Critical look at resection for pancreatic cancer

Pancreatic cancer: translational research aspects and clinical implications

Despite improvements in surgical techniques and adjuvant chemotherapy, the overall mortality rates in pancreatic cancer have generally remained relatively unchanged and the 5-year survival rate is actually below 2%. This paper will address the importance of achieving an early diagnosis and identifying markers for prognosis and response to therapy such as genes, proteins, microRNAs or epigenetic modifications. However, there are still major hurdles when translating investigational biomarkers into routine clinical practice. Furthermore, novel ways of secondary screening in high-risk individuals, such as artificial neural networks and modern imaging, will be discussed. Drug resistance is ubiquitous in pancreatic cancer. Several mechanisms of drug resistance have already been revealed, including human equilibrative nucleoside transporter-1 status, multidrug resistance proteins, aberrant signaling pathways, microRNAs, stromal influence, epithelial-mesenchymal transition-type cells and recently the presence of cancer stem cells/cancer-initiating cells. These factors must be considered when developing more customized types of intervention ("personalized medicine"). In the future, multifunctional nanoparticles that combine a specific targeting agent, an imaging probe, a cell-penetrating agent, a biocompatible polymer and an anti-cancer drug may become valuable for the management of patients with pancreatic cancer.

Fate of patients with obstructive jaundice

BACKGROUND/OBJECTIVE

Systematic data are limited on the etiology and prognosis of unselected patients with obstructive jaundice (OJ). We aimed to review the clinical features, etiology, and prognosis of patients with OJ.

METHODS

All adult patients with bilirubin >or= 5.85 mg/dL (100 micromol/L) at a university hospital in Sweden in 2003-2004 were identified. Medical records from patients with OJ were reviewed.

RESULTS

Seven hundred and forty-nine patients were identified, of whom 241 (32%) had OJ (median age 71 years, 129 women). No one was lost to follow-up. The biliary obstruction of 154 patients (64%) was a result of a malignancy: 69 patients (46%) had pancreatic cancer, 44 (29%) had cholangiocarcinoma (CC), 5 (3%) had papilla vateri cancers, and 36 patients (23%) had other malignancies. Of the 87 patients with a benign obstruction, 57 (65%) had choledocholithiasis, 7 (8%) had biliary strictures, 6% had PSC, and the obstruction of 16 patients (20.7%) had other causes. A total of 115 of the 242 patients (48%) had abdominal pain associated with jaundice, whereas 52% had painless jaundice. Thirty-four percent of patients with a malignant obstruction had abdominal pain versus 71% of patients with a benign obstruction (P < .05). At the end of follow-up, only 5% (8 patients) with a malignant obstruction were alive versus 78% with a benign obstruction.

CONCLUSIONS

Obstructive jaundice was the cause of the severe jaundice of one third of patients. Most cases of OJ were a result of a malignancy, which carried a very poor prognosis, with a 2-year mortality rate of 95%.