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1.
Takahashi S Kinoshita T Konishi M Gotohda N Kato Y Kinoshita T Kobayashi T Mitsunaga S Nakachi K Ikeda M 《Journal of hepato-biliary-pancreatic sciences》2011,18(4):567-574
Background
Borderline resectable pancreatic cancer (BRPC) appears to be most frequently related to a positive surgical margin and has a poor prognosis after resection. However, few reports are available on differences in tumor characteristics and prognoses among resectable pancreatic cancer (PC), BRPC, and unresectable PC.Methods
Records of 133 patients resected for pancreatic ductal adenocarcinoma and 185 patients treated as locally advanced PC (LAPC) were reviewed.Results
Twenty-four patients who initially underwent resection (BRPC-s) and 10 patients who were initially treated as LAPC (BRPC-n) met the criteria for BRPC. Prognosis of BRPC was significantly better than that of unresectable PC, but was significantly worse than that of resectable PC. BRPC-s showed more frequent nerve plexus invasion (P < 0.01), portal vein invasion (P < 0.01), and loco-regional recurrence (P = 0.03) than resectable PC. The positive surgical margin rate was not significantly higher in BRPC-s (29%) than in resectable PC (19%) (P = 0.41).Conclusions
BRPC had a poorer prognosis with more local failure than resectable PC although prognosis of BRPC was significantly better than that of unresectable PC. Considering the tumor and treatment characteristics, multidisciplinary treatment including resection is required for BRPC. 相似文献2.
Akira Sawaki Noriyuki Hoki Satoko Ito Kazuya Matsumoto Nobumasa Mizuno Kazuo Hara Tadayuki Takagi Yuji Kobayashi Yugo Sawai Hiroki Kawai Masahiro Tajika Tsuneya Nakamura Kenji Yamao 《Journal of gastroenterology》2009,44(12):1209-1214
Background
Although a randomized controlled trial for locally advanced pancreatic cancer (PC) has demonstrated a survival advantage for treatment with gemcitabine alone, chemoradiotherapy remains the treatment of choice for locally advanced disease in Japan. The aim of this study was to compare the survival benefits associated with gemcitabine and concurrent chemoradiotherapy in locally advanced unresectable PC.Patients
Seventy-seven patients with locally advanced unresectable PC were retrospectively enrolled from April 2001 to December 2006. All cases were histologically proven, and patients received gemcitabine chemotherapy (n = 30) or concurrent chemoradiotherapy (based on 5-fluorouracil, n = 28, or gemcitabine, n = 19, as a radiosensitizer) at Aichi Cancer Center Hospital.Results
Patients who received chemoradiotherapy had significantly better performance status than those who had chemotherapy. Tumor response was 0% for chemotherapy and 13% chemoradiotherapy, but survival benefit was similar among patients in the chemotherapy group (overall response (OS) 12 months; progression-free survival (PFS), 3 months) and those in the chemoradiotherapy group (OS, 13 months; PFS, 5 months). Two-year survival was 21% for chemotherapy patients and 19% for chemoradiotherapy patients. Severe toxicities (Grade 3–4 National Cancer Institute-Common Toxicity Criteria, version 3.0) were significantly more frequent for chemoradiotherapy than for chemotherapy.Conclusions
Gemcitabine chemotherapy showed similar survival benefit compared to 5-fluorouracil- and gemcitabine-based chemoradiotherapy. 相似文献3.
Background
Duodenal obstruction from pancreatic cancer historically occurs in 2–25 % of patients without surgery, but with new advances in chemotherapy and radiation therapy, the life expectancy of pancreatic cancer has increased.Aim
The aim of the study was to determine the rate of development of duodenal obstruction requiring intervention in patients with pancreatic head adenocarcinoma who do not undergo surgical resection, but receive modern chemoradiation.Methods
It is a retrospective single center study. Inclusion criteria were patients with pancreatic cancer who underwent ERCP with metal biliary stent and then chemoradiation who subsequently developed symptomatic duodenal obstruction and underwent either metal duodenal stent placement or surgical duodenal bypass.Results
Twenty-four of 63 patients (38 %, 95 % CI 26–50 %) with unresectable pancreatic cancer and biliary stents who received chemotherapy and/or radiation therapy developed duodenal obstruction. The average length of time from diagnosis of pancreatic adenocarcinoma to development of outlet obstruction was 11.4 ± 4.9 months (range 1.5–40 months). Average length of time from development of duodenal obstruction to death was 4.8 ± 2.1 months (range 0.5–60 months). Average survival time from diagnosis to death was 16.6 ± 5.6 months (range 4.5–58 months).Conclusion
Thirty-eight percent of patients with unresectable pancreatic head adenocarcinoma and metal biliary stents who receive chemotherapy and/or radiation therapy eventually develop symptomatic duodenal obstruction requiring duodenal stent or surgical bypass. This rate of duodenal obstruction is nearly twice that of previous reports using older oncologic therapy and will likely increase as patients survive longer with advances in medical therapy for pancreatic cancer. 相似文献4.
Isabella Frigerio Roberto Girelli Alessandro Giardino Paolo Regi Roberto Salvia Claudio Bassi 《Journal of hepato-biliary-pancreatic sciences》2013,20(6):574-577
Background
Neo-adjuvant chemotherapy (CHT) has gained increasing importance in resectable and borderline resectable pancreatic cancer leading to a better performing surgery when we look at negative resection margins and selection of patients with less aggressive disease. We apply this principle to patients with Stage III (LAC) pancreatic cancer undergoing RFA and try to select patients who may benefit from a local treatment.Methods
All patients affected by LAC were treated with RFA for a stable disease after a short CHT. Postoperative morbidity and mortality were evaluated together with overall survival (OS) and disease specific survival (DSS).Results
We consecutively treated 57 patients affected by LAC. Median duration of CHT before RFA was 5 months. The postoperative mortality rate was zero. Overall morbidity was 14 % with RFA-related morbidity of 3.5 %. The OS and DSS were 19 months and when compared to a similar population who received RFA as up front treatment, there was no difference.Conclusions
Our results do not support the adoption of a short CHT as a way to identify patients to treat with RFA with the most benefit. Based on this and by knowing the role of immune modulation after RFA and its specific involvement in pancreatic carcinoma, we can propose RFA as upfront treatment. 相似文献5.
Kato K Kondo S Hirano S Tanaka E Shichinohe T Tsuchikawa T Matsumoto J 《Journal of hepato-biliary-pancreatic sciences》2011,18(5):712-716
Background
To evaluate the prognostic impact of surgical intervention for initially-unresectable pancreatic ductal adenocarcinomas with long-term favorable responses to chemotherapy.Method
Twelve patients with initially-unresectable pancreatic ductal carcinomas who underwent radical surgery after a favorable response to chemotherapy for six months or longer in principle were enrolled in this study. We retrospectively reviewed the charts of these 12 patients and performed a survival analysis.Results
Initially, the included patients were unable to undergo resection secondary to locally-advanced disease in eight patients and metastatic disease in four patients. The length of preoperative therapy was five to 44?months (median 12). The operative procedure included resection of the area initially involved by tumor and regional major vessels. The postoperative mortality and morbidity rates were 0% for patients with locally-advanced disease and 50% in those with metastatic disease. R0 resection was achieved in nine patients (75%) and pathological CR was seen in one patient. Estimated overall five-year survival from initial therapy was 50.0%. The survival rate (0% at 5?years) of the four patients with metastatic disease as the cause of initial unresectability was significantly worse than that (100% at 5?years) of the eight patients with locally-advanced disease (P?=?0.0014).Conclusion
Surgical intervention should be considered for patients with initially-unresectable pancreatic cancers who demonstrate long-term favorable responses to chemotherapy. R0 resection may significantly contribute to cure, especially in patients with initially locally-advanced disease. Large cohort prospective studies will be necessary to demonstrate the efficacy of this strategy. 相似文献6.
Sofuni A Moriyasu F Sano T Yamada K Itokawa F Tsuchiya T Tsuji S Kurihara T Ishii K Itoi T 《Journal of hepato-biliary-pancreatic sciences》2011,18(3):295-303
Introduction
Pancreatic carcinoma has one of the poorest prognoses among malignant tumors. Many pancreatic carcinoma patients who undergo common treatments, such as surgery, radio-chemotherapy and chemotherapy, gained little benefit because of the histological characteristics.Materials and methods
HIFU is a new technique of noninvasive treatment for unresectable pancreatic carcinoma. HIFU has the ability to ablate the deep tissues inside body from an external source using high-intensity focused ultrasound. The effects of HIFU can result in cell destruction and tissue necrosis.Results
Results from study in China in 251 patients with advanced pancreatic carcinoma suggested that HIFU treatment could reduce the size of tumors without causing complications and prolong survival. Moreover, according to some reports from China, HIFU treatment is suggested to be useful as the one of palliative treatments for unresectable pancreatic carcinoma. Our case of HIFU therapy for pancreatic carcinoma is presented including pathological findings in this paper. The results suggested that HIFU treatment might be effective in controlling local tumor.Conclusion
HIFU therapy may have the possibility of becoming one of the combination therapies for treating pancreatic carcinoma in the future. 相似文献7.
Kyoko Yorozuya Toru Takeuchi Miwa Yoshida Yukako Mouri Junko Kousaka Kimihito Fujii Shogo Nakano Takashi Fukutomi Kazuo Hara Shu Ichihara Yingsong Lin Shogo Kikuchi 《Journal of cancer research and clinical oncology》2010,136(6):939-944
Purpose
We sought to evaluate the use of the Onco type DX Breast Cancer Assay for identifying candidates for adjuvant therapy in patients with estrogen receptor (ER)-positive, node-negative primary Stage I or IIA breast cancer.Methods
A retrospective case–control study was conducted on 40 patients who underwent surgery between 2000 and 2008. Cases (n = 10) were patients who had metastases after surgery. Controls (n = 30) were patients who did not develop metastases and were individually matched to their case with respect to age. All patients were analyzed with regard to age, tumor size, histological grade, HER2 status, and the values of Recurrence Score (RS), ER score and PgR score generated by Onco type DX. We also divided the patients into low, intermediate or high-risk groups according to individual RS values.Results
RS, risk category and histological grade were associated with metastases in patients with ER-positive, node-negative Stage I or IIA breast cancer. However, ER status, tumor size and PgR status were not associated with metastases. Histological grade was associated with RS value and the distribution pattern of risk category (P < 0.001 for each).Conclusions
Both histological grade and risk-category classification were effective in identifying women at risk of developing distant metastases after initial therapy for ER-positive, node-negative Stage I or IIA breast cancer. These patients may benefit from the addition of adjuvant therapy at diagnosis. 相似文献8.
Hajime Ishikawa Motohiro Imano Osamu Shiraishi Atsushi Yasuda Ying-Feng Peng Masayuki Shinkai Takushi Yasuda Haruhiko Imamoto Kazuyoshi Takeda Hitoshi Shiozaki 《Esophagus》2012,9(2):105-112
Background
Up-regulated gene in lung cancer 10 (URLC10), confirmed to be lymphocyte antigen 6 complex locus K and defined as an oncoantigen, has been identified as a tumor-associated antigen by systematic analysis of expression levels of thousands of genes in lung cancer tissues and esophageal squamous cell carcinoma tissues, which were compared with those of normal human tissues by use of cDNA microarray analysis. Human leukocyte antigen (HLA)-A*2402-positive dendritic cells pulsed with URLC10-derived epitope peptide induced CD8+ cytotoxic T lymphocytes to exert specific cytotoxicity against the HLA-A*2402-positive URLC10-expressing esophageal carcinoma cell lines.Methods
In a phase I clinical trial we evaluated the safety and immunogenicity of a URLC10-177 peptide vaccine emulsified with Montanide ISA51 for patients with unresectable advanced esophageal cancer. One milligram of URLC10-177 peptide in 1 mL sterile saline was emulsified with 1 mL incomplete Freund’s adjuvant and administered subcutaneously to the inguinal region or axilla of the patients. One course of treatment comprised four vaccinations, which were performed every week in the first and second treatment courses and subsequently every 2 weeks after the first vaccination in the third treatment course.Results
Redness and induration of the skin were the only adverse events at the injection site and were believed to be a delayed-type hypersensitivity (DTH) reaction against the peptide vaccine. A URLC10-177-specific immune reaction in the enzyme-linked immunospot assay was detected in three of four DTH-positive patients (75 %) and in one of three DTH-negative patients (33 %). Furthermore, patients who had a DTH reaction seemed to survive longer than those who had no DTH reaction.Conclusion
URLC10-177 peptide/Montanide vaccine therapy was well tolerated and induced a URLC10-177 peptide-specific immune response. Therapeutic URLC10-177 peptide vaccination is expected to have clinical benefit in prolonging the survival of patients with unresectable advanced esophageal cancer. 相似文献9.
Kento Takatori Kazuki Terashima Rihito Yoshida Aya Horai Shinya Satake Takayuki Ose Naoto Kitajima Yoshikazu Kinoshita Yusuke Demizu Nobukazu Fuwa 《Journal of gastroenterology》2014,49(6):1074-1080
Background
Little is known about acute upper gastrointestinal (GI) complications associated with gemcitabine-concurrent proton radiotherapy (GPT) for inoperable pancreatic cancer. We investigated acute GI complications following GPT in patients with inoperable pancreatic cancer using small-bowel endoscopy.Methods
This prospective single center observational study was conducted at the Hyogo Ion Beam Medical Center from January 2010 to January 2012. Ninety-one patients who had clinically and medically inoperable pancreatic cancer treated by GPT were analyzed. Endoscopic examinations were performed before and after GPT to clarify the incidence rates of radiation-induced ulcers, GI hemorrhage, and GI perforation associated with GPT.Results
Post-treatment endoscopic examinations revealed that 45 (49.4 %) patients had radiation-induced ulcers in the stomach and duodenum. Of those, many ulcerative lesions were found in the lower stomach (51 %) and horizontal part of the duodenum (39 %), regardless of the primary tumor site in the pancreas. Neither GI hemorrhage, nor perforation, was found in post-treatment endoscopy examinations.Conclusion
Approximately half of the patients treated with GPT for inoperable pancreatic cancer exhibited radiation-induced ulcers in the stomach and duodenum. 相似文献10.
Masayuki Sho Takahiro Akahori Toshihiro Tanaka Shoichi Kinoshita Tetsuro Tamamoto Takeo Nomi Ichiro Yamato Daisuke Hokuto Satoshi Yasuda Chihiro Kawaguchi Hideyuki Nishiofuku Nagaaki Marugami Yasunori Enomonoto Takahiko Kasai Masatoshi Hasegawa Kimihiko Kichikawa Yoshiyuki Nakajima 《Journal of hepato-biliary-pancreatic sciences》2013,20(2):197-205
Background/purpose
The therapeutic options available as preoperative strategies for resectable pancreatic cancer have received worldwide attention. We have recently introduced neoadjuvant chemoradiotherapy (NACRT) to achieve local control and possibly complete cure. In this study, we have retrospectively evaluated its impact on pathology and the perioperative clinical course in addition to its safety.Methods
Sixty-one patients who received full-dose gemcitabine (1000 mg/m2) preoperatively with concurrent radiation (50 or 54 Gy) were evaluated. Seventy-one patients who received no preoperative therapy served as controls. Perioperative outcomes, postoperative complications, immunonutritional status, and the performance of adjuvant chemotherapy were compared.Results
Fifty-nine patients (97 %) completed NACRT. Toxicity was acceptable and the regimen was feasible as outpatient treatment. The perioperative outcomes were closely comparable to control. The rate of pancreatic fistula was lower and hospital stay was shorter in the NACRT group. The rate of lymph node metastasis and stage was lower in the NACRT group. Furthermore, R0 resection could be achieved in 92 % of patients treated with NACRT. Nutritional status decreased after NACRT and further deteriorated during adjuvant chemotherapy. The initiation of postoperative chemotherapy was delayed in the NACRT group.Conclusions
Our current protocol of neoadjuvant chemoradiotherapy is feasible and substantially improves the pathology. However, it has some detrimental effects on postoperative nutritional status and performance of adjuvant chemotherapy. Furthermore, it should be noted that there is a possibility of arterial complications. 相似文献11.
Background
Pancreatic surgery is a challenging application of minimally invasive surgery. Due to the complexity of the surgical technique, requiring dissection along major abdominal vessels as well as delicate reconstruction involving biliary, pancreatic and enteric anastomoses, reports on laparoscopic pancreatic surgery have been scanty. With the advent of robotic-assisted surgery, however, the increased dexterity granted by endo-wristed instruments, the improved three-dimensional vision and the computer filtration of the surgeon’s movements have brought minimally invasive pancreatic surgery into a new era.Methods
As the surgical group which has performed the highest number of robotic-assisted pancreatic procedures worldwide, we review the state of the art of minimally invasive robotic-assisted pancreatic surgery. Clinical results from all major robotic-assisted pancreatic surgery series are considered.Results
Preliminary reports from the published major pancreatic surgery series show encouraging results, with morbidity and mortality comparable to open surgery. Preliminary data on cancer survival rates also appear to be similar to open series.Conclusion
Robotic-assisted pancreatic surgery is safe and feasible for all pancreatic diseases. The complexity of pancreatic procedures warrant them to be carried out in specialised centres, where short- and long-term outcomes seem to be similar to the ones achieved in open surgery. 相似文献12.
Yen-Chen Shao Yu-Yao Chang Jen-Kou Lin Chun-Chi Lin Huann-Sheng Wang Shung-Haur Yang Jeng-Kai Jiang Yuan-Tzu Lan Tzu-Chen Lin Anna Fen-Yau Li Wei-Shone Chen Shih-Ching Chang 《International journal of colorectal disease》2013,28(10):1359-1365
Background
The prognosis for colorectal cancer (CRC) patients with unresectable metastases is dismal. This study compared outcomes of different metastatic treatments.Patients and methods
We collected 653 CRC cases with unresectable metastases including 490 cases receiving primary tumor resection then chemotherapy (surgery group) and 163 patients receiving neoadjuvant chemotherapy then did or did not receive operations (chemotherapy (C/T) group) from 2004 to 2010. The statistical endpoint was overall survival from the date of diagnosis.Results
In the C/T group, 124 (76 %) patients received an operation after 9.0?±?6.2 months of chemotherapy, including 57 (34.9 %) patients with curative surgery. The C/T group had a higher proportion of T4 lesions (37.4 %) than the surgery group (26.9 %). Survival of the C/T group was longer than that of the surgery group (28.8?±?8.8 vs. 24.3?±?7.5 months; p?=?0.043). Survival of 57 patients receiving curative surgery was 36.0?±?6.3 months, which was significantly better than that of the 67 patients receiving palliative resection (25.2?±?5.6, p?<?0.001). In the surgery group, 42 (8.6 %) patients received curative metastasectomy after 8.5?±?7.1 months of postoperative chemotherapy; survival was 30.8?±?7.8 months, which was significantly better than that of patients who did not receive metastasectomy (22.4?±?6.3 months). In multivariate analysis, poor differentiation, lymphovascular invasion, isolated cancer nodules, clinical risk score, and curative surgery were independent prognostic factors of overall patient survival.Conclusions
Neoadjuvant chemotherapy can improve outcome of CRC patients with unresectable metastases. 相似文献13.
Takeshi Ogura Kenji Yamao Kazuo Hara Nobumasa Mizuno Susumu Hijioka Hiroshi Imaoka Akira Sawaki Yasumasa Niwa Masahiro Tajika Shinya Kondo Tsutomu Tanaka Yasuhiro Shimizu Vikram Bhatia Kazuhide Higuchi Waki Hosoda Yasushi Yatabe 《Journal of gastroenterology》2013,48(5):640-646
Background
Although recent reports indicate that K-ras mutation status is a biomarker that acts as a prognostic factor, only a few analyses of K-ras mutation subtypes have been published. In addition, there are no reports that analyze overall survival and prognostic factors according to K-ras mutation status and subtypes in only unresectable pancreatic cancer (PC) determined from tissues obtained by endoscopic ultrasound-guided fine-needle aspiration.Methods
We retrospectively analyzed 242 patients who were diagnosed as having unresectable PC with available histological diagnosis. Clinical data collected included sex, age, Eastern Cooperative Oncology Group performance status, carbohydrate antigen (CA) 19-9, primary tumor location, stage (local or metastatic) according to TNM staging, first-line chemotherapy, K-ras mutation status and subtypes (G12D, G12V, and G12R), and overall survival. We analyzed the negative prognostic factors for reduced overall survival in unresectable PC patients using these data.Results
From multivariate analysis, CA19-9 ≥1000 U/ml (hazard ratio [HR] 1.78, 95 % confidence interval [CI] 1.28–2.46, P < 0.01), metastatic stage (HR 2.26, 95 % CI 1.58–3.24, P < 0.01), and mutant-K-ras (HR 1.76, 95 % CI 1.03–3.01, P = 0.04) were negative prognostic factors, indicating a reduced survival. Among the patients who had K-ras mutation subtypes, CA19-9 ≥1000 U/ml (HR 1.65, 95 % CI 1.12–2.37, P < 0.01), metastatic stage (HR 2.12, 95 % CI 1.44–3.14, P < 0.01), and the presence of the G12D or G12R mutations (HR 1.60, 95 % CI 1.11–2.28) were negative prognostic factors for overall survival.Conclusions
K-ras mutation status and subtypes may be associated with survival duration in pancreatic cancer patients. 相似文献14.
Naohiro Sata Kentaro Kurashina Hideo Nagai Takukazu Nagakawa Osamu Ishikawa Tetsuo Ohta Masaaki Oka Hisafumi Kinoshita Wataru Kimura Hiroshi Shimada Masao Tanaka Akimasa Nakao Kouichi Hirata Hideki Yasuda 《Journal of hepato-biliary-pancreatic sciences》2009,16(4):485-492
Background
Pancreatic carcinoma causes more than 20,000 deaths every year in Japan. The role of (neo-) adjuvant chemotherapy for pancreatic carcinoma is still controversial.Methods
At the 34th Annual Meeting of the Japanese Society of Pancreatic Surgery in 2007, questionnaires were distributed regarding the use of (neo-) adjuvant chemo(radio)therapy for pancreatic carcinoma between 2001 and 2005.Results
Sixty of the 146 member institutions responded to the questionnaires. There were a total of 1,846 cases of resected pancreatic carcinoma between 2001 and 2005. The study population had a greater proportion of males, and a mean age of 65.3 years (range 34–90 years). The lesion was located in the head of the pancreas in 1,204 cases (71.7%), in the body in 353 cases (21.0%), and in the tail in 111 cases (6.6%). Overall survival rates were 67.3% at 1 year, 36.0% at 2 years, and 23.9% at 3 years, respectively. Adjuvant chemotherapy (usually involving gemcitabine) was used in 66.0% of cases. The use of adjuvant chemotherapy was found to improve the overall survival rate. Interestingly, adjuvant chemotherapy only improved survival in late-stage (UICC stages IIB, III, and IV) but not early stage (IA, IB, and IIA) patients. Survival was treatment duration-dependent, with patients who received more than 12 months of therapy having a 3-year survival rate of 51.2%.Conclusion
This high volume retrospective data indicated the promising effect of gemcitabine-based adjuvant chemotherapy and the rational duration of adjuvant chemotherapy should be determined in the future prospective studies. 相似文献15.
Sung Ill Jang Jie-Hyun Kim Jung Whan You Kwangwon Rhee Se Joon Lee Ho Gak Kim Jimin Han Im Hee Shin Sang-Heum Park Dong Ki Lee 《Digestive diseases and sciences》2013,58(3):865-871
Background
The placement of a self-expandable metallic stent (SEMS) is a widely used nonsurgical treatment method in patients with unresectable malignant biliary obstructions but SEMS is susceptible to occlusion by tumor ingrowth or overgrowth.Aim
The efficacy and safety of a metallic stent covered with a paclitaxel-incorporated membrane (MSCPM) in which paclitaxel provided an antitumoral effect was compared prospectively with those of a covered metal stent (CMS) in patients with malignant biliary obstructions.Methods
Patients with unresectable distal malignant biliary obstructions (n = 106) were prospectively enrolled in this study at multiple treatment centers. A MSCPM was inserted endoscopically in 60 patients, and a CMS was inserted in 46 patients. Patients underwent systemic chemotherapy regimens alternatively according to disease characteristics.Results
The two groups did not differ significantly in mean age, male to female ratio, or mean follow-up period. Stent occlusion due to tumor ingrowth occurred in 12 patients who received MSCPMs and in eight patients who received CMSs. Stent patency and survival time did not differ significantly between the two groups (p = 0.116, 0.981). Chemotherapy had no influence on stent patency, but gemcitabine-based chemotherapy was a significant prognostic factor for survival time (p = 0.012). Complications, including cholangitis and pancreatitis, were found to be acceptable in both groups.Conclusions
Although the use of a MSCPM produced no significant differences in stent patency or patient survival in patients with malignant biliary obstructions compared with the use of a CMS, this study demonstrated that MSCPM can be used safely in humans. 相似文献16.
Chan OC Tang CN Lai EC Yang GP Li MK 《Journal of hepato-biliary-pancreatic sciences》2011,18(4):471-480
Background
Robotic surgery has emerged as one of the most promising surgical advances since its launch at the turn of the millennium. Despite its worldwide acceptance in many different surgical specialties, the use of robotic assistance in the field of hepatobiliary and pancreatic (HBP) surgery remains relatively unexplored. This article aims to evaluate the efficacy and outcomes of robotic HBP surgery in a single surgical center.Methods
Between May 2009 and December 2010, all patients admitted to our unit for robotic HBP surgery were evaluated. A retrospective analysis of a prospectively maintained database on clinical outcomes was performed.Results
There were 55 robotic HBP operations performed during the study period. There were 27 robotic liver resections (left lateral sectionectomies n = 17, left hepatectomy n = 1, other segmentectomies n = 2 and wedge resections n = 7), 12 robotic pancreatic procedures (Whipple’s operations n = 8, spleen-preserving distal pancreatectomies n = 2, double bypass n = 1 and cystojejunostomy n = 1) and 16 biliary procedures (biliary enteric bypass n = 9, bile duct exploration and related procedures n = 7). The median postoperative hospital stays for robotic liver resections, biliary procedures and pancreatic operations were 5.5 days (range 3–11 days), 6 days (range 4–11 days) and 12 days (range 6–21 days), respectively. Morbidities for liver resection, biliary procedures and pancreatic operations were 7.4, 18 and 33%, respectively. There was no mortality in our series.Conclusions
Robotic surgery is feasible and can be safely performed in patients with complicated HBP pathologies. Further evaluation with clinical trials is required to validate its real benefits. 相似文献17.
Kazuhiro Nouso Maho Amano Yoichi M. Ito Koji Miyahara Yuki Morimoto Hironari Kato Koichiro Tsutsumi Takeshi Tomoda Naoki Yamamoto Shinichiro Nakamura Sayo Kobayashi Kenji Kuwaki Hiroaki Hagihara Hideki Onishi Yasuhiro Miyake Fusao Ikeda Hidenori Shiraha Akinobu Takaki Taku Nakahara Shin-Ichiro Nishimura Kazuhide Yamamoto 《Journal of gastroenterology》2013,48(10):1171-1179
Background
Most of the glycan changes reported in cancers were based on the examinations of a small number of patients or particular proteins. The aim of this study was to determine the changes of the serum N-glycan profile comprehensively in a large number of pancreatic cancer patients and investigate its clinical utility.Methods
Glycan levels in the serum of 92 pancreatic cancer patients and 243 healthy volunteers (HLT) were examined by comprehensive quantitative high-throughput glycome analysis and were compared with clinical parameters.Results
Out of 66 glycans detected, 15 were differentially expressed in pancreatic cancer, and 10 out of the 15 glycans were significantly up-regulated in cases with distant metastasis. There was a clear increase in overall expression of serum glycans, especially highly-branched glycans with fucose moieties, in pancreatic cancer. Among these 15 glycans, a tri-antennary complex type glycan (m/z 3195) showed the highest area under the receiver operating characteristic curve (AUROC = 0.799) for the diagnosis of pancreatic cancer. The ratio of pairs of glycans on the same path of the biosynthesis pathway (m/z 3195/1914) was found to be significantly higher in pancreatic cancer than in HLT (median = 1.11 and 0.41, respectively; p < 0.0001, AUROC = 0.831). For this pair ratio, the hazard ratio for survival (2.60, 95 % CI = 1.44–4.79) was higher than that of any single glycan and 1-year survival of patients with a high and low ratio was 36.9 and 69.2 %, respectively, (p = 0.001).Conclusions
Comprehensive glycome analysis can be used to know the presence of pancreatic cancer, distant metastasis, and patient prognosis, simultaneously. 相似文献18.
Jia Jin Xinli Zhou Xiaohua Liang Ruofan Huang Zhaohui Chu Jingwei Jiang Qiong Zhan 《Journal of cancer research and clinical oncology》2013,139(3):403-408
Objective
Brain metastasis as the first symptom of lung cancer is a unique clinical entity. We conducted a retrospective study to investigate the clinical characteristics and survival of patients with lung cancer whose first symptom was brain metastases in an Asian population.Methods
A retrospective study of 186 such patients who had been admitted to one institution in China between January 1, 2003 and December 30, 2008 was performed. The following data were collected and analyzed: manifesting signs and symptoms, imaging studies, extracerebral metastases, initial diagnosis, treatment, and patient survival.Results
This sample population exhibited high rates of misdiagnosis upon initial presentation (46.8 %). Fifty-seven (30.6 %) patients presented with silent extracerebral metastases. Pathologies among this cohort varied, and adenocarcinomas were most commonly observed. Most patients received surgical resection, and some patients had additional whole-brain radiotherapy or stereotactic radiosurgery. The median survival time for the entire cohort was 15 months (95 % confidence interval, 12.9–17.1 months). Survival rates for 1, 2, and 5 years were 58.2, 34.2, and 6.5 %, respectively. The median survival time was 15, 14, 19, and 7 months for the gross total resection, incomplete resection, surgery + whole-brain radiotherapy, and surgery + stereotactic radiosurgery groups, respectively.Conclusions
Brain metastasis as the first symptom of lung cancer is a distinct clinical entity. Although overall survival was poor, combined treatments based on surgery for selected patients were reasonable with the exception of a minority who experienced long-term survival. 相似文献19.
Hirotoshi Kobayashi Kenjiro Kotake Kimihiko Funahashi Kazuo Hase Koichi Hirata Tsuneo Iiai Shingo Kameoka Yukihide Kanemitsu Koutarou Maeda Akihiko Murata Masayuki Ohue Kazuo Shirouzu Keiichi Takahashi Toshiaki Watanabe Hideaki Yano Toshimasa Yatsuoka Yojiro Hashiguchi Kenichi Sugihara 《Journal of gastroenterology》2014,49(4):646-654
Background
Peritoneal metastasis is well-known as a poor prognostic factor in patients with colorectal cancer. It is important to improve the prognosis of patients with colorectal cancer and synchronous peritoneal metastasis. This study aimed to clarify the factors affecting R0 resection and the prognosis of colorectal cancer patients with synchronous peritoneal metastasis.Methods
We investigated the data of patients with stage IV colorectal cancer between 1991 and 2007 in 16 hospitals that were members of the Japanese Society for Cancer of the Colon and Rectum.Results
Of the 564 colorectal cancer patients with synchronous peritoneal metastases, 341 also had hematogenous metastases. The 5-year overall survival rates in patients with and without R0 resection were 32.4 and 4.7 %, respectively. A Cox proportional hazards model showed that histologic type of poorly differentiated adenocarcinoma, regional lymph node metastasis, liver metastasis, chemotherapy after surgery, R0 resection, the Japanese classification of peritoneal metastasis, and the size of peritoneal metastases were independent prognostic factors. Of the 564 patients, 28.4 % had R0 resection. The Japanese classification of peritoneal metastasis (P1–P2, p = 0.0024) and absence of hematogenous metastases (p < 0.0001) were associated with R0 resection.Conclusions
P1–P2 peritoneal metastasis and the absence of hematogenous metastasis were the most favorable factors benefiting from synchronous resection of peritoneal metastasis. In addition, chemotherapy after surgery was essential. 相似文献20.
Richard Kozarek 《Journal of hepato-biliary-pancreatic sciences》2013,20(6):567-572