Deciphering the Etiology of Weight Loss Following Pancreatectomy
Recurrence rates after resection for pancreatic cancer are high, with >70% of patients developing recurrence within 1 year following their index operation.1 While guidelines recommend close surveillance with cross-sectional imaging every 3–6 months postoperatively for the first 2 years, population-level studies show that only 40% of patients actually undergo imaging surveillance by the 2-year mark.2 Additionally, the current gold-standard serum biomarker, carbohydrate antigen (CA) 19-9, is not synthesized in 10% of patients and is normal in another one-third of patients, limiting its clinical [...]
Proposal for a New Pathologic Prognostic Index After Neoadjuvant Chemotherapy in Pancreatic Ductal Adenocarcinoma (PINC)
Background Limited information is available on the relevant prognostic variables after surgery for patients with pancreatic ductal adenocarcinoma (PDAC) subjected to neoadjuvant chemotherapy (NACT). NACT is known to induce a spectrum of histological changes in PDAC. Different grading regression systems are currently available; unfortunately, they lack precision and accuracy. We aimed to identify a new quantitative prognostic index based on tumor morphology. Patients and Methods The study population was composed of 69 patients with resectable or borderline resectable PDAC treated [...]
Deciphering the Etiology of Weight Loss Following Pancreatectomy
Recurrence rates after resection for pancreatic cancer are high, with >70% of patients developing recurrence within 1 year following their index operation.1 While guidelines recommend close surveillance with cross-sectional imaging every 3–6 months postoperatively for the first 2 years, population-level studies show that only 40% of patients actually undergo imaging surveillance by the 2-year mark.2 Additionally, the current gold-standard serum biomarker, carbohydrate antigen (CA) 19-9, is not synthesized in 10% of patients and is normal in another one-third of patients, limiting its clinical [...]
Proposal for a New Pathologic Prognostic Index After Neoadjuvant Chemotherapy in Pancreatic Ductal Adenocarcinoma (PINC)
Background Limited information is available on the relevant prognostic variables after surgery for patients with pancreatic ductal adenocarcinoma (PDAC) subjected to neoadjuvant chemotherapy (NACT). NACT is known to induce a spectrum of histological changes in PDAC. Different grading regression systems are currently available; unfortunately, they lack precision and accuracy. We aimed to identify a new quantitative prognostic index based on tumor morphology. Patients and Methods The study population was composed of 69 patients with resectable or borderline resectable PDAC treated [...]
Clinical impact of atrophic changes in remnant pancreas on the development of nonalcoholic fatty liver disease after pancreaticoduodenectomy
Abstract Aim: The aim of this study was to evaluate risk factors for nonalcoholic fatty liver disease (NAFLD) after pancreaticoduodenectomy (PD), with a special focus on remnant pancreatic volume (RPV) as assessed using computed tomography (CT). Methods: From February 2004 to June 2017, 101 patients who underwent PD in our institution were enrolled. We defined a CT attenuation value of less than 40 HU as hepatic steatosis and measured RPV at 7 days, 3 months, and 1 year after PD [...]
Analysis of Intraoperative Frozen Pancreatic Resection Margin and Prediction of Postoperative Pancreatic Fistula Risk During Pancreatoduodenectomy
BACKGROUND: Pancreatic duct diameter and pancreatic texture are important predictive factors for a postoperative pancreatic fistula (POPF) and are assessed intraoperatively by the surgeon. However, surgical evaluation is arbitrary and difficult to objectify, especially in minimally invasive approaches in pancreatic surgery. STUDY DESIGN: We conducted a retrospective analysis of 275 patients that underwent pancreatoduodenectomy from 2012 to 2019 at our institution. Pancreatic duct diameter and pancreatic fibrosis were assessed by histopathologic examination of the pancreatic resection margin using intraoperative frozen [...]