Search

Introduction: Pancreatic surgery is technically challenging, with mortality rates at high-volume centers ranging from 0% to 5%. An inverse relationship between surgeon volume and perioperative mortality has been reported suggesting that patients benefit from experienced surgeons at high-volume centers. There is little published on the volume of pancreatic surgeries performed in military treatment facilities (MTF) and there is no centralization policy regarding pancreatic surgery. This study evaluates pancreatic procedures at MTFs. We hypothesize that a small group of MTFs perform most pancreatic procedures, including more complex pancreatic surgeries. Methods: This is a retrospective review of de-identified data from MHS Mart (M2) from 2014 to 2020. The database contains patient data from all Defense Health Agency treatment facilities. Variables collected include number and types of pancreatic procedures performed and patient demographics. The primary endpoint was the number and type of surgery for each MTF. Results: Twenty-six MTFs performed pancreatic surgeries from 2014 to 2020. There was a significant decrease in the number of cases from 2014 to 2020. Nine hospitals performed one surgery over eight years. The most common surgery was a distal pancreatectomy, followed by a pancreaticoduodenectomy. There was a decrease in the number of pancreaticoduodenectomies and distal pancreatectomies performed over this period. Conclusions: Pancreatic surgery is being performed at few MTFs with a downward trajectory over time. Further studies would be needed to assess the impact on patient care regarding postoperative complications, barriers to timely patient care, and impact on readiness of military surgeons. [ABSTRACT FROM AUTHOR]

Background: This study compared the cost-effectiveness of open (ODP), laparoscopic (LDP), and robotic (RDP) distal pancreatectomy (DP). Methods: Studies reporting the costs of DP were included in a literature search until August 2023. Bayesian network meta-analysis was conducted, and surface under cumulative ranking area (SUCRA) values, mean difference (MD), odds ratio (OR), and 95% credible intervals (CrIs) were calculated for outcomes of interest. Cluster analysis was performed to examine the similarity and classification of DP approaches into homogeneous clusters. A decision model-based cost–utility analysis was conducted for the cost-effectiveness analysis of DP strategies. Results: Twenty-six studies with 29,164 patients were included in the analysis. Among the three groups, LDP had the lowest overall costs, while ODP had the highest overall costs (LDP vs. ODP: MD − 3521.36, 95% CrI − 6172.91 to − 1228.59). RDP had the highest procedural costs (ODP vs. RDP: MD − 4311.15, 95% CrI − 6005.40 to − 2599.16; LDP vs. RDP: MD − 3772.25, 95% CrI − 4989.50 to − 2535.16), but incurred the lowest hospitalization costs. Both LDP (MD − 3663.82, 95% CrI − 6906.52 to − 747.69) and RDP (MD − 6678.42, 95% CrI − 11,434.30 to − 2972.89) had significantly reduced hospitalization costs compared to ODP. LDP and RDP demonstrated a superior profile regarding costs–morbidity, costs–mortality, costs–efficacy, and costs–utility compared to ODP. Compared to ODP, LDP and RDP cost $3110 and $817 less per patient, resulting in 0.03 and 0.05 additional quality-adjusted life years (QALYs), respectively, with positive incremental net monetary benefit (NMB). RDP costs $2293 more than LDP with a negative incremental NMB but generates 0.02 additional QALYs with improved postoperative morbidity and spleen preservation. Probabilistic sensitivity analysis suggests that LDP and RDP are more cost-effective options compared to ODP at various willingness-to-pay thresholds. Conclusion: LDP and RDP are more cost-effective than ODP, with LDP exhibiting better cost savings and RDP demonstrating superior surgical outcomes and improved QALYs. [ABSTRACT FROM AUTHOR]

Complete surgical resection in the context of a multimodal approach has been associated with excellent long-term survival in children diagnosed with pancreatoblastoma (PB). Traditionally, curative intent surgery for PB implies standard pancreatic resections such as pancreaticoduodenectomies and distal pancreatectomies with splenectomies, surgical procedures that may lead to significant long-term pancreatic functional deficiencies. Postoperative pancreatic functional deficiencies are particularly interesting to children because they may interfere with their development, considering their long life expectancy and the significant role of pancreatic functions in their nutritional status and growth. Thus, organ-sparing pancreatectomies, such as spleen-preserving distal pancreatectomies and central pancreatectomies, are emerging in specific tumoral pathologies in children. However, data about organ-sparing pancreatectomies' potential role in curative-intent PB surgery in children are scarce. Based on the literature data, the current review aims to present the early and late outcomes of pancreatectomies in children (including long-term deficiencies and their potential impact on the development and quality of life), particularly for PB, and further explore the potential role of organ-sparing pancreatectomies for PB. Organ-sparing pancreatectomies are associated with better long-term pancreatic functional outcomes, particularly central pancreatectomies, and have a reduced impact on children's development and quality of life without jeopardizing their oncological safety. The long-term preservation of pancreatic functions should not be disregarded when performing pancreatectomies for PB in children. A subset of patients with PB might benefit from organ-sparing pancreatectomies, particularly from central pancreatectomies, with the same oncological results as standard pancreatectomies but with significantly less impact on long-term functional outcomes. [ABSTRACT FROM AUTHOR]

Introduction: New Zealand has a population of only 5.5 million meaning that for many surgical procedures the country qualifies as a "low‐volume center." However, the health system is well developed and required to provide complex surgical procedures that benchmark internationally against comparable countries. This investigation was undertaken to review regional variation and volumes of complex resection and palliative upper gastrointestinal (UGI) surgical procedures within New Zealand. Methods: Data pertaining to patients undergoing complex resectional UGI procedures (esophagectomy, gastrectomy, pancreatectomy, and hepatectomies) and palliative UGI procedures (esophageal stenting, enteroenterostomy, biliary enteric anastomosis, and liver ablation) in a New Zealand hospital between January 1, 2000 and December 31, 2019 were obtained from the National Minimum Dataset. Results: New Zealand is a low‐volume center for UGI surgery (229 hepatectomies, 250 gastrectomies, 126 pancreatectomies, and 74 esophagectomies annually). Over 80% of patients undergoing hepatic resection/ablation, gastrectomy, esophagectomy, and pancreatectomy are treated in one of the six national cancer centers (Auckland, Waikato, Mid‐Central, Capital Coast, Canterbury, or Southern). There is evidence of the decreasing frequency of these procedures in small centers with increasing frequency in large centers suggesting that some regionalization is occurring. Palliative procedures were more widely performed. Indigenous Māori were less likely to be treated in a nationally designated cancer center than non‐Māori. Conclusions: The challenge for New Zealand and similarly sized countries is to develop and implement a system that optimizes the skills and pathways that come from a frequent performance of complex surgery while maintaining system resilience and ensuring equitable access for all patients. [ABSTRACT FROM AUTHOR]

Pancreatic pseudocysts are surrounded by a non-epithelialized wall confined to the pancreas and localized to the pancreatic tissue or adjacent pancreatic cavity. In contrast, pancreatic cystic tumors occur less frequently than solid lesions and are often detected incidentally on imaging. Regarding the qualitative diagnosis of pancreatic pseudocysts, it is important to differentiate them from neoplastic cysts. We report the case of a 74-year-old woman with a giant hemorrhagic pancreatic pseudocyst and a suspected cystic pancreatic tumor, wherein distal pancreatectomy and splenectomy with lymph node dissection were performed. The patient was discharged 11 days postsurgery, with a good postoperative course. There are no reports of giant pancreatic pseudocysts larger than 10 cm with hematoma contents. The presumptive diagnosis of pseudocysts based on imaging alone may be difficult. Surgical resection is considered when it is difficult to distinguish a giant pancreatic pseudocyst from a cystic neoplasm. [ABSTRACT FROM AUTHOR]

Pancreatic cancer is the most common medical condition that requires pancreatic resection. Over the last three decades, significant improvements have been made in the conditions and procedures related to pancreatic surgery, resulting in mortality rates lower than 5%. However, it is important to note that the morbidity in pancreatic surgery remains r latively high, with a percentage range of 30–60%. Pre-operative malnutrition is considered to be an independent risk factor for post-operative complications in pancreatic surgery, such as impaired wound healing, higher infection rates, prolonged hospital stay, hospital readmission, poor prognosis, and increased morbidity and mortality. Regarding the post-operative period, it is crucial to provide the best possible management of gastrointestinal dysfunction and to handle the consequences of alterations in food digestion and nutrient absorption for those undergoing pancreatic surgery. The European Society for Clinical Nutrition and Metabolism (ESPEN) suggests that early oral feeding should be the preferred way to initiate nourishing surgical patients as it is associated with lower rates of complications. However, there is ongoing debate about the optimal post-operative feeding approach. Several studies have shown that enteral nutrition is associated with a shorter time to recovery, superior clinical outcomes and biomarkers. On the other hand, recent data suggest that nutritional goals are better achieved with parenteral feeding, either exclusively or as a supplement. The current review highlights recommendations from existing evidence, including nutritional screening and assessment and pre/post-operative nutrition support fundamentals to improve patient outcomes. Key areas for improvement and opportunities to enhance guideline implementation are also highlighted. [ABSTRACT FROM AUTHOR]

The swine is a valuable model for preclinical research and surgical technique training. Induction of Type I diabetes is achieved by total pancreatectomy, therefore these animals may be used in several research studies, including islet transplantation field. Given the lack of information in the literature, the purpose of this work is to describe anatomic aspects of swine pancreas, the total pancreatectomy surgical technique, intra- and postoperative complications and the autopsy results. Five hybrid male pigs, 20-35 kg, submitted to total pancreatectomy with duodenum, bile duct, and spleen preservation. Postoperatively, daily clinical assessment and capillary blood glucose collection were performed. At the end of the 30-day period or in the occurrence of serious clinical complications, euthanasia and autopsy were performed. The average duration of surgery was 128 minutes, without intraoperative deaths or anesthesia induction failures. The median survival was 6.6 days. Postoperative complications were weight loss (3), emesis (2), constipation (2), abdominal distension (2), diarrhea (1), and loss of appetite (1). All animals were euthanized due to serious complications. Two animals presented surgical complications (duodenal necrosis with gastroparesis and internal hernia with intestinal necrosis). The other 3 animals presented serious clinical complications related to exocrine pancreatic insufficiency due to deficiency of pancreatic enzymes. Glycemic values above 200 mg/dL were found on the first postoperative day and above 300 mg/dL on the seventh day in all animals. A model of total pancreatectomy with duodenum, spleen, and bile duct preservation in pigs was established. All animals became diabetic, however, animals without postoperative complications were euthanized due to serious complications related to pancreas exocrine insufficiency. [ABSTRACT FROM AUTHOR]

Purpose of review: Pancreatic resection stands as one of the most challenging abdominal surgeries, primarily indicated for pancreatic malignancies such as pancreatic ductal adenocarcinoma (PDAC), pre-malignant conditions like intraductal papillary mucinous neoplasm (IPMN), and benign pathologies that manifest with significant symptoms, including intractable pain, often concomitant with endocrine or exocrine dysfunction. The inherent complexity and morbidity associated with pancreatic resection, exacerbated by the high risk of pancreatic anastomosis complications, including pancreatic leaks of amylase-rich fluid, is further amplified by the pancreas's retroperitoneal location near vital anatomical structures. This underscores the imperative need for a thorough assessment of emerging surgical approaches, with particular attention to the application of robotic technology. This review appraises the impact of robotic-assisted surgery on the operative and oncological outcomes of patients afflicted with benign and malignant, pancreatic and peri-pancreatic, diseases. Recent findings: Robotic surgery has exhibited a correlation with enhanced post-operative outcomes such as reduced morbidity and mortality following pancreatic resections. Furthermore, it has demonstrated a positive association with improved oncological resection and outcomes in patients diagnosed with pancreatic and peri-pancreatic cancer. Summary: Minimally invasive surgery has substantially refined the landscape of pancreatic resections, offering diminished post-operative pain and reduced hospital stay. Robotic surgery, distinguished by its superior visualization and meticulous tissue handling capabilities, enables precise dissection and seamless anastomosis in the complex realm of pancreatic surgery. Consequently, this has translated into ameliorated morbidity and mortality in this patient cohort, emphasizing the critical role of surgeon proficiency and case volume. Minimally invasive resection in the context of malignancy has demonstrated favorable oncological outcomes. This is potentially attributed to improved oncological resection (increased negative margins and lymph node yield) expedited post-operative recovery, facilitating prompt initiation of adjuvant therapy and attenuating surgical stress-induced tumorigenesis. Nonetheless, future randomized controlled trials are indispensable to comprehensively elucidate the impact of robotic resection on the host immune response and long-term outcomes following pancreatic resections, encompassing both benign and malignant etiologies. Such investigations hold the promise of advancing our understanding and optimizing the role of robotic surgery in the context of pancreatic diseases. [ABSTRACT FROM AUTHOR]

Background Postoperative pancreatic fistulas remain a driver of major complications after partial pancreatectomy. It is unclear whether coverage of the anastomosis or pancreatic remnant can reduce the incidence of postoperative pancreatic fistulas. The aim of this study was to evaluate the effect of autologous or artificial coverage of the pancreatic remnant or anastomosis on outcomes after partial pancreatectomy. Methods A systematic literature search was performed using MEDLINE and the Cochrane Central Register of Controlled Trials (CENTRAL) up to March 2024. All RCTs analysing a coverage method in patients undergoing partial pancreatoduodenectomy or distal pancreatectomy were included. The primary outcome was postoperative pancreatic fistula development. Subgroup analyses for pancreatoduodenectomy or distal pancreatectomy and artificial or autologous coverage were conducted. Results A total of 18 RCTs with 2326 patients were included. In the overall analysis, coverage decreased the incidence of postoperative pancreatic fistulas by 29% (OR 0.71, 95% c.i. 0.54 to 0.93, P < 0.01). This decrease was also seen in the 12 RCTs covering the remnant after distal pancreatectomy (OR 0.69, 95% c.i. 0.51 to 0.94, P < 0.02) and the 4 RCTs applying autologous coverage after pancreatoduodenectomy and distal pancreatectomy (OR 0.53, 95% c.i. 0.29 to 0.96, P < 0.04). Other subgroup analyses (artificial coverage or pancreatoduodenectomy) showed no statistically significant differences. The secondary endpoints of mortality, reoperations, and re-interventions were each affected positively by the use of coverage techniques. The certainty of evidence was very low to moderate. Conclusion The implementation of coverage, whether artificial or autologous, is beneficial after partial pancreatectomy, especially in patients undergoing distal pancreatectomy with autologous coverage. [ABSTRACT FROM AUTHOR]

Background: Neutrophil extracellular traps (NETs) occur when neutrophil chromatin is decondensed and extruded into the extracellular space in a web-like structure. Originally described as an anti-microbial function, this process has been implicated in the pathogenesis of pancreatic disease. In addition, NETs are upregulated during physiologic wound-healing and coagulation. This study evaluated how the inflammatory response to pancreatic surgery influences NET formation. Methods: For this study, 126 patients undergoing pancreatectomy gave consent before participation. Plasma was collected at several time points (preoperatively and through the postoperative outpatient visit). Plasma levels of NET markers, including cell-free DNA (cfDNA), citrullinated histone H3 (CitH3), interleukin (IL)-8, IL-6, and granulocyte colony-stimulating factor (G-CSF) were measured using enzyme-linked immunosorbent assay (ELISA). Patient clinical data were retrospectively collected from a prospectively maintained database. Results: After pancreatic resection, NET markers (cfDNA and CitH3) were elevated, peaking on postoperative days 3 and 4. This increase in NETs was due to an inherent change in neutrophil biology. Postoperatively, NET-inducing cytokines (IL-8, IL-6, and G-CSF) were increased, peaking early in the postoperative course. The patients undergoing the robotic approach had a reduction in NETs during the postoperative period compared with those who underwent the open approach. The patients who experienced a pancreatic leak had an increase in NET markers during the postoperative period. Conclusions: Pancreatectomy induces cancer-promoting NET formation. The minimally invasive robotic approach may induce fewer NETs, although the current analysis was limited by selection bias. Pancreatic leak resulted in increased NETs. Further study into the potential for NET inhibition during the perioperative period is warranted. [ABSTRACT FROM AUTHOR]

Intraperitoneal prophylactic drain (IPD) use in pancreaticoduodenectomy (PD) is still controversial. A survey was designed to investigate surgeons' use of IPD in PD patients through 23 questions and one clinical vignette. For the clinical scenario, respondents were asked to report their regret of omission and commission regarding the use of IPD elicited on a scale between 0 (no regret) and 100 (maximum regret). The threshold model and a multilevel mixed regression were applied. One hundred three (97.2%) respondents confirmed using at least two IPDs. The median regret due to the omission of IPD was 84 (67–100, IQR). The median regret due to the commission of IPD was 10 (3.5–20, IQR). The CR-POPF probability threshold at which drainage omission was the less regrettable choice was 3% (1–50, IQR). The threshold was lower for those surgeons who performed minimally invasive PD (P = 0.048), adopted late removal (P = 0.002), perceived FRS able to predict the risk (P = 0.006), and IPD able to avoid relaparotomy P = 0.036). Drain management policies after PD remain heterogeneous among surgeons. The regret model suggested that IPD omission could be performed in low-risk patients. [ABSTRACT FROM AUTHOR]

ABSTRACT Aims Surgical resection is the primary treatment option for patients diagnosed with nonfunctional pancreatic neuroendocrine tumors (NF‐Pan‐NETs). However, the postoperative prognostic evaluation for NF‐Pan‐NET patients remains obscure. This study aimed to construct an efficient model to predict the prognosis of NF‐Pan‐NET patients who have received surgical resection. Methods NF‐Pan‐NET patients after pancreatectomy were retrieved from the SEER database for the period of 2010 to 2019. A total of 2844 patients with NF‐Pan‐NET from SEER database were included in our study. After careful screening, six clinicopathological variables including age, grade, AJCC T stage, AJCC N stage, AJCC M stage, and chemotherapy were selected to develop nomograms to predict overall survival (OS) and cancer‐specific survival (CSS) respectively of the patients. Results The novel models demonstrated high accuracy and discrimination in prognosticating resected NF‐Pan‐NET through various validation methods. Furthermore, the risk subgroups classified by the newly developed risk stratification systems based on the nomograms exhibited significant differences in both OS and CSS, surpassing the efficacy of the AJCC 8th TNM staging system. Novel nomograms and corresponding risk classification systems were developed to predict OS and CSS in patients with NF‐Pan‐NET after pancreatectomy. Conclusion The models demonstrated superior performance compared to traditional staging systems, providing clinicians with more accurate and personalized guidance for postoperative surveillance and treatment.

IntroductionPancreatic neoplasms are rare among children and very few studies have reported on surgical outcomes for pediatric pancreatic neoplasms. Therefore, we aimed to describe patient and tumor characteristics and report on the surgical outcomes of pediatric pancreatic neoplasm.MethodsIn this retrospective single-center study, we reviewed and analyzed the data of patients who underwent surgery for pediatric pancreatic neoplasms at Severance Children's Hospital between January 2007 and December 2022. Clinical data including demographics, surgical procedures, and postoperative and long-term outcomes were evaluated.ResultsA total of 28 patients underwent surgical treatment for pancreatic neoplasms with a median age of 11.7 years (range: 0.4–17.8). The most common histological diagnosis among benign tumors was solid pseudopapillary neoplasm (SPN), which occurred in 20 patients (71.4%). This was followed by a mucinous cyst, nesidioblastosis, pseudocyst, duplication cyst, and benign cyst, each occurring in one patient (3.5%). Regarding malignant tumors, pancreatoblastoma, solid pseudopapillary carcinoma, and malignant pheochromocytoma were noted in one patient each (3.5%). Tumor locations included the head in 4 patients (14.2%), the body in 7 (25%), and the tail in 16 (57.1%), and was diffuse in 1 (3.5%). The most common surgical resection range was distal pancreatectomy, found in 22 patients (78.5%), followed by pylorus-preserving pancreaticoduodenectomy, found in 2 (7.2%); duodenum-preserving pancreatic resection, central pancreatectomy, tumor enucleation, and near-total pancreatectomy were performed in one patient each (3.5%). Overall, 4 patients developed grade B or C postoperative pancreatic fistulas, and 1 experienced postoperative mortality due to uncontrollable bleeding. The mean follow-up period was 6.1 years (range: 1–15.6 years), during which no significant impact on growth after surgery was detected. Among the 20 patients with SPN, tumor rupture occurred in 4 (20%), among whom 2 experienced tumor recurrences.ConclusionsHistological diagnosis of benign tumors was predominant in this case series and various extents of surgical resection were performed. Surgical treatment for pediatric pancreatic neoplasms appears to be safe and effective. However, considering the long-term prognosis of these patients, it is essential to determine the appropriate extent of surgical resection based on the location of the tumor.

The editorial in "Frontiers in Oncology" discusses technological innovations in pancreatic cancer treatment, emphasizing the need for research due to poor survival outcomes and rising incidence rates. The article highlights advances in early detection through liquid biopsy and methylation analysis, as well as improvements in neoadjuvant and adjuvant chemotherapy regimens. Surgical technologies, including minimally invasive and robotic surgery, are also evolving to enhance patient outcomes. The use of Artificial Intelligence (AI) shows promise in improving detection, therapy delivery, and data analysis for pancreatic cancer. [Extracted from the article]

Background:Granulicatella adiacens inhabits the oral cavity, urogenital, and gastrointestinal tracts and is a typical commensal of human mucosal surfaces. It rarely causes disease. Identification of these gram-positive cocci can be challenging. Case Report: In a 58-year-old male in an oncology center, we report the first occurrence of bacterial infection caused by G. adiacens. After a precise diagnosis of the infection, the patient received effective treatment. Conclusion: Owing to a lack of sufficient diagnostic tools, G. adiacens may be a more notable pathogen than has been previously identified. Sensitivity testing standards are desperately needed. [ABSTRACT FROM AUTHOR]

Watch a video of this article. [ABSTRACT FROM AUTHOR]

This research letter published in the British Journal of Surgery examines the role of splenectomy during left-sided pancreatectomy for pancreatic ductal adenocarcinoma (PDAC). The authors analyzed data from the DIPLOMA randomized trial, which included 185 patients with resectable left-sided PDAC. They found that splenic lymph node involvement was rare, particularly in patients with pancreatic body PDAC. The authors suggest that further studies are needed to determine the significance of splenectomy in left pancreatectomy for pancreatic cancer. The document also includes a table with data on various factors related to distal pancreatic cancer, which can be useful for researchers studying prognosis and treatment outcomes. [Extracted from the article]

Delayed gastric emptying (DGE) is common in patients undergoing pancreaticoduodenectomy (PD). The effect of DGE on mortality is less clear. We sought to identify predictors of mortality in patients undergoing PD for pancreatic adenocarcinoma hypothesizing DGE to independently increase risk of 30-day mortality. The ACS-NSQIP targeted pancreatectomy database (2014-2017) was queried for patients with pancreatic adenocarcinoma undergoing PD. A multivariable logistic regression analysis was performed. Separate sensitivity analyses were performed adjusting for postoperative pancreatic fistula (POPF) grades A-C. Out of 8011 patients undergoing PD, 1246 had DGE (15.6%). About 8.5% of patients with DGE had no oral intake by postoperative day-14. The DGE group had a longer median operative duration (373 vs. 362 min, p = 0.019), and a longer hospital length of stay (16.5 vs. 8 days, p

Complete surgical resection in the context of a multimodal approach has been associated with excellent long-term survival in children diagnosed with pancreatoblastoma (PB). Traditionally, curative intent surgery for PB implies standard pancreatic resections such as pancreaticoduodenectomies and distal pancreatectomies with splenectomies, surgical procedures that may lead to significant long-term pancreatic functional deficiencies. Postoperative pancreatic functional deficiencies are particularly interesting to children because they may interfere with their development, considering their long life expectancy and the significant role of pancreatic functions in their nutritional status and growth. Thus, organ-sparing pancreatectomies, such as spleen-preserving distal pancreatectomies and central pancreatectomies, are emerging in specific tumoral pathologies in children. However, data about organ-sparing pancreatectomies’ potential role in curative-intent PB surgery in children are scarce. Based on the literature data, the current review aims to present the early and late outcomes of pancreatectomies in children (including long-term deficiencies and their potential impact on the development and quality of life), particularly for PB, and further explore the potential role of organ-sparing pancreatectomies for PB. Organ-sparing pancreatectomies are associated with better long-term pancreatic functional outcomes, particularly central pancreatectomies, and have a reduced impact on children’s development and quality of life without jeopardizing their oncological safety. The long-term preservation of pancreatic functions should not be disregarded when performing pancreatectomies for PB in children. A subset of patients with PB might benefit from organ-sparing pancreatectomies, particularly from central pancreatectomies, with the same oncological results as standard pancreatectomies but with significantly less impact on long-term functional outcomes.

Abstract Total pancreatectomy with islet autotransplantation (TPIAT) is an established and effective treatment modality for patients diagnosed with intractable chronic pancreatitis (CP) and recurrent acute pancreatitis (RAP). TPIAT primarily aims to manage debilitating pain leading to impaired quality of life among patients with CP or RAP, which can be successfully managed with medical, endoscopic, or surgical interventions. TPIAT is significantly successful in relieving pain associated with CP and improving health‐related quality of life outcomes. Furthermore, the complete loss of pancreatic endocrine function attributed to total pancreatectomy (TP) can be compensated by autologous islet transplantation (IAT). Patients receiving IAT can achieve insulin independence or can be less dependent on exogenous insulin compared with those receiving TP alone. Historically, TPIAT has been mainly used in the United States, and its outcomes have been improving due to technological advancements. Despite some challenges, TPIAT can be a promising treatment for patients with CP‐related intractable pain. Thus far, TPIAT is not commonly performed in Japan. Nevertheless, it may improve health‐related quality of life in Japanese patients with CP, similar to Western patients. This review article aimed to provide an overview of the indications, related procedures, and outcomes of TPIAT and to discuss future prospects in Japan.

Background: Patients with pancreatic cancer only have a chance of a cure through a curative resection. However, this is not performed in most patients because the tumour is widespread, multivisceral involvement is thought to be incurable, or the procedure is too risky. Aims: To evaluate the outcomes of pancreaticoduodenectomy with and without multi-visceral resections in patients with locally advanced pancreatic cancer, specifically examining short-term outcomes and long-term survival rates. The study seeks to determine if patients who undergo more extensive surgery involving adjacent organs have a survival benefit despite higher operative mortality. Materials and Methods: We examined, from our prospectively maintained database, the outcome of patients between 2010 and 2020 who had undergone pancreatectomy for locally advanced lesions that also needed resection of one or more adjacent involved organs and compared their short-term outcome with those who underwent pancreatectomy alone and whether any of them survived years. Results: There were a total of 360 patients who underwent Whipple's pancreaticoduodenectomy (WP) during the study period, of whom 343 patients (95%) had standard procedures and 17 patients (5%) had additional multivisceral resections (MVRs). The colon was the most frequently resected organ in 11 (65%) of the patients who had Whipples pancreaticoduodenectomy with multivisceral (WPMVR) resections. The overall mortality (in-hospital and long-term) was higher in the WPMVR group compared to the WP group (5/17, 30%) versus (22/343, 6%) (P ≤ 0.05), and the morbidity was found to be comparable in both groups: 3 (18%) versus 158 (44%) (P ≤ 0.05). However, of the 12 patients who had undergone WPMVR, to our surprise, seven survived for 5 years. Conclusions: Although patients with pancreatic cancer who undergo MVRs have higher operative mortality, a number, albeit small, may have long-term survival.

Abstract Background Pancreatic neuroendocrine tumors (PNETs) represent 1–2% of pancreatic tumors, with recent guidelines recommending active surveillance for non-functioning PNETs (NF-PNETs) smaller than 2 cm. However, the management of multiple NF-PNETs, as well as the influence of tumor number on prognosis, remains under-researched. Methods This retrospective study analyzed NF-PNET patients who underwent pancreatic resection at Severance Hospital between February 1993 and August 2023, comparing the characteristics of patients diagnosed with multifocal tumors and those with unifocal tumors. A subgroup analysis of overall survival (OS) and recurrence-free survival (RFS) was performed based on multifocality employing the Kaplan-Meier method and the log-rank test. Results Of 187 patients, 169 (90.4%) had unifocal and 18 (9.6%) had multifocal tumors. Multifocal tumors were more likely to be diffusely spread, necessitating more total pancreatectomies (diffuse tumor location: 4.7% in unifocal vs. 38.9% in multifocal cases, p

Abstract A 75-year-old male developed acute kidney injury KDIGO stage 3 a few weeks after Whipple surgery was performed for a distal cholangiocarcinoma. Kidney biopsy revealed oxalate nephropathy. This was attributed to post-Whipple malabsorption, poor compliance with pancreatic enzyme replacement therapy, and daily intake of vitamin C supplements. Pancreatic enzyme replacement therapy was resumed and calcium carbonate initiated, with an improvement in glomerular filtration rate. Unfortunately, due to oncological progression, best supportive care was initiated. We review the pathophysiology and conditions predisposing to secondary hyperoxaluria and oxalate nephropathy. This diagnosis should be considered among the main causes of acute kidney injury following pancreatectomy, with important therapeutic implications.

Abstract Aim The aim of this study was to evaluate the intra‐abdominal status related to postoperative pancreatic fistula by combining postoperative fluid collection and drain amylase levels. Methods We retrospectively reviewed the data of 203 patients who underwent distal pancreatectomy and classified their postoperative abdominal status into four groups based on postoperative fluid collection size and drain amylase levels. We also evaluated the incidence of clinically relevant postoperative pancreatic fistula in each group according to C‐reactive protein values. Results The incidence of clinically relevant postoperative pancreatic fistula in the entire cohort (n = 203) was 28.1%. Multivariate analysis revealed that postoperative fluid collection, drain amylase levels, and C‐reactive protein levels are considerable risk factors for clinically relevant postoperative pancreatic fistula. In the subgroup with large postoperative fluid collection and high drain amylase levels, 65.9% of patients developed clinically relevant postoperative pancreatic fistula. However, no significant difference was observed in C‐reactive protein levels between patients with clinically relevant postoperative pancreatic fistula and those without it. In contrast, in the subgroup with a large postoperative fluid collection size or a high amylase level alone, a significant difference was observed in C‐reactive protein values between the patients with clinically relevant postoperative pancreatic fistula and those without it. Conclusion Postoperative fluid collection status and the C‐reactive protein value provide a more precise assessment of intra=abdominal status related to postoperative pancreatic fistula after distal pancreatectomy. This detailed analysis may be a clinically reasonable approach to individual drain management.

\nIntroduction: To evaluate and describe the diagnostic process, medical, nutritional, and surgical approach, and neurological outcome, we report data from a large Italian cohort of patients with congenital hyperinsulinism (CHI). Methods: We retrospectively analyzed 154 CHI patients admitted to Ospedale Pediatrico Bambino Gesù from 1985 to 2022. Results: Hypoglycemia occurred within the first year of life in 85.5% of patients, median time to diagnosis was 1 day (IQR 14 days). Ninety-two percent of patients were treated with diazoxide: 66.9% were responsive. Octreotide was administered to 28.6% of patients: 61.4% were responsive. Forty percent of patients were off-therapy, mostly from diazoxide. Thirty-four percent of patients carried mutations in ABCC8, 12.6% were syndromic, and 9.2% were transient CHI. Surgery was performed in 23/47 diazoxide-unresponsive and 2/95 diazoxide-responsive patients: 64.0% were focal at histology. Combining data from genetics, pancreatic venous sampling, 18F-DOPA PET/CT, and histology, 80.6% resulted diffuse, 16.7% focal, and 2.8% atypical CHI. Post-surgical diabetes developed in 6 patients. Neurocognitive evaluation revealed developmental delay or intellectual disability in 15.7% of 70 patients, mostly of a mild degree. Epilepsy was documented in 13.7% of 139 patients. Conclusion: Our diagnostic and therapeutic results are mainly consistent with the international indications and the CHI Global Registry data, with relatively low rates of neurological outcomes. Good outcomes were likely associated with early diagnosis and prompt management of patients because the majority of patients were diagnosed within 2 weeks. Remarkably, it is of utmost importance to spread the knowledge and refer CHI patients to multidisciplinary expert centers. We present retrospective data from the largest Italian cohort of patients with congenital hyperinsulinism, in order to evaluate our diagnostic and therapeutic process and the neurological outcome. We focused the discussion on some differences from the literature regarding the timing of molecular analysis performed by the use of virtual panels from clinical exome, regardless of diazoxide responsiveness. We also reported a different approach with the surgical intervention, recording a lower rate of subtotal pancreatectomy in case of diffuse forms unresponsive to medical therapy. Furthermore, we have a different strategy of drug discontinuation to test the remission of disease, without the need of the fasting tolerance test. Despite the mentioned deviations from the recent guidelines, the neurological outcome in our cohort is superimposable and lower than other cohorts. [ABSTRACT FROM AUTHOR]

PURPOSE: Inherited cancer susceptibility is often not suspected in the absence of a significant cancer family history. Pathogenic germline variants in pancreatic cancer are well-studied, and routine genetic testing is recommended in the guidelines. However, data on rare periampullary cancers other than pancreatic cancer are insufficient. We compared the prevalence of germline susceptibility variants in patients with pancreatic cancer and nonpancreatic periampullary cancers. MATERIALS AND METHODS: Six hundred and eight patients who had undergone pancreaticoduodenal resection at a tertiary referral hospital were studied, including 213 with pancreatic ductal adenocarcinoma, 172 with ampullary cancer, 154 with distal common bile duct cancer, and 69 with duodenal adenocarcinoma. Twenty cancer susceptibility and candidate susceptibility genes were sequenced, and variant interpretation was assessed by interrogating ClinVar and PubMed. RESULTS: Pathogenic or likely pathogenic, moderate- to high-penetrant germline variants were identified in 46 patients (7.7%), including a similar percentage of patients with pancreatic (8.5%) and nonpancreatic periampullary cancer (7.1%). Low-penetrant variants were identified in an additional 11 patients (1.8%). Eighty-nine percent of the moderate- to high-penetrant variants involved the major cancer susceptibility genes BRCA2 , ATM , BRCA1 , CDKN2A , MSH2 / MLH1 , and PALB2 ; the remaining 11% involved other cancer susceptibility genes such as BRIP1 , BAP1 , and MSH6. Almost all pathogenic variant carriers had a family history of cancer. CONCLUSION: Patients with pancreatic and nonpancreatic periampullary cancer have a similar prevalence of pathogenic cancer susceptibility variants. Germline susceptibility testing should be considered for patients with any periampullary cancer. [ABSTRACT FROM AUTHOR]

Background: Pancreatic neuroendocrine tumors (pNETs) represent a rare subset of pancreatic cancer. Functional tumors cause hormonal changes and clinical syndromes, while non-functional ones are often diagnosed late. Surgical management needs multidisciplinary planning, involving enucleation, distal pancreatectomy with or without spleen preservation, central pancreatectomy, pancreaticoduodenectomy or total pancreatectomy. Minimally invasive approaches have increased in the last decade compared to the open technique. The aim of this study was to analyze the current diagnostic and surgical trends for pNETs, to identify better interventions and their outcomes. Methods: The study adhered to the PRISMA guidelines, conducting a systematic review of the literature from May 2008 to March 2022 across multiple databases. Several combinations of keywords were used ("NET", "pancreatic", "surgery", "laparoscopic", "minimally invasive", "robotic", "enucleation", "parenchyma sparing") and relevant article references were manually checked. The manuscript quality was evaluated. Results: The study screened 3867 manuscripts and twelve studies were selected, primarily from Italy, the United States, and China. A total of 7767 surgically treated patients were collected from 160 included centers. The mean age was 56.3 y.o. Enucleation (EN) and distal pancreatectomy (DP) were the most commonly performed surgeries and represented 43.4% and 38.6% of the total interventions, respectively. Pancreatic fistulae, postoperative bleeding, re-operation, and follow-up were recorded and analyzed. Conclusions: Enucleation shows better postoperative outcomes and lower mortality rates compared to pancreaticoduodenectomy (PD) or distal pancreatectomy (DP), despite the similar risks of postoperative pancreatic fistulae (POPF). DP is preferred over enucleation for the pancreas body–tail, while laparoscopic enucleation is better for head pNETs. [ABSTRACT FROM AUTHOR]

Background: Mature cystic teratomas or dermoid cysts of the pancreas complicate surgical approaches because of their anatomical position and ever-growing size. Herein, we report a case of a giant mature cystic teratoma of the pancreas that was successfully resected via complete laparoscopic distal pancreatectomy (LDP). Case presentation: A 39-year-old female patient was referred to our hospital for the evaluation of a pancreatic tumor. Three years of follow-up revealed that the tumor had increased in size to 18 cm, with hyperintense solid components on diffusion-weighted magnetic resonance imaging. Considering the possibility of malignancy, we decided to perform an LDP. The capsule appeared solid enough to withstand the retraction of the endoscopic forceps. Tumor size made it difficult to dissect the dorsal side of the tumor from the caudal to the cranial side. Early transection of the pancreas and additional ports facilitated dissection of the dorsal side of the tumor. We completed the LDP without intraoperative cyst rupture. On pathological examination, the tumor was diagnosed as a mature cystic teratoma originating from the pancreatic tail. The patient was discharged on postoperative day 13 with no complications. Conclusion: LDP may be an option for surgical procedures in patients with large cystic lesions of the pancreatic body or tail. Intraoperative observation of the tumor and surgical refinement are necessary to complete the laparoscopic procedure without tumor rupture. [ABSTRACT FROM AUTHOR]

Background: Distal pancreatectomy with celiac axis resection (DP–CAR) represents an innovative surgical approach for locally advanced pancreatic body cancer in cases involving celiac axis invasion. However, this procedure carries significant perioperative risks, including arterial aneurysms and organ ischemia. Understanding these risks is crucial for optimizing patient outcomes and guiding treatment decisions. Case presentation: This case report describes a unique case of a 74-year-old male patient who was diagnosed with locally advanced pancreatic body cancer with invasion of the celiac and splenic arteries. He underwent DP–CAR after six cycles of chemotherapy. His postoperative course was uneventful without any evidence of postoperative pancreatic fistula. However, at the 10-month postoperative follow-up, pseudoaneurysm was incidentally detected in the anterior superior pancreaticoduodenal artery by follow-up computed tomography. It was successfully treated with coil embolization. He had no signs of tumor recurrence or relapse of pseudoaneurysm formation 2 years postoperatively. This case report discusses the potential risks of pseudoaneurysm formation in patients undergoing DP–CAR due to hemodynamic changes. We emphasize the significance of close monitoring in such cases. Conclusions: The case highlights the importance of recognizing and managing potential complications associated with DP–CAR in patients with pancreatic cancer. Despite its effectiveness in achieving complete resection, DP–CAR carries inherent risks, including the development of pseudoaneurysms. Vigilant surveillance and prompt intervention are crucial for optimizing patient outcomes and minimizing postoperative complications. [ABSTRACT FROM AUTHOR]

Background: Drainage fluid amylase (DFA) is useful for predicting clinically relevant postoperative pancreatic fistula (CR-POPF) after distal pancreatectomy (DP). However, difference in optimal cutoff value of DFA for predicting CR-POPF between open DP (ODP) and laparoscopic DP (LDP) has not been investigated. This study aimed to identify the optimal cutoff values of DFA for predicting CR-POPF after ODP and LDP. Methods: Data for 294 patients (ODP, n = 127; LDP, n = 167) undergoing DP at Kobe University Hospital between 2010 and 2021 were reviewed. Propensity score matching was performed to minimize treatment selection bias. Receiver operating characteristic (ROC) analysis was performed to determine the optimal cutoff values of DFA for predicting CR-POPF for ODP and LDP. Logistic regression analysis for CR-POPF was performed to investigate the diagnostic value of DFA on postoperative day (POD) three with identified cutoff value. Results: In the matched cohort, CR-POPF rates were 24.7% and 7.9% after ODP and LDP, respectively. DFA on POD one was significantly lower after ODP than after LDP (2263 U/L vs 4243 U/L, p < 0.001), while the difference was not significant on POD three (543 U/L vs 1221 U/L, p = 0.171). ROC analysis revealed that the optimal cutoff value of DFA on POD one and three for predicting CR-POPF were different between ODP and LDP (ODP, 3697 U/L on POD one, 1114 U/L on POD three; LDP, 10564 U/L on POD one, 6020 U/L on POD three). Multivariate analysis showed that DFA on POD three with identified cutoff value was the independent predictor for CR-POPF both for ODP and LDP. Conclusions: DFA on POD three is an independent predictor for CR-POPF after both ODP and LDP. However, the optimal cutoff value for it is significantly higher after LDP than after ODP. Optimal threshold of DFA for drain removal may be different between ODP and LDP. [ABSTRACT FROM AUTHOR]

Background: The purpose of this study is to examine and analyse the outcomes and patient experiences associated with laparoscopic central pancreatectomy. Methods: The perioperative data of 16 patients who underwent laparoscopic central pancreatectomy were retrospectively analysed at Ningbo Medical Center Lihuili Hospital (Xingning Branch and Eastern Branch) from September 2017 to July 2023. Results: All surgical procedures were completed without the need for intraoperative conversion to open surgery. In two cases, intraoperative cholangiography was performed, while in four cases, intraoperative fluoroscopic laparoscopic assistance was utilized. The duration of the operations varied from 160 to 360 min, with an average of 281.75 min. The estimated volume of intraoperative bleeding ranged from 50 to 300 mL, with an average of 113.75 mL. The postoperative pathology results revealed that there were two cases of intraductal papillary mucinous neoplasm, six cases of serous cystic neoplasms, one case of mucinous cystic neoplasm, five cases of solid pseudopapillary neoplasms, and two cases of neuroendocrine tumours. The maximum diameter of the tumours ranged from 3.0 to 5.0 cm, with an average of 3.67 cm. There were no instances of postoperative common bile duct stenosis or biliary leakage. Among the cases, five did not exhibit pancreatic fistula, six experienced biochemical leakage, three had grade B pancreatic fistula, and two had grade C pancreatic fistula. Conclusion: Laparoscopic central pancreatectomy, as a method to preserve pancreatic function, entails specific surgical risks and a notable likelihood of postoperative pancreatic fistula, necessitating the expertise of seasoned surgeons for its execution. [ABSTRACT FROM AUTHOR]

Introduction: Splenectomy is known to carry a risk of infection with encapsulated organisms and associated sepsis. Current Australian guidelines recommend intensive vaccination schedules and long‐term antibiotic therapy. We postulate that in some clinical scenarios where distal pancreatectomy (DP) and splenectomy is being performed, a partial splenectomy is feasible. This may preserve splenic function and help retain immunocompetence. Methods: Five patients underwent laparoscopic distal pancreatectomy with partial splenectomy (LDPPS). The DP is performed with proximal division and resection of the splenic artery and vein. The inferior portion of the spleen is removed en bloc with the distal pancreas with ligasure and linear cutting staplers. The line of demarcation on the spleen after the division of the splenic artery identifies the portion supplied by the short gastric vessels. Temporary clamping of the short gastrics during splenic parenchymal transection reduces blood loss. All operations were completed laparoscopically and within 4 h. Results: The pathology of resected lesions includes a serous cystadenoma, a pseudocyst, an IPMN and two small medial pancreatic ductal adenocarcinomas. The benign lesions involved splenic vessels at the hilum, making Kimura or Warshaw procedures untenable. No patient required blood transfusion. One patient suffered a postoperative collection consistent with postoperative pancreatic fistula requiring a drain for 10 days. Follow‐up ranged from 6 to 24 months. Following surgery, all patients had a perfused splenic remnant on imaging and benign blood films, which suggests retained splenic function. Conclusion: Preserving some spleen when performing distal pancreatectomy may provide long‐term benefits for patients. [ABSTRACT FROM AUTHOR]

Background: Postoperative pancreatic fistula (POPF) is responsible of most major complications and fatalities after PD. By avoiding POPF, TP may improve operative outcomes in high‐risk patients. The aim was to compare total pancreatectomy (TP) and pancreatoduodenectomy (PD) in high‐risk patients and evaluate results of implementing a risk‐tailored strategy in clinical practice. Methods: Between 2014 and 2023, 139 patients (76 men, median age 67 years) underwent resection of disease located in the head of the pancreas. Starting January 1, 2022, we offered TP to patients at high POPF risks (fistula risk score (FRS) ≥7) and to patients with intermediate POPF risks (FRS: 3–6) and high risks of failure to rescue (age> 75 years, ASA score ≥3). We compared outcomes of TP and PD and evaluated the results of the new strategy implementation on operative outcomes. Propensity score–based analysis was performed to limit bias of between‐group comparison. Results: Eventually, 26 (19%) patients underwent TP and 113 (81%) patients underwent PD. Severe complications occurred in 42 (30%) patients and 13 (9%) patients died. TP resulted in shorter lengths of hospital stay (median: 14 days [11; 18] vs. 17 days [13; 24], p = 0.016) and less risks of post‐pancreatectomy hemorrhage (PPH) (0% vs. 20%, p < 0.001) compared to PD. Crude and propensity match analysis showed that the implementation of a risk‐tailored strategy led to significant reduction of reoperation, POPF, PPH and mortality rates. Conclusion: The use of TP as part of a risk‐tailored strategy in high‐risk patients can be lifesaving. [ABSTRACT FROM AUTHOR]

Background: For patients with gastric cancer, a well‐balanced treatment that considers both oncological aspects and surgical risk is demanded. This study aimed to explore the optimal extent of lymph node dissection (LND) for patients with gastric cancer according to surgical risk, stratified by the risk calculator system produced by the Japan National Clinical Database (NCD). Patients and Methods: We retrospectively evaluated 187 patients who underwent radical gastrectomy for gastric cancer. Using the median predicted anastomotic leak rate obtained by the NCD risk calculator as the cutoff value, we classified 97 and 90 patients as having high and low risks, respectively. Results: In low‐risk patients, although limited LND reduced the postoperative intraabdominal infectious complications (IAIC), multivariate analysis revealed standard LND as an independent prognostic factor that improved Relapse‐free survival (RFS). In high‐risk patients, the rates of postoperative IAIC and RFS were similar between standard and limited LND. Pancreatic fistula was not observed in the limited dissection group. Conclusion: Limited LND might be the optimal treatment strategy for patients with gastric cancer with high surgical risk. [ABSTRACT FROM AUTHOR]

Background: Clinically relevant postoperative pancreatic fistula (CR‐POPF) after pancreatic resection can lead to severe postoperative complications. POPF is defined based on postoperative day (POD) 3 drainage fluid amylase level. POPF correlates with inflammatory parameters as well as drainage fluid bacterial infection. However, a standardized model based on these factors for predicting CR‐POPF remains elusive. We aimed to identify inflammatory parameter‐ and drainage fluid culture‐related risk factors for CR‐POPF on POD 3 after pancreatoduodenectomy (PD) and distal pancreatectomy (DP). Methods: Data from 351 patients who underwent PD or DP between 2013 and 2022 at a single institution were retrospectively analyzed. Risk factors for CR‐POPF were investigated using multivariate analyses, and a prediction model combining the risk factors for CR‐POPF was developed. Results: Of the 351 patients, 254 and 97 underwent PD and DP, respectively. Multivariate analyses revealed that drainage fluid amylase level ≥722 IU/L, culture positivity, as well as neutrophil count ≥5473/mm3 on POD 3 were independent risk factors for CR‐POPF in PD group. Similarly, drainage fluid, amylase level ≥500 IU/L, and culture positivity on POD 3 as well as pancreatic thickness ≥11.1 mm were independent risk factors in the DP group. The model for predicting CR‐POPF achieved the maximum overall accuracy rate when the number of risk factors was ≥2 in both the PD and DP groups. Conclusions: Inflammatory parameters on POD 3 significantly influence the risk of CR‐POPF onset after pancreatectomy. The combined models based on these values can accurately predict the risk of CR‐POPF after pancreatectomy. [ABSTRACT FROM AUTHOR]

Simple Summary: Despite the massive therapeutic advances made and the huge interest in discovering the characteristics of pancreatic cancer and its biological behavior, it continues to present a devastating prognosis. One of the characteristics of this disease is its intense capacity for locoregional invasion, increasing the capacity for recurrence and, therefore, the mortality of the patient. Recently, a population of cells known as pancreatic cancer stem cells, capable of self-renewal and differentiation and highly resistant to conventional therapy, has been identified as the origin of pancreatic cancer. Due to the above, the use of HIPEC with gemcitabine after cytoreductive surgery in patients with pancreatic ductal adenocarcinoma could decrease locoregional recurrence and improve prognosis by eliminating residual abdominal pancreatic cancer stem cells. Background: Despite the improvement in therapies, pancreatic cancer represents one of the most cancer-related deaths. In our hypothesis, we propose that Hyperthermic Intraperitoneal Chemotherapy with gemcitabine after pancreatic cytoreductive surgery could reduce tumor progression by reducing residual neoplastic volume and residual pancreatic cancer stem cells. Materials and methods: A randomized trial involving 42 patients. All patients were diagnosed with pancreatic ductal adenocarcinoma. Group I: R0 resection. Group II. R0 resection and HIPEC with gemcitabine (120 mg/m2 for 30 min). Effectiveness was measured with analysis of overall survival, disease-free survival, distant recurrence, locoregional recurrence, and measuring of pancreatic cancer stem cells (EpCAM+CXCR4+CD133+). Results: From 2017 to 2023, 63 patients were recruited for our clinical trial; 21 patients were included in each group, and 21 were excluded. Locoregional recurrence, p-value: 0.022, was lower in the experimental group. There were no significant differences between the two groups in hospital mortality, perioperative complications, or hospital costs. We found a significant decrease in pancreatic cancer stem cells in patients in the experimental group after treatment, p -value of 0.018. Conclusions: The use of HIPEC with gemcitabine after surgery in patients with resectable pancreatic ductal adenocarcinoma reduces locoregional recurrence and may be associated with a significant decrease in pancreatic cancer stem cells. [ABSTRACT FROM AUTHOR]

In selected patients with metastatic renal cell carcinoma, metastasectomy can achieve prolonged survival. Herein we report a patient with concomitant pancreatic and duodenal metastases occurring 12 years after total right nephrectomy for a renal cell carcinoma. The metastases were successfully treated by a pancreas-sparing duodenectomy and distal pancreatectomy. A 66-year-old man was referred to our hospital with a chief complaint of right upper abdominal pain. He had undergone laparoscopic total right nephrectomy for renal cell carcinoma 12 years before. Enhanced computed tomography showed hypervascular tumors in the pancreatic body and the descending duodenum near the papilla of Vater. Histopathological examination of endoscopic ultrasonography-guided fine needle aspiration cytology specimens revealed metastatic clear cell renal cancer. The patient underwent pancreas-sparing duodenectomy and distal pancreatectomy. He developed a pancreatic fistula after surgery that improved with conservative treatment, and has been free of evidence of recurrence up to 20 months postoperatively. [ABSTRACT FROM AUTHOR]

Background: Distal tibia fracture surgery can be quite difficult and have a lot of problems. In order to successfully treat distal tibial fractures, soft tissue recovery is crucial. Because of the adequate soft tissue cover on the anterolateral distal tibia, the use of anterolateral plates is on an upward trend. The aim of the study is to assess the effectiveness and side effects of a minimally invasive anterolateral locking device in management of distal tibial Pilon fractures. Methods: It was an observational prospective cohort research. After receiving the ethical permission for our study, we recruited and treated adult patients with distal tibial fractures of the AO 43C type who were hospitalized to our level I trauma center between March 2022 and August 2023. Following surgery, every patient was monitored for a minimum of 9 months. The mechanism of trauma, comorbidities, classifications, fracture-surgery interval, radiological exposure, surgery duration, complications, and the American Orthopedic Foot and Ankle Society (AOFAS) score were collected. Results: The 25 patients were monitored for 9 to 18 months. The anatomic reduction was achieved in all cases. With the exception of one case, the majority of incisions healed well without necrosis two weeks following surgery. The healing time for the fractures was between 12 and 18 weeks (on average, 13.71.2 weeks). In the meantime, period of 4.95 months (3e12 months), full weight bearing was permitted. In any event, no significant local wound complication requiring revision surgery was observed. Five instances had minor problems, including two cases of delayed union, one case of a muscle hernia, one case of a superficial infection, and one case of sensory disturbance over the anterolateral foot. The average distance (6--8 cm) between the posterolateral and anteromedial incisions was 7 cm. At one year following surgery, the AOFAS scores were excellent in 15 patients and good in 10 patients (average: 86.5 points, with excellent and good rates of 100%). Conclusions: The anterolateral plating is a good one-step treatment for tibial pilon fractures. Using locking plates and minimally invasive procedures can reduce issues with soft tissue and bone healing. [ABSTRACT FROM AUTHOR]

Background: Post‐operative diarrhoea is a common adverse event after pancreatic surgery. While the risk factors for this condition have been identified, the increasing trend of administering chemotherapy before surgery might change these factors. This study aimed to identify the risk factors of post‐operative diarrhoea in patients with pancreatic ductal adenocarcinoma (PDAC) who underwent neoadjuvant chemotherapy. Design: A retrospective cohort study. Methods: Patients who underwent neoadjuvant chemotherapy and pancreatectomy because of PDAC between 2021 and 2023 were included. The preoperative characteristics of, operative details of and post‐operative outcomes in patients with and without post‐operative diarrhoea were collected and compared. The independent risk factors of post‐operative diarrhoea were identified using logistic regression analysis. STROBE checklist was used. Results: Post‐operative diarrhoea occurred in 65 out of 145 (44.8%) patients during hospitalization. Elevated white blood cell count, advanced tumour stage, and late abdominal drain removal were independent risk factors for post‐operative diarrhoea (p <.001, p =.006 and p =.009, respectively). Conclusions: Some perioperative factors influence post‐operative diarrhoea in patients who undergo neoadjuvant chemotherapy. More attention should be paid to patients at a higher risk of post‐operative diarrhoea, with an emphasis on high‐quality management for these patients. [ABSTRACT FROM AUTHOR]

Inadequate specimen quality or quantity hinders comprehensive genomic profiling in identifying actionable mutations and guiding treatment strategies. We investigated the optimal conditions for pancreatic cancer specimen selection for comprehensive genomic profiling. We retrospectively analyzed 213 pancreatic cancer cases ordered for comprehensive genomic profiling and compared results from pancreatic biopsy, liver biopsy of pancreatic cancer metastases, pancreatectomy, liquid, and nonliver metastatic organ specimens. We examined preanalytical conditions, including cellularity (tumor cell count/size). The successfully tested cases were those that underwent comprehensive genomic profiling tests without any issues. The successfully tested case ratio was 72.8%. Pancreatic biopsy had the highest successfully tested case ratio (87%), with a high tumor cell percentage, despite the small number of cells (median, 3425). Pancreatic biopsy, liver biopsy of pancreatic cancer metastases, and non‐liver metastatic organ had higher successfully tested case ratios than that for pancreatectomy. Liver biopsy of pancreatic cancer metastases and pancreatectomy cases with tumor size (mm2) × tumor ratio (%) > 150 and >3000, respectively, had high successfully tested case ratios. The success of comprehensive genomic profiling is significantly influenced by the tumor cell ratio, and pancreatic biopsy is a potentially suitable specimen for comprehensive genomic profiling. [ABSTRACT FROM AUTHOR]

Pancreatic schwannoma is an extremely rare neurogenic tumor, lacking of specific clinical manifestations and imaging signs. It is difficult to make a definite diagnosis before operation, and it is frequently misdiagnosed with other benign and malignant tumors of the pancreas. In this article, the diagnosis and treatment of a patient with pancreatic schwannoma were reported. The 44-year-old female patient was admitted to the hospital because of pancreatic mass found by physical examination for 5 days. Abdominal enhanced CT scan showed pancreatic body mass, approximately 6.4 cm×5.4 cm in size. The patient underwent middle pancreatectomy and distal pancreatic stump jejunum Roux-en-Y anastomosis. Postoperative pathological report was consistent with pancreatic epithelioid schwannoma. During the follow-up of 2 years, no tumor recurrence or metastasis was found. This case provides clinical reference for clinicians to diagnose and treat pancreatic schwannoma. [ABSTRACT FROM AUTHOR]

Purpose: This study aimed to evaluate the preoperative risk factors in patients with radiologically resectable pancreatic ductal adenocarcinomas (PDACs), deemed to be unresectable intraoperatively. Methods: Data on patients radiologically diagnosed with resectable PDACs and subsequently underwent pancreatectomy between January 2020 and December 2021 were retrospectively collected. Preoperative risk factors were also analysed. Results: Fifty‐three patients with resectable PDAC who underwent laparotomy for curative intent were divided into the no‐metastases (n = 32) and distant metastases (n = 21) groups. Univariate analysis identified factors associated with distant metastases found intraoperatively, such as significant weight loss (odds ratio [OR] 5.29, P =.02), tumour size >35 mm (OR 4.15, P =.017), tumours located at the body and tail of the pancreas (OR 6, P =.041), superior mesenteric vein (SMV) abutment from the tumour (OR 7.5, P =.02), serum carbohydrate antigen 19‐9 > 385 IU/mL (OR 3.58, P =.031) and serum carcinoembryonic antigen (CEA) levels >9 IU/mL. However, multivariate analysis showed that only significant weight loss (adjusted OR 27.19, P =.011), SMV abutment from the tumour (adjusted OR 52.64, P =.01) and serum CEA levels >9 IU/mL were associated with distant metastases found intraoperatively. Conclusion: Significant weight loss, SMV abutment and serum CEA levels of >9 IU/mL were intraoperatively associated with distant metastases. Staging laparoscopy and positron emission tomography–computed tomography may reduce unnecessary laparotomies and change clinical management in these patients. [ABSTRACT FROM AUTHOR]