Deciphering the Etiology of Weight Loss Following Pancreatectomy
Recurrence rates after resection for pancreatic cancer are high, with >70% of patients developing recurrence within 1 year following their index operation.1 While guidelines recommend close surveillance with cross-sectional imaging every 3–6 months postoperatively for the first 2 years, population-level studies show that only 40% of patients actually undergo imaging surveillance by the 2-year mark.2 Additionally, the current gold-standard serum biomarker, carbohydrate antigen (CA) 19-9, is not synthesized in 10% of patients and is normal in another one-third of patients, limiting its clinical [...]
Proposal for a New Pathologic Prognostic Index After Neoadjuvant Chemotherapy in Pancreatic Ductal Adenocarcinoma (PINC)
Background Limited information is available on the relevant prognostic variables after surgery for patients with pancreatic ductal adenocarcinoma (PDAC) subjected to neoadjuvant chemotherapy (NACT). NACT is known to induce a spectrum of histological changes in PDAC. Different grading regression systems are currently available; unfortunately, they lack precision and accuracy. We aimed to identify a new quantitative prognostic index based on tumor morphology. Patients and Methods The study population was composed of 69 patients with resectable or borderline resectable PDAC treated [...]
Deciphering the Etiology of Weight Loss Following Pancreatectomy
Recurrence rates after resection for pancreatic cancer are high, with >70% of patients developing recurrence within 1 year following their index operation.1 While guidelines recommend close surveillance with cross-sectional imaging every 3–6 months postoperatively for the first 2 years, population-level studies show that only 40% of patients actually undergo imaging surveillance by the 2-year mark.2 Additionally, the current gold-standard serum biomarker, carbohydrate antigen (CA) 19-9, is not synthesized in 10% of patients and is normal in another one-third of patients, limiting its clinical [...]
Proposal for a New Pathologic Prognostic Index After Neoadjuvant Chemotherapy in Pancreatic Ductal Adenocarcinoma (PINC)
Background Limited information is available on the relevant prognostic variables after surgery for patients with pancreatic ductal adenocarcinoma (PDAC) subjected to neoadjuvant chemotherapy (NACT). NACT is known to induce a spectrum of histological changes in PDAC. Different grading regression systems are currently available; unfortunately, they lack precision and accuracy. We aimed to identify a new quantitative prognostic index based on tumor morphology. Patients and Methods The study population was composed of 69 patients with resectable or borderline resectable PDAC treated [...]
Prognostic Effect of Aberrant Right Hepatic Artery with Pancreaticoduodenectomy: Focus on Hepatic Recurrence
Introduction Metastatic progression occurs along the locoregional vasculature, and a common anatomic variant is an aberrant right hepatic artery (aRHA). This study evaluated the effect of an aRHA following pancreaticoduodenectomy, with a focus on hepatic metastases. Methods This was a single-institution retrospective review of non-metastatic pancreatic cancer cases between 2012 and 2020. aRHA cases were compared with patients with conventional anatomy. The primary outcome was hepatic recurrence rates, while secondary analysis survival outcomes were measured by overall survival (OS) and [...]
Importance of Nodal Metastases Location in Pancreatoduodenectomy for Pancreatic Ductal Adenocarcinoma: Results from a Prospective, Lymphadenectomy Protocol
Background Implementing a prospective lymphadenectomy protocol, we investigated the nodal yields and metastases per anatomical stations and nodal echelon following upfront pancreatoduodenectomy (PD) for cancer. Next, the relationship between the extension of nodal dissection, the number of examined and positive nodes (ELN/PLN), disease staging and prognosis was assessed. Methods Lymphadenectomy included stations 5, 6, 8a-p, 12a-b-p, 13, 14a-b, 17, and jejunal mesentery nodes. Data were stratified by N-status, anatomical stations, and nodal echelons. First echelon was defined as stations embedded [...]