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Jain T, Sharma P, Giri B, Iyer S, Sethi V, Bava EP, Vaish U, Sahay P, Datta J, Reddy S, Bart Rose J, Khan A, Merchant N, Chari ST, Dudeja V. Prescription patterns of pancreatic enzyme replacement therapy for patients with pancreatic cancer in the United States. HPB (Oxford) 2022; 24:1729-1737. [PMID: 35717430 DOI: 10.1016/j.hpb.2022.05.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2021] [Revised: 02/16/2022] [Accepted: 05/09/2022] [Indexed: 12/12/2022]
Abstract
BACKGROUND Exocrine pancreatic insufficiency (EPI) is frequently seen in patients with pancreatic cancer (PDAC) and is thought to contribute to nutritional complications. While EPI can be pharmacologically temporized with pancreatic enzyme replacement therapy (PERT), there is lack of clear evidence informing its use in PDAC. Here we aim to survey pancreatic surgeons regarding their utilization of PERT in the management of EPI for PDAC. METHODS An online survey was distributed to the members of The Americas Hepato-Pancreato-Biliary Association (AHPBA) and The Pancreas Club. RESULTS 86.5% (180/208) of surgeons prescribe PERT for at least some resectable/borderline resectable PDAC cases. Only a minority of surgeons order investigations to confirm EPI before starting PERT (28.1%) or test for adequacy of therapy (28.3%). Few surgeons believe that PERT has an effect on overall survival (19.7%) or disease-free survival (6.25%) in PDAC. CONCLUSION PERT is widely prescribed in patients with resectable/borderline resectable PDAC, but investigations establishing EPI and assessing PERT adequacy are underutilized. A substantial proportion of surgeons are unclear as to the effect of PERT on survival outcomes in PDAC. These data call for prospective studies to establish guidelines for optimal use of PERT and its effects on survival outcomes in PDAC.
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Affiliation(s)
- Tejeshwar Jain
- Division of Surgical Oncology at Department of Surgery, O'Neal Comprehensive Cancer Centre, UAB, Birmingham, AL, USA
| | - Prateek Sharma
- Division of Surgical Oncology at Department of Surgery, O'Neal Comprehensive Cancer Centre, UAB, Birmingham, AL, USA
| | - Bhuwan Giri
- Division of Surgical Oncology at Department of Surgery, Sylvester Comprehensive Cancer Centre, University of Miami -Leonard M. Miller School of Medicine, Miami, FL, USA
| | - Srikanth Iyer
- Division of Surgical Oncology at Department of Surgery, O'Neal Comprehensive Cancer Centre, UAB, Birmingham, AL, USA
| | - Vrishketan Sethi
- Division of Surgical Oncology at Department of Surgery, O'Neal Comprehensive Cancer Centre, UAB, Birmingham, AL, USA
| | - Ejas P Bava
- Division of Surgical Oncology at Department of Surgery, O'Neal Comprehensive Cancer Centre, UAB, Birmingham, AL, USA
| | - Utpreksha Vaish
- Division of Surgical Oncology at Department of Surgery, O'Neal Comprehensive Cancer Centre, UAB, Birmingham, AL, USA
| | - Preeti Sahay
- Division of Surgical Oncology at Department of Surgery, O'Neal Comprehensive Cancer Centre, UAB, Birmingham, AL, USA
| | - Jashodeep Datta
- Division of Surgical Oncology at Department of Surgery, Sylvester Comprehensive Cancer Centre, University of Miami -Leonard M. Miller School of Medicine, Miami, FL, USA
| | - Sushanth Reddy
- Division of Surgical Oncology at Department of Surgery, O'Neal Comprehensive Cancer Centre, UAB, Birmingham, AL, USA
| | - John Bart Rose
- Division of Surgical Oncology at Department of Surgery, O'Neal Comprehensive Cancer Centre, UAB, Birmingham, AL, USA
| | - Anam Khan
- Department of Gastroenterology Hepatology and Nutrition, Division of Internal Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Nipun Merchant
- Division of Surgical Oncology at Department of Surgery, Sylvester Comprehensive Cancer Centre, University of Miami -Leonard M. Miller School of Medicine, Miami, FL, USA
| | - Suresh T Chari
- Department of Gastroenterology Hepatology and Nutrition, Division of Internal Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Vikas Dudeja
- Division of Surgical Oncology at Department of Surgery, O'Neal Comprehensive Cancer Centre, UAB, Birmingham, AL, USA.
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Giri B, Sharma P, Jain T, Ferrantella A, Vaish U, Mehra S, Garg B, Iyer S, Sethi V, Malchiodi Z, Signorelli R, Jacob HKC, George J, Sahay P, Bava EP, Dawra R, Ramakrishnan S, Saluja A, Dudeja V. Hsp70 modulates immune response in pancreatic cancer through dendritic cells. Oncoimmunology 2021; 10:1976952. [PMID: 34552825 PMCID: PMC8451449 DOI: 10.1080/2162402x.2021.1976952] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Heat shock protein 70 (Hsp70), a protein chaperone, is known to promote cell survival and tumor progression. However, its role in the tumor microenvironment (TME) is largely unknown. We specifically evaluated Hsp70 in the TME by implanting tumors in wild-type (WT) controls or Hsp70-/- animals, thus creating a TME with or without Hsp70. Loss of Hsp70 led to significantly smaller tumors; there were no differences in stromal markers, but interestingly, depletion of CD8 + T-cells abrogated this tumor suppressive effect, indicating that loss of Hsp70 in the TME affects tumor growth through the immune cells. Compared to WT, adoptive transfer of Hsp70-/- splenocytes exhibited greater antitumor activity in immunodeficient NSG and Rag 1-/- mice. Hsp70-/- dendritic cells showed increased expression of MHCII and TNF-α both in vitro and in vivo. These results suggest that the absence of Hsp70 in the TME inhibits tumors through increased dendritic cell activation. Hsp70 inhibition in DCs may emerge as a novel therapeutic strategy against pancreatic cancer.
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Affiliation(s)
- Bhuwan Giri
- DeWitt Daughtry Family Department of Surgery, University of Miami, Coral Gables, FL, USA
| | - Prateek Sharma
- Division of Surgical Oncology, Department of Surgery, The University of Alabama at Birmingham, Birmingham, AL, USA
| | - Tejeshwar Jain
- Division of Surgical Oncology, Department of Surgery, The University of Alabama at Birmingham, Birmingham, AL, USA
| | - Anthony Ferrantella
- DeWitt Daughtry Family Department of Surgery, University of Miami, Coral Gables, FL, USA
| | - Utpreksha Vaish
- Division of Surgical Oncology, Department of Surgery, The University of Alabama at Birmingham, Birmingham, AL, USA
| | - Siddharth Mehra
- DeWitt Daughtry Family Department of Surgery, University of Miami, Coral Gables, FL, USA
| | - Bharti Garg
- DeWitt Daughtry Family Department of Surgery, University of Miami, Coral Gables, FL, USA
| | - Srikanth Iyer
- Division of Surgical Oncology, Department of Surgery, The University of Alabama at Birmingham, Birmingham, AL, USA
| | - Vrishketan Sethi
- Division of Surgical Oncology, Department of Surgery, The University of Alabama at Birmingham, Birmingham, AL, USA
| | - Zoe Malchiodi
- DeWitt Daughtry Family Department of Surgery, University of Miami, Coral Gables, FL, USA
| | - Rossana Signorelli
- DeWitt Daughtry Family Department of Surgery, University of Miami, Coral Gables, FL, USA
| | - Harrys K C Jacob
- DeWitt Daughtry Family Department of Surgery, University of Miami, Coral Gables, FL, USA
| | - John George
- DeWitt Daughtry Family Department of Surgery, University of Miami, Coral Gables, FL, USA
| | - Preeti Sahay
- Division of Surgical Oncology, Department of Surgery, The University of Alabama at Birmingham, Birmingham, AL, USA
| | - Ejas P Bava
- Division of Surgical Oncology, Department of Surgery, The University of Alabama at Birmingham, Birmingham, AL, USA
| | - Rajinder Dawra
- DeWitt Daughtry Family Department of Surgery, University of Miami, Coral Gables, FL, USA
| | - Sundaram Ramakrishnan
- DeWitt Daughtry Family Department of Surgery, University of Miami, Coral Gables, FL, USA
| | - Ashok Saluja
- DeWitt Daughtry Family Department of Surgery, University of Miami, Coral Gables, FL, USA
| | - Vikas Dudeja
- Division of Surgical Oncology, Department of Surgery, The University of Alabama at Birmingham, Birmingham, AL, USA
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Sahay P, Bava EP, Iyer S, Dudeja V. Modulation of macrophage polarity for treatment of acute pancreatitis: Are we there yet? EBioMedicine 2020; 60:103002. [PMID: 32979834 PMCID: PMC7511811 DOI: 10.1016/j.ebiom.2020.103002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2020] [Accepted: 08/28/2020] [Indexed: 12/30/2022] Open
Affiliation(s)
- Preeti Sahay
- Department of Surgery, Sylvester Comprehensive Cancer Center, University of Miami, Miami, FL, USA
| | - Ejas P Bava
- Department of Surgery, Sylvester Comprehensive Cancer Center, University of Miami, Miami, FL, USA
| | - Srikanth Iyer
- Department of Surgery, Sylvester Comprehensive Cancer Center, University of Miami, Miami, FL, USA
| | - Vikas Dudeja
- Department of Surgery, Sylvester Comprehensive Cancer Center, University of Miami, Miami, FL, USA.
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De M, Bava EP, Gera S, Bhoi D. Proteus syndrome: Unveiling the anesthetic myths. Asian J Anesthesiol 2017; 55:22-23. [PMID: 28846538 DOI: 10.1016/j.aja.2017.05.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2016] [Revised: 10/21/2016] [Accepted: 12/26/2016] [Indexed: 11/30/2022]
Affiliation(s)
- Manish De
- All India Institute of Medical Sciences, Department Anaesthesiology, Pain Medicine & Critical Care, 5th floor, Teaching Block, New Delhi 110029, India.
| | - Ejas P Bava
- All India Institute of Medical Sciences, Department Anaesthesiology, Pain Medicine & Critical Care, 5th floor, Teaching Block, New Delhi 110029, India
| | - Sakshi Gera
- All India Institute of Medical Sciences, Department Anaesthesiology, Pain Medicine & Critical Care, 5th floor, Teaching Block, New Delhi 110029, India
| | - Debesh Bhoi
- All India Institute of Medical Sciences, Department Anaesthesiology, Pain Medicine & Critical Care, 5th floor, Teaching Block, New Delhi 110029, India
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Bava EP, Ramachandran R, Rewari V, Chandralekha, Bansal VK, Trikha A. Analgesic efficacy of ultrasound guided transversus abdominis plane block versus local anesthetic infiltration in adult patients undergoing single incision laparoscopic cholecystectomy: A randomized controlled trial. Anesth Essays Res 2016; 10:561-567. [PMID: 27746552 PMCID: PMC5062234 DOI: 10.4103/0259-1162.186620] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
Abstract
Background: Transversus abdominis plane (TAP) block has been used to provide intra- and post-operative analgesia with single incision laparoscopic (SIL) bariatric and gynecological surgery with mixed results. Its efficacy in providing analgesia for SIL cholecystectomy (SILC) via the same approach remains unexplored. Aims: The primary objective of our study was to compare the efficacy of bilateral TAP block with local anesthetic infiltration for perioperative analgesia in patients undergoing SILC. Settings and Design: This was a prospective, randomized, controlled, double-blinded trial performed in a tertiary care hospital. Materials and Methods: Forty-two patients undergoing SILC were randomized to receive either ultrasound-guided (USG) bilateral mid-axillary TAP blocks with 0.375% ropivacaine or local anesthetic infiltration of the port site. The primary outcome measure was the requirement of morphine in the first 24 h postoperatively. Statistical Analysis: The data were analyzed using t-test, Mann–Whitney test or Chi-square test. Results: The 24 h morphine requirement (mean ± standard deviation) was 34.57 ± 14.64 mg in TAP group and 32.76 ± 14.34 mg in local infiltration group (P = 0.688). The number of patients requiring intraoperative supplemental fentanyl in TAP group was 8 and in local infiltration group was 16 (P = 0.028). The visual analog scale scores at rest and on coughing were significantly higher in the local infiltration group in the immediate postoperative period (P = 0.034 and P = 0.007, respectively). Conclusion: USG bilateral TAP blocks were not effective in decreasing 24 h morphine requirement as compared to local anesthetic infiltration in patients undergoing SILC although it provided some analgesic benefit intraoperatively and in the initial 4 h postoperatively. Hence, the benefits of TAP blocks are not worth the effort and time spent for administering them for this surgery.
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Affiliation(s)
- Ejas P Bava
- Department of Anesthesiology, Pain Medicine and Critical Care, All India Institute of Medical Sciences, New Delhi, India
| | - Rashmi Ramachandran
- Department of Anesthesiology, Pain Medicine and Critical Care, All India Institute of Medical Sciences, New Delhi, India
| | - Vimi Rewari
- Department of Anesthesiology, Pain Medicine and Critical Care, All India Institute of Medical Sciences, New Delhi, India
| | - Chandralekha
- Department of Anesthesiology, Pain Medicine and Critical Care, All India Institute of Medical Sciences, New Delhi, India
| | | | - Anjan Trikha
- Department of Anesthesiology, Pain Medicine and Critical Care, All India Institute of Medical Sciences, New Delhi, India
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