Association between preoperative sarcopenia and prognosis of pancreatic cancer after curative-intent surgery: a updated systematic review and meta-analysis

BACKGROUND

Sarcopenia is associated with poor outcomes in many malignancies. However, the relationship between sarcopenia and the prognosis of pancreatic cancer has not been well understood. The aim of this meta-analysis was to identify the prognostic value of preoperative sarcopenia in patients with pancreatic cancer after curative-intent surgery.

METHODS

Database from PubMed, Embase, and Web of Science were searched from its inception to July 2023. The primary outcomes were overall survival (OS), progression-free survival (PFS), and the incidence of major complications. The hazard ratio (HR), odds ratio (OR), and 95% confidence intervals (CIs) were used to assess the relationship between preoperative sarcopenia and the prognosis of patients with pancreatic cancer. All statistical analyses were conducted by Review Manager 5.3 and STATA 17.0 software.

RESULTS

A total of 23 retrospective studies involving 5888 patients were included in this meta-analysis. The pooled results demonstrated that sarcopenia was significantly associated with worse OS (HR = 1.53, P < 0.00001) and PFS (HR = 1.55, P < 0.00001). However, this association was not obvious in regard to the incidence of major complications (OR = 1.33, P = 0.11).

CONCLUSION

Preoperative sarcopenia was preliminarily proved to be associated with the terrible prognosis of pancreatic cancer after surgery. However, this relationship needs to be further validated in more prospective studies.

Is endoscopic radiofrequency ablation plus stent placement superior to stent placement alone for the treatment of malignant biliary obstruction? A systematic review and meta-analysis

OBJECTIVE

Malignant biliary obstruction (MBO) is a rare disease with a poor prognosis. Recent studies have shown that endoscopic radiofrequency ablation (ERFA) may improve survival. We conducted a systematic review and meta-analysis of the efficacy of ERFA in combination with biliary stent placement for the treatment of MBO.

METHODS

The study was registered in INPLASY (number 202340096). The PubMed, Cochrane Library, Web of Science, and Embase databases were searched from inception to April 2023. We selected studies comparing the efficacy of ERFA plus stent placement with stent placement alone. The primary outcomes were pooled hazard ratios (HRs) for overall survival and stent patency; the secondary outcomes were the odds ratios (ORs) for adverse events.

RESULTS

Eleven studies (four randomized controlled trials and seven observational studies) were included in the meta-analysis. Pooled analysis showed a difference in survival time between the two groups (HR 0.65, 95% confidence interval [CI] 0.58-0.73, I2 = 40%). However, there were no differences in the duration of stent patency or the incidence of adverse events (HR 1.04, 95% CI 0.84-1.29, I2 = 46%; OR 1.41, 95% CI 1.02-1.96, I2 = 29%).

CONCLUSIONS

ERFA has a significant survival benefit for MBO, but does not increase the risk of adverse events.

Laparoscopic pancreaticoduodenectomy versus open pancreaticoduodenectomy for carcinoma of the ampulla of Vater in a medium-volume center: a propensity score matching analysis

OBJECTIVE

To compare the efficacy of laparoscopic pancreaticoduodenectomy (LPD) and open pancreaticoduodenectomy (OPD) in a medium-volume medical center.

METHODS

Data for patients who underwent OPD or LPD for carcinoma of the ampulla of Vater (VPC) between January 2017 and June 2022 were acquired retrospectively. Propensity score-matching (PSM) analysis was performed to balance the baseline characteristics between the groups. The primary outcome was disease-free survival (DFS). Cox regression analysis was used to explore the independent risk factors for DFS.

RESULTS

A total of 124 patients with pathologically diagnosed VPC were included. After 1:1 matching, there were 23 cases each in the OPD and LPD groups. Kaplan-Meier survival analyses showed that the median DFS in the OPD and LPD groups was identical (16.0 months vs 16.0 months, respectively). Multivariate Cox regression analysis showed that low levels of alkaline phosphatase and γ-glutamyl transpeptidase, positive surgical margin, and lymph node enlargement were independent risk factors for DFS.

CONCLUSION

LPD in medium-volume centers with acceptable technical conditions may approach or even achieve the efficacy of LPD in large-volume centers.

Relationship between time to hemostasis and outcomes of pulpotomy using iRoot BP Plus in symptomatic young permanent teeth: a prospective study

The aim was to investigate the relationship between time to hemostasis and pulpotomy outcomes with the use of iRoot BP Plus (Innovative Bioceramics, Vancouver, Canada) for young permanent teeth of patients aged from 7 to 12 with symptomatic irreversible pulpitis and evaluate the outcomes of pulpotomy. The present study was a prospective cohort study. Two hundred and six young permanent teeth with symptomatic irreversible pulpitis underwent pulpotomy with the use of iRoot BP Plus. All patients underwent pulpotomy in accordance with a standardized protocol. Patients were postoperatively re-called after 3, 6, 12 months. Successful cases were defined according to clinical and radiographic evaluations. Main outcome measures included tooth position, cave shape, previous restoration, preoperative symptoms, time to hemostasis and outcomes. On the basis of univariate linear regression model, the relationships between time to hemostasis was evaluated, and p < 0.05 indicated a difference that achieved statistical significance. One hundred and ninety-three teeth can be evaluated after a follow-up for 6 to 36 months. The mean age of subjects was 9.43 ± 1.51 years. The overall clinical and radiographic success rate of pulpotomy reached 71.5% (138/193). After adjusting potential confounders (age, sex, previous restoration), non-linear relationship was detected between time to hemostasis and pulpotomy outcomes whose point was 4 minutes. The relationship between time to hemostasis and pulpotomy outcomes is non-linear. Pulpotomy outcomes was negatively related with time to hemostasis when time to hemostasis is more than 4 minutes.