Evaluating staging laparoscopy indications for pancreatic cancer based on resectability classification and treatment strategies for patients with positive peritoneal washing cytology

Igarashi, Takamichi; Fukasawa, Mina; Watanabe, Tôru; Kimura, Naoko; Itoh, Ayaka; Kanda, Mitsuro; Shibuya, Kazuto; Yoshioka, Isaku; Hirabayashi, Kenichi; Fujii, Tsutomu

doi:10.1002/ags3.12719

Cited by 7 publications

(2 citation statements)

References 39 publications

(83 reference statements)

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“…Pancreatic cancer accounts for the majority of diseases requiring pancreatectomy. In recent years, advances in multidisciplinary treatment for pancreatic cancer have led to an increase in the 5‐year survival rate of pancreatic cancer patients and an increase in the number of patients who survive for a long period 6–9 . Therefore, we need to address mid‐ to long‐term complications after PD for stable and reliable continuation of postoperative chemotherapy.…”

Section: Introductionmentioning

confidence: 99%

“…In recent years, advances in multidisciplinary treatment for pancreatic cancer have led to an increase in the 5‐year survival rate of pancreatic cancer patients and an increase in the number of patients who survive for a long period. 6 , 7 , 8 , 9 Therefore, we need to address mid‐ to long‐term complications after PD for stable and reliable continuation of postoperative chemotherapy. However, various complications, such as pancreatic fistula and delayed gastric emptying, can occur in 10%–23% of patients after PD 10 , 11 and overwhelmingly cause the most frequent and troublesome aspects of all abdominal surgeries.…”

Section: Introductionmentioning

confidence: 99%

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Novel choledochojejunostomy technique “T‐shaped anastomosis” for preventing the development of postoperative cholangitis in pancreatoduodenectomy: A propensity score matching analysis

Kimura,

Igarashi,

Murotani

et al. 2023

Annals of Gastroent Surgery

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BackgroundThere have been few studies of countermeasures against postoperative cholangitis, a serious complication after pancreaticoduodenectomy (PD) that impairs quality of life.ObjectiveTo evaluate our recently developed, novel method of choledochojejunostomy with a larger anastomotic diameter, the “T‐shaped anastomosis.”MethodsThe study included 261 cases of PD. The T‐shaped choledochojejunostomy technique was performed with an additional incision for a distance greater than half the diameter of the bile duct at the anterior wall of the bile duct and the anterior wall of the elevated jejunum. To compensate for potential confounding biases between the standard anastomosis group (n = 206) and the T‐shaped anastomosis group (n = 55), we performed propensity score matching (PSM). The primary endpoint was the incidence of medium‐term postoperative cholangitis adjusted for PSM.ResultsIn the PSM analysis, 54 patients in each group were matched, and the median bile duct diameter measured by preoperative CT was 8.8 mm versus 9.3 mm, the rate of preoperative biliary drainage was 31% versus 37%, the incidence of cholangitis within 1 month before surgery was 9% versus 13%, and the incidence of postoperative bile leakage was 2% versus 2%, with no significant differences. The incidence of medium‐term postoperative cholangitis was 15% versus 4%, and multivariate logistic regression revealed that T‐shaped choledochojejunostomy was an independent predictor of a reduced incidence of cholangitis (odds ratio, 0.17, 95% CI 0.02–0.81; p = 0.024).ConclusionsThe T‐shaped choledochojejunostomy technique was shown to be effective with a significant reduction in the incidence of medium‐term postoperative cholangitis. Clinical trial identification: UMIN000050990.

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Novel choledochojejunostomy technique “T‐shaped anastomosis” for preventing the development of postoperative cholangitis in pancreatoduodenectomy: A propensity score matching analysis

Kimura,

Igarashi,

Murotani

et al. 2023

Annals of Gastroent Surgery

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Impact of endoscopic ultrasound‐guided fine needle aspiration on positive peritoneal lavage cytology in patients with resectable pancreatic body and tail cancer

Ishii,

Serikawa,

Uemura

et al. 2024

J Hepato Biliary Pancreat

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Background/PurposeA recent study has demonstrated that the timing of endoscopic ultrasound‐guided fine needle aspiration (EUS‐FNA) significantly influences the peritoneal lavage cytology (CY) outcomes in pancreatic body‐tail cancer. The aim of this study was to clarify the impact of EUS‐FNA on CY positivity in patients with resectable pancreatic body‐tail cancer.MethodsPatients with anatomically resectable pancreatic body‐tail cancer surgically resected at Hiroshima University Hospital were enrolled, and elated clinicopathological factors, including EUS‐FNA variables and CY positivity rate, were analyzed.ResultsOf the 129 eligible patients, 16 (12%) had positive CY. The EUS‐FNA rates of the CY‐positive and CY‐negative groups were not significantly different (63% vs. 52%, p = .440). Multivariate analysis revealed that lymph node metastasis was the only independent risk factor for CY positivity (odds ratio: 5.734, p = .031). A total of 10 (14%) of the 69 patients who underwent EUS‐FNA had positive CY; however, needle specifications and the interval between EUS‐FNA and CY examination did not differ between the CY‐positive and CY‐negative groups. CY positivity rates were comparable for intervals ≤14 days and ≥15 days (17% vs. 14%, p = 1.000).ConclusionsEUS‐FNA may not affect CY positivity in patients with resectable pancreatic body‐tail cancer, regardless of the timing.

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Efficacy of staging laparoscopy for resectable pancreatic cancer on imaging and the therapeutic effect of systemic chemotherapy for positive peritoneal cytology

Fukasawa,

Watanabe,

Tanaka

et al. 2023

J Hepato Biliary Pancreat

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BackgroundThe frequency and prognosis of positive peritoneal washing cytology (CY1) in resectable pancreatic ductal adenocarcinoma (R‐PDAC) remains unclear. The objective of this study was to identify the clinical implications of CY1 in R‐PDAC and staging laparoscopy (SL).MethodsWe retrospectively analyzed 115 consecutive patients with R‐PDAC who underwent SL between 2018 and 2022. Patients with negative cytology (CY0) received radical surgery after neoadjuvant chemotherapy, while CY1 patients received systemic chemotherapy and were continuously evaluated for cytology.ResultsOf the 115 patients, 84 had no distant metastatic factors, 22 had only CY1, and nine had distant metastasis. Multivariate logistic regression revealed that larger tumor size was an independent predictor of the presence of any distant metastatic factor (OR: 6.30, p = .002). Patients with CY1 showed a significantly better prognosis than patients with distant metastasis (MST: 24.6 vs. 18.9 months, p = .040). A total of 11 CY1 patients were successfully converted to CY‐negative, and seven underwent conversion surgery. There was no significant difference in overall survival between patients with CY0 and those converted to CY‐negative.ConclusionSL is effective even for R‐PDAC. The prognosis of CY1 patients converted to CY‐negative is expected to be similar to that of CY0 patients.

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Evaluating staging laparoscopy indications for pancreatic cancer based on resectability classification and treatment strategies for patients with positive peritoneal washing cytology

Cited by 7 publications

References 39 publications

Novel choledochojejunostomy technique “T‐shaped anastomosis” for preventing the development of postoperative cholangitis in pancreatoduodenectomy: A propensity score matching analysis

Novel choledochojejunostomy technique “T‐shaped anastomosis” for preventing the development of postoperative cholangitis in pancreatoduodenectomy: A propensity score matching analysis

Impact of endoscopic ultrasound‐guided fine needle aspiration on positive peritoneal lavage cytology in patients with resectable pancreatic body and tail cancer

Efficacy of staging laparoscopy for resectable pancreatic cancer on imaging and the therapeutic effect of systemic chemotherapy for positive peritoneal cytology

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