Objective: This study investigates the use of serum DUPAN-2 in predicting the PC progression in CA19-9 nonsecretors. Background: Although we previously reported that serum CA19-9 > 500U/ mL is a poor prognostic factor and an indication for enhanced neoadjuvant treatment, there is not a biomarker surrogate that equivalently predicts prognosis for CA19-9 nonsecretors. Methods: We evaluated consecutive PC patients who underwent pancreatectomy from 2005 to 2019. All patients were categorized as either nonsecretor or secretor (CA19-9 ≤ or > 2.0U/mL). Results: Of the 984 resected PC patients, 94 (9.6%) were nonsecretors and 890 (90.4%) were secretors. The baseline characteristics were not statistically different between the 2 groups except for the level of DUPAN-2 (720 vs. 100U/mL, P < 0.001). Survival curves after resection were similar between the 2 groups (29.4 months vs. 31.3 months, P = 0.900). Survival curves of patients with DUPAN-2 > 2000U/mL in the nonsecretors and patients with CA19-9 > 500U/mL in the secretors were nearly equivalent as well (hazard ratio 2.08 vs. 1.89). In the multivariate analysis, DUPAN-2 > 2000U/mL (hazard ratio 2.53, P = 0.010) was identified as independent prognostic factor after resection. Conclusion: DUPAN-2 > 2000U/mL in CA19-9 nonsecretors can be an unfavorable factor that corresponds to CA19-9 > 500U/mL in CA19-9 secretors which is an indicator for enhanced neoadjuvant treatment. The current results shed light on the subset of nonsecretors with poor prognosis that were traditionally categorized in a group with a more favorable prognosis group.
Background: Severe inflammation with necrosis and fibrosis of the gallbladder in acute cholecystitis increases operative difficulty during laparoscopic cholecystectomy. This study aimed to assess the use of preoperative MRI in predicting pathological changes of the gallbladder associated with surgical difficulty. Methods: Patients who underwent both preoperative MRI and early cholecystectomy for acute cholecystitis between 2012 and 2018 were identified retrospectively. On the basis of the layered pattern of the gallbladder wall on MRI, patients were classified into three groups: high signal intensity (HSI), intermediate signal intensity (ISI), and low signal intensity (LSI). The endpoint was the presence of pathological changes of the gallbladder associated with surgical difficulty, such as necrosis, abscess formation and fibrosis. Results: Of 229 eligible patients, pathological changes associated with surgical difficulty were found in 17 (27 per cent) of 62 patients in the HSI group, 84 (85 per cent) of 99 patients in the ISI group, and 66 (97 per cent) of 68 patients in the LSI group (P < 0⋅001). For detecting these changes, intermediate to low signal intensity of the gallbladder wall had a sensitivity of 90 (95 per cent c.i. 84 to 94) per cent, specificity of 73 (60 to 83) per cent and accuracy of 85 (80 to 90) per cent. Conclusion: Preoperative MRI predicted pathological changes associated with surgical difficulty during laparoscopic cholecystectomy for acute cholecystitis.
Recently, bail-out surgery (BOS) has been proposed to avoid but BDI not also major vessels injury. In this retrospective study, we evaluated that pre-and peri operative risk factor for conversion from total cholecystectomy (TC) to conversion BOS. Methods: This study included 584 patients who underwent elective LC for Gall bladder diseases were between Jan. 2006 and Apt. 2019. We divided into two groups of TC group (including conversion open total cholecystectomy) and BOS group. Univariate and multivariate analyses using pre and perioperative clinicolaboratory characteristics were performed to investigate the most significant risk factors for conversion to BOS. Results: There were 33 cases in BOS group, which had 18 cases of female and 35 male. Procedures of BOS were as follow: open BOS was 19 cases; laparoscopic BOS was 14 cases. On univariate analyses, age, Albumin level, CRP level, WBC, Lymph ratio, Neutro. ratio, platelet count (PLt), NLR, PLR, CAR, with acute cholecystitis (AC), with previous biliary tract drainage(PBTD)were risk factor for conversion BOS. Multivariate analysis using thirteen parameters selected by univariate analyses demonstrated that AC (p=0.04), albumin level (p=0.01) and age (p=0.04) were significant different risk factors. Conclusions: Patients with PBTD or AC are considered to have a high risk of conversion from LTC to BOS and it seems that LC should be cautiously applied.
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.