to 47 months. A significant benefit for adjuvant treatment was observed in four of the studies, restricted to patients at stage IIB or higher. Likewise, patients with positive nodes may have a longer median survival with adjuvant chemoradiation compared to observation. CONCLUSIONS The present review suggests a benefit for adjuvant treatment for patients with locally advanced tumors. Randomized trials are needed to ascertain the topic, as well as studies reporting toxicity and quality of life of resected true ampullary cancer patients.
Collapse
|
20
|
Bundred J, Kamarajah SK, Roberts KJ. Body composition assessment and sarcopenia in patients with pancreatic cancer: a systematic review and meta-analysis. HPB (Oxford) 2019; 21:1603-1612. [PMID: 31266698 DOI: 10.1016/j.hpb.2019.05.018] [Citation(s) in RCA: 64] [Impact Index Per Article: 12.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2019] [Revised: 05/21/2019] [Accepted: 05/27/2019] [Indexed: 12/12/2022]
Abstract
BACKGROUND Numerous studies have suggested an association between sarcopenia in pancreatic cancer and adverse outcomes. This systematic review examines the evidence for the impact of sarcopenia on post-operative complications and survival METHODS: A systematic literature search was conducted to identify randomised and non-randomised studies of sarcopenia in pancreatic cancer. Meta-analyses of intra- and post-operative outcomes were performed (operating time, all complications, major complications, pancreatic fistulae, peri-operative mortality, overall survival). RESULTS Forty-two studies reported the assessment of body composition in 7619 patients. Methods used to assess body composition in patients with pancreatic cancers were computerized tomography (n = 34), bioelectrical impedance analysis (n = 7), and dual-energy-X-ray-absorptiometry (n = 1). Only 10 studies reported the impact of pre-operative sarcopenia upon post-operative outcomes. Sarcopenia was associated with increased peri-operative mortality (OR: 2.40, CI95%:1.19-4.85, p < 0.01) and decreased overall survival by univariable (HR: 1.95, CI95%:1.35-2.81, p < 0.001) and multivariable analysis (HR: 1.78, CI95%:1.54-2.05). Sarcopenia was not significantly associated with all complications (OR: 0.96, CI95%:0.78-1.19) or pancreatic fistula (OR: 0.95, CI95%: 0.59-1.54). CONCLUSIONS Assessment of sarcopenia in pancreatic cancer provides prognostic value but, more importantly, may provide a basis for therapeutic intervention. However, variation in the methods of assessing and reporting sarcopenia in this patient group limits the assessment of post-operative outcomes currently.
Collapse
Affiliation(s)
- James Bundred
- College of Medical and Dental Sciences, University of Birmingham, United Kingdom
| | - Sivesh K Kamarajah
- Department of Hepatobiliary, Pancreatic and Transplant Surgery, Freeman Hospital, Newcastle University NHS Trust Hospitals, Newcastle, United Kingdom; Institute of Cellular Medicine, University of Newcastle, Newcastle, United Kingdom
| | - Keith J Roberts
- University of Birmingham and Consultant Surgeon Queen Elizabeth Hospital Birmingham, United Kingdom.
| |
Collapse
|
21
|
Goh HL, Hawkins L, Kamarajah SK, Karandikar S, Goldstein M. Is water-soluble contrast enema examination for integrity of rectal anastomosis necessary prior to ileostomy reversal? JGH OPEN 2019; 4:417-421. [PMID: 32514447 PMCID: PMC7273697 DOI: 10.1002/jgh3.12267] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/07/2018] [Revised: 04/15/2019] [Accepted: 09/04/2019] [Indexed: 02/06/2023]
Abstract
Background and Aim Routine use of water-soluble contrast enema (WSCE) to assess anastomotic integrity is debated. This study aimed to evaluate the role of WSCE to assess anastomotic integrity following anterior resections (AR) with defunctioning stoma prior to reversal and identify factors to limit its selective use. Methods This retrospective study evaluated all WSCE performed over a 7-year period at a high-volume colorectal unit. Risk factors for radiological abnormality/leak, including malignancy, chemoradiotherapy, and immediate postoperative complications, were recorded. A gastrointestinal specialist radiologist and surgeon validated all WSCEs reported as abnormal. Results Of the 486 WSCE studies identified, 92 were excluded (repeat studies (n = 51), pediatric cases [n = 2], no AR [n = 39]). A total of 394 WSCE studies were evaluated (260 cancer; 134 noncancer patients); 14% (37/260) of cancer patients and 8% (10/134) of noncancer patients had abnormal studies (P = 0.072). Of the 37 abnormal studies in cancer patients, 73% (27/37) radiological leaks were found, and 41% (n = 11/27) of these patients had postoperative complications. Of the 10 abnormal studies in noncancer patients, 20% (2/10) radiological leaks were found, but none of these patients had postoperative complications. Overall leak rates were 7% (29/394), and rates were significantly higher in cancer patients than noncancer patients (10 vs 2%, P = 0.005). Conclusion Routine use of WSCE may not be necessary prior to reversal. WSCE should be selectively used in event of postoperative leak or complications. Noncancer resections are less likely demonstrate a leak.
Collapse
Affiliation(s)
- Hui Lu Goh
- Heartlands Hospital University Hospitals Birmingham Foundation NHS Trust Birmingham UK
| | - Lauren Hawkins
- Heartlands Hospital University Hospitals Birmingham Foundation NHS Trust Birmingham UK
| | - Sivesh K Kamarajah
- Department of HPB and Transplant Surgery The Freeman Hospital Newcastle upon Tyne UK.,Institute of Cellular Medicine University of Newcastle Newcastle upon Tyne UK
| | - Sharad Karandikar
- Heartlands Hospital University Hospitals Birmingham Foundation NHS Trust Birmingham UK
| | - Mark Goldstein
- Heartlands Hospital University Hospitals Birmingham Foundation NHS Trust Birmingham UK
| |
Collapse
|
22
|
Lu JY, Yu H, Zou XL, Li Z, Hu XM, Shen YQ, Hu DY. Apparent diffusion coefficient-based histogram analysis differentiates histological subtypes of periampullary adenocarcinoma. World J Gastroenterol 2019; 25:6116-6128. [PMID: 31686767 PMCID: PMC6824280 DOI: 10.3748/wjg.v25.i40.6116] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/23/2019] [Revised: 09/17/2019] [Accepted: 09/28/2019] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND For periampullary adenocarcinoma, the histological subtype is a better prognostic predictor than the site of tumor origin. Intestinal-type periampullary adenocarcinoma (IPAC) is reported to have a better prognosis than the pan-creatobiliary-type periampullary adenocarcinoma (PPAC). However, the classification of histological subtypes is difficult to determine before surgery. Apparent diffusion coefficient (ADC) histogram analysis is a noninvasive, non-enhanced method with high reproducibility that could help differentiate the two subtypes.
AIM To investigate whether volumetric ADC histogram analysis is helpful for distinguishing IPAC from PPAC.
METHODS Between January 2015 and October 2018, 476 consecutive patients who were suspected of having a periampullary tumor and underwent magnetic resonance imaging (MRI) were reviewed in this retrospective study. Only patients who underwent MRI at 3.0 T with different diffusion-weighted images (b-values = 800 and 1000 s/mm2) and who were confirmed with a periampullary adenocarcinoma were further analyzed. Then, the mean, 5th, 10th, 25th, 50th, 75th, 90th, and 95th percentiles of ADC values and ADCmin, ADCmax, kurtosis, skewness, and entropy were obtained from the volumetric histogram analysis. Comparisons were made by an independent Student's t-test or Mann-Whitney U test. Multiple-class receiver operating characteristic curve analysis was performed to determine and compare the diagnostic value of each significant parameter.
RESULTS In total, 40 patients with histopathologically confirmed IPAC (n = 17) or PPAC (n = 23) were enrolled. The mean, 5th, 25th, 50th, 75th, 90th, and 95th percentiles and ADCmax derived from ADC1000 were significantly lower in the PPAC group than in the IPAC group (P < 0.05). However, values derived from ADC800 showed no significant difference between the two groups. The 75th percentile of ADC1000 values achieved the highest area under the curve (AUC) for differentiating IPAC from PPAC (AUC = 0.781; sensitivity, 91%; specificity, 59%; cut-off value, 1.50 × 10-3 mm2/s).
CONCLUSION Volumetric ADC histogram analysis at a b-value of 1000 s/mm2 might be helpful for differentiating the histological subtypes of periampullary adenocarcinoma before surgery.
Collapse
Affiliation(s)
- Jing-Yu Lu
- Department of Radiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, Hubei Province, China
- Department of Radiology, the First Affiliated Hospital of Soochow University, Suzhou 215006, Jiangsu Province, China
| | - Hao Yu
- Department of Radiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, Hubei Province, China
| | - Xian-Lun Zou
- Department of Radiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, Hubei Province, China
| | - Zhen Li
- Department of Radiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, Hubei Province, China
| | - Xue-Mei Hu
- Department of Radiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, Hubei Province, China
| | - Ya-Qi Shen
- Department of Radiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, Hubei Province, China
| | - Dao-Yu Hu
- Department of Radiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, Hubei Province, China
| |
Collapse
|
23
|
Kamarajah SK, Bundred J, Marc OS, Jiao LR, Manas D, Abu Hilal M, White SA. Robotic versus conventional laparoscopic pancreaticoduodenectomy a systematic review and meta-analysis. Eur J Surg Oncol 2019; 46:6-14. [PMID: 31409513 DOI: 10.1016/j.ejso.2019.08.007] [Citation(s) in RCA: 63] [Impact Index Per Article: 12.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2019] [Revised: 07/03/2019] [Accepted: 08/06/2019] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND Robotic pancreaticoduodenectomy (RPD) offers theoretical advantages to conventional laparoscopic surgery including improved instrument dexterity, 3D visualization and better ergonomics. This review aimed to determine if these theoretical advantages translate into improved patient outcomes comparing patients having either robotic pancreaticoduodenectomy or laparoscopic (LPD) equivalent. METHOD A systematic literature search was conducted for studies reporting minimally invasive surgery for pancreaticoduodenectomy either robotic assisted or totally laparoscopic. Meta-analysis of intra-operative (blood loss, operating times, conversion and R0 resections) and postoperative outcomes (overall complications, pancreatic fistula, length of hospital stay) was performed using a random effects model. RESULT This review identified 44 studies, of which six were non-randomised comparative studies including 3462 patients (1025 robotic and 2437 laparoscopic). Intraoperatively, RPD was associated with significantly lower conversion rates (OR 0.45, p < 0.001) and transfusion rates (OR: 0.60, p = 0.002) compared to LPD. However, no significant difference in blood loss (mean: 220 vs 287 mL, p = 0.1), operating time (mean: 405 vs 418 min, p = 0.3) was noted. Postoperatively RPD was associated with a shorter hospital stay (mean: 12 vs 11 days, p < 0.001) but no significant difference was noted in postoperative complications, incidence of pancreatic fistulae and R0 resection rates. CONCLUSION RPD appears to offer some advantages compared to conventional laparoscopic surgery, although both approaches appear to offer equivalent clinical outcomes. Importantly, the quality of evidence is generally limited to cohort studies and a high-quality randomised trial comparing both techniques is needed.
Collapse
Affiliation(s)
- Sivesh K Kamarajah
- Department of HPB and Transplant Surgery, The Freeman Hospital, Newcastle upon Tyne, Tyne and Wear, UK; Institute of Cellular Medicine, Newcastle University, Newcastle upon Tyne, Tyne and Wear, UK.
| | - James Bundred
- College of Medical and Dental Sciences, University of Birmingham, UK
| | - Olivier Saint Marc
- Department of Surgery, Centre Hospitalier Régional Orleans, Orleans, France
| | - Long R Jiao
- Department of Surgery and Cancer, HPB Surgical Unit, Imperial College, Hammersmith Hospital Campus, London, UK
| | - Derek Manas
- Department of HPB and Transplant Surgery, The Freeman Hospital, Newcastle upon Tyne, Tyne and Wear, UK; Institute of Cellular Medicine, Newcastle University, Newcastle upon Tyne, Tyne and Wear, UK
| | - Mohammed Abu Hilal
- Department of Surgery, Southampton University Hospital NHS Foundation Trust, Southampton, UK
| | - Steven A White
- Department of HPB and Transplant Surgery, The Freeman Hospital, Newcastle upon Tyne, Tyne and Wear, UK; Institute of Cellular Medicine, Newcastle University, Newcastle upon Tyne, Tyne and Wear, UK
| |
Collapse
|
24
|
Cloyd JM. Staging for Ampullary Carcinoma: Is Less Actually More? Ann Surg Oncol 2019; 26:1598-1600. [DOI: 10.1245/s10434-019-07241-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2019] [Indexed: 08/30/2023]
|
25
|
Kamarajah SK, Bundred J. Comments on: Sarcopenia and sarcopenic obesity are significantly associated with poorer overall survival in patients with pancreatic cancer: Systematic review and meta-analysis. Int J Surg 2019; 66:99-100. [PMID: 30836140 DOI: 10.1016/j.ijsu.2019.02.015] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2019] [Accepted: 02/08/2019] [Indexed: 12/23/2022]
Affiliation(s)
- Sivesh K Kamarajah
- Department of Hepatobiliary, Pancreatic and Transplant Surgery, Freeman Hospital, Newcastle University NHS Foundation Trust Hospitals, Newcastle Upon Tyne, UK; Department of Surgery, Freeman Hospital, Newcastle upon Tyne, Tyne and Wear, UK.
| | - James Bundred
- College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
| |
Collapse
|
26
|
Hester CA, Dogeas E, Augustine MM, Mansour JC, Polanco PM, Porembka MR, Wang SC, Zeh HJ, Yopp AC. Incidence and comparative outcomes of periampullary cancer: A population-based analysis demonstrating improved outcomes and increased use of adjuvant therapy from 2004 to 2012. J Surg Oncol 2019; 119:303-317. [PMID: 30561818 DOI: 10.1002/jso.25336] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2018] [Accepted: 11/26/2018] [Indexed: 12/16/2022]
Abstract
BACKGROUND AND OBJECTIVES Periampullary adenocarcinoma (PAC) is stratified anatomically: ampullary adenocarcinoma (AA), distal cholangiocarcinoma (DCC), duodenal adenocarcinoma (DA), and pancreatic ductal adenocarcinoma (PDAC). We aimed to determine differences in incidence, prognosis, and treatment in stage-matched PAC patients in a longitudinal study. METHODS PAC patients were identified in The National Cancer Database from 2004 to 2012. Clinicopathological variables were compared between subtypes. Covariate-adjusted treatment use and OS were compared. RESULTS The 116 705 patients with PAC were identified: 1320 (9%) AA, 3732 (3%) DCC, 7142 (6%) DA, and 95 511 (82%) PDAC. DA, DCC, and PDAC were associated with worse survival compared with AA (hazard ratio [HR], 1.10; 95% CI, 1.1-1.1; HR, 1.50; 95% CI, 1.4-1.6, and HR, 1.90; 95% CI, 1.8-1.9). Among resected patients, DA was associated with improved survival compared with AA (HR, 0.70; 95% CI, 0.67-0.75); DCC and PDAC were associated with worse survival (HR, 1.41; 95% CI, 1.31-1.53 and HR, 2.041; 95% CI, 1.07-2.12). Resected AA, PDAC, and DA, but not DCC, demonstrated significantly improved survival over the studied period. While all patients had increased adjuvant therapy (AT) receipt over time (P < 0.001), only patients with PDAC had increased neoadjuvant therapy (NAT) receipt ( P < 0.001). CONCLUSION Resected PDAC, AA, and DA were associated with clinically significant improved survival over time, mirroring a concurrent associated increased receipt of AT.
Collapse
Affiliation(s)
- Caitlin A Hester
- Department of Surgery, Division of Surgical Oncology, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Epameinondas Dogeas
- Department of Surgery, Division of Surgical Oncology, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Mathew M Augustine
- Department of Surgery, Division of Surgical Oncology, University of Texas Southwestern Medical Center, Dallas, Texas
| | - John C Mansour
- Department of Surgery, Division of Surgical Oncology, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Patricio M Polanco
- Department of Surgery, Division of Surgical Oncology, University of Texas Southwestern Medical Center, Dallas, Texas
- Department of Veterans Affairs North Texas Health Care System, Dallas, Texas
| | - Matthew R Porembka
- Department of Surgery, Division of Surgical Oncology, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Sam C Wang
- Department of Surgery, Division of Surgical Oncology, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Herbert J Zeh
- Department of Surgery, Division of Surgical Oncology, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Adam C Yopp
- Department of Surgery, Division of Surgical Oncology, University of Texas Southwestern Medical Center, Dallas, Texas
| |
Collapse
|
27
|
Arnoletti JP, Fanaian N, Reza J, Sause R, Almodovar AJ, Srivastava M, Patel S, Veldhuis PP, Griffith E, Shao YP, Zhu X, Litherland SA. Pancreatic and bile duct cancer circulating tumor cells (CTC) form immune-resistant multi-cell type clusters in the portal venous circulation. Cancer Biol Ther 2018; 19:887-897. [PMID: 30067440 DOI: 10.1080/15384047.2018.1480292] [Citation(s) in RCA: 34] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
Circulating tumor cells (CTC) enter the blood from many carcinomas and represent a likely source of metastatic dissemination. In contrast to the peripheral circulation, KRAS mutation- positive CTC thrive in the portal venous blood of patients with pancreatic ductal adenocarcinoma (PDAC). To analyze the essential interactions that contribute to carcinoma CTC growth and immune resistance, portal venous blood was collected during pancreatico-duodenectomy in 41 patients with peri-ampullary pathologies (PDAC = 11; ampullary adenocarcinoma (AA) = 15; distal cholangiocarcinoma (CC) = 6; IPMN = 7; non-malignant pancreatitis = 2). FACS-isolated cell populations from the portal circulation were reconstituted ex vivo using mixed cell reaction cultures (MCR). During the first 48hr, PDAC, AA, and CC patient CTC were all highly proliferative (mean 1.7 hr/cell cycle, 61.5% ± 20% growing cells) and resistant to apoptosis (mean 39% ± 25% apoptotic cells). PDAC CTC proliferation and resistance to T cell cytotoxicity were decreased among patients who received pre-operative chemotherapy (p = 0.0019, p = 0.0191, respectively). After 7 days in culture, CTC from PDAC, CC, and AA patients recruited multiple immune cell types, including CD105 + CD14 + myeloid fibroblasts, to organize into spheroid-like clusters. It was only in PDAC and CC-derived MCR that cluster formation promoted CTC survival, growth, and fibroblast differentiation. FACS depletion of CTC or myeloid fibroblast cells eliminated cluster network formation, and re-introduction of these cell populations reconstituted such ability. Our findings suggest that PDAC and CC CTC survival within the portal venous circulation is supported by their interactions with immune cells within multi-cell type clusters that could represent vectors of local recurrence and metastatic progression.
Collapse
Affiliation(s)
- J Pablo Arnoletti
- a Departments of Translational Research (SAL, RS, AJOA, MS, EG, Y-PS); Surgical Oncology (JPA), Florida Hospital Cancer Institute , Orlando , FL , USA
| | - Na'im Fanaian
- b Florida Hospital Diagnostic Pathology (NF) , Orlando , FL , USA
| | - Joseph Reza
- c General Surgery Residency Program , Orlando , FL , USA
| | - Ryan Sause
- a Departments of Translational Research (SAL, RS, AJOA, MS, EG, Y-PS); Surgical Oncology (JPA), Florida Hospital Cancer Institute , Orlando , FL , USA
| | - Alvin Jo Almodovar
- a Departments of Translational Research (SAL, RS, AJOA, MS, EG, Y-PS); Surgical Oncology (JPA), Florida Hospital Cancer Institute , Orlando , FL , USA
| | - Milan Srivastava
- a Departments of Translational Research (SAL, RS, AJOA, MS, EG, Y-PS); Surgical Oncology (JPA), Florida Hospital Cancer Institute , Orlando , FL , USA
| | - Swati Patel
- d Institute for Surgical Advancement , Orlando , FL , USA
| | | | - Elizabeth Griffith
- a Departments of Translational Research (SAL, RS, AJOA, MS, EG, Y-PS); Surgical Oncology (JPA), Florida Hospital Cancer Institute , Orlando , FL , USA
| | - Yai-Ping Shao
- a Departments of Translational Research (SAL, RS, AJOA, MS, EG, Y-PS); Surgical Oncology (JPA), Florida Hospital Cancer Institute , Orlando , FL , USA
| | - Xiang Zhu
- e Center for Interventional Endoscopy , Orlando , FL , USA
| | - Sally A Litherland
- a Departments of Translational Research (SAL, RS, AJOA, MS, EG, Y-PS); Surgical Oncology (JPA), Florida Hospital Cancer Institute , Orlando , FL , USA
| |
Collapse
|