Summary: Introduction: Robotic pancreatic surgery is still not widely used in the Czech Republic. On a global scale, it is gradually being systematically implemented, especially in high-volume centers. The study presents the first experiences with robotic pancreatic surgery in a pancreatic surgery high-volume center in the Czech Republic. Methods: Comparative analysis of the first ten patients operated on robotically for pancreatic pathology with a comparable group operated open (smaller procedures: left pancreatectomy with/without splenectomy, enucleation, central resection) evaluates age, length of hospitalization, ICU stay, blood loss and operative time using non-parametric Mann--Whitney U-test, and complications and rehospitalization using descriptive statistics. The results: The compared sets consist of 10 patients, 5 women, with a robotic procedure (5× enucleation, 4× distal pancreatectomy and central resection – median age 65.3 [46–76] years) and 10 patients, 5 women, with comparable open procedures (5× enucleation, 4× distal resection and central resection – median age 65.5 [52–78]years. Hospitalization length 4.5 days vs. 9 days (P = 0.0003) and operation time 275 min vs. 142 min (P = 0.004) were statistically different in the robotic vs open group. ICU stay and blood loss were lower in the robotic group, but not statistically significant, age was comparable. Complications according to the Clavien-Dindo classification in the open group: 3× type II, 1× type IIIa, 1× type IIIb, in the robotic group 1× type II and 1× type IIIa. Rehospitalization in the open group was 2×, in the robotic group 1x, always for late postoperative complications. Conclusion: Robotic surgery of the pancreas is currently in its infancy in the Czech Republic. The experience so far with the first ten patients operated on using the DaVinci Xi robotic system has yielded promising results in form of shorter hospitalization, but at cost of longer operating time. Key words: pancreatectomy – enucleation – pancreas – robotics – minimal invasiveness – hospital stay – enhanced postsurgical recovery
The authors present a prospective study on a value of oncologic markers CEA and CA 19-9 in patients after curative therapy for colorectal adenocarcinoma. During a five-year follow-up in 320 patients, a significant elevation of CEA or CA 19-9 was documented in 71 patients (22.8 %), and resulted in tumour detection in 39/71 patients (55 %). Although the levels were defined as false positive in 32 patients (45 %), the importance of CEA and CA 19-9 monitoring is documented by elevated levels of oncomakers in 39/55 patients (71%) with metastases or local-regional recurrence of colorectal adenocarcinoma. (Tab. 3, Ref: 21.)
Abstract Introduction: Colorectal cancer (CRC) stands as a prominent contributor to global cancer-related mortality. Post-surgical management of CRC patients often involves the administration of opioid analgesics. These analgesics operate through opioid and cannabinoid receptors, pathways implicated in tumor progression and metastasis, potentially impacting patient survival adversely. This investigation delves into the influence of piritramide and morphine on cancer dissemination, encompassing in vitro and in vivo assessments, cytotoxicity analyses, and elucidation of their mode of action. Methods: The presence of circulating tumor cells (CTCs) in the blood of 131 CRC patients was quantitatively assessed using the real-time polymerase chain reaction (qPCR) method. Cytotoxic effects of morphine and piritramide were evaluated via colony-forming assays (CFA) utilizing HCT116 and HT29 cell lines. The impact of piritramide and morphine on opioid receptor activity was gauged through transfected reporter cell lines and fluorescence imaging plater reader (FLIPR) calcium assays. In vivo models involving subcutaneous and intrasplenic administration in SCID and BALB mice, respectively, utilizing HCT116 and HT29 cell lines, were conducted. Morphological profiling, employing the cell painting assay, facilitated high-content image-based analysis on both cell lines. Results: Perioperative analgesia with piritramide exhibited a tendency towards longer time to recurrence (TTR) survival in CRC patients (HR=1.8, p=0.104). Conversely, morphine-treated patients demonstrated a twofold increase in TTR events (HR=4.7, p=0.011). Piritramide, but not morphine, significantly inhibited colony growth in HCT116 and HT-29 cell lines in the CFA, consistent with cytotoxicity test results. Functional assays revealed agonistic effects of both piritramide and morphine on opioid receptor kappa 1 (OPRK1) and mu 1 (OPRM1), with piritramide exhibiting greater potency as an OPRK1 agonist. In the SCID mice model, subcutaneous application of HT29 cell lines resulted in significantly reduced tumor growth in piritramide-treated mice. In the intrasplenic model utilizing BALB mice, mice treated with piritramide exhibited diminished tumor growth and a reduction in both the number and size of metastases. Comparative analysis with reference compounds revealed a distinct phenotypic profile of piritramide affecting the endoplasmic reticulum. Conclusion: Piritramide, as opposed to morphine, demonstrated cytotoxic effects on both in vitro and in vivo CRC cell lines, resulting in reduced tumor growth and dissemination. Perioperative analgesia with piritramide exhibited potential in improving time to recurrence survival in CRC patients. Acknowledgement: This study received support from the European Union - Next Generation EU (LX22NPO5102) and Palacky University Olomouc (LF 2023_006). Citation Format: Josef Srovnal, Emil Berta, Monika Vidlarova, Alona Rehulkova, Katerina Jecmenova, Miroslav Popper, Alzbeta Srovnalova, Petr Prasil, Pavel Skalicky, Tomas Gabrhelik, Jan Maca, Pavel Michalek, Marian Hajduch. The piritramide-based perioperative analgesia can affect the cancer dissemination in colorectal cancer patients [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2024; Part 1 (Regular Abstracts); 2024 Apr 5-10; San Diego, CA. Philadelphia (PA): AACR; Cancer Res 2024;84(6_Suppl):Abstract nr 7496.
The purpose was to identify 5-year survivors among a group of radically resected patients with pancreatic cancer and analyse the characteristics and factors associated with their 5-year survival. Single tertiary centre experience.A prospectively maintained database of 155 pancreatic resections from January 2006 to June 2010 was scanned to identify patients after curative radical resections for pancreatic ductal adenocarcinoma. The clinical and pathological data was analysed retrospectively. The outcomes of the PDAC group were evaluated using Kaplan-Meier analysis (survival) with the Log-rank test and Cox regression analysis (evaluation of prognostic factors). Characteristics of the survivors were discussed. Significance level of 0.05 was used. Those factors were used as independent variables for Cox regression analysis whose significant effect on survival was shown based on Kaplan-Meier analysis.Among 155 patients undergoing a curative pancreatic resection, 73 had a pancreatic ductal adenocarcinoma. Fifteen patients (20.5%) after radical surgery survived over 5 years, 13 of whom are still alive. In the group of the survivors, the mean overall survival was 77.1 months (60110) and the median survival was 74 months. The mean relapse-free interval in the group of the survivors was 63.3 months (14110) with the median of 65 months. Factors associated with a longer survival included the absence of lymph node infiltration (p=0.031), uncomplicated postoperative course (p=0.025), absence of vascular invasion (p=0.017), no blood transfusions (p=0.015) and the use of postoperative therapy - predominantly chemotherapy (p=0.009). Significant independent predictors of survival included vascular invasion HR=2.239 (95%CI: 1.0934.590; p=0.028), postoperative chemotherapy HR=2.587 (95%CI: 1.3015.145; p=0.007) and blood transfusion HR=2.080 (95%CI: 1.0274.212; p=0.042). The risk of death was increased 2.2 times in patients with vascular invasion, 2.1 times in patients with transfusions, and finally 2.6 times in those with no chemotherapy.Factors associated with an improved overall survival included: the absence of lymph node infiltration, an uncomplicated postoperative course, absence of vascular invasion, no need of blood transfusions, and finally the use of postoperative chemotherapy. Vascular invasion, use of blood transfusions and postoperative adjuvant chemotherapy were significant independent prognostic factors of survival.
Currently, no international consensus includes surgery as part of the standard of metastatic pancreatic ductal adenocarcinoma care. There is weak evidence to support the general introduction of surgical resection in the metastatic pancreatic ductal adenocarcinoma treatment. However, in the rare cases of oligometastatic spread there is increasing evidence that surgical intervention can lead to favourable outcomes. Individualisation of the care and tailored therapy refers not only to targeted treatment but also to the whole complex cancer care, including the indication for surgery. This review summarizes the current status of combined oncosurgical therapy in the multidisciplinary management of oligometastatic pancreatic cancer, together with our own experience, and discusses future perspectives, particularly regarding prognostic and predictive factors that could better predict this group.
Summary: Background and aim: Primary diagnosis of the distal biliary stricture can be sometime difficult. Brush cytology (BC) is known to have low diagnostic sensitivity in these cases. Fluorescence in situ hybridization (FISH) has been reported as a useful adjunctive test in patients with biliary strictures. We aimed to determine performance characteristics of BC, FISH and their combination (BC + FISH) in the primary diagnosis of distal biliary strictures. Methods: This single-center prospective study was conducted between April 2019 and January 2021. Consecutive patients with unsampled biliary strictures undergoing first ERCP in our institution were included. Cytological and FISH analysis of tissue specimens from two standardized transpapillary brushings from the distal strictures were provided. Histopathological confirmation after surgery or 12-month follow-up was regarded as the reference standard for the final diagnosis. Results: A total of 109 patients were enrolled. Seven patients were lost from the final analysis and 26 suffered proximal stenosis. Of the 76 remaining patients (61.8% males, mean age 67.6, range 25–89 years) with distal stenosis, the proportions of benign and malignant strictures were 25 (32.9%) and 51 (67.1%), respectively. Of the subgroup of malignant strictures, 17.7% were cholangiocarcinoma, 74.5% were pancreatic tumors and 7.8% others. In comparison to BC alone, FISH increased the sensitivity from 0.373% to 0.706% (p = 0.0007) with a slight decrease in specificity (p = 0.045). Conclusions: Dual modality tissue evaluation using BC + FISH has better sensitivity for the primary diagnosis of distal biliary strictures, compared to BC alone. Key words: primary diagnosis of distal biliary strictures – first retrograde cholangiopancreatography – brush cytology – fluorescence in situ hybridization
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