1
|
Hirono S, Higuchi R, Honda G, Nara S, Esaki M, Gotohda N, Takami H, Unno M, Sugiura T, Ohtsuka M, Shimizu Y, Matsumoto I, Kin T, Isayama H, Hashimoto D, Seyama Y, Nagano H, Hakamada K, Hirano S, Nagakawa Y, Mizuno S, Takahashi H, Shibuya K, Sasanuma H, Aoki T, Kohara Y, Rikiyama T, Nakamura M, Endo I, Sakamoto Y, Horiguchi A, Hatori T, Akita H, Ueki T, Idichi T, Hanada K, Suzuki S, Okano K, Maehira H, Motoi F, Fujino Y, Tanno S, Yanagisawa A, Takeyama Y, Okazaki K, Satoi S, Yamaue H. Is multidisciplinary treatment effective for invasive intraductal papillary mucinous carcinoma? Ann Gastroenterol Surg 2024; 8:845-859. [PMID: 39229554 PMCID: PMC11368504 DOI: 10.1002/ags3.12790] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2023] [Revised: 02/03/2024] [Accepted: 02/24/2024] [Indexed: 09/05/2024] Open
Abstract
Background Surgical resection is standard treatment for invasive intraductal papillary mucinous carcinoma (IPMC); however, impact of multidisciplinary treatment on survival including postoperative adjuvant therapy (AT), neoadjuvant therapy (NAT), and treatment for recurrent lesions is unclear. We investigated the effectiveness of multidisciplinary treatment in prolonging survival of patients with invasive IPMC. Methods This retrospective multi-institutional study included 1183 patients with invasive IPMC undergoing surgery at 40 academic institutions. We analyzed the effects of AT, NAT, and treatment for recurrence on survival of patients with invasive IPMC. Results Completion of the planned postoperative AT for 6 months improved the overall survival (OS), disease-specific survival (DSS), and recurrence-free survival (RFS) of patients with stage IIB and stage III resected invasive IPMC, elevated preoperative carbohydrate antigen 19-9 level, lymphovascular invasion, perineural invasion, serosal invasion, and lymph node metastasis on un-matched and matched analyses. Of the patients with borderline resectable (BR) invasive IPMC, the OS (p = 0.001), DSS (p = 0.001), and RFS (p = 0.001) of patients undergoing NAT was longer than that of those without on the matched analysis. Of the 484 invasive IPMC patients (40.9%) who developed recurrence after surgery, the OS of 365 patients who received any treatment for recurrence was longer than that of those without treatment (40.6 vs. 22.4 months, p < 0.001). Conclusion Postoperative AT might benefit selected patients with invasive IPMC, especially those at high risk of poor survival. NAT might improve the survivability of BR invasive IPMC. Any treatment for recurrence after surgery for invasive IPMC might improve survival.
Collapse
Affiliation(s)
- Seiko Hirono
- Second Department of SurgeryWakayama Medical University, School of MedicineWakayamaJapan
- Division of Hepato‐Biliary‐Pancreatic Surgery, Department of Gastroenterological SurgeryHyogo Medical UniversityNishinomiyaJapan
| | - Ryota Higuchi
- Department of Surgery, Institute of GastroenterologyTokyo Women's Medical UniversityTokyoJapan
| | - Goro Honda
- Department of Surgery, Institute of GastroenterologyTokyo Women's Medical UniversityTokyoJapan
| | - Satoshi Nara
- Department of Hepatobiliary and Pancreatic SurgeryNational Cancer Center HospitalTokyoJapan
| | - Minoru Esaki
- Department of Hepatobiliary and Pancreatic SurgeryNational Cancer Center HospitalTokyoJapan
| | - Naoto Gotohda
- Department of Hepatobiliary and Pancreatic SurgeryNational Cancer Center Hospital EastKashiwaJapan
| | - Hideki Takami
- Department of Gastroenterological SurgeryNagoya University Graduate School of MedicineNagoyaJapan
| | - Michiaki Unno
- Department of SurgeryTohoku University Graduate School of MedicineSendaiJapan
| | - Teiichi Sugiura
- Division of Hepato‐Biliary‐Pancreatic SurgeryShizuoka Cancer CenterShizuokaJapan
| | - Masayuki Ohtsuka
- Department of General SurgeryChiba University, Graduate School of MedicineChibaJapan
| | - Yasuhiro Shimizu
- Department of Gastroenterological SurgeryAichi Cancer Center HospitalNagoyaJapan
| | - Ippei Matsumoto
- Division of Hepato‐Biliary‐Pancreatic Surgery, Department of SurgeryKindai University Faculty of MedicineOsakasayamaJapan
| | | | - Hiroyuki Isayama
- Department of Gastroenterology, Graduate School of MedicineJuntendo UniversityTokyoJapan
| | | | - Yasuji Seyama
- Department of Hepato‐Biliary‐Pancreatic SurgeryTokyo Metropolitan Cancer and Infectious Diseases Center Komagome HospitalTokyoJapan
| | - Hiroaki Nagano
- Department of Gastroenterological Breast and Endocrine SurgeryYamaguchi University Graduate MedicineUbeJapan
| | - Kenichi Hakamada
- Department of Gastroenterological SurgeryHirosaki University Graduate School of MedicineHirosakiJapan
| | - Satoshi Hirano
- Department of Gastroenterological Surgery IIHokkaido University Faculty of MedicineSapporoJapan
| | - Yuichi Nagakawa
- Department of Gastrointestinal and Pediatric SurgeryTokyo Medical UniversityTokyoJapan
| | - Shugo Mizuno
- Department of Hepatobiliary Pancreatic & Transplant SurgeryMie UniversityTsuJapan
| | - Hidenori Takahashi
- Department of Gastroenterological Surgery, Graduate School of MedicineOsaka UniversitySuitaJapan
| | - Kazuto Shibuya
- Department of Surgery and Science, Faculty of Medicine, Academic AssemblyUniversity of ToyamaToyamaJapan
| | - Hideki Sasanuma
- Department of SurgeryJichi Medical UniversityShimotsukeJapan
| | - Taku Aoki
- Department of Hepato‐Biliary‐Pancreatic SurgeryDokkyo Medical UniversityMibuJapan
| | | | - Toshiki Rikiyama
- Department of Surgery, Saitama Medical CenterJichi Medical UniversitySaitamaJapan
| | - Masafumi Nakamura
- Department of Surgery and Oncology, Graduate School of Medical SciencesKyushu UniversityFukuokaJapan
| | - Itaru Endo
- Department of Gastroenterological SurgeryYokohama City University School of MedicineYokohamaJapan
| | - Yoshihiro Sakamoto
- Department of Hepato‐Biliary‐Pancreatic SurgeryKyorin University HospitalMitakaJapan
| | - Akihiko Horiguchi
- Department of Gastroenterological SurgeryFujita Health University School of Medicine, Bantane HospitalNagoyaJapan
| | - Takashi Hatori
- Digestive Disease Center, International University of Health and WelfareMita HospitalTokyoJapan
| | - Hirofumi Akita
- Osaka International Cancer InstituteDepartment of Gasteroenterological SugeryOsakaJapan
| | - Toshiharu Ueki
- Department of GastroenterologyFukuoka University Chikushi HospitalFukuokaJapan
| | - Tetsuya Idichi
- Department of Digestive SurgeryKagoshima UniversityKagoshimaJapan
| | - Keiji Hanada
- Department of GastroenterologyOnomichi General HospitalOnomichiJapan
| | - Shuji Suzuki
- Department of Gastroenterological Surgery, Ibaraki Medical CenterTokyo Medical UniversityIneshikiJapan
| | - Keiichi Okano
- Department of Gastroenterological SurgeryKagawa UniversityKidaJapan
| | | | | | - Yasuhiro Fujino
- Department of Gastroenterological SurgeryHyogo Cancer CenterAkashiJapan
| | - Satoshi Tanno
- Department of GastroenterologyIMS Sapporo Digestive Disease Central General HospitalSapporoJapan
| | - Akio Yanagisawa
- Department of PathologyJapanese Red Cross Kyoto Daiichi HospitalKamigyo‐kuJapan
| | - Yoshifumi Takeyama
- Division of Hepato‐Biliary‐Pancreatic Surgery, Department of SurgeryKindai University Faculty of MedicineOsakasayamaJapan
| | | | - Sohei Satoi
- Department of SurgeryKansai Medical UniversityHirakataJapan
| | - Hiroki Yamaue
- Second Department of SurgeryWakayama Medical University, School of MedicineWakayamaJapan
| |
Collapse
|
2
|
Löhr JM. Pancreas 2000. My journey with the central organ. Pancreatology 2024; 24:671-676. [PMID: 38641487 DOI: 10.1016/j.pan.2024.03.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2024] [Accepted: 03/27/2024] [Indexed: 04/21/2024]
Abstract
The European Pancreatic Club Lifetime Achievement Award is a distinction awarded for research on the pancreas and service to European Pancreatology. It comes with the obligation to submit a review article to our society's journal, Pancreatology. It was awarded to me 2023 and I take this opportunity to highlight my journey with the central organ AKA the pancreas, that is inseparatable from "Pancreas 2000" - an educational program for future pancreatologists, inaugurated by Karolinska Institutet.
Collapse
Affiliation(s)
- J-Matthias Löhr
- Karolinska Institutet, Alfred Nobels Allé 8, S-141 86, Stockholm, Sweden.
| |
Collapse
|
3
|
Leonhardt CS, Gustorff C, Klaiber U, Le Blanc S, Stamm TA, Verbeke CS, Prager GW, Strobel O. Prognostic Factors for Early Recurrence After Resection of Pancreatic Cancer: A Systematic Review and Meta-Analysis. Gastroenterology 2024:S0016-5085(24)05004-2. [PMID: 38825047 DOI: 10.1053/j.gastro.2024.05.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2024] [Revised: 05/17/2024] [Accepted: 05/24/2024] [Indexed: 06/04/2024]
Abstract
BACKGROUND & AIMS More than half of pancreatic ductal adenocarcinomas (PDACs) recur within 12 months after curative-intent resection. This systematic review and meta-analysis was conducted to identify all reported prognostic factors for early recurrence in resected PDACs. METHODS After a systematic literature search, a meta-analysis was conducted using a random effects model. Separate analyses were performed for adjusted vs unadjusted effect estimates as well as reported odds ratios (ORs) and hazard ratios (HRs). Risk of bias was assessed using the Quality in Prognostic Studies tool, and evidence was rated according to Grading of Recommendations Assessment, Development and Evaluation recommendations. RESULTS After 2903 abstracts were screened, 65 studies were included. Of these, 28 studies (43.1%) defined early recurrence as evidence of recurrence within 6 months, whereas 34 (52.3%) defined it as evidence of recurrence within 12 months after surgery. Other definitions were uncommon. Analysis of unadjusted ORs and HRs revealed 41 and 5 prognostic factors for early recurrence within 6 months, respectively. When exclusively considering adjusted data, we identified 25 and 10 prognostic factors based on OR and HR, respectively. Using a 12-month definition, we identified 38 (OR) and 15 (HR) prognostic factors from unadjusted data and 38 (OR) and 30 (HR) prognostic factors from adjusted data, respectively. On the basis of frequency counts of adjusted data, preoperative carbohydrate antigen 19-9, N status, nondelivery of adjuvant therapy, grading, and tumor size based on imaging were identified as key prognostic factors for early recurrence. CONCLUSIONS Reported prognostic factors of early recurrence vary considerably. Identified key prognostic factors could aid in the development of a risk stratification framework for early recurrence. However, prospective validation is necessary.
Collapse
Affiliation(s)
- Carl-Stephan Leonhardt
- Division of Visceral Surgery, Department of General Surgery, Medical University of Vienna, Vienna, Austria; Usher Institute, The University of Edinburgh, Edinburgh, United Kingdom.
| | - Charlotte Gustorff
- Division of Visceral Surgery, Department of General Surgery, Medical University of Vienna, Vienna, Austria
| | - Ulla Klaiber
- Division of Visceral Surgery, Department of General Surgery, Medical University of Vienna, Vienna, Austria
| | - Solange Le Blanc
- Division of Visceral Surgery, Department of General Surgery, Medical University of Vienna, Vienna, Austria
| | - Tanja A Stamm
- Institute of Outcomes Research, Center for Medical Data Science, Medical University of Vienna, Vienna, Austria; Ludwig Boltzmann Institute for Arthritis and Rehabilitation, Vienna, Austria
| | - Caroline S Verbeke
- Department of Pathology, Oslo University Hospital Rikshospitalet, Oslo, Norway; Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Gerald W Prager
- Division of Oncology, Department of Medicine I, Medical University of Vienna, Vienna, Austria
| | - Oliver Strobel
- Division of Visceral Surgery, Department of General Surgery, Medical University of Vienna, Vienna, Austria
| |
Collapse
|
4
|
Abdalla TSA, Duhn J, Klinkhammer-Schalke M, Zeissig SR, Kleihues-van Tol K, Honselmann KC, Braun R, Kist M, Bolm L, von Fritsch L, Lapshyn H, Litkevych S, Hummel R, Zemskov S, Wellner UF, Keck T, Deichmann S. Oncological Outcomes and Patterns of Recurrence after the Surgical Resection of an Invasive Intraductal Papillary Mucinous Neoplasm versus Primary Pancreatic Ductal Adenocarcinoma: An Analysis from the German Cancer Registry Group of the Society of German Tumor Centers. Cancers (Basel) 2024; 16:2016. [PMID: 38893136 PMCID: PMC11171342 DOI: 10.3390/cancers16112016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2024] [Revised: 05/19/2024] [Accepted: 05/20/2024] [Indexed: 06/21/2024] Open
Abstract
BACKGROUND Intraductal papillary mucinous neoplasms (IPMNs) are premalignant cystic neoplasms of the pancreas (CNPs), which can progress to invasive IPMN and pancreatic cancer. The available literature has shown controversial results regarding prognosis and clinical outcomes after the resection of invasive IPMN. AIMS This study aims to characterize the oncologic outcomes and metastatic progression pattern after the resection of non-metastatic invasive IPMN. METHODS Data were obtained from 24 clinical cancer registries participating in the German Cancer Registry Group of the Society of German Tumor Centers (ADT). Patients with invasive IPMN (n = 217) as well as PDAC (n = 5794) between 2000 and 2021 were included and compared regarding oncological outcomes. RESULTS Invasive IPMN was significantly smaller in size (p < 0.001) and of a lower tumor grade (p < 0.001), with fewer lymph node metastases (p < 0.001), lymphangiosis (p < 0.001), and consequently a higher R0 resection rate (88 vs. 74%) compared to PDAC. Moreover, invasive IPMN was associated with fewer local (11 vs. 15%) and distant recurrences (29 vs. 46%) and metastasized more frequently in the lungs only (26% vs. 14%). Invasive IPMN was associated with a longer median OS (29 vs. 19 months) and DFS (31 vs. 15 months) compared to PDAC and stayed independently prognostic in multivariable analyses. These survival differences were most pronounced in early tumor stages. Interestingly, postoperative chemotherapy was not associated with improved overall survival in surgically resected invasive IPMN. CONCLUSIONS Invasive IPMN is a rare pancreatic entity with increasing incidence in Germany. It is associated with favorable histopathological features at the time of resection and longer OS and DFS compared to PDAC, particularly before the locoregional spread has occurred. Invasive IPMNs are associated with lung-only metastasis. The benefit of postoperative chemotherapy after the resection of invasive IPMN remains uncertain.
Collapse
Affiliation(s)
- Thaer S. A. Abdalla
- Department of Surgery, University Medical Center Schleswig-Holstein, Campus Lübeck, 23562 Lübeck, Germany
- Network for Care, Quality and Research in Oncology (ADT), German Cancer Registry Group of the Society of German Tumor Centers, 14057 Berlin, Germany
| | - Jannis Duhn
- Department of Surgery, University Medical Center Schleswig-Holstein, Campus Lübeck, 23562 Lübeck, Germany
- Network for Care, Quality and Research in Oncology (ADT), German Cancer Registry Group of the Society of German Tumor Centers, 14057 Berlin, Germany
| | - Monika Klinkhammer-Schalke
- Network for Care, Quality and Research in Oncology (ADT), German Cancer Registry Group of the Society of German Tumor Centers, 14057 Berlin, Germany
| | - Sylke Ruth Zeissig
- Network for Care, Quality and Research in Oncology (ADT), German Cancer Registry Group of the Society of German Tumor Centers, 14057 Berlin, Germany
- Institute of Clinical Epidemiology and Biometry (ICE-B), University of Würzburg, 97974 Würzburg, Germany
| | - Kees Kleihues-van Tol
- Network for Care, Quality and Research in Oncology (ADT), German Cancer Registry Group of the Society of German Tumor Centers, 14057 Berlin, Germany
| | - Kim C. Honselmann
- Department of Surgery, University Medical Center Schleswig-Holstein, Campus Lübeck, 23562 Lübeck, Germany
- Network for Care, Quality and Research in Oncology (ADT), German Cancer Registry Group of the Society of German Tumor Centers, 14057 Berlin, Germany
| | - Rüdiger Braun
- Department of Surgery, University Medical Center Schleswig-Holstein, Campus Lübeck, 23562 Lübeck, Germany
- Network for Care, Quality and Research in Oncology (ADT), German Cancer Registry Group of the Society of German Tumor Centers, 14057 Berlin, Germany
| | - Markus Kist
- Department of Surgery, University Medical Center Schleswig-Holstein, Campus Lübeck, 23562 Lübeck, Germany
- Network for Care, Quality and Research in Oncology (ADT), German Cancer Registry Group of the Society of German Tumor Centers, 14057 Berlin, Germany
| | - Louisa Bolm
- Department of Surgery, University Medical Center Schleswig-Holstein, Campus Lübeck, 23562 Lübeck, Germany
- Network for Care, Quality and Research in Oncology (ADT), German Cancer Registry Group of the Society of German Tumor Centers, 14057 Berlin, Germany
| | - Lennart von Fritsch
- Department of Surgery, University Medical Center Schleswig-Holstein, Campus Lübeck, 23562 Lübeck, Germany
- Network for Care, Quality and Research in Oncology (ADT), German Cancer Registry Group of the Society of German Tumor Centers, 14057 Berlin, Germany
| | - Hryhoriy Lapshyn
- Department of Surgery, University Medical Center Schleswig-Holstein, Campus Lübeck, 23562 Lübeck, Germany
| | - Stanislav Litkevych
- Department of Surgery, University Medical Center Schleswig-Holstein, Campus Lübeck, 23562 Lübeck, Germany
| | - Richard Hummel
- Network for Care, Quality and Research in Oncology (ADT), German Cancer Registry Group of the Society of German Tumor Centers, 14057 Berlin, Germany
- Department of Surgery, University Medical Center Greiswald, 17489 Greifswald, Germany
| | - Sergii Zemskov
- Department of General Surgery, Bogomolets National Medical University, 01601 Kiev, Ukraine
| | - Ulrich Friedrich Wellner
- Department of Surgery, University Medical Center Schleswig-Holstein, Campus Lübeck, 23562 Lübeck, Germany
- Network for Care, Quality and Research in Oncology (ADT), German Cancer Registry Group of the Society of German Tumor Centers, 14057 Berlin, Germany
| | - Tobias Keck
- Department of Surgery, University Medical Center Schleswig-Holstein, Campus Lübeck, 23562 Lübeck, Germany
- Network for Care, Quality and Research in Oncology (ADT), German Cancer Registry Group of the Society of German Tumor Centers, 14057 Berlin, Germany
| | - Steffen Deichmann
- Department of Surgery, University Medical Center Schleswig-Holstein, Campus Lübeck, 23562 Lübeck, Germany
- Network for Care, Quality and Research in Oncology (ADT), German Cancer Registry Group of the Society of German Tumor Centers, 14057 Berlin, Germany
| |
Collapse
|
5
|
Pavlidis ET, Galanis IN, Pavlidis TE. Current considerations on intraductal papillary neoplasms of the bile duct and pancreatic duct. World J Gastroenterol 2024; 30:1461-1465. [PMID: 38596486 PMCID: PMC11000088 DOI: 10.3748/wjg.v30.i10.1461] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/02/2024] [Revised: 01/19/2024] [Accepted: 02/26/2024] [Indexed: 03/14/2024] Open
Abstract
Pancreatobiliary intraductal papillary neoplasms (IPNs) represent precursors of pancreatic cancer or bile duct cholangiocarcinoma that can be detected and treated. Despite advances in diagnostic methods, identifying these premalignant lesions is still challenging for treatment providers. Modern imaging, biomarkers and molecular tests for genomic alterations can be used for diagnosis and follow-up. Surgical intervention in combination with new chemotherapeutic agents is considered the optimal treatment for malignant cases. The balance between the risk of malignancy and any risk of resection guides management policy; therefore, treatment should be individualized based on a meticulous preoperative assessment of high-risk stigmata. IPN of the bile duct is more aggressive; thus, early diagnosis and surgery are crucial. The conservative management of low-risk pancreatic branch-duct lesions is safe and effective.
Collapse
Affiliation(s)
- Efstathios T Pavlidis
- 2nd Propedeutic Department of Surgery, Hippokration General Hospital, School of Medicine, Aristotle University of Thessaloniki, Thessaloniki 54642, Greece
| | - Ioannis N Galanis
- 2nd Propedeutic Department of Surgery, Hippokration General Hospital, School of Medicine, Aristotle University of Thessaloniki, Thessaloniki 54642, Greece
| | - Theodoros E Pavlidis
- 2nd Propedeutic Department of Surgery, Hippokration General Hospital, School of Medicine, Aristotle University of Thessaloniki, Thessaloniki 54642, Greece
| |
Collapse
|
6
|
Djoumi Y, Sadr-Azodi O, Vujasinovic M, Del Chiaro M, Sparrelid E, Ghorbani P, Holmberg M. Pre-emptive resection for intraductal papillary mucinous neoplasia - Long-term outcome is similar between non-invasive and early invasive lesions in a tertiary single center. Pancreatology 2023; 23:389-395. [PMID: 37002181 DOI: 10.1016/j.pan.2023.03.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2023] [Revised: 03/08/2023] [Accepted: 03/19/2023] [Indexed: 06/04/2023]
Abstract
BACKGROUND Pre-emptive resection for intraductal papillary mucinous neoplasm (IPMN) aims to reduce the risk before invasive transformation has taken place. Pancreatic resections are highly associated with major morbidity and mortality. Long-term overall survival (OS) after resection for invasive IPMN (inv-IPMN) in early stages is favorable. Comparison of long-term OS for resected non-invasive IPMN and early staged inv-IPMN is poorly delineated. This study aims to compare outcomes for resected non-invasive IPMN and T1-staged inv-IPMN. METHODS All patients ≥18 years of age resected for IPMN up to stage T1 at Karolinska University Hospital between 2008 and 2020 were included. Two-year OS were compared between groups by chi-squared test, and 5-year OS was estimated using Kaplan-Meier method. Covariates associated with death was assessed in multivariable Cox regression model. RESULTS We included 284 patients, 264 (93%) non-invasive IPMN and 20 (7%) T1-staged inv-IPMN. Dysplasia of low grade (LGD) and high grade, i.e., tumor in situ (Tis) were present in 190 (67%) and 75 (26%) patients respectively. The 2-year OS for the entire cohort was 96%, and there were no differences between non-invasive and inv-IPMN (96% vs 92%, p = 0.203), nor between IPMN with LGD and Tis-T1b-staged IPMN (96% vs 95%, p = 0.734). CONCLUSION Two thirds of the specimen from pre-emptive resections were of LGD and did not involve superior OS than in situ or early cancer. Due to high complication burden, efforts should be made to avoid resection when LGD is probable and rather identify more accurate predictors for surgery.
Collapse
Affiliation(s)
- Yasmine Djoumi
- Department of Clinical Science, Intervention, and Technology, Karolinska Institute, Stockholm, Sweden
| | - Omid Sadr-Azodi
- Department of Clinical Science, Intervention, and Technology, Karolinska Institute, Stockholm, Sweden; Department of Upper Gastrointestinal Surgery, Capio S.t Görans Hospital, Stockholm, Sweden
| | - Miroslav Vujasinovic
- Department of Upper Digestive Diseases, Karolinska University Hospital, Stockholm, Sweden; Department of Medicine, Karolinska University Hospital, Stockholm, Sweden
| | - Marco Del Chiaro
- Department of Surgery, University of Colorado, Anschutz Medical Campus, Denver, USA
| | - Ernesto Sparrelid
- Department of Clinical Science, Intervention, and Technology, Karolinska Institute, Stockholm, Sweden; Department of Upper Digestive Diseases, Karolinska University Hospital, Stockholm, Sweden
| | - Poya Ghorbani
- Department of Clinical Science, Intervention, and Technology, Karolinska Institute, Stockholm, Sweden; Department of Upper Digestive Diseases, Karolinska University Hospital, Stockholm, Sweden
| | - Marcus Holmberg
- Department of Clinical Science, Intervention, and Technology, Karolinska Institute, Stockholm, Sweden; Department of Upper Gastrointestinal Surgery, Capio S.t Görans Hospital, Stockholm, Sweden.
| |
Collapse
|
7
|
Gorris M, van Huijgevoort NCM, Farina A, Brosens LAA, van Santvoort HC, Groot Koerkamp B, Bruno MJ, Besselink MG, van Hooft JE. Comparing Survival after Resection of Pancreatic Cancer with and without Pancreatic Cysts: Nationwide Registry-Based Study. Cancers (Basel) 2022; 14:cancers14174228. [PMID: 36077765 PMCID: PMC9454588 DOI: 10.3390/cancers14174228] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2022] [Revised: 08/19/2022] [Accepted: 08/23/2022] [Indexed: 11/24/2022] Open
Abstract
Background: Outcome after resection of pancreatic ductal adenocarcinoma associated with pancreatic cystic neoplasms (PCN-PDAC) might differ from PDAC not associated with PCN. This nationwide, registry-based study aimed to compare the overall survival (OS) in these patients. Methods: Data from consecutive patients after pancreatic resection for PDAC between 2013 and 2018 were matched with the corresponding pathology reports. Primary outcome was OS for PCN-PDAC and PDAC including 1-year and 5-year OS. Cox regression analysis was used to correct for prognostic factors (e.g., pT-stage, pN-stage, and vascular invasion). Results: In total, 1994 patients underwent resection for PDAC including 233 (12%) with PCN-PDAC. Median estimated OS was better in patients with PCN-PDAC (34.5 months [95%CI 25.6 to 43.5]) as compared to PDAC not associated with PCN (18.2 months [95%CI 17.3 to 19.2]; hazard ratio 0.53 [95%CI 0.44−0.63]; p < 0.001). The difference in OS remained after correction for prognostic factors (adjusted hazard ratio 1.58 [95%CI 1.32−1.90]; p < 0.001). Conclusions: This nationwide registry-based study showed that 12% of resected PDAC were PCN-associated. Patients with PCN-PDAC had better OS as compared to PDAC not associated with PCN.
Collapse
Affiliation(s)
- Myrte Gorris
- Amsterdam UMC, Location University of Amsterdam, Department of Gastroenterology and Hepatology, 1081 HV Amsterdam, The Netherlands
- Amsterdam Gastroenterology Endocrinology Metabolism, 1105 BK Amsterdam, The Netherlands
- Amsterdam UMC, Location University of Amsterdam, Department of Surgery, 1105 AZ Amsterdam, The Netherlands
- Cancer Center Amsterdam, 1081 HV Amsterdam, The Netherlands
| | - Nadine C. M. van Huijgevoort
- Amsterdam UMC, Location University of Amsterdam, Department of Gastroenterology and Hepatology, 1081 HV Amsterdam, The Netherlands
- Amsterdam Gastroenterology Endocrinology Metabolism, 1105 BK Amsterdam, The Netherlands
| | - Arantza Farina
- Cancer Center Amsterdam, 1081 HV Amsterdam, The Netherlands
- Amsterdam UMC, Location University of Amsterdam, Department of Pathology, 1081 HV Amsterdam, The Netherlands
| | - Lodewijk A. A. Brosens
- Department of Pathology, University Medical Centre Utrecht, Utrecht University, 3508 GA Utrecht, The Netherlands
| | - Hjalmar C. van Santvoort
- Department of Surgery, St. Antonius Hospital, 3435 CM Nieuwegein, The Netherlands
- Department of Surgery, University Medical Centre Utrecht, Heidelberglaan 100, 3584 CX Utrecht, The Netherlands
| | - Bas Groot Koerkamp
- Department of Surgery, Erasmus MC Cancer Institute, University Medical Centre Rotterdam, Doctor Molewaterplein 40, 3015 GD Rotterdam, The Netherlands
| | - Marco J. Bruno
- Department of Gastroenterology and Hepatology, Erasmus MC Cancer Institute, University Medical Centre Rotterdam, Doctor Molewaterplein 40, 3015 GD Rotterdam, The Netherlands
| | - Marc G. Besselink
- Amsterdam UMC, Location University of Amsterdam, Department of Surgery, 1105 AZ Amsterdam, The Netherlands
- Cancer Center Amsterdam, 1081 HV Amsterdam, The Netherlands
| | - Jeanin E. van Hooft
- Department of Gastroenterology and Hepatology, Leiden University Medical Center, Albinusdreef 2, 2333 ZA Leiden, The Netherlands
- Correspondence:
| |
Collapse
|