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Preoperative biliary drainage for resectable or borderline resectable periampullary tumor: what is the best management?

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Hepatobiliary Surgery and Nutrition 2019年第4期8卷 398-400页

作者： Julie Perinel mustapha adham Service de chirurgie Digestive Hopital Edouard HerriotHospices Civils de LyonLyonFrance Faculte de Medecine de Lyon Universite Claude Bernard Lyon 1(UCBL1)LyonFrance

Management of preoperative biliary drainage (PBD) in patients undergoing pancreaticoduodenectomy (PD) is still debated. Obstructive jaundice is associated with a proinflammatory state, impaired immune function and disturbances in coagulation. Patients with jaundice are at high risk to develop renal dysfunction and bacteriobilia. In this context, PBD was traditionally performed before surgery to improve postoperative outcomes.

关键词： impaired biliary jaundice

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International assessment and validation of the prognostic role of lymph node ratio in patients with resected pancreatic head ductal adenocarcinoma

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Hepatobiliary Surgery and Nutrition 2022年第6期11卷 822-833页

作者： Gaetan-Romain Joliat Ismail Labgaa Jesse Sulzer Dionisios Vrochides Alessandro Zerbi Gennaro Nappo Julie Perinel mustapha adham Stijn van Roessel Marc G.Besselink JSven D.Mieog Jesse V.Groen Nicolas Demartines Markus Schafer Department of Visceral Surgery Lausanne University Hospital CHUVLausanneSwitzerland Graduate School for Health Sciences University of BernBernSwitzerland Division of Hepatobiliary and Pancreatic Surgery Carolinas Medical CenterCharlotteNCUSA Humanitas Clinical and Research Center-IRCCS MilanItaly Department of Biomedical Sciences Humanitas UniversityMilanItaly Department of Digestive Surgery Edouard Herriot HospitalLyonFrance Department of Surgery Cancer Center AmsterdamAmsterdam UMCUniversity of AmsterdamAmsterdamThe Netherlands Department of Surgery Leiden University Medical CenterLeidenThe Netherlands

Background:Lymph node ratio(LNR;positive/harvested lymph nodes)was identified as overall survival predictor in several cancers,including pancreatic *** remains unclear if LNR is predictive of overall survival in pancreatic adenocarcinoma patients staged *** study assessed the prognostic overall survival role of LNR in pancreatic adenocarcinoma patients in relation with lymph node ***:A retrospective international study in six different centers(Europe and United States)was *** adenocarcinoma patients who underwent pancreatoduodenectomy from 2000 to 2017 were *** with neoadjuvant treatment,metastases,R2 resections,or missing data regarding nodal status were *** curves were calculated using Kaplan-Meier method and compared using log-rank *** Cox regressions were performed to find independent overall survival predictors adjusted for potential ***:A total of 1,327 patients were *** node involvement(pN+)was found in 1,026 patients(77%),561 pN1(55%)and 465 pN2(45%).Median LNR in pN+patients was 0.214[interquartile range(IQR):0.105-0.364].On multivariable analysis,LNR was the strongest overall survival predictor in the entire cohort[hazard ratio(HR)=5.5;95%confidence interval(CI):3.1-9.9;P<0.001]and pN+patients(HR=3.8;95%CI:2.2-6.6;P<0.001).Median overall survival was better in patients with LNR<0.225 compared to patients with LNR≥0.225 in the entire cohort and pN+*** results were found in pN2 patients(worse overall survival when LNR≥0.225).Conclusions:LNR appeared as an important prognostic factor in patients undergoing surgery for pancreatic adenocarcinoma and permitted to stratify overall survival in pN2 *** should be routinely used in complement to tumor-node-metastasis(TNM)stage to better predict patient prognosis.

关键词： Pancreatectomy cancer lymphatic involvement

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