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1.
Nicolas Santucci Olivier Facy Pablo Ortega-Deballon Jean-Baptiste Lequeu Paul Rat Patrick Rat 《Pancreatology》2018,18(6):666-670
Background
Surgical resection remains the only curative option for pancreatic adenocarcinoma. Despite recent improvements in medical imaging, unresectability is still often discovered at the time of surgery. It is essential to identify unresectable patients preoperatively to avoid unnecessary surgery. High serum CA 19-9 levels have been suggested as a marker of unresectability but considered inaccurate in patients with hyperbilirubinemia.Aim of the study
To evaluate CA 19-9 serum levels as a predictor of unresectability of pancreatic adenocarcinomas with a special focus on jaundiced patients.Methods
All patients presenting with histologically-confirmed pancreatic adenocarcinoma and having serum CA 19-9 levels available prior to any treatment were included in this retrospective study. The relationship between serum concentrations of CA 19–9 and resectability was studied by regression analysis and theROC curves obtained. A cut-off value of CA 19–9 was calculated. In jaundiced patients, a CA 19–9 adjusted for bilirubinemia was also evaluated.Results
Of the 171 patients included, 49 (29%) were deemed resectable and 122 (71%) unresectable. Altogether, 93 patients (54%) had jaundice. The area under the ROC curve for CA 19–9 as a predictor of resectability was 0.886 (95%CI:[0.832–0.932]); in jaundiced patients it was 0.880 (95% CI [0.798–0.934]. A cut-off in CA 19–9?at 178 UI/mlyielded 85% sensitivity, 81% specificity and 91% positive predictive value for resectability. There was no correlation between the levels of bilirubin and CA 19–9 (r?=?0.149).Conclusion
Serum CA 19–9 is a good predictive marker of unresectability of pancreatic adenocarcinoma, even in jaundiced patients. CA 19-9 levels over 178 UI/ml strongly suggest unresectable disease. 相似文献2.
Systematic review on the role of serum tumor markers in the detection of recurrent pancreatic cancer
Lois A. Daamen Vincent P. Groot Hanne D. Heerkens Martijn P.W. Intven Hjalmar C. van Santvoort I. Quintus Molenaar 《HPB : the official journal of the International Hepato Pancreato Biliary Association》2018,20(4):297-304
Background
Biomarker testing can be helpful to monitor disease progression after resection of pancreatic cancer. This systematic review aims to give an overview of the literature on the diagnostic value of serum tumor markers for the detection of recurrent pancreatic cancer during follow-up.Methods
A systematic search was performed to 2 October 2017. All studies reporting on the diagnostic value of postoperatively measured serum biomarkers for the detection of pancreatic cancer recurrence were included. Data on diagnostic accuracy of tumor markers were extracted. Forest plots and pooled values of sensitivity and specificity were calculated.Results
Four articles described test results of CA 19-9. A pooled sensitivity and specificity of respectively 0.73 (95% CI 0.66–0.80) and 0.83 (95% CI 0.73–0.91) were calculated. One article reported on CEA, showing a sensitivity of 50% and specificity of 65%. No other serum tumor markers were discussed for surveillance purposes in the current literature.Conclusion
Although testing of serum CA 19-9 has considerable limitations, CA 19-9 remains the most used serum tumor marker for surveillance after surgical resection of pancreatic cancer. Further studies are needed to assess the role of serum tumor marker testing in the detection of recurrent pancreatic cancer and to optimize surveillance strategies. 相似文献3.
Leonardo Solaini Thijs de Rooij E. Madelief Marsman Wouter W. te Riele Pieter J. Tanis Thomas M. van Gulik Dirk J. Gouma Neal H. Bhayani Thilo Hackert Olivier R. Busch Marc G. Besselink 《HPB : the official journal of the International Hepato Pancreato Biliary Association》2018,20(10):881-887
Background
Radical resection of advanced pancreatic cancer may occasionally require a simultaneous colon resection. The risks and benefits of this combined procedure are largely unknown. This systematic review aimed to assess short and long term outcome after pancreatoduodenectomy with colon resection (PD-colon) for pancreatic ductal adenocarcinoma (PDAC).Methods
A systematic literature search was performed in PubMed, Embase, and the Cochrane Library for studies published between 1994 and 2017 concerning PD-colon for PDAC.Results
After screening 2038 articles, 5 articles with a total of 181 patients undergoing PD-colon were eligible for inclusion. Included studies showed a relatively low risk of bias. The pooled complication rate was 73% (95% CI 61–84) including a pooled colonic anastomotic leak rate of 5.5%. Pooled mortality was 10% (95% CI 6–15). Pooled mean survival (data from 86 patients) was 18 months (95% CI 13–23) with pooled 3- and 5-year survival of 31% (95% CI 20–72) and 19% (95% CI 6–38).Conclusion
Based on the available data, PD-colon for PDAC seems to be associated with an increased morbidity and mortality but with survival comparable with standard PD in selected patients. Future large series are needed to allow for better patient selection for PD-colon. 相似文献4.
Jony van Hilst Matteo de Pastena Thijs de Rooij Adnan Alseidi Olivier R. Busch Susan van Dieren Casper H. van Eijck Francesco Giovinazzo Bas Groot Koerkamp Giovanni Marchegiani G. Ryne Marshall Mohammed Abu Hilal Claudio Bassi Marc G. Besselink 《HPB : the official journal of the International Hepato Pancreato Biliary Association》2018,20(11):1044-1050
Background
Postoperative pancreatic fistula (POPF) remains the most common complication after distal pancreatectomy. The International Study Group on Pancreatic Surgery definition of POPF is used worldwide. Recently, an update of the definition was published. The aim of this study was to determine the clinical impact of the update.Methods
An international retrospective validation study, including patients who underwent DP (2005 –2016) in 5 centers was performed. Distribution of complications amongst POPF grades were compared for the old and updated definition.Results
In total, 1089 patients were included. The incidence of POPF decreased with the updated definition from 47% to 24% (P < 0.01), largely because a downgrade of grade A and grade B into biochemical leak. Comparable morbidity was seen in the old and updated ‘no POPF group’ (Clavien –Dindo 3 5% vs. 6% P = 0.320 and hospital stay (7 vs. 7 days P = 0.301). The change in definition of POPF grade B resulted in more Clavien –Dindo 3 (38% vs. 51%) P < 0.01) and longer hospital stay (9 [9 –13] vs. 9 days [7 –15] P < 0.01) in the updated `grade B group’.Conclusion
Applying the updated POPF definition showed improved discrimination between grades and should therefore be used to report POPF after DP. 相似文献5.
Kazunari Sasaki Georgios A. Margonis Nikolaos Andreatos Qinyu Chen Carlotta Barbon Fabio Bagante Matthew Weiss Irinel Popescu Hugo P. Marques Luca Aldrighetti Shishir K. Maithel Carlo Pulitano Todd W. Bauer Feng Shen George A. Poultsides Olivier Soubrane Guillaume Martel Bas Groot Koerkamp Timothy M. Pawlik 《HPB : the official journal of the International Hepato Pancreato Biliary Association》2018,20(10):956-965
Background
While several prognostic models have been developed to predict long-term outcomes in resectable intrahepatic cholangiocarcinoma (ICC), their prognostic discrimination remains limited. The addition of tumor markers might improve the prognostic power of the classification schemas proposed by the AJCC 8th edition and the Liver Cancer Study Group of Japan (LCSGJ).Methods
The prognostic discrimination of the AJCC and the LCSGJ were compared before and after the addition of CA 19-9 and CEA, using Harrell's C-index, net reclassification improvement (NRI) and the integrated discrimination improvement (IDI) in an international, multi-institutional cohort.Results
Eight hundred and five surgically treated patients with ICC that met the inclusion criteria were identified. On multivariable analysis, CEA5 ng/mL, 100IU/mL CA 19-9< 500IU/mL and CA 19-9500 IU/mL were associated with worse overall survival. The C-index of the AJCC and the LCSGJ improved from 0.540 to 0.626 and 0.553 to 0.626, respectively following incorporation of CA 19-9 and CEA. The NRI and IDI metrics confirmed the superiority of the modified AJCC and LCSGJ, compared to the original versions.Conclusion
The inclusion of preoperative CA 19-9 and CEA in the AJCC and LCSGJ staging schemas may improve prognostic discrimination among surgically treated patients with ICC. 相似文献6.
Guopei Luo Zhiyao Fan He Cheng Kaizhou Jin Meng Guo Yu Lu Chao Yang Kun Fan Qiuyi Huang Jiang Long Liang Liu Jin Xu Renquan Lu Quanxing Ni Andrew L. Warshaw Chen Liu Xianjun Yu 《Pancreatology》2018,18(8):971-976
Background
Carbohydrate antigen 19-9 (CA19-9) is the best-validated biomarker for pancreatic cancer. The National Comprehensive Cancer Network (NCCN) guideline asserts that “CA19-9 will be undetectable in Lewis antigen-negative individuals”. However, reports of CA19-9 secretion and its significance in Lewis (-) patients with pancreatic cancer have been inconsistent. This study was to examine serum CA19-9 levels in patients with pancreatic cancer according to Lewis status.Methods
Patients with pancreatic cancer (1482 cases) were retrieved from a prospectively maintained database. Patients with benign pancreatic disease (210 cases) and normal subjects (315 cases) were used as controls. Lewis genotypes were examined by fucosyltransferase 3 (FUT3) sequencing.Results
In patients with pancreatic cancer, 8.4% of subjects were Lewis (-), but only 41.9% of Lewis (-) subjects had CA19-9 values?≤?2 U/mL. CA19-9 was even elevated (>37 U/mL) in 27.4% of Lewis (-) patients. The area under the receiver operating characteristic (ROC) curve for CA19-9 as a diagnostic biomarker was 0.842 in Lewis (-) patients with pancreatic cancer, which is closing to that of CA19-9 applied in all of patients with pancreatic cancer (0.898). Lewis (-) status was an independent prognostic factor for shorter survival in a multivariable analysis (hazard ratio (HR), 1.30, 95% confidence interval (CI), 1.03–1.64; P?=?0.028).Conclusions
Not all Lewis (-) patients with pancreatic cancer are non-secretors of CA19-9. Contrary to general understanding, CA19-9 can retain its utility as a biomarker in these patients in spite of Lewis (-) genotype. 相似文献7.
Zhijian Wen Anfeng Si Jue Yang Pinghua Yang Xinwei Yang Hu Liu Xingzhou Yan Wengang Li Baohua Zhang 《HPB : the official journal of the International Hepato Pancreato Biliary Association》2017,19(11):951-956
Aims
The aim of this study was to determine whether a combination of the tumour markers carcinoembryonic (CEA) and carbohydrate antigen 19-9 (CA19-9) would be helpful in predicting the prognosis of patients with gallbladder carcinoma (GBC) who underwent resection.Methods
A retrospective analysis of clinico-pathological features and survival of 390 patients with GBC who were treated between January 2003 and December 2013. Time-dependent receiver operating characteristic (ROC) was used to evaluate the prognostic ability of tumour markers. Combinations of preoperative CEA and CA19-9 were tested as potential prognostic factors.Results
The evaluation of preoperative CEA and CA19-9 showed that patients with both tumour markers within the normal range had the best prognosis with a median survival of 27 months and R0 rate of 86%. Patients with both tumour markers elevated had the poorest prognosis and lower R0 rate (p < 0.001). The combination of CEA and CA19-9 was an independent risk factor for overall survival. The AUROC at 5 years of combination of CEA and CA19-9 was 0.798, which was similar to CEA (0.765) or CA19-9 (0.771) alone (p = 0.103, p = 0.147).Conclusions
A combination of an elevated preoperative CEA and CA19-9 was associated with a worse prognosis for patients with GBC who underwent resection. 相似文献8.
Rianne C.J. Beckers Doenja M.J. Lambregts Max J. Lahaye Sheng-Xiang Rao Kelly Kleinen Cecile Grootscholten Geerard L. Beets Regina G.H. Beets-Tan Monique Maas 《HPB : the official journal of the International Hepato Pancreato Biliary Association》2018,20(2):120-127
Background
The assessment of colorectal liver metastases (CRLM) after treatment with chemotherapy is challenging due to morphological and/or functional change without changes in size. The aim of this review was to assess the value of FDG-PET, FDG-PET-CT, CT and MRI in predicting response to chemotherapy in CRLM.Methods
A systematic review was undertaken based on PRISMA statement. PubMed and Embase were searched up to October 2016 for studies on the accuracy of PET, PET-CT, CT and MRI in predicting RECIST or metabolic response to chemotherapy and/or survival in patients with CRLM. Articles evaluating the assessment of response after chemotherapy were excluded.Results
Sixteen studies met the inclusion criteria and were included for further analysis. Study results were available for 6 studies for FDG-PET(-CT), 6 studies for CT and 9 studies for MRI. Generally, features predicting RECIST or metabolic response often predicted shorter survival. The ADC (apparent diffusion coefficient, on MRI) seems to be the most promising predictor of response and survival. In CT-related studies, few attenuation-related parameters and texture features show promising results. In FDG-PET(-CT), findings were ambiguous.Conclusion
Radiological data on the prediction of response to chemotherapy for CRLM is relatively sparse and heterogeneous. Despite that, a promising parameter might be ADC. Second, there seems to be a seemingly counterintuitive correlation between parameters that predict a good response and also predict poor survival. 相似文献9.
Hua-Xiang Xu Shuo Li Chun-Tao Wu Zi-Hao Qi Wen-Quan Wang Wei Jin He-Li Gao Shi-Rong Zhang Jin-Zhi Xu Chen Liu Jiang Long Jin Xu Quan-Xing Ni Xian-Jun Yu Liang Liu 《Pancreatology》2018,18(6):671-677
Objective
To evaluate the prediction of benefits from adjuvant chemoradiotherapy by postoperative serum CA19-9, CA125 and CEA.Methods
The relations between benefits from adjuvant chemoradiotherapy and levels of postoperative serum CA19-9, CA125 and CEA were investigated in 804 pancreatic adenocarcinoma patients who received radical resection.Results
Adjuvant chemoradiotherapy was an independent factor for late recurrence [12.2 vs. 8.5 months, P?=?0.001 for recurrence free survival (RFS)] and long survival [23.7 vs. 17.0 months, P?<?0.001 for overall survival (OS)] in resected pancreatic adenocarcinoma. Postoperative serum CA19-9, CA125 and CEA were independent risk predictors for poor surgical outcome in pancreatic adenocarcinoma (P?<?0.001 for all). Adjuvant chemradiotherapy (hazard ratio: 0.359, 95% confidence interval: 0.253–0.510, P?<?0.001 for OS; hazard ratio: 0.522, 95% confidence interval: 0.387–0.705, P?<?0.001 for RFS) were confirmed to improve the surgical outcome in patients with abnormal levels of any one of the three postoperative markers, but not in patients with normal levels of the three postoperative markers. In the subgroup of patients with negative lymph node, its improvement of surgical outcome was also significant in patients with abnormal levels of any one of postoperative serum CA19-9, CA125 and CEA (hazard ratio: 0.412, 95% confidence interval: 0.244–0.698, P?=?0.001 for OS; hazard ratio: 0.546, 95% confidence interval: 0.352–0.847, P?=?0.007 for RFS).Conclusion
Postoperative serum CA19-9, CA125 and CEA could serve as predictors of response for adjuvant chemoradiotherapy even if the status of lymph nodes is negative. 相似文献10.
Aafke H. van Dijk Philip R. de Reuver Marc G. Besselink Kees J. van Laarhoven Ewen M. Harrison Stephen J. Wigmore Tom J. Hugh Marja A. Boermeester 《HPB : the official journal of the International Hepato Pancreato Biliary Association》2017,19(4):297-309
Background
Gallstone disease is a frequent disorder in the Western world with a prevalence of 10–20%. Recommendations for the assessment and management of gallstones vary internationally. The aim of this systematic review was to assess quality of guideline recommendations for treatment of gallstones.Methods
PubMed, EMBASE and websites of relevant associations were systematically searched. Guidelines without a critical appraisal of literature were excluded. Quality of guidelines was determined using the AGREE II instrument. Recommendations without consensus or with low level of evidence were considered to define problem areas and clinical research gaps.Results
Fourteen guidelines were included. Overall quality of guidelines was low, with a mean score of 57/100 (standard deviation 19). Five of 14 guidelines were considered suitable for use in clinical practice without modifications. Ten recommendations from all included guidelines were based on low level of evidence and subject to controversy. These included major topics, such as definition of symptomatic gallstones, indications for cholecystectomy and intraoperative cholangiography.Conclusion
Only five guidelines on gallstones are evidence-based and of a high quality, but even in these controversy exists on important topics. High quality evidence is needed in specific areas before an international guideline can be developed and endorsed worldwide. 相似文献11.
Ryuta Shintakuya Naru Kondo Yoshiaki Murakami Kenichiro Uemura Naoya Nakagawa Keisuke Okano Shinya Takahashi Taijiro Sueda 《Pancreatology》2018,18(2):191-197
Background
Although postoperative adjuvant chemotherapy for pancreatic ductal adenocarcinoma (PDAC) improves survival, its efficacy varies among individuals. Identification of biomarkers that can predict the efficacy of adjuvant chemotherapy for PDAC is essential.Objectives
To investigate the predictive value of secreted protein acidic and rich in cysteine (SPARC) expression in patients with PDAC treated with adjuvant gemcitabine in combination with S-1 (adjuvant GS) or adjuvant gemcitabine alone (adjuvant G alone).Methods
Stromal SPARC and cytoplasmic SPARC were examined immunohistochemically in 211 PDAC patients treated with adjuvant GS or G alone after resection. The association of SPARC expression with clinicopathological factors, disease-free survival (DFS) and overall survival (OS) were analyzed.Results
In multivariate analysis, borderline resectable with arterial contact (BR-A) (P?=?.002), higher preoperative CA 19-9 level (≥91 U/ml) (P?=?.005), moderately or poorly (P?=?.003), presence of lymph node metastasis (P?=?.012) and high stromal SPARC expression (P?=?.013) were independent predictors of poor DFS. Moreover, BR-A (P?=?.003), higher preoperative CA 19-9 level (≥91 U/ml) (P?=?.007) and high stromal SPARC expression (P?<?.001) were identified as independent predictors of poor OS. In contrast, cytoplasmic SPARC expression did not affect DFS and OS.Conclusions
High stromal SPARC expression was an independent predictor of poor DFS and OS in patients treated with adjuvant GS or G alone. Stromal SPARC expression could be a relevant biomarker for prediction of prognosis in PDAC patients after resection treated with adjuvant GS or G alone. 相似文献12.
Jony van Hilst Thijs de Rooij Mohammed Abu Hilal Horacio J. Asbun Jeffrey Barkun Uggo Boggi Olivier R. Busch Kevin C.P. Conlon Marcel G. Dijkgraaf Ho-Seong Han Paul D. Hansen Michael L. Kendrick Andre L. Montagnini Chinnusamy Palanivelu Bård I. Røsok Shailesh V. Shrikhande Go Wakabayashi Herbert J. Zeh Marc G.H. Besselink 《HPB : the official journal of the International Hepato Pancreato Biliary Association》2017,19(3):190-204
Background
The introduction of minimally invasive pancreatic resection (MIPR) into surgical practice has been slow. The worldwide utilization of MIPR and attitude towards future perspectives of MIPR remains unknown.Methods
An anonymous survey on MIPR was sent to the members of six international associations of Hepato-Pancreato-Biliary (HPB) surgery.Results
The survey was completed by 435 surgeons from 50 countries, with each surgeon performing a median of 22 (IQR 12–40) pancreatic resections annually. Minimally invasive distal pancreatectomy (MIDP) was performed by 345 (79%) surgeons and minimally invasive pancreatoduodenectomy (MIPD) by 124 (29%). The median total personal experience was 20 (IQR 10–50) MIDPs and 12 (IQR 4–40) MIPDs. Current superiority for MIDP was claimed by 304 (70%) and for MIPD by 44 (10%) surgeons. The most frequently mentioned reason for not performing MIDP (54/90 (60%)) and MIPD (193/311 (62%)) was lack of specific training. Most surgeons (394/435 (90%)) would consider participating in an international registry on MIPR.Discussion
This worldwide survey showed that most participating HPB surgeons value MIPR as a useful development, especially for MIDP, but the role and implementation of MIPD requires further assessment. Most HPB surgeons would welcome specific training in MIPR and the establishment of an international registry. 相似文献13.
Marcia P. Gaspersz Stefan Buettner Jeroen L.A. van Vugt Eva Roos Robert J.S. Coelen Jaynee Vugts Eric J. Belt Jeroen de Jonge Wojciech G. Polak François E.J.A. Willemssen Thomas M. van Gulik Jan N.M. IJzermans Bas Groot Koerkamp 《HPB : the official journal of the International Hepato Pancreato Biliary Association》2017,19(11):966-971
Background
Conditional survival is the life expectancy from a point in time for a patient who has survived a specific period after presentation.The aim of the study was to estimate conditional survival for patients with unresectable perihilar cholangiocarcinoma.Methods
Patients with unresectable perihilar cholangiocarcinoma from two academic hospitals in the Netherlands between 2002 and 2012 were assessed. A multivariable Cox proportional hazards analysis was performed to identify risk factors associated with overall survival. Survival was estimated using the Kaplan–Meier method to evaluate factors associated with overall survival.Results
In total, 572 patients were included. Overall survival was 42% at one year and 6% at three years. The conditional chance of surviving three years was 15% at 1 year and increased to 38% at 2 years. Independent poor prognostic factors for overall survival were age ≥65 years, tumor size >3 cm on imaging, bilirubin levels (>250 μmol/L), CA19-9 level at presentation (>1000 U/ml), and suspected distant metastases on imaging. The conditional survival of patients with and without these prognostic factors was comparable after patients survived the first two or more years.Conclusion
The conditional chance of surviving for patients with unresectable perihilar cholangiocarcinoma increases with time. Poor prognostic factors become less relevant once patients have survived two years. 相似文献14.
Jae Hyuck Jun Sung Koo Lee So Yeon Kim Dong Hui Cho Tae Jun Song Do Hyun Park Sang Soo Lee Dong-Wan Seo Myung-Hwan Kim 《Pancreatology》2018,18(7):805-811
Background/objectives
The pancreatoduodenal groove (anatomical groove) is a potential space bordered by the head of the pancreas, duodenum, and common bile duct. Discerning between groove carcinoma (GC) and groove pancreatitis (GP) is often difficult, but clinically important. We retrospectively analyzed and compared the findings of computed tomography (CT), laboratory tests, and endoscopic ultrasound-fine needle aspiration (EUS-FNA) for GC and GP.Methods
GC (n?=?36) and GP (n?=?44) patients at Asan Medical Center from January 1, 2000, to May 31, 2017 were retrospectively reviewed. MDCT findings, baseline characteristics, laboratory test results, and EUS and EUS-FNA findings of GC and GP patients were compared.Results
CT showed no significant difference in groove enhancement between the groups. Mass-like lesions, cystic groove lesions, and calcification were observed in 86.1% and 15.9%, 38.9% and 75%, and 2.8% and 29.5% of GC and GP patients, respectively. Patients were tested for total bilirubin (GC: 2.0 vs. GP: 0.6?mg/dL), cancer antigen 19-9 (CA19-9) (GC: 76 vs. GP: 12.5 U/mL), and carcinoembryonic antigen (GC: 2.4 vs. GP: 2?ng/mL). Three GP patients died, and one GP patient was diagnosed with GC. However, among 30?GC patients with at least 1-year follow-up, 20 died. In multivariate logistic regression, CA19-9, and mass-like lesion on multidetector CT (MDCT) were discriminating factors between GC and GP. Among 23 (10?GC, 13?GP) patients who underwent EUS-FNA, the diagnostic sensitivity, specificity, positive predictive value, negative predictive value, accuracy of EUS-FNA were 90%, 100%, 100%, 92.86%, and 95.65%, respectively.Conclusions
Several MDCT and laboratory findings favor GC over GP. EUS-FNA should be considered in patients with elevated CA19-9 levels and mass-like lesions on MDCT. 相似文献15.
Linda M. Pak Mark A. Schattner Vinod Balachandran Michael I. D&#x;Angelica Ronald P. DeMatteo T. Peter Kingham William R. Jarnagin Peter J. Allen 《HPB : the official journal of the International Hepato Pancreato Biliary Association》2018,20(2):182-187
Background
Elevation in the serum immunoglobulin-G4 (IgG4) level has been used as a diagnostic marker to distinguish autoimmune pancreatitis (AIP) from pancreatic ductal adenocarcinoma (PDAC), but its true utility is ill-defined. This study evaluates the clinical utility of IgG4 in differentiating AIP from PDAC.Methods
All patients evaluated in the hepatopancreaticobiliary surgery clinics with measured serum IgG4 were included. Patients were divided into normal IgG4 (<135 mg/dL) and elevated IgG4 (≥135 mg/dL) groups. The final diagnosis was determined by operative pathology when available or by clinical outcome. The sensitivity, specificity, PPV, and NPV of IgG4 for diagnosing AIP was assessed.Results
Between 1997 and 2015, 298 patients were identified. Normal IgG4 levels were present in 85% of patients (254/298), while 15% (44/298) were elevated. The overall prevalence of AIP was 17% (52/298). The sensitivity and specificity of IgG4 for AIP was 67% and 96%, respectively; however, the PPV was only 80%, including a 9% occurrence of PDAC in patients with an elevated IgG4.Conclusion
In this study of selected patients who underwent IgG4 testing, 9% of elevated IgG4 patients had PDAC. The overreliance on IgG4 as diagnostic for AIP may lead to mis-diagnosis and delayed treatment for PDAC. 相似文献16.
Shuichi Fujioka Takeyuki Misawa Tomoyoshi Okamoto Takeshi Gocho Yasuro Futagawa Yuichi Ishida Katsuhiko Yanaga 《Journal of hepato-biliary-pancreatic sciences》2007,14(6):539-544
Background Purpose
Although carcinoembryonic antigen (CEA) and carbohydrate antigen 19-9 (CA19-9) are the most studied serum tumor markers that have been evaluated for diagnosis and prognosis in patients with pancreatic cancer, little is known of the value of these markers for the prediction of curability and resectability.Methods
We retrospectively reviewed preoperative serum levels of CEA and CA 19-9 in 244 consecutive patients with pancreatic operations.Results
Although 159 pancreatic operations seemed “resectable”, 93 of them were judged curative (R0) and the other 66 turned out to be noncurative (R1/2). The remaining 85 failed resection because of unexpected metastasis or locally advanced disease (LD), which was unresectable compared with levels in those patients without liver metastasis or LD. CEA levels were significantly higher in patients with liver metastasis and LD, while CA 19-9 levels were correlated with liver and peritoneal metastases. When both markers were negative, curative (R0) and respectable (R0 + R1/2) operation were performed in 70% and 85% of patients, respectively. Logistic regression analysis indicated that under conditions where both CEA and CA 19-9 were negative, the odds ratios for curative and respectable operations were 4.43 and 3.58, respectively.Conclusions
Our data suggest that combined preoperative CEA and CA 19-9 levels are suitable for assessing expected curability and resectability in patients with pancreatic cancer.17.
Pim B. Olthof Robert J.S. Coelen Jimme K. Wiggers Bas Groot Koerkamp Massimo Malago Roberto Hernandez-Alejandro Stefan A. Topp Marco Vivarelli Luca A. Aldrighetti Ricardo Robles Campos Karl J. Oldhafer William R. Jarnagin Thomas M. van Gulik 《HPB : the official journal of the International Hepato Pancreato Biliary Association》2017,19(5):381-387
Introduction
Resection of perihilar cholangiocarcinoma (PHC) entails high-risk surgery with postoperative mortality reported up to 18%, even in specialized centers. The aim of this study was to compare outcomes of PHC patients who underwent associating liver partition and portal vein ligation for staged hepatectomy (ALPPS) to patients who underwent resection without ALPPS.Methods
All patients who underwent ALPPS for PHC were identified from the international ALPPS registry and matched controls were selected from a standard resection cohort from two centers based on future remnant liver size. Outcomes included morbidity, mortality, and overall survival.Results
ALPPS for PHC was associated with 48% (14/29) 90-day mortality. 90-day mortality was 13% in 257 patients who underwent major liver resection for PHC without ALPPS. The 29 ALPPS patients were matched to 29 patients resected without ALPPS, with similar future liver remnant volume (P = 0.480). Mortality in the matched control group was 24% (P = 0.100) and median OS was 27 months, comparted to 6 months after ALPPS (P = 0.064).Discussion
Outcomes of ALPPS for PHC appear inferior compared to standard extended resections in high-risk patients. Therefore, portal vein embolization should remain the preferred method to increase future remnant liver volume in patients with PHC. ALPPS is not recommended for PHC. 相似文献18.
Hanne D. Heerkens Lisanne van Berkel Dorine S.J. Tseng Evelyn M. Monninkhof Hjalmar C. van Santvoort Jeroen Hagendoorn Inne H.M. Borel Rinkes Irene M. Lips Martijn Intven I. Quintus Molenaar 《HPB : the official journal of the International Hepato Pancreato Biliary Association》2018,20(2):188-195
Background
Surgery for pancreatic cancer yields significant morbidity and mortality risks and survival is limited. Therefore, the influence of complications on quality of life (QoL) after pancreatic surgery is important. This study compares QoL in patients with and without severe complications after surgery for pancreatic (pre-)malignancy.Methods
This prospective cohort study scored complications after pancreatic surgery according to the Clavien–Dindo system and the definitions of the International Study Group of Pancreatic Surgery. QoL was measured by the RAND36 questionnaire, the European Organization for Research and Treatment of Cancer core questionnaire (QLQ-C30) and the pancreas specific QLQ-PAN26. QoL in patients with severe complications was compared with QoL in patients with no or mild complications over a period of 12 months. Analysis was performed with linear mixed models for repeated measurements.Results
Between March 2012 and July 2016, 137 patients were included. Sixty-eight patients (50%) had at least 1 severe complication. There were no statistically significant and clinically relevant differences between both groups in QoL up to 12 months after surgery.Conclusion
In this study, no differences in QoL between patients with and without severe postoperative complications were encountered during the first 12 months after surgery for pancreatic (pre-)malignancy.19.
Jesse Clanton Stephen Oh Stephen J. Kaplan Emily Johnson Andrew Ross Richard Kozarek Adnan Alseidi Thomas Biehl Vincent J. Picozzi William S. Helton David Coy Russell Dorer Flavio G. Rocha 《HPB : the official journal of the International Hepato Pancreato Biliary Association》2018,20(10):925-931
Background
Accurate prediction of mesenteric venous involvement in pancreatic ductal adenocarcinoma (PDAC) is necessary for adequate staging and treatment.Methods
A retrospective cohort study was conducted in PDAC patients at a single institution. All patients with resected PDAC and staging CT and EUS between 2003 and 2014 were included and sub-divided into “upfront resected” and “neoadjuvant chemotherapy (NAC)” groups. Independent imaging re-review was correlated to venous resection and venous invasion. Sensitivity, specificity, positive and negative predictive values were then calculated.Results
A total of 109 patients underwent analysis, 60 received upfront resection, and 49 NAC. Venous resection (30%) and vein invasion (13%) was less common in patients resected upfront than those who received NAC (53% and 16%, respectively). Both CT and EUS had poor sensitivity (14–44%) but high specificity (75–95%) for detecting venous resection and vein invasion in patients resected upfront, whereas sensitivity was high (84–100%) and specificity was low (27–44%) after NAC.Conclusions
Preoperative CT and EUS in PDAC have similar efficacy but different predictive capacity in assessing mesenteric venous involvement depending on whether patients are resected upfront or received NAC. Both modalities appear to significantly overestimate true vascular involvement and should be interpreted in the appropriate clinical context. 相似文献20.
M. Willemijn Steen Dennis C. van Duijvenbode Frederike Dijk Oliver R. Busch Marc G. Besselink Michael F. Gerhards Sebastiaan Festen 《HPB : the official journal of the International Hepato Pancreato Biliary Association》2018,20(4):289-296