Journal of Surgical Innovation and Education publishes original articles, review articles, and short letters on all aspects of Journal of Surgical Innovation and Education. The main topics include migraine. Journal of Surgical Innovation and Education
Neoadjuvant treatment (NAT) followed by surgery is the primary treatment for borderline resectable pancreatic cancer (BRPC). However, there is limited high-level evidence supporting the efficacy of NAT in BRPC. PubMed was searched to identify studies that compared the survival between BRPC patients who underwent NAT and those who underwent upfront surgery (UFS). The overall survival (OS) was compared using intention-to-treat (ITT) analysis. A total of 1204 publications were identified, and 19 publications with 21 data sets (2906 patients; NAT, 1516; UFS, 1390) were analyzed. Two randomized controlled trials and two prospective studies were included. Thirteen studies performed an ITT analysis, while six presented the data of resected patients. The NAT group had significantly better OS than the UFS group in the ITT analyses (HR: 0.63, 95% CI = 0.53–0.76) and resected patients (HR: 0.68, 95% CI = 0.60–0.78). Neoadjuvant chemotherapy with gemcitabine or S-1 and FOLFIRINOX improved the survival outcomes. Among the resected patients, the R0 resection and node-negativity rates were significantly higher in the NAT group. NAT improved the OS, R0 resection rate, and node-negativity rate compared with UFS. Standardizing treatment regimens based on high-quality evidence is fundamental for developing an optimal protocol.
Surgical indications of main duct-involved intraductal papillary mucinous neoplasm (IPMN), especially for main pancreatic duct (MPD) of 5-9 mm, remain controversial. We aimed to predict malignancy risk of main duct-involved IPMN.Total 258 patients with main duct-involved IPMN between 2000 and 2017 in our institute were retrospectively analyzed. Main duct IPMN was classified into segmental and diffuse-type by dilated MPD pattern. Clinicopathologic features and predictive factors for malignancy were analyzed.Among 258 patients, 47 and 211 had pure main duct (segmental: 27, diffuse type: 20) and mixed type, respectively. Malignant IPMN presented higher in main duct type (66.0%) compared to mixed type (46.9%). The diffuse type (72.2%) had more invasive carcinoma than the segmental type (40.7%). Invasive IPMN risk increased proportionally to the MPD diameter (5 ≤ MPD <10 mm vs 10 ≤ MPD < 15 mm vs MPD ≥ 15 mm; 23.4% vs 40.0% vs 48.6%). Symptoms, elevated serum carbohydrate antigen, MPD ≥10 mm, mural nodule, thickened wall, and distal atrophy were independent predictive factors for malignancy. Patients with MPD of 5-9 mm with at least one predictive factor had 35.0% of malignancy risk.The invasive IPMN risk was different according to the dilated main duct pattern. Patients with main duct type, diffuse type, MPD ≥10 mm, and MPD 5-9 mm with at least one predictive factor should be candidates for immediate surgery.
Background: In the era of minimal invasive surgery (MIS), robotic pancreatoduodenectomy (PD) is being actively performed.Although clinical fellows who need to perform surgery in the MIS era need to thoroughly prepare the MIS-PD during the training process, there are obstacles regarding patient safety and lack of time in the actual operating room.Pancreaticojejunostomy (PJ) anastomosis is one of the difficult anastomosis that requires repetitive practice.This study evaluated the effect of simulation-based training of robotic duct-to-mucosa PJ using the pancreas and intestine silicone models with the scoring system.Methods: Three pancreatobiliary clinical fellows, who completed basic robot training course and open PJ course with silicon model but never performed real robotic PJ, were participated.The master video was created by a senior surgeon who has performed over 300 robotic pancreatoduodenectomies.Each trainee who was well acquainted with this video carried out the PJ procedures nine times and three pancreatobiliary surgeons assessed the videos and analyzed the scores.Results: The mean robotic PJ time of 3 trainees was 38.7 minutes in the first video and 32.8 minutes in the ninth video.The mean score was 11.8 (range, 5-19) at the first video, and 17.5 (range, 15-20) at the ninth video.The PJ time showed a decreasing trend, and the test score showed an increasing trend.Conclusions: This robotic education system would help the pancreatobiliary trainees to overcome the learning curves efficiently and quickly without ethical issues related with the animal models or direct practice to human subject.It will be of practical help to trainees preparing for MIS-PD.
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