This statement was developed to promote international consensus on the definition of borderline resectable pancreatic ductal adenocarcinoma (BR-PDAC) which was adopted by the National Comprehensive Cancer Network (NCCN) in 2006, but which has changed yearly and become more complicated. Based on a symposium held during the 20th meeting of the International Association of Pancreatology (IAP) in Sendai, Japan, in 2016, the presenters sought consensus on issues related to BR-PDAC. We defined patients with BR-PDAC according to the three distinct dimensions: anatomical (A), biological (B), and conditional (C). Anatomic factors include tumor contact with the superior mesenteric artery and/or celiac artery of less than 180° without showing stenosis or deformity, tumor contact with the common hepatic artery without showing tumor contact with the proper hepatic artery and/or celiac artery, and tumor contact with the superior mesenteric vein and/or portal vein including bilateral narrowing or occlusion without extending beyond the inferior border of the duodenum. Biological factors include potentially resectable disease based on anatomic criteria but with clinical findings suspicious for (but unproven) distant metastases or regional lymph nodes metastases diagnosed by biopsy or positron emission tomography-computed tomography. This also includes a serum carbohydrate antigen (CA) 19-9 level more than 500 units/ml. Conditional factors include the patients with potentially resectable disease based on anatomic and biologic criteria and with Eastern Cooperative Oncology Group (ECOG) performance status of 2 or more. The definition of BR-PDAC requires one or more positive dimensions (e.g. A, B, C, AB, AC, BC or ABC). The present definition acknowledges that resectability is not just about the anatomic relationship between the tumor and vessels, but that biological and conditional dimensions are also important. The aim in presenting this consensus definition is also to highlight issues which remain controversial and require further research.
Background: Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), which causes coronavirus disease 2019 (COVID-19), has emerged as a serious threat to human health worldwide. Efficient disinfection of surfaces contaminated with SARS-CoV-2 may help prevent its spread. This study aimed to investigate the in vitro efficacy of 222-nm far-ultraviolet light (UVC) on the disinfection of SARS-CoV-2 surface contamination. Methods: We investigated the titer of SARS-CoV-2 after UV irradiation (0.1 mW/cm 2) at 222 nm for 10-300 seconds using the 50% tissue culture infectious dose (TCID 50). In addition, we used quantitative reverse transcription polymerase chain reaction to quantify SARS-CoV-2 RNA under the same conditions. Results: One and 3 mJ/cm 2 of 222-nm UVC irradiation (0.1 mW/cm 2 for 10 and 30 seconds) resulted in 88.5 and 99.7% reduction of viable SARS-CoV-2 based on the TCID 50 assay, respectively. In contrast, the copy number of SARS-CoV-2 RNA did not change after UVC irradiation even after a 5-minute irradiation. Conclusions: This study shows the efficacy of 222-nm UVC irradiation against SARS-CoV-2 contamination in an in vitro experiment. Further evaluation of the safety and efficacy of 222-nm UVC irradiation in reducing the contamination of real-world surfaces and the potential transmission of SARS-CoV-2 is needed.
ObjectiveTo determine the pattern of middle (Bim) and distal (Bi) bile duct cancers in an attempt to optimize surgical treatment.
Summary Background DataLymph node involvement and neural plexus invasion are the prognostic factors most amenable to surgery in Bm and Bi disease. However, a detailed analysis of these factors has not been conducted.
MethodsFifty patients with Bm and Bi disease (Bm 14 patients, Bi 36 patients) were examined histopathologically. A precise determination was made of lymph node involvement and neural plexus invasion. Important prognostic factors were examined by clinicopathologic study to apply these findings to surgical management.
ResultsFrequencies of nodal involvement for Bm and Bi disease were 57% and 71 %, respectively. The inferior periductal and superior pancreaticoduodenal lymph nodes were most commonly involved. Neural plexus invasion occurred in 20% of patients, particularly involving the plexus in the hepatoduodenal ligament and pancreatic head. Tumor was present at the surgical margin in 50% and 14% of patients with Bm and Bi disease, respectively. Five-year survival rates were 65% in the absence of nodal metastasis and 21 % with nodal metastasis. A significant correlation existed between absence of tumor at the surgical margin and survival. A Cox proportional hazard model projected absence of tumor at the surgical margin, followed by nodal involvement, as the strongest prognostic variables.
ConclusionsAbsence of tumor at the surgical margin and nodal involvement are important independent prognostic factors in Bm and Bi disease. Skeletonization of the hepatoduodenal ligament, including portal vein resection, is necessary for patients with Bm disease, and a wide nodal dissection is essential in all patients.The survival rate for periampullary carcinoma is low among the malignant gastrointestinal diseases. The prognosis of bile duct cancer is better than that of carcinoma of the head of the pancreas.' Pancreatobiliary carcinoma is characterized by tumor spread by neural invasion and lymph node metastasis.24 Nodal involvement and nerve plexus invasion are important prognostic factors that may be surgically resectable. We already have reported that a radical resection is necessary for pancreatobiliary cancer.26 However, even after curative surgery, some patients still have recurrence.The goal of the current study was to determine the pattern of tumor spread, including nodal involvement and nerve plexus invasion, and other factors that may affect long-term survival. We also discuss the implications for the surgical treatment of carcinoma of the middle or distal bile duct.Address reprint requests to Masato Kayahara, MD, PhD, The Second
It was emphasized that the nerve originating from SMPlx to the uncinate process chiefly ran along the IPDA and it was necessary to focus one's attention not only on the extrapancreatic perineural invasion but also on the intrapancreatic perineural invasion in carcinoma of the body and tail of the pancreas.
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