Objective
Accurate, easily accessible and economically viable cancer diagnostic tools are pivotal in improving the abysmal 5% survival rate of pancreatic cancer.
Methods
A novel, affordable, ...non‐invasive diagnostic method has been developed by combining measurement precision of infrared spectroscopy with classification using machine learning tools.
Results
Diagnosis accuracy as high as 90% has been achieved. The study investigated urine and blood from pancreas cancer patients and healthy volunteers, and significantly improved accuracy by focusing on sweet‐spots within blood plasma fractions containing molecules within a narrow range of molecular weights.
The graphical table of contents depicts the flow of cancer information, data acquisition and diagnosis.
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FZAB, GIS, IJS, KILJ, NLZOH, NUK, OILJ, SBCE, SBMB, UL, UM, UPUK
To compare short-term clinical outcomes after Kimura and Warshaw MIDP.
Spleen preservation during distal pancreatectomy can be achieved by either preservation (Kimura) or resection (Warshaw) of the ...splenic vessels. Multicenter studies reporting outcomes of Kimura and Warshaw spleen-preserving MIDP are scarce.
Multicenter retrospective study including consecutive MIDP procedures intended to be spleen-preserving from 29 high-volume centers (≥15 distal pancreatectomies annually) in 8 European countries. Primary outcomes were secondary splenectomy for ischemia and major (Clavien-Dindo grade ≥III) complications. Sensitivity analysis assessed the impact of excluding ("rescue") Warshaw procedures which were performed in centers that typically (>75%) performed Kimura MIDP.
Overall, 1095 patients after MIDP were included with successful splenic preservation in 878 patients (80%), including 634 Kimura and 244 Warshaw procedures. Rates of clinically relevant splenic ischemia (0.6% vs 1.6%, P = 0.127) and major complications (11.5% vs 14.4%, P = 0.308) did not differ significantly between Kimura and Warshaw MIDP, respectively. Mortality rates were higher after Warshaw MIDP (0.0% vs 1.2%, P = 0.023), and decreased in the sensitivity analysis (0.0% vs 0.6%, P = 0.052). Kimura MIDP was associated with longer operative time (202 vs 184 minutes, P = 0.033) and less blood loss (100 vs 150 mL, P < 0.001) as compared to Warshaw MIDP. Unplanned splenectomy was associated with a higher conversion rate (20.7% vs 5.0%, P < 0.001).
Kimura and Warshaw spleen-preserving MIDP provide equivalent short-term outcomes with low rates of secondary splenectomy and postoperative morbidity. Further analyses of long-term outcomes are needed.
Background
Pancreaticoduodenectomy is often required in patients with duodenal adenoma and adenocarcinoma and these patients generally have soft pancreatic texture and small pancreatic ducts, the two ...most significant factors associated with post‐operative pancreatic fistula (POPF). The aims of the study were to evaluate the rate of POPF and long‐term outcomes for patients with duodenal adenoma and adenocarcinoma who underwent curative resection.
Methods
This retrospective study (2004–2014) examined patients treated surgically with non‐ampullary duodenal tumours (NADTs) in two hepatopancreaticobiliary units in Victoria, Australia, and Swansea, UK.
Results
There were 49 resections performed including 33 pancreaticoduodenectomies, five pancreas‐preserving total duodenectomies and 11 segmental duodenal resections. Median length of follow‐up was 23.5 months. Final histopathology revealed 18 duodenal adenomas and 31 adenocarcinomas. POPF rate for NADTs was 28.9% (of which 54.5% were grade C) compared to 14.5% for all other pathologies. Grade C POPF was associated with poorer survival outcomes (hazard ratio = 6.73; P = 0.005). The 5‐year overall survival for patients with duodenal adenocarcinoma was 66.5%.
Conclusion
Due to the soft pancreatic texture and small pancreatic duct, pancreatic resection for NADTs is associated with a high rate of POPF which contributes to reduced survival. Nevertheless, surgery is associated with favourable 5‐year survival compared to pancreatic resection for pancreatic adenocarcinoma.
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BFBNIB, FZAB, GIS, IJS, KILJ, NLZOH, NUK, OILJ, SBCE, SBMB, UL, UM, UPUK
Kidins220 is a transmembrane scaffold protein involved in several types of cancer. The aim of the present study was to examine the role of Kidins220 in tumorigenesis and disease progression of ...pancreatic cancer. The relevant signalling pathways including EGFR, EMT, and MMP were also investigated. The expression of Kidins220 was examined at the transcript and protein level. The Kidins220 knockdown cell model was established and its influence on cellular functions was determined. Involvement of Kidins220 in tumorigenesis and metastasis was examined in CD1 mice, respectively. The results showed that, reduced Kidin220 expression was associated with tumorigenesis, metastasis, and overall survival of pancreatic cancer. Knockdown of Kidins220 promoted proliferation, colony formation and tumorigenic capacity of pancreatic cancer cells in vitro and in vivo, respectively. Kidins220 regulated pancreatic cancer cell migration through the EGFR/AKT/ERK signalling pathway. Furthermore, enhanced EMT was observed in the pancreatic cancer cell lines with the knockdown of Kidins220, underlying EGFR regulation. Kidins220 also affected cell invasion via MMP1. A reduced expression of Kidins220 was observed in pancreatic cancer, which is associated with disease progression, distant metastasis and poor prognosis. The loss of Kidins220 in pancreatic cancer may contribute to disease progression through the upregulation of EGFR and downstream signalling. Key words: Kidins220, pancreatic cancer, metastasis, epidermal growth factor receptor, invasion and matrix metalloproteinase
The microbiology of infected pancreatic necrosis Mowbray, Nicholas G.; Ben-Ismaeil, Bassam; Hammoda, Mohammed ...
Hepatobiliary & pancreatic diseases international,
10/2018, Volume:
17, Issue:
5
Journal Article
Peer reviewed
Acute pancreatitis (AP) continues to cause significant morbidity and mortality, especially when it leads to infected pancreatic necrosis (IPN). Modern treatment of IPN frequently involves prolonged ...courses of antibiotics in combination with minimally invasive therapies. This study aimed to update the existing evidence base by identifying the pathogens causing IPN and therefore aid future selection of empirical antibiotics.
Clinical data, including microbiology results, of consecutive patients with IPN undergoing minimally invasive necrosectomy at our institution between January 2009 and July 2016 were retrospectively reviewed.
The results of 40 patients (22 males and 18 females, median age 60 years) with IPN were reviewed. The etiology of AP was gallstones, alcohol, dyslipidemia and unknown in 31, 2, 2 and 5 patients, respectively. The most frequently identified microbes in microbiology cultures were Enterococcus faecalis and faecium (22.5% and 20.0%) and Escherichia coli (20.0%). In 19 cases the cultures grew multiple organisms. The antibiotics with the least resistance amongst the microbiota were teicoplanin (5.0%), linezolid (5.6%), ertapenem (6.5%), and meropenem (7.4%).
The carbapenem antibiotics, ertapenem and meropenem provide good antimicrobial cover against the common, mainly enteral, microorganisms causing IPN. Culture and sensitivity results of acquired samples should be regularly reviewed to adjust prescribing and monitor for emergence of resistance.
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GEOZS, IJS, IMTLJ, KILJ, KISLJ, NLZOH, NUK, OILJ, PNG, SAZU, SBCE, SBJE, UL, UM, UPCLJ, UPUK, ZRSKP
Aims: The aim of this bibliometric analysis was to identify the main topics and publications that have enhanced our understanding and influenced the management of intraductal papillary mucinous ...neoplasm (IPMN). Methods: The Thompson Reuters Web of Science database was searched using the terms 'Intraductal papillary mucinous neoplasm', or 'IPMN' to identify all English language manuscripts for the study. The 100 most cited articles were further analyzed by journal, topic, year, author and institution. Results: Total 2,833 eligible manuscripts were identified. The median (range) citation number was 129 (93-1006). The most cited paper presented consensus guidelines regarding the management of IPMN (1006 citations). The Annals of Surgery published the highest number of manuscripts (n = 13) and subsequently had the highest number of citations (n = 2889). The USA published most manuscripts within the top 100 (n = 46). The most discussed topic was IPMN management (n = 29), incorporating diagnosis and surgery. The second most commonly discussed topic was histology (n = 18). Conclusion: This bibliometric analysis highlights how advances in the histological evaluation of IPMN have influenced current management strategies for IPMN. This manuscript highlights the most cited and influential references related to IPMN and serves as a guide to the most popular IPMN research themes.
Abstract
Pancreatic cancer still has one of the worst prognoses of all solid malignancies, despite developments in cancer knowledge and care. Research into pancreatic cancer has not fully translated ...into clinical improvements and as a result, fewer than 1% of patients survive 10 years post-diagnosis. This bleak outlook for patients could be improved by earlier diagnosis. The human erythrocyte phosphatidylinositol glycan class A (PIG-A) assay monitors the mutation status of the X-linked PIG-A gene by measuring glycosyl phosphatidylinositol (GPI)-anchored proteins on the extracellular surface. We have previously identified an elevated PIG-A mutant frequency in oesophageal adenocarcinoma patients and here investigate whether this could be seen in a pancreatic cancer cohort, given the urgent need for novel pancreatic cancer biomarkers. In our pilot study, an elevated PIG-A mutant frequency (5.775 × 10−6 (95% CI 4.777–10) mutants per million) was seen in pancreatic cancer patients (n = 30) when compared to the non-cancer control group (n = 14) who had an erythrocyte mutant frequency of 4.211 × 10−6 (95% CI 1.39–5.16) mutants per million (p = 0.0052). A cut-off value of 4.7 mutants per million provided an AUROC of 0.7595 with a sensitivity of 70% and specificity of 78.57%. A secondary measure of DNA damage in an alternative blood cell population also showed an increase in peripheral lymphocytes using the cytokinesis-block micronucleus assay (p = 0.0164) (AUROC = 0.77, sensitivity = 72.22%, specificity = 72.73%). The micronucleus frequency and PIG-A status show some potential as blood-based biomarkers of pancreatic cancer, but further investigations of these DNA damage tests are required to assess their utility in pancreatic cancer diagnosis.
The neutrophil-to-lymphocyte ratio (NLR) is thought to reflect cancer disease burden. To assess the prognostic ability of the NLR on overall survival in patients with resectable, pancreatic cancer a ...meta-analysis of published literature was undertaken.
A systematic review was performed independently by two authors using PubMed, Ovid MEDLINE and Embase databases. Included studies detailed the pre-operative NLR and overall survival of pancreatic cancer patients.
Of the 214 studies retrieved using the search strategy, 8 studies involving 1519 patients were included in the meta-analysis. Only one study did not find a statistically significant association between a high NLR and OS. The pooled Hazard Ratio was 1.77 (95% CI 1.45–2.15; p < 0.01). The NLR cut-off values ranged from 2 to 5. There was low to moderate inter-study heterogeneity (I2 = 31%; p = 0.17), a low risk of intra-study bias, and potentially 3 unpublished (negative) studies.
A high pre-operative NLR indicates a worse prognosis than in patients with a low NLR. There is potential to use the NLR to direct therapies. A specific cut-off value has not been established from this study and so further research is required.
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GEOZS, IJS, IMTLJ, KILJ, KISLJ, NLZOH, NUK, OILJ, PNG, SAZU, SBCE, SBJE, UILJ, UL, UM, UPCLJ, UPUK, ZAGLJ, ZRSKP
OBJECTIVE:The aim of the study was to define histopathologic characteristics that independently predict overall survival (OS) and disease-free survival (DFS), in patients who underwent resection of ...an ampullary adenocarcinoma with curative intent.
SUMMARY BACKGROUND DATA:A broad range of survival rates have been described for adenocarcinoma of the ampulla of Vater, presumably due to morphological heterogeneity which is a result of the different epitheliums ampullary adenocarcinoma can arise from (intestinal or pancreaticobiliary). Large series with homogenous patient selection are scarce.
METHODS:A retrospective multicenter cohort analysis of patients who underwent pancreatoduodenectomy for ampullary adenocarcinoma in 9 European tertiary referral centers between February 2006 and December 2017 was performed. Collected data included demographics, histopathologic details, survival, and recurrence. OS and DFS analyses were performed using Kaplan–Meier curves and Cox proportional hazard models.
RESULTS:Overall, 887 patients were included, with a mean age of 66 ± 10 years. The median OS was 64 months with 1-, 3-, 5-, and 10-year OS rates of 89%, 63%, 52%, and 37%, respectively. Histopathologic subtype, differentiation grade, lymphovascular invasion, perineural invasion, T-stage, N-stage, resection margin, and adjuvant chemotherapy were correlated with OS and DFS. N-stage (HR = 3.30 2.09–5.21), perineural invasion (HR = 1.50 1.01–2.23), and adjuvant chemotherapy (HR = 0.69 0.48–0.97) were independent predictors of OS in multivariable analysis, whereas DFS was only adversely predicted by N-stage (HR = 2.65 1.65–4.27).
CONCLUSIONS:Independent predictors of OS in resected ampullary cancer were N-stage, perineural invasion, and adjuvant chemotherapy. N-stage was the only predictor of DFS. These findings improve predicting survival and recurrence after resection of ampullary adenocarcinoma.
Introduction
The centralisation of pancreatic cancer (PC) services still varies worldwide. This study aimed to assess the impact that a centralisation has had on patients in South Wales, UK.
Methods
...A retrospective cohort analysis of patients in South Wales, UK, with PC prior to (2004–2009), and after (2010–2014) the formation of a specialist centre. Patients were identified using record linkage of electronic health records.
Results
The overall survival (OS) of all 3413 patients with PC increased from a median (IQR) 10 weeks (3–31) to 11 weeks (4–35),
p
= 0.038, after centralisation. The OS of patients undergoing surgical resection or chemotherapy alone did not improve (93 weeks (39–203) vs. 90 weeks (50–95),
p
= 0.764 and 33 weeks (20–57) vs. 33 weeks (19–58),
p
= 0.793). Surgical resection and chemotherapy rates increased (6.1% vs. 9.2%,
p
< 0.001 and 19.7% vs. 27.0%,
p
< 0.001). The 30-day mortality rate trended downwards (7.2% vs. 3.6%,
p
= 0.186). The percentage of patients who received no treatment reduced (75.2% vs. 69.6%,
p
< 0.001).
Conclusion
The centralisation of PC services in South Wales is associated with a small increase in OS and a larger increase in PC treatment utilisation. It is concerning that many patients still fail to receive any treatments.
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EMUNI, FZAB, GEOZS, IJS, IMTLJ, KILJ, KISLJ, MFDPS, NUK, OILJ, PNG, SAZU, SBCE, SBMB, SBNM, UKNU, UL, UM, UPUK, VKSCE, ZAGLJ
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