Background
The impact of body compositions on surgical results is controversially discussed. This study examined whether visceral obesity, sarcopenia or sarcopenic obesity influence the outcome after ...hepatic resections of synchronous colorectal liver metastases.
Methods
Ninety-four consecutive patients with primary hepatic resections of synchronous colorectal metastases were identified from a single center database between January 2013 and August 2018. Patient characteristics and 30-day morbidity were retrospectively analyzed. Body fat and skeletal muscle were calculated by planimetry from single-slice CT images at the level of L3.
Results
Fifty-nine patients (62.8%) underwent minor hepatectomies, and 35 patients underwent major resections (37.2%). Postoperative complications occurred in 60 patients (62.8%) including 35 patients with major complications (Clavien–Dindo grade III–V). The mortality was nil at 30 days and 2.1% at 90 days. The body mass index showed no influence on postoperative outcomes (
p
= 1.0). Visceral obesity was found in 66 patients (70.2%) and was significantly associated with overall and major complication rates (
p
= .002,
p
= .012, respectively). Sarcopenia was observed in 34 patients (36.2%) without a significant impact on morbidity (
p
= .461), however, with longer hospital stay. Sarcopenic obesity was found in 18 patients (19.1%) and was significantly associated with postoperative complications (
p
= .014). Visceral obesity, sarcopenia and sarcopenic obesity were all identified as significant risk factors for overall postoperative complications.
Conclusion
Visceral obesity, sarcopenic obesity and sarcopenia are independent risk factors for overall complications after resections of CRLM. Early recognition of extremes in body compositions could prompt to perioperative interventions and thus improve postoperative outcomes.
Abstract
Artificial intelligence (AI)-driven language models have the potential to serve as an educational tool, facilitate clinical decision-making, and support research and academic writing. The ...benefits of their use are yet to be evaluated and concerns have been raised regarding the accuracy, transparency, and ethical implications of using this AI technology in academic publishing. At the moment, Chat Generative Pre-trained Transformer (ChatGPT) is one of the most powerful and widely debated AI language models. Here, we discuss its feasibility to answer scientific questions, identify relevant literature, and assist writing in the field of human reproduction. With consideration of the scarcity of data on this topic, we assessed the feasibility of ChatGPT in academic writing, using data from six meta-analyses published in a leading journal of human reproduction. The text generated by ChatGPT was evaluated and compared to the original text by blinded reviewers. While ChatGPT can produce high-quality text and summarize information efficiently, its current ability to interpret data and answer scientific questions is limited, and it cannot be relied upon for a literature search or accurate source citation due to the potential spread of incomplete or false information. We advocate for open discussions within the reproductive medicine research community to explore the advantages and disadvantages of implementing this AI technology. Researchers and reviewers should be informed about AI language models, and we encourage authors to transparently disclose their use.
Background
Liver metastases occur in 40–50 per cent of patients with colorectal cancer and determine long‐term survival. The aim of this study was to examine the immunological architecture of ...colorectal liver metastases and its impact on patient survival.
Methods
Specimens from patients with colorectal liver metastases were stained with haematoxylin and eosin and Masson trichrome, immunostained for α‐smooth muscle actin, CD4, CD45RO and CD8, and analysed by flow cytometry. In addition to histomorphological evaluation, immunohistochemically stained sections were analysed for cell numbers in the tumour area, infiltrative margin and distant liver stroma separately. These findings were correlated with clinical data and patient outcome.
Results
Tumour containment by a fibrotic capsule around liver metastases was observed in 37·8 per cent of 201 patients and was prognostic for improved survival (median (s.e.) survival 64 (6) and 31 (4) months for patients with capsule and no capsule respectively; P < 0·001) and independently led to higher R0 resection rates (P = 0·040). In multivariable analysis, CD45RO+ cell infiltration at the peritumoral margin with low CD45RO+ cell infiltration in the distant liver stroma (P = 0·001) and fibrotic capsule formation (P = 0·008) both independently prolonged patient survival. Using these two factors, a cellular immune score was designed and shown to stratify patient survival in test and validation samples (both P < 0·001).
Conclusion
Fibrotic capsule formation and localized cell infiltration of colorectal liver metastases by CD45RO+ cells were related to prolonged patient survival. Based on these immunological criteria a cellular immune score was developed to stratify patients according to prognosis.
Better prognosis if tumour is encapsulated
Data on perioperative chemotherapy in resectable pancreatic ductal adenocarcinoma (rPDAC) are limited. NEONAX examined perioperative or adjuvant chemotherapy with gemcitabine plus nab-paclitaxel in ...rPDAC (National Comprehensive Cancer Network criteria).
NEONAX is a prospective, randomized phase II trial with two independent experimental arms. One hundred twenty-seven rPDAC patients in 22 German centers were randomized 1 : 1 to perioperative (two pre-operative and four post-operative cycles, arm A) or adjuvant (six cycles, arm B) gemcitabine (1000 mg/m2) and nab-paclitaxel (125 mg/m2) on days 1, 8 and 15 of a 28-day cycle.
The primary endpoint was disease-free survival (DFS) at 18 months in the modified intention-to-treat (ITT) population R0/R1-resected patients who started neoadjuvant chemotherapy (CTX) (A) or adjuvant CTX (B). The pre-defined DFS rate of 55% at 18 months was not reached in both arms A: 33.3% (95% confidence interval CI 18.5% to 48.1%), B: 41.4% (95% CI 20.7% to 62.0%). Ninety percent of patients in arm A completed neoadjuvant treatment, and 42% of patients in arm B started adjuvant chemotherapy. R0 resection rate was 88% (arm A) and 67% (arm B), respectively. Median overall survival (mOS) (ITT population) as a secondary endpoint was 25.5 months (95% CI 19.7-29.7 months) in arm A and 16.7 months (95% CI 11.6-22.2 months) in the upfront surgery arm. This difference corresponds to a median DFS (mDFS) (ITT) of 11.5 months (95% CI 8.8-14.5 months) in arm A and 5.9 months (95% CI 3.6-11.5 months) in arm B. Treatment was safe and well tolerable in both arms.
The primary endpoint, DFS rate of 55% at 18 months (mITT population), was not reached in either arm of the trial and numerically favored the upfront surgery arm B. mOS (ITT population), a secondary endpoint, numerically favored the neoadjuvant arm A 25.5 months (95% CI 19.7-29.7months); arm B 16.7 months (95% CI 11.6-22.2 months). There was a difference in chemotherapy exposure with 90% of patients in arm A completing pre-operative chemotherapy and 58% of patients starting adjuvant chemotherapy in arm B. Neoadjuvant/perioperative treatment is a novel option for patients with resectable PDAC. However, the optimal treatment regimen has yet to be defined.
The trial is registered with ClinicalTrials.gov (NCT02047513) and the European Clinical Trials Database (EudraCT 2013–005559-34).
Perioperative or only adjuvant gemcitabine plus nab-paclitaxel for resectable pancreatic cancer:•Did not meet its primary endpoint in either arm of the study (DFS rate at 18 months of 55% in the mITT population).•Showed that pre-operative chemotherapy can be completed by the majority of patients (90%).•Showed an mOS as a secondary endpoint of 25.5 months in arm A (perioperative) and 16.7 months in arm B (upfront surgery).•Gemcitabine and nab-paclitaxel were safe and well tolerated both in the perioperative as well as the adjuvant setting.
In this ATLAS upgrade R&D project, we explore the concept of using a deep-submicron HV-CMOS process to produce a drop-in replacement for traditional radiation-hard silicon sensors. Such active ...sensors contain simple circuits, e.g. amplifiers and discriminators, but still require a traditional (pixel or strip) readout chip. This approach yields most advantages of MAPS (improved resolution, reduced cost and material budget, etc.), without the complication of full integration on a single chip. After outlining the basic design of the HV2FEI4 test ASIC, results after irradiation with X-rays to 862 Mrad and neutrons up to 10 super(16) (1 MeV n sub(eq)) /cm super(2) will be presented. Finally, a brief outlook on further development plans is given.
Purpose
To develop nomograms for pre- and early-postoperative risk assessment of patients undergoing pancreatic head resection.
Methods
Clinical data from 956 patients were collected in a ...prospectively maintained database. A test (
n
= 772) and a validation cohort (
n
= 184) were randomly generated. Uni- and multi-variate analysis and nomogram construction were performed to predict severe postoperative complications (Clavien-Dindo Grades III–V) in the test cohort. External validation was performed with the validation cohort.
Results
We identified ASA score, indication for surgery, body mass index (BMI), preoperative white blood cell (WBC) count, and preoperative alkaline phosphatase as preoperative factors associated with an increased perioperative risk for complications. Additionally to ASA score, BMI, indication for surgery, and the preoperative alkaline phosphatase, the following postoperative parameters were identified as risk factors in the early postoperative setting: the need for intraoperative blood transfusion, operation time, maximum WBC on postoperative day (POD) 1–3, and maximum serum amylase on POD 1–3. Two nomograms were developed on the basis of these risk factors and showed accurate risk estimation for severe postoperative complications (ROC-AUC-values for Grades III–V—preoperative nomogram: 0.673 (95%, CI: 0.626–0.721); postoperative nomogram: 0.734 (95%, CI: 0.691-0.778); each
p
≤ 0.001). Validation yielded ROC-AUC-values for Grades III–V—preoperative nomogram of 0.676 (95%, CI: 0.586–0.766) and postoperative nomogram of 0.677 (95%, CI: 0.591–0.762); each
p
= 0.001.
Conclusion
Easy-to-use nomograms for risk estimation in the pre- and early-postoperative setting were developed. Accurate risk estimation can support the decisional process, especially for IPMN-patients with an increased perioperative risk.
Background
This study evaluated the outcome and survival of patients with radiologically suspected intraductal papillary mucinous neoplasms (IPMNs).
Methods
IPMN management was reviewed according to ...Fukuoka risk factors and IPMN localization, differentiating main‐duct (MD), mixed‐type (MT) and branch‐duct (BD) IPMNs. Perioperative results were compared with those of patients undergoing resection of pancreatic ductal adenocarcinoma (PDAC) over the same interval (2010–2014). Overall (OS) and disease‐specific (DSS) survival rates were calculated and subgroups compared.
Results
Of 142 patients with IPMNs, 26 had MD‐IPMN, eight had MT‐IPMN and 108 had BD‐IPMN. Some 74 per cent of patients with MD‐ and MT‐IPMN were managed by primary resection, whereas this was used in only 27·8 per cent of those with BD‐IPMN. The risk of secondary resection and malignant transformation for BD‐IPMNs smaller than 20 mm was 8 and 2 per cent respectively during follow‐up. Pancreatic head resection of IPMNs was associated with an increased risk of postoperative pancreatic fistula grade B/C compared with resection of PDAC (12 of 33 (36 per cent) versus 41 of 221 (18·6 per cent) respectively; P = 0·010), and greater morbidity and mortality (Clavien–Dindo grade III: 15 of 33 (45 per cent) versus 56 of 221 (25·3 per cent) respectively; grade IV: 1 (3 per cent) versus 7 (3·2 per cent); grade V: 2 (6 per cent) versus 2 (0·9 per cent); P = 0·008). Five‐year OS and DSS rates in patients with MD‐IPMN were worse than those for MT‐ and BD‐IPMN (OS: 44, 86 and 97·4 per cent respectively, P < 0·001; DSS: 60, 100 and 98·6 per cent; P < 0·001). Patients with invasive IPMN had worse OS and DSS rates than those with non‐invasive dysplasia (OS: IPMN‐carcinoma (10 patients) 33 per cent, high‐grade dysplasia 100 per cent, intermediate‐grade dysplasia 63 per cent, low grade‐dysplasia 100 per cent, P < 0·001; DSS: IPMN‐carcinoma 43 per cent, all grades of dysplasia 100 per cent, P < 0·001). Patients with high‐risk stigmata had poorer survival than those without risk factors (OS: high‐risk stigmata (35 patients) 55 per cent, worrisome features (31) 95 per cent, no risk factors (76) 100 per cent, P < 0·001; DSS: 71, 100 and 100 per cent respectively, P < 0·001).
Conclusion
The risk of malignant transformation was very low for BD‐IPMNs, but the development of high‐risk stigmata was associated with disease‐specific mortality. Patients with IPMN had greater morbidity after resection than those having resection of PDAC.
In this analysis of the clinical management of intraductal papillary mucinous neoplasms (IPMNs), ranging from first diagnosis of a pancreatic cystic lesion to surgical resection or follow‐up, a low risk of progression of IPMNs with no risk factors and a high risk of malignancy in lesions with high‐risk stigmata was shown, associated with a substantial decrease in disease‐free and overall survival. Applying current guidelines, the study revealed a risk of overtreating patients with IPMNs displaying worrisome features; these patients are at high risk of developing perioperative morbidity and mortality following pancreatic head resection. Timely treatment should be offered to patients with a high risk of malignancy, as the development of high‐risk stigmata is associated with reduced survival.
Current guidelines produce good results.
Many techniques have been developed to prevent postoperative pancreatic fistula (POPF) after distal pancreatectomy, but POPF rates remain high. The aim of our study was to analyze POPF occurrence ...after closure of the pancreatic remnant by different operative techniques.
Between 2006 and 2017, 284 patients underwent distal pancreatectomy in our institution. For subgroup analysis the patients were divided into hand-sewn (n = 201) and stapler closure (n = 52) groups. The hand-sewn closure was performed in three different ways (fishmouth-technique, n = 27; interrupted transpancreatic U-suture technique, n = 77; common interrupted suture, n = 97). All other techniques were summarized in a separate group (n = 31). Results were gained by analysis of our prospective pancreatic database.
The median age was 63 (range 23–88) years. 74 of 284 patients (26%) were operated with spleen preservation (similar rates in subgroups). ASA-classes, median BMI as well as frequencies of malignant diseases, chronic pancreatitis, alcohol and nicotine abuse were also comparable in the subgroups. Neither the rates of overall POPF (fishmouth-technique 30%, common interrupted suture 40%, stapler closure 33% and interrupted U-suture 38%) nor the rates of POPF grades B and C showed significant differences in the subgroups. However is shown to be associated with pancreatic function and parenchymal texture.
In our experience the technique of pancreatic stump closure after distal resection did not influence postoperative pancreatic fistula rate. As a consequence patient specific reasons rather than surgical techniques may be responsible for POPF formation after distal pancreatectomy.
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