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المؤلفون: Richard A. Burkhart, Lei Zheng, Daniel A. Laheru, Christopher L. Wolfgang, Matthew J. Weiss, Alex B. Blair, Minako Nagai, Kelly J. Lafaro, Jin He, Georgios Gemenetzis, Joseph M. Herman, Ding Ding, Elliot K. Fishman, Ralph H. Hruban, Amol Narang, Vincent P. Groot, Ammar A. Javed, William R. Burns, John L. Cameron
المصدر: Annals of surgical oncology. 29(1)
مصطلحات موضوعية: Chemotherapy, medicine.medical_specialty, business.industry, medicine.medical_treatment, Anatomical structures, Interdisciplinary Studies, urologic and male genital diseases, Resection, Locally advanced pancreatic cancer, Radiation therapy, Pancreatic Neoplasms, Oncology, Surgical oncology, Induction therapy, medicine, Humans, Surgery, In patient, Radiology, Prospective Studies, business
الوصف: The introduction of multi-agent chemotherapy and radiation therapy has facilitated potential resection with curative intent in selected locally advanced pancreatic cancer (LAPC) patients with excellent outcomes. Nevertheless, there remains a remarkable lack of consensus on the management of LAPC. We sought to describe the outcomes of patients with LAPC and objectively define the multidisciplinary selection process for operative exploration based on anatomical factors. Consecutive patients with LAPC were evaluated for pancreatic surgery in the multidisciplinary clinic of a high-volume institution, between 2013 and 2018. Prospective stratification (LAPC-1, LAPC-2, and LAPC-3), based on the involvement of regional anatomical structures, was performed at the time of presentation prior to the initiation of treatment. Resection rates and patient outcomes were evaluated and correlated with the initial anatomic stratification system. Overall, 415 patients with LAPC were included in the study, of whom 84 (20%) were successfully resected, with a median overall survival of 35.3 months. The likelihood of operative exploration was associated with the pretreatment anatomic LAPC score, with a resection rate of 49% in patients classified as LAPC-1, 32% in LAPC-2, and 11% in LAPC-3 (p
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المؤلفون: John L. Cameron, Roberto J. Rivero-Soto, Vincent P. Groot, Jun Yu, Alex B. Blair, Jin He, Matthew J. Weiss, Georgios Gemenetzis, Inne H.M. Borel Rinkes, Ammar A. Javed, Christopher L. Wolfgang, I. Quintus Molenaar, Richard A. Burkhart
المصدر: Annals of Surgery, 269(6), 1154. Lippincott Williams and Wilkins
مصطلحات موضوعية: Adult, Male, medicine.medical_specialty, Time Factors, Pancreatic ductal adenocarcinoma, Early Recurrence, medicine.medical_treatment, Research Support, Disease-Free Survival, Resection, Cohort Studies, 03 medical and health sciences, Pancreatectomy, 0302 clinical medicine, Risk Factors, Late Recurrence, Journal Article, Carcinoma, Humans, Pancreatic Neoplasms/mortality, Medicine, Non-U.S. Gov't, Survival rate, Neoplasm Recurrence, Local/epidemiology, Pancreatic Ductal/mortality, Local/epidemiology, business.industry, Research Support, Non-U.S. Gov't, Background data, Middle Aged, medicine.disease, Combined Modality Therapy, Pancreatic Neoplasms, Survival Rate, Neoplasm Recurrence, 030220 oncology & carcinogenesis, Female, 030211 gastroenterology & hepatology, Surgery, Radiology, Neoplasm Recurrence, Local, Carcinoma, Pancreatic Ductal/mortality, business, Carcinoma, Pancreatic Ductal
الوصف: OBJECTIVES: To establish an evidence-based cut-off to differentiate between early and late recurrence and to compare clinicopathologic risk factors between the two groups. SUMMARY BACKGROUND DATA: A clear definition of "early recurrence" after pancreatic ductal adenocarcinoma resection is currently lacking. METHODS: Patients undergoing pancreatectomy for pancreatic ductal adenocarcinoma between 2000 and 2013 were included. Exclusion criteria were neoadjuvant therapy and incomplete follow-up. A minimum P-value approach was used to evaluate the optimal cut-off value of recurrence-free survival to divide the patients into early and late recurrence cohorts based on subsequent prognosis. Potential risk factors for early recurrence were assessed with logistic regression models. RESULTS: Of 957 included patients, 204 (21.3%) were recurrence-free at last follow-up. The optimal length of recurrence-free survival to distinguish between early (n = 388, 51.5%) and late recurrence (n = 365, 48.5%) was 12 months (P < 0.001). Patients with early recurrence had 1-, and 2-year post-recurrence survival rates of 20 and 6% compared with 45 and 22% for the late recurrence group (both P < 0.001). Preoperative risk factors for early recurrence included a Charlson age-comorbidity index ≥4 (OR 1.65), tumor size > 3.0 cm on computed tomography (OR 1.53) and CA 19-9 > 210 U/mL (OR 2.30). Postoperative risk factors consisted of poor tumor differentiation grade (OR 1.66), microscopic lymphovascular invasion (OR 1.70), a lymph node ratio > 0.2 (OR 2.49), and CA 19-9 > 37 U/mL (OR 3.38). Adjuvant chemotherapy (OR 0.28) and chemoradiotherapy (OR 0.29) were associated with a reduced likelihood of early recurrence. CONCLUSION: A recurrence-free interval of 12 months is the optimal threshold for differentiating between early and late recurrence, based on subsequent prognosis.
وصف الملف: image/pdf
URL الوصول: https://explore.openaire.eu/search/publication?articleId=doi_dedup___::35dbe074b111a744591310d00ff9291a
https://doi.org/10.1097/sla.0000000000002734 -
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المؤلفون: Ralph H. Hruban, Vincent P. Groot, Christopher L. Wolfgang, Matthew J. Weiss, Sameer S. Thakker, Jin He, Elliot K. Fishman, John L. Cameron, Christopher J. VandenBussche, Behnoud Baradaran Noveiry, Richard A. Burkhart, Anne Marie Lennon, Georgios Gemenetzis, Michaël Noë, Ammar A. Javed
المصدر: HPB, 20(7), 612. John Wiley and Sons Inc.
مصطلحات موضوعية: Endoscopic ultrasound, Adult, Male, medicine.medical_specialty, Cholangiopancreatography, Magnetic Resonance, medicine.medical_treatment, Unnecessary Procedures, Diagnosis, Differential, 03 medical and health sciences, Young Adult, 0302 clinical medicine, Pancreatectomy, Predictive Value of Tests, Internal medicine, Biopsy, medicine, Humans, Endoscopic Ultrasound-Guided Fine Needle Aspiration, Aged, Retrospective Studies, medicine.diagnostic_test, Hepatology, business.industry, fungi, Gastroenterology, Magnetic resonance imaging, Middle Aged, Prognosis, Magnetic Resonance Imaging, Cystic Neoplasm, Pancreatic Neoplasms, medicine.anatomical_structure, Fine-needle aspiration, 030220 oncology & carcinogenesis, 030211 gastroenterology & hepatology, Female, Radiology, sense organs, Pancreatic Cyst, Pancreas, business, Neoplasms, Cystic, Mucinous, and Serous, Tomography, X-Ray Computed, Precancerous Conditions
الوصف: Background Lymphoepithelial cysts (LECs) are rare pancreatic cystic lesions. Since LECs are benign, preoperative diagnosis is important to differentiate from a cystic neoplasm and avoid unnecessary surgery. The aim of this study was to identify clinical, radiographic and cytopathologic features associated with LECs. Methods A retrospective review was performed of patients diagnosed with LEC between 1995 and 2017 at our hospital. Clinicopathologic and radiographic imaging features were documented. Results Of 29 patients with pancreatic LEC, 22 underwent surgical resection. The majority were male (n = 24) with a median age of 55 years (range, 21-74). During the evaluation, all patients underwent a CT, with endoscopic ultrasound (EUS) guided fine needle aspiration (FNA) biopsy (n = 22) and/or MRI/MRCP (n = 11) performed in a smaller number of patients. A combination of exophytic tumor growth on imaging and the presence of specific cytomorphologic features on the EUS-FNA cytology biopsy led to the correct diagnosis of LEC and prevention of unnecessary surgery in 7 patients. Discussion Differentiating LECs from premalignant pancreatic cystic neoplasms remains difficult. Findings of an exophytic growth pattern of the lesion on abdominal imaging and the presence of specific cytomorphologic features in the EUS-FNA biopsy could help clinicians diagnose LEC preoperatively.
وصف الملف: image/pdf
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المؤلفون: Matthew J. Weiss, John L. Cameron, Christopher L. Wolfgang, Lei Zheng, Jin He, Lauren M. Rosati, Joseph M. Herman, Georgios Gemenetzis, Ralph H. Hruban, Alex B. Blair, Neda Rezaee
مصطلحات موضوعية: Male, medicine.medical_specialty, medicine.medical_treatment, Radiosurgery, Article, 03 medical and health sciences, 0302 clinical medicine, Pancreatectomy, Postoperative Complications, medicine, Carcinoma, Humans, Neoadjuvant therapy, Aged, Retrospective Studies, Chemotherapy, business.industry, Retrospective cohort study, Perioperative, Middle Aged, medicine.disease, Neoadjuvant Therapy, Pancreatic Neoplasms, 030220 oncology & carcinogenesis, Cohort, Baltimore, 030211 gastroenterology & hepatology, Surgery, Female, Radiology, business, Carcinoma, Pancreatic Ductal
الوصف: The impact of neoadjuvant stereotactic body radiation therapy on postoperative complications for patients with borderline resectable or locally advanced pancreatic ductal adenocarcinoma remains unclear. Limited studies have compared neoadjuvant stereotactic body radiation therapy versus conventional chemoradiation therapy. A retrospective study was performed to determine if perioperative complications were different among patients with borderline resectable or locally advanced pancreatic ductal adenocarcinoma receiving neoadjuvant stereotactic body radiation therapy or chemoradiation therapy.Patients with borderline resectable or locally advanced pancreatic ductal adenocarcinoma who underwent neoadjuvant chemotherapy with stereotactic body radiation therapy or chemoradiation therapy followed by pancreatectomy at the Johns Hopkins Hospital between 2008 and 2015 were included. Predictive factors for severe complications (Clavien grade ≥ III) were assessed by univariate and multivariate analyses.A total of 168 patients with borderline resectable or locally advanced pancreatic ductal adenocarcinoma underwent neoadjuvant chemotherapy and RT followed by pancreatectomy. Sixty-one (36%) patients underwent stereotactic body radiation therapy and 107 (64%) patients received chemoradiation therapy. Compared with the chemoradiation therapy cohort, the neoadjuvant stereotactic body radiation therapy cohort was more likely to have locally advanced pancreatic ductal adenocarcinoma (62% vs 43% P = .017) and require a vascular resection (54% vs 37%, P = .027). Multiagent chemotherapy was used more commonly in the stereotactic body radiation therapy cohort (97% vs 75%, P .001). Postoperative complications (Clavien grade ≥ III 23% vs 28%, P = .471) were similar between stereotactic body radiation therapy and chemoradiation therapy cohort. No significant difference in postoperative bleeding or infection was noted in either group.Compared with chemoradiation therapy, neoadjuvant stereotactic body radiation therapy appears to offer equivalent rates of perioperative complications in patients with borderline resectable or locally advanced pancreatic ductal adenocarcinoma despite a greater percentage of locally advanced disease and more complex operative treatment.
URL الوصول: https://explore.openaire.eu/search/publication?articleId=doi_dedup___::b44d9bbf2a0e3ed77c19168c025dd8ef
https://europepmc.org/articles/PMC6220675/
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