To enhance the resectability of cancer of the pancreatic body, a new surgical technique should be developed. Of 25 patients with cancer of the pancreatic body who underwent distal pancreatectomy with curative intent, seven with cancer invasion around the celiac artery underwent stomach-preserving distal pancreatectomy with combined resection of the celiac artery. This procedure secured arterial blood supply to the whole stomach and liver via the inferior pancreaticoduodenal artery without arterial reconstruction. There was no postoperative mortality. One patient developed transient passage disturbance in the duodenum. Another one developed a minor pancreatic fistula. No patients had serious complications related to ischemia of the stomach or liver. The quality of life of the patients after surgery was well maintained, and planned adjuvant therapy was accomplished. Local recurrence was evident in only two patients. The median survival time of patients who underwent distal pancreatectomy with (n = 7) or without (n = 18) resection of the celiac artery was 19 and 25 months, respectively. The overall survival rate was not significantly different between the two groups (P = 0.5300). The present study suggests that this surgical procedure is a rational approach to locally advanced pancreatic body cancer invading around the celiac artery. In view of the feasibility of this procedure, it can also be adopted for less advanced cancer of the pancreatic body to enhance local control and survival.
We retrospectively reviewed the cases of 34 patients with pancreatic cancer who underwent resection between January 1988 and December 1996. Adjuvant radiotherapy was performed in 24 patients, with 13 receiving both intra- and postoperative radiotherapy, 2 receiving postoperative radiotherapy (PORT) alone, and 9 receiving intraoperative radiotherapy (IORT) alone. The 1- and 3-year survival rates for all 34 patients were 59% and 19%, respectively, with a median survival of 13 months. At the time of the analysis, three patients were still alive. Recurrence patterns were assessed in 25 patients who had had no distant metastases at the time of surgery, had survived more than 3 months after surgery, and had undergone close surveillance for recurrence. Based on computed tomography (CT) and autopsy findings, a total of 15 (60%) of these 25 patients had local recurrence, 13 (52%) had liver metastases, and 8 (32%) had both. Eight (62%) of the 13 patients who received IORT and/or PORT developed local recurrence, and we failed to detect any survival advantage of IORT and/or PORT over surgery alone. However, autopsies revealed a suppressive effect of radiation on cancer growth, and local recurrence was not considered to be the direct cause of death in any of the patients, nor did any of the patients develop gastrointestinal obstruction due to local recurrence. The incidence of liver metastasis in the patients with and without tumor invasion of the portal system was 80% (8/10) and 33% (5/15), respectively. The patients who did not develop liver metastasis had significantly longer survivals than who did. Further improvements of survival await effective prophylactic treatment for liver metastases.
Background: Several preoperative systemic inflammatory parameters, such as the neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), lymphocyte-to-monocyte ratio (LMR), and Glasgow Prognostic Score, have been reported to be associated with the prognosis of solid tumors. However, there are conflicting survival data regarding these parameters in cholangiocarcinoma. Objectives: In this study, we performed a retrospective cohort analysis of patients with distal cholangiocarcinoma (DCC) who underwent surgical resection to evaluate the prognostic value of a cluster of preoperative hematological inflammatory parameters for survival. Method: Fifty-three patients with DCC who underwent pancreaticoduodenectomy with curative intent were enrolled. The optimal cutoff values of hematological inflammatory parameters, including the absolute lymphocyte count, NLR, PLR, and LMR, were determined by time-dependent receiver operating characteristic analysis. Results: The univariate analysis for overall survival (OS) of conventional factors and hematological inflammatory parameters identified that portal vein invasion and PLR had p values of ≤0.1. The univariate analysis for disease-free survival (DFS) identified that lymph node metastasis, PLR, lymphocyte count, and number of positive lymph nodes (≥3) had p values of ≤0.1. These factors were incorporated into the full model and variables were selected using the backward stepwise method. The multivariate analysis identified portal vein invasion and high PLR as independent prognostic factors for OS (p = 0.033 and 0.039, respectively) and high PLR and number of positive lymph nodes (≥3) as independent prognostic factors for DFS (p = 0.016 and 0.004, respectively). Conclusions: Preoperative PLR assessment may be useful for detecting high-risk DCC patients undergoing surgical resection for aggressive adjuvant therapy.
The SCC component of ASC in the biliary tract displayed a relatively higher proliferative ability, which might be associated with local invasiveness. However, not only the high proliferative ability of the SCC component but also other biological factors might contribute to tumor progression and metastasis in ASC of the biliary tract.
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