Radical Resection For Pancreatic Cancer Research Articles

Risk factors of early recurrence after radical resection for pancreatic cancer

Risk factors of early recurrence after radical resection for pancreatic cancer

Clinical significance of tumor suppressor genes methylation in circulating tumor DNA of patients with pancreatic cancer

BackgroundCirculating tumor DNA (ctDNA) has emerged as a potential diagnostic and prognostic biomarker in various tumors. However, the role of tumor suppressor genes (TSGs) methylation in ctDNA of patients with pancreatic cancer (PC) remains largely unclear. MethodsPatients with PC (n = 43), pancreatic benign diseases (n = 39), and healthy controls (n = 20) were enrolled in the study. Quantitative analysis of methylation pattern of five candidate TSGs including NPTX2, RASSF1A, EYA2, p16, and ppENK in ctDNA was performed by next generation sequencing (NGS). The diagnostic performances of these 5-TSGs methylation were assessed by the operating characteristic (ROC) curve and clinicopathological features correlation analysis. Meanwhile, the changes in methylation levels of these 5-TSGs on the 7th postoperative day were evaluated in 23 PC patients who underwent radical resection. ResultsThe methylation levels of RASSF1A, EYA2, ppENK and p16 genes in patients with PC were significantly higher than those in healthy controls. EYA2, p16 and ppENK genes showed significantly hypermethylation in PC than those in pancreatic benign diseases. NPTX2, RASSF1A, EYA2, p16 and ppENK genes showed significantly hypermethylation in pancreatic benign diseases than those in healthy controls (P < 0.05). The methylation levels of these 5 candidate TSGs were not correlated with the tumor size, nerve invasion, lymph node metastasis and TNM stage of PC. The AUC of these biomarkers for diagnosis of PC ranged from 0.65 to 0.96. The AUC values of these methylated genes and CpG sites for differentiating malignant and benign pancreatic diseases were ranging from 0.68 to 0.92. Combined the hypermethylated genes improved the detective ability of PC than single gene. The methylation levels of NPTX2, EYA2 and ppENK genes were significantly decreased after radical resection of PC. ConclusionQuantitative analysis of methylation pattern of NPTX2, RASSF1A, EYA2, p16 and ppENK in ctDNA by NGS could be a valuable non-invasive tool for detection and monitoring of PC.

A Case of Pancreatic Cancer With Rare Cutaneous and Muscle Metastases on 18 F-FDG PET/CT Imaging.

A 46-year-old man underwent PET/CT for metastatic survey 6 years after radical resection of pancreatic cancer. In addition to the increased uptake observed in the operative area, increased FDG uptake was also observed in the left external abdominal oblique muscle and the left frontal scalp. Both intramuscular and subcutaneous lesions were surgically excised and diagnosed as metastases from pancreatic cancer.

Progress of radical resection of pancreatic cancer in 30 years

Pancreatic cancer is a malignant disease with extremely poor prognosis. For now, radical resection is the only approach for long-term survival. Therefore, for complete resection of different type of pancreatic neoplasms, quantities of surgical methods have been innovated and applied by scholars and surgeons. Aiming at various situations, amounts of methods and principle have been suggested. Unresectable neoplasms have been challenged day by day. Meanwhile, with progression of technology, minimally invasive techniques have been applied into resection of pancreatic neoplasms. This article mainly reviews the innovation of surgical methods and technology on radical surgery of pancreatic cancer in recent years.

Neoadjuvant Chemotherapy Efficacy and Safety in Borderline Resectable Pancreatic Cancer

The current study was designed to investigate the safety and effectiveness of neoadjuvant therapy in patients with borderline resectable pancreatic cancer. The study was a retrospective case control with propensity score similarity. From January 2017 to June 2022, data regarding 70 patients who had received radical resection of pancreatic cancer at the department of hepatobiliary and pancreatic surgery of first affiliated hospital of Huzhou university was acquired. The neoadjuvant therapy group consisted of 35 patients who underwent neoadjuvant therapy before surgery. Patients who received extensive surgical resection were included in the control group directly. The effect of the neoadjuvant therapy group was evaluated before the operation and serum tumor markers carcinoembryonic antigen, cancer antigen 125 and cancer antigen 19-9 levels were compared before and after neoadjuvant therapy. Comparative analyses of perioperative surgical variables, postoperative pathological symptoms and postoperative complications were performed between both groups. Among the patients without complete remission or progressive disease after neoadjuvant therapy, 13 cases (37.14 %) were evaluated as partial response and 22 cases (62.86 %) were assessed as stable disease. After neoadjuvant therapy, serum levels of cancer antigen 19-9, cancer antigen 125 and carcinoembryonic antigen indexes revealed a significant (all p<0.05) downward trend. There were no statistically significant differences (all p>0.05) between the two groups regarding surgery type, operation duration, intraoperative blood loss, number of cases requiring blood transfusion, or postoperative hospital stay. Neoadjuvant treatment patient’s tumor diameters and the number of removed lymph nodes were significantly less (p<0.05) than those of the control group and their R0 resection rates were significantly greater (p<0.05) than those of the control group. There was no substantial variation in the frequency of complications between both groups (p>0.05). Preoperative neoadjuvant therapy for patients with minimally resectable pancreatic cancer can lower tumor marker levels. Moreover, it can produce a specific curative impact without raising surgical risk levels and boosting the R0 resection rate, which is safe and appropriate.

The Efficacy of Comfortable Nursing Combined with Traditional Chinese Medicine Volunteers Nursing in Perioperative Radical Resection of Pancreatic Cancer

The Efficacy of Comfortable Nursing Combined with Traditional Chinese Medicine Volunteers Nursing in Perioperative Radical Resection of Pancreatic Cancer

Clinical Analysis of Gemcitabine Combined with Tegafur Chemotherapy after Radical Surgery on Pancreatic Cancer

Objective: To study and analyze the clinical efficacy of gemcitabine combined with Tegafur chemotherapy after radical resection of pancreatic cancer. Methods: The subjects of the study were 200 patients who were admitted to the hospital from January 2018 to February 2021 requiring chemotherapy after radical resection of pancreatic cancer. According to the different treatment methods, they were divided into a experimental group (gemcitabine combined with Tegafur chemotherapy) and a control group (single gemcitabine chemotherapy), and the treatment efficacy of the two groups of patients was observed and compared. Results: Compared with the control group, patients in the experimental group had significantly better treatment efficacy, quality of life scores and post-treatment anxiety and depression scores. The difference between the groups was significant (p&lt;0.05). Conclusion: Gemcitabine combined with Tegafur chemotherapy for patients requiring chemotherapy after radical resection of pancreatic cancer can significantly improve the treatment efficacy for the disease, improve the patient's quality of life, and ensure that the patient's emotional state during treatment is more positive.

Analysis on the Clinical Therapeutic Effect of Hepatic Artery Chemoembolization in the Treatment of Advanced Liver Cancer

Objective: To study and analyze the clinical efficacy of gemcitabine combined with Tegafur chemotherapy after radical resection of pancreatic cancer. Methods: The subjects of the study were 200 patients who were admitted to the hospital from January 2018 to February 2021 requiring chemotherapy after radical resection of pancreatic cancer. According to the different treatment methods, they were divided into a experimental group (gemcitabine combined with Tegafur chemotherapy) and a control group (single gemcitabine chemotherapy), and the treatment efficacy of the two groups of patients was observed and compared. Results: Compared with the control group, patients in the experimental group had significantly better treatment efficacy, quality of life scores and post-treatment anxiety and depression scores. The difference between the groups was significant (p&lt;0.05). Conclusion: Gemcitabine combined with Tegafur chemotherapy for patients requiring chemotherapy after radical resection of pancreatic cancer can significantly improve the treatment efficacy for the disease, improve the patient's quality of life, and ensure that the patient's emotional state during treatment is more positive.

Perioperative Glucocorticoids are Associated with Improved Recurrence-Free Survival After Pancreatic Cancer Surgery: A Retrospective Cohort Study with Propensity Score-Matching.

PurposePerioperative anesthetic management may affect long-term outcome after cancer surgery. This study investigated the effect of perioperative glucocorticoids on long-term survival in patients after radical resection for pancreatic cancer.MethodsIn this retrospective cohort study with propensity score-matching, patients who underwent radical resection for pancreatic cancer from January 2005 to December 2016 were recruited. Baseline and perioperative data including use of glucocorticoids for prevention of postoperative nausea and vomiting were collected. Patients were followed up by qualified personnel for cancer recurrence and survival. The primary outcome was the recurrence-free survival. Outcomes were compared before and after propensity matching. The association between perioperative glucocorticoid use and recurrence-free survival was analyzed with multivariable regression models.ResultsA total of 215 patients were included in the study; of these, 112 received perioperative glucocorticoids and 103 did not. Patients were followed up for a median of 74.0 months (95% confidence interval [CI] 68.3–79.7). After propensity score-matching, 64 patients remained in each group. The recurrence-free survivals were significantly longer in patients with glucocorticoids than in those without (full cohort: median 12.0 months [95% CI 6.0–28.0] vs 6.9 months [4.2–17.0], P<0.001; matched cohort: median 12.0 months [95% CI 5.8–26.3] vs 8.3 months [4.3–18.2], P=0.015). After correction for confounding factors, perioperative glucocorticoids were significantly associated with prolonged recurrence-free survivals (full cohort: HR 0.66, 95% CI 0.48–0.92, P=0.015; matched cohort: HR 0.54, 95% CI 0.35–0.84, P=0.007).ConclusionPerioperative use of low-dose glucocorticoids is associated with improved recurrence-free survival in patients following radical surgery for pancreatic cancer.

Nab-P and Gem Compared With Gem and Tegafur in Adjuvant Chemotherapy After Radical Resection of Pancreatic Cancer

Nab-P and Gem Compared With Gem and Tegafur in Adjuvant Chemotherapy After Radical Resection of Pancreatic Cancer

Prognostic value of important driver gene mutations in patients with radical resection of pancreatic cancer

Objective: To examine the prognostic value of four important driver gene mutations in patients with radical resection of pancreatic cancer. Methods: The clinical data and follow-up data of pancreatic cancer patients undergoing radical pancreatectomy and targeted sequencing from January 2016 to March 2018 at Department of Hepato-Biliary-Pancreatic Surgery, Changhai Hospital were retrospectively analyzed.There were 159 males and 88 females,aged of (60.8±8.7)years(range:33-83 years) and preoperative CA19-9 of (492.4±496.6)kU/L(range: 2-1 200 kU/L). One hundred and fifty nine cases of tumors were located in the head and 88 cases in the body and tail of the pancreas. After univariate analysis of clinical pathological factors (including gender, age, preoperative CA19-9, tumor location, tumor differentiation, pathological T and N stage, Micr. perineural invasion, Micr. lympho-vascular invasion, resection margin), the variable whose P<0.1 was included in COX regression model with four important driver gene mutations to find which mutation was related to prognosis independently. The number of gene mutations and KRAS subgroups were analyzed by Kaplan-Meier curve. Results: Among 247 patients,the number of KRAS,TP53, SMAD4 and CDKN2A mutations was 212 cases(85.8%), 160 cases(64.8%), 66 cases(26.7%) and 44 cases(17.8%),respectively.KRAS mutation was correlated with the tumor differentiation and pathological T stage (χ(2)=24.570/6.690, P=0.000/0.035), TP53 mutation was correlated with the tumor differentiation and the resected margin(χ(2)=5.500/4.620, P=0.019/0.032), and CDKN2A mutation was correlated with gender(χ(2)=16.574, P=0.000).COX regression model analysis showed that only KRAS mutation was an independent risk factor for disease free survival and overall survival(HR=1.776, 95%CI: 1.079-2.923, P=0.024; HR=1.923, 95%CI: 1.016-3.639, P=0.045); KRAS(G12D) mutation was associated with shorter OS(P=0.007). Conclusion: KRAS and its subgroup KRAS(G12D) mutation can be used as a prognostic index for patients with radical resection of pancreatic cancer.

The peritoneal fluid reflects the effect on pancreatic cancer by intraoperative radiation therapy (IORT).

e15742 Background: Pancreatic cancer has high aggressive features. Intraoperative radiation therapy (IORT) has advantage to deliver the radiation to the restrictive tumor bed immediately. In breast cancer, a study analyzing the wound fluid in patients underwent IORT found that the curative effect was due to the influence to the remaining cancer cell and tumor microenvironment. However, there is a lack of mechanism study related to the effectiveness of IORT in pancreatic cancer. The aim of this study is to investigate whether IORT influenced the responses of pancreatic cancer with peritoneal fluid in vitro and to evaluate the effect and mechanism of the IORT on pancreatic cancer. Methods: Between Apr 2018 and Jan 2019, 28 patients underwent radical resection for pancreatic cancer at Gangnam Severance Hospital. Peritoneal Fluid were obtained 24 hours immediately after operation by surgical drains. And fluid were treated in the pancreatic cancer cell lines (Miapaca-2, PANC1, AsPC1, BxPC3) in total 28 patients (IORT n = 14, no IORT n = 14). Proliferation of cells were measured by WST-1 manner and matrigel coated chambers were used to analyses the invasiveness. Proteomic analysis of fluid was determined by human cytokine antibody array kit (84 targets). Results: When the fluid from each patient was treated to cells different concentrations, the two-dimensional proliferation was stimulated 48 hours later in common but different reactivity was observed for each cell. In invasion assay, cancer cell attracted more by fluid than FBS and decreased invasiveness of cells was observed when treated the fluid from patient underwent IORT. According to the cytokine array, fluid displayed altered expression of several cytokines in patients underwent IORT (Angiogenin, MCP-1, IL-8, IL-6,ENA-78, p &lt; 0.01). Conclusions: We demonstrated that IORT cause the proteomic difference, thereby inducing a change in the biologic activity to pancreatic cancer cell. These results will help us understand the mechanism related to local tumor control and establish the biological basis of IORT. Through the further analysis and long-term follow-up, it will be possible to establish IORT dependent new molecular therapeutic targets or new treatments.

Diagnostic value of combined serum CA19-9 with CT scanning in patients with pancreatic cancer

Objective To evaluate the diagnostic value of combined serum tumor marker CA19-9 with CT scanning in the patients with pancreatic cancer. Methods A total of 89 patients with suspected pancreatic cancer diagnosed by CT scanning were selected at our hospital from May 2012 to December 2016.The detected results of serum CA19-9 were recorded, and the specificity, sensitivity, positive and negative predictive value of serum CA19-9 in the diagnosis of pancreatic cancer were statistically calculated and analyzed.The correlations between the pre- and post-operative serum levels of CA19-9 and the survival time in pancreatic cancer patients undergoing operation were analyzed. Results The specificity, sensitivity, positive predictive value and negative predictive value of serum CA19-9 combined with CT scanning in the diagnosis of pancreatic cancer were 97.2%, 86.4%, 100.0%, 94.0% respectively.With the increase of preoperative serum levels of CA19-9, the resection rate and median postoperative survival time gradually decreased.Patients with normal serum levels of CA19-9 after operation had longer postoperative survival time than patients with high postoperative serum levels of CA19-9. Conclusions As one of the tumor markers of pancreatic cancer, serum CA19-9 detection has a high diagnostic sensitivity.Combined with CT scanning, serum CA19-9 detection can significantly improve the diagnostic accuracy of pancreatic cancer.Serum CA19-9 can also be used as a mean of efficacy evaluation after radical resection of pancreatic cancer. Key words: Pancreatic neoplasms; Antigens, neoplasm

From morphological resection to biological benefits: decision and reflection in the treatment of pancreatic adenocarcinoma

Pancreatic adenocarcinoma (PAC) is a highly lethal disease for human being. Surgery in the past 100 years, novel drug combination and neoadjuvant therapy haven′t changed the prognosis of PAC fundamentally. Traditionally, authors only focused on the treatment in term of morphological changes, while it′s tumor biology that will ultimately determine the long-term survival of PAC patients. Surgeons should continuously pursue the radical resection of pancreatic cancer, however, with the guidance of tumor biology. Omics′ researches, artificial intelligence and next generation platform of translational study will improve our understanding and treatment for PAC. Key words: Pancreas; Neoplasms; Morphology; Biology

A long-term survival case treated with conversion surgery following chemotherapy after diagnostic metastasectomy for pancreatic cancer with synchronous liver metastasis

BackgroundPancreatic cancer with distant metastases is classified as “unresectable,” for which the standard treatment is systemic chemotherapy. The effectiveness of radical resection for pancreatic cancer with distant metastases is unknown. Here, we report a case of long term survival treated with conversion surgery following chemotherapy after diagnostic metastasectomy for pancreatic cancer with synchronous liver metastasis.Case presentationA 73-year-old man was referred to our hospital to examine and treat for cancer of the pancreatic body. Computed tomography (CT) scan revealed a 26-mm hypovascular tumor in contact with the common hepatic artery (CHA) (> 180°), the celiac artery (< 180°), and portal vein at the pancreatic body. Resectability was determined as “borderline resectable.” Two courses of gemcitabine plus S-1 combination therapy (GS) were administered as neoadjuvant chemotherapy (NAC). CT scan showed tumor shrinkage (21 mm), determined as stable disease (SD) according to Response Evaluation Criteria in Solid Tumors (RECIST). Although the abdomen was opened for radical resection, a small nodule on the liver was detected and removed. Since the nodule was diagnosed as adenocarcinoma by intraoperative frozen section, resection of the primary tumor was not performed. After three subsequent courses of GS therapy, no distant metastases were detected under radiological findings. Distal pancreatectomy with celiac artery resection (DP-CAR) was performed as radical surgery 6 months after the initial diagnosis. Histological diagnosis was well-differentiated tubular adenocarcinoma, showing ypT1 ypN1 M1 stage IV, negative surgical margin (R0), and grade III in the Evans classification. S-1 was administered every other day from 6 months after resection up to the present. The patient has been alive with no recurrence for 5 years after the initial diagnosis and 4.5 years after the resection.ConclusionThere is a case that received survival benefits from conversion surgery following chemotherapy after diagnostic metastasectomy in pancreatic cancer with synchronous liver metastasis.

Clinical efficacy of modified FOLFIRINOX as neoadjuvant chemotherapy for borderline resectable pancreatic cancer

Objective To investigate the clinical efficacy of modified FOLFIRINOX as neoadjuvant chemotherapy for borderline resectable pancreatic cancer. Methods The retrospective cross-sectional study was conducted. The clinicopathological data of 28 patients diagnosed as borderline resectable pancreatic cancer who were admitted to the Tianjin Medical University Cancer Institute and Hospital between April 2013 and October 2015 were collected. Twenty-eight patients were treated with modified FOLFIRINOX( irinotecan 135 mg/m2, oxaliplatin 64 mg/m2, leucovorin 400 mg/m2, 5-FU 2 400 mg/m2, repeat the regimen every 2 weeks) as neoadjuvant chemotherapy. After the completion of neoadjuvant chemotherapy, patients were evaluated operation feasibility and developed surgical planning in 3 weeks. Observation indicators: (1) Efficacy of neoadjuvant chemotherapy; (2) adverse events of neoadjuvant chemotherapy; (3) surgical and postoperative situations; (4) follow-up situations. Follow-up using outpatient examination, telephone interview and we-chat was performed to etect survival of patients up to January 2017. Measurement data with skewed distribution were described as median (range). The survival curve was drawn by Kaplan-Meier method and the survival analysis was done by Log-rank test. Results (1) Efficacy of neoadjuvant chemotherapy: 28 patients received chemotherapy with a median cycle of 6 cycles (range, 3-12 cycles). Chemotherapy reaction of 28 patients: 14 had partial remission, 10 had stable disease and 4 had progressive disease. (2) Adverse events of neoadjuvant chemotherapy: there were 22 adverse events of 28 patients during chemotherapy, including 15 with grade1-2 and 7 with grade 3-4. (3) Surgical and postoperative situations: of 28 patients, 18 received radical resection for pancreatic cancer including 11 receiving pancreaticoduodenectomy, 7 receiving distal pancreatectomy with splenectomy. Surgeries included 6 with portal vein and superior mesenteric vein resection and reconstruction, 1 with coeliac trunk resection. Ten patients received R0 resection and 8 received R1 resection. Of 18 patients, 8 with postoperative complications were improved by conservative treatment, including 2 with pancreatic fistula, 1 with biliary fistula, 3 with delayed gastric empty, 1 with anastomotic hemorrhage, 1 with lympha fistula. No patient received re-operation or died within 30 days postoperatively. Pathological TNM staging: 2 patients were detected in stage Ⅰ-Ⅱ, 14 in stage Ⅲ and 2 in stage Ⅳ. All the 18 patients received chemotherapy after operation. Ten patients without operation continued chemotherapy. (4) Following up: 28 patients were followed up for 5-21 months with a median time of 13 months. Of the 15 died patients, 5 received operation and 10 received no operation. The median progression-free survival time and median overall survival time were 14 months and 19 months in the 18 operative patients, 7 months and 11 months in the 10 non-operative patients, respectively, with statistically significant differences (χ2=7.335, 9.950, P<0.05). Conclusions Modified FOLFIRINOX as neoadjuvant chemotherapy for borderline resectable pancreatic cancer is safe and effective, and patients can tolerate mild adverse reactions. Operable patients undergo surgeries after chemotherapy have relatively good outcome. Key words: Pancreatic neoplasm; Neoadjuvant chemotherapy; Modified FOLFIRINOX

FDG-PET predicts treatment efficacy and surgical outcome of pre-operative chemoradiation therapy for resectable and borderline resectable pancreatic cancer

BackgroundThe efficacy of neoadjuvant chemoradiotherapy (NACRT) for resectable and borderline resectable pancreatic cancer is important for predicting outcomes after radical surgery, but few clinical indicators predict outcome before resection. This study examined the utility of FDG-PET in predicting the efficacy of NACRT and outcome after radical surgery. MethodsEighty-three pancreatic cancer patients who underwent FDG-PET before and after NACRT and had positive standard uptake values (SUVs) before NACRT were enrolled in this study. Peri-operative clinical factors, including FDG-PET findings, were examined to predict the efficacy of NACRT and outcome after surgery. ResultsEvans grade I, IIA, IIB, III, and IV was determined in 11, 31, 27, 11, and 3 patients, respectively. The maximum SUVs after NACRT (post SUV-max) and tumor size were significantly decreased compared to pretreatment values (p < 0.001 and p = 0.007, respectively). The post SUV-max and regression index were significantly related to grade III/IV (p = 0.04 and p < 0.001, respectively), but only the regression index predicted NACRT efficacy (p = 0.002). The AUC of the regression index for the detection of grade III/IV was 0.822, and 13 of 14 grade III/IV patients were picked up using 50% as the threshold (p < 0.001). Patients with a regression index >50% had a significantly better prognosis after radical resection than patients with <50% (p = 0.032). Regression index as well as pathological lymph node status and resectability status were independent prognostic factors in multivariate analysis (exp 2.086, p = 0.043). ConclusionThe regression index is potentially a good indicator of the efficacy of NACRT and outcome after radical resection for pancreatic cancer.

Impact of improvement of diabetes on survival after radical pancreatic resection in patients with pancreatic cancer and diabetes

To explorer the effect of improvement of diabetes on survival after radical pancreatic resection in patients with pancreatic cancer and diabetes. Seventy-three patients who underwent radical resection for pancreatic cancer at Ruijin Hospital (Shanghai, China) between July 2007 and December 2011 and had preoperative diabetes were retrospectively analyzed. Clinical characteristics and overall postoperative survival were compared between patients with controlled/uncontrolled diabetes. Among patients with uncontrolled diabetes, comparison was made in clinical characteristics and overall postoperative survival between patients with long-term (≥2 years) diabetes and those with new-onset (<2 years) diabetes. Controlled diabetes after radical pancreatic resection was observed in 38.4% (28/73) in the patients with pancreatic cancer and diabetes. The median follow-up time was 44.5 months (95CI: 31.7-57.2 months). Patients in whom diabetes was controlled had well-differentiated tumors and longer overall survival compared to patients with uncontrolled diabetes [median overall survival (95%CI) 41.0 (34.2-47.7) months vs 17.0 (14.8-19.2) months, P<0.001]. Among the 45 patients with uncontrolled diabetes, there was no differences in clinic characteristic and overall survival between new-onset (n=21) and long-term diabetes (n=24) [median overall survival (95%CI): 17.8 (15.7-20.1) months vs 15.8 (10.5-21.1) months, P=0.198]. Good postoperative control of diabetes after radical pancreatic resection in patients with pancreatic cancer and diabetes may predict favorable survival.

Outcomes of robotic surgery for pancreatic ductal adenocarcinoma.

To explore the effectiveness, safety, and efficacy of the robot-assisted surgery in the radical resection of pancreatic ductal adenocarcinoma (PDAC). The clinical data of 72 patients with PDAC who underwent radical resection using the da Vinci Surgical System from April 2010 to December 2014 were retrospectively analyzed. Among these 72 patients, three were converted to conventional laparotomy due to the vascular invasion or due to the difficulties in tissue isolation from the surrounding organs. Among 39 patients who underwent the pancreatoduodenectomy, the average operative time was 395.3±118.8 min, and the mean intra-operative blood loss was 447.3±269.9 mL. Among 31 patients who underwent the distal pancreatectomy (DP), the average operative time was 185.5±74.1 min, and the mean intra-operative blood loss was 267.1±305.3 mL. In two patients who received the middle pancreatectomy (MP), the average operative time was 225 min and mean intra-operative blood loss was 100 mL. Among all the 72 patients, an average of 4.2±2.6 lymph nodes were dissected, with an average hospital stay of 22.6±10.7 days. Complications were observed in 18 patients, which included pancreatic fistula (n=11), bile leak (n=5), anastomotic bleeding (n=2), pancreatic fistula complicated with portal vein thrombosis (n=1), and anastomotic bleeding complicated with acute renal failure (n=1). Except that one patient died due to post-operative bleeding and acute renal failure, all the other patients were cured after conservative treatment. These 72 patients were followed for 1-45 (15.6±5.8) months, during which 10 patients died. Eleven patients suffered from recurrence or metastasis, among which 6 had local recurrence, 4 had liver metastasis, and 1 had ascites accompnaied with incision site tumor metastasis. Radical resection of PDAC by robotic surgical system is safe and feasible. It has less surgical trauma and enables faster post-operative recovery, and therefore can achieve the lymph node dissection scope and tumor resection margin required by the standards of radical resection for pancreatic cancer. Nevertheless, its long-term efficacy requires further validation.

Preoperative ultrasound ablation for borderline resectable pancreatic cancer: A report of 30 cases

Background and objectivesCurrently, extended resection and preoperative neoadjuvant chemotherapy are the two main modalities for improvement of the resection rate and R0 resection rate of borderline resectable pancreatic cancer. The past few years, however, have witnessed some progress in the treatment of unresectable pancreatic cancer with high intensity focused ultrasound (HIFU). The aim of this study is twofold: first, to evaluate the feasibility and safety of HIFU ablation as a preoperative adjuvant therapy for borderline resectable pancreatic cancer, and second, to conduct pathological analyses to verify the safety and effectiveness of HIFU treatment of pancreatic cancer. MethodsFrom January 2011 to December 2012, 30 patients with borderline resectable pancreatic cancer underwent HIFU ablation by Haifu Model-JC200 Focused Ultrasound Tumor Therapeutic System prior to radical surgery. The effect of pre-operative HIFU ablation was evaluated by post-HIFU functional imaging results, operation time of radical surgery, blood loss volume, R0 resection rate, postoperative 1-year survival rate and Ca199 curve. Postoperative pathological specimens were obtained for histological examination. ResultsAll 30 patients with borderline resectable pancreatic cancer had completed the treatments and follow-ups. Functional image assessment after HIFU treatment showed a mean tumor ablation rate of (61.5±24.3)%. 28 patients underwent radical resection of pancreatic cancer 7–9days after HIFU treatment (23 cases underwent pancreaticoduodenectomy. 4 patients underwent pancreatectomy and 1 patient had total pancreatectomy). 7 patients underwent combined resection and reconstruction of portal-superior mesenteric vein (23.3%), with the resectability rate of 93.3%, the R0 resection rate of 92.7%, and the 1-year survival rate of 96.7%. The biological coagulative necrosis regions identified by the postoperative pathological examination matched well with the necrosis foci identified by post-operative functional imaging. ConclusionThe effectiveness of HIFU ablation of pancreatic tumors, as well as interstitial tissues within he main vascular spaces was confirmed by post-operative pathological examinations. Based on these observations, we conclude that preoperative HIFU ablation of borderline resectable pancreatic cancer can significantly improve the resection rate, R0 resection rate, and reduce the difficulty and risk of surgery. Therefore, HIFU may be a valuable pre-operative adjunct therapy for resectable pancreatic cancer. However, the safety and the efficacy on the improvement of the surgery need to established with future multicenter, randomized studies.