Inflammatory bowel diseases are an increasing phenomenon in western countries and in growing populations. The physiopathology of these conditions is linked to intestinal stem cells homeostasis and regenerative potential in a chronic inflammatory microenvironment. Patients with IBD present an increased risk of developing colorectal cancer (CRC), or colitis associated cancer (CAC). Conventional treatment for IBD target the inflammatory process (and include anti-inflammatory and immunosuppressive drugs) with biological agents emerging as a therapeutic approach for non-responders to traditional therapy. Conventional treatment provides scarce results and present severe complications. The intestinal environment may host incoming stem cells, able to engraft in the epithelial damaged sites and differentiate. Therefore, stem cell therapies represent an emerging alternative in inflammatory bowel diseases, with current investigations on the use of haematopoietic and mesenchymal stem cells, in particular adipose stem cells, apparently fundamental as regenerators and as immune-modulators. Here, we discuss stem cells in intestinal homeostasis and as therapeutic agents for the treatment of inflammatory bowel diseases.

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Background Whether patients who are resected for ampullary adenocarcinoma have a survival benefit from adjuvant chemotherapy is currently not known. The aim of this study was to compare propensity score-matched survival between patients with and without adjuvant chemotherapy after resection of ampullary adenocarcinoma. Methods An international multicentre cohort study was conducted, including patients who underwent pancreatoduodenectomy for ampullary adenocarcinoma (2006-2017) in 13 centres in six countries. Propensity scores were used to match patients who received adjuvant chemotherapy to those who did not; both in the entire cohort and in two subgroups (pancreaticobiliary/mixed and intestinal subtype). Survival was assessed using the Kaplan-Meier method and Cox regressions. Results Overall, 1163 patients underwent pancreatoduodenectomy for ampullary adenocarcinoma. After excluding 179 patients, median survival in the resulting 976 patients was 67 months (95 per cent confidence interval 56-78), of which a total of 520 (53 per cent) patients received adjuvant chemotherapy. In a propensity-matched cohort (194 vs 194 patients), median survival was better after adjuvant chemotherapy compared to those without adjuvant chemotherapy (median survival not reached vs 60 months, respectively; p=0.051). In the pancreaticobiliary/mixed subtype a survival benefit was seen; median survival was not reached in patients receiving adjuvant chemotherapy vs 32 months in the group without chemotherapy, p=0.020. The intestinal subtype did not show survival benefit from adjuvant chemotherapy. Conclusions Patients with resected ampullary adenocarcinoma may benefit from gemcitabinebased adjuvant chemotherapy, but this effect may be reserved for those with the pancreaticobiliary and/or mixed subtype.

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