Pancreatic ductal adenocarcinoma( PDAC) is an extremely malignant tumor and carries a poor prognosis. Therefore, PDAC should be treated with multiple modalities. Chemotherapy has proven effective in some cases of unresectable (UR) PDAC, and there are published reports of cases in which curative surgery could be performed after chemotherapy. We examined the cases from January 2010 through November 2012 in which initially UR PDAC could be treated surgically after chemotherapy. Whether or not each cancer was resectable was evaluated according to the National Comprehensive Cancer Network (NCCN) guidelines. We performed surgery in 7 of the 25 patients initially diagnosed as UR during this period. The cancer proved inoperable in 2 of these 7 patients: 1 patient with peritoneal dissemination and 1 with locally advanced tumor. Some reports have suggested that resection after chemotherapy for UR pancreatic cancer improved the prognosis in patients relative to those in whom surgery was not attempted. From our experience, we believe that it very important for patients undergoing chemotherapy for UR pancreatic cancer to consider surgical treatment.
Background The relationship between sarcopenia and patient outcomes after pancreaticoduodenectomy (PD) for distal cholangiocarcinoma (DCC) remains unclear. We assessed the impact of sarcopenia on the outcomes after PD for DCC. Methods We retrospectively analysed 65 patients who underwent PD for DCC. The quality of skeletal muscle indicated by the psoas muscle mass index (PMI) were measured on pre‐operative computed tomography images. The impact of pre‐operative sarcopenia on short‐ and long‐term outcomes was evaluated. Results Regarding short‐term surgical outcomes, there were no marked differences between the high and low PMI groups. Regarding long‐term oncological outcomes, the rates of recurrence (23.5% versus 58.3%, P = 0.011) was significantly lower in the high PMI group than in the low PMI group. Furthermore, the recurrence‐free survival and disease‐specific survival were longer in the high PMI group ( P = 0.023 and P = 0.043, respectively). On multivariate analyses, low PMI was an independent predictor of recurrence (hazard ratio (HR) 11.06; P = 0.022) and disease‐specific death (HR 11.88; P = 0.043). Conclusions Our findings suggested an association between pre‐operative sarcopenia and poor long‐term oncological outcomes after PD for DCC.
The serum ferritin (SF) concentration is a widely available and objective laboratory parameter. SF is also widely recognized as an acute-phase reactant. The purpose of the present study was to identify the chronological changes in the recipient's SF concentration during liver transplantation (LT) and to clarify factors having an effect on the recipient's intraoperative SF level. In addition, the study retrospectively evaluated the usefulness of measuring SF during LT. Ninety-eight pediatric recipients were retrospectively analyzed. The data were analyzed and compared according to the SF level in the recipient. Patients were classified into 2 groups based on the intraoperative peak SF levels of ≤ 1000 ng/mL (low-SF group) or >1000 ng/mL (high-SF group). The SF value increased dramatically after reperfusion and fell to normal levels within the early postoperative period. The warm ischemia time (WIT) was significantly longer in the high-SF group (47.0 versus 58.5 minutes; P = 0.003). In addition, a significant positive correlation was observed between the peak SF value and WIT (r = 0.35; P < 0.001). There were significant positive correlations between the peak SF value and the donors' preoperative laboratory data, including transaminases, cholinesterase, hemoglobin, transferrin saturation, and SF, of which SF showed the strongest positive correlation (r = 0.74; P < 0.001). The multivariate analysis revealed that WIT and donor's SF level were a significant risk factor for high SF level in the recipient (P = 0.007 and 0.02, respectively). In conclusion, the SF measurement can suggest the degree of ischemia/reperfusion injury (IRI). A high SF level in the donor is associated with the risk of further acute reactions, such as IRI, in the recipient.
β-D glucan in the portal vein blood is processed by the hepatic reticuloendothelial system, and therefore, it is possible that the β-D glucan kinetics of the peripheral vein blood may be useful as a biological index. In this study, the β-D glucan levels in the peripheral and portal vein blood during liver transplantation were measured in order to study the clinical significance of the molecule.The subjects comprised 20 patients who underwent living donor liver transplantation. In the perioperative period, the β-D glucan levels were measured before liver transplantation, during surgical procedure, then on postoperative days 5, 14 and 21.The portal vein blood showed a significantly higher level of β-D glucan than the peripheral blood (p<0.001). A significant difference of β-D glucan levels was observed between the pre-liver transplantation and postoperative days 5 (p=0.048). There was a significant positive correlation between the preoperative β-D glucan level and the period of postoperative hospitalization (p<0.001). The patients with fungal infections (35.0%) had a significantly longer period of hospitalization (p=0.019).The β-D glucan kinetics accurately reflects the liver function and fungal infections. The β-D glucan level before liver transplantation can be used to
