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Impact of postoperative glycemic control and nutritional status on clinical outcomes after total pancreatectomy

World Journal of Gastroenterology 2017年第2期23卷 265-274页

作者： Hao-Jun Shi Chen Jin De-Liang Fu department of pancreatic surgery Pancreatic Disease InstituteHuashan HospitalFudan UniversityShanghai 200040China

AIM To evaluate the impact of glycemic control and nutritional status after total pancreatectomy(TP) on complications, tumor recurrence and overall *** Retrospective records of 52 patients with pancreatic tumors who underwent TP were collected from 2007 to 2015. A series of clinical parameters collected before and after surgery, and during the follow-up were evaluated. The associations of glycemic control and nutritional status with complications, tumor recurrence and long-term survival were determined. Risk factors for postoperative glycemic control and nutritional status were *** High early postoperative fasting blood glucose(FBG) levels(OR = 4.074, 95%CI: 1.188-13.965, P = 0.025) and low early postoperative prealbumin levels(OR = 3.816, 95%CI: 1.110-13.122, P = 0.034) were significantly associated with complications after TP. Postoperative Hb A1 c levels over 7%(HR = 2.655, 95%CI: 1.299-5.425, P = 0.007) were identified as one of the independent risk factors for tumor recurrence. Patients with postoperative Hb A1 c levels over 7% had much poorer overall survival than those with Hb A1 c levels less than 7%(9.3 mo vs 27.6 mo, HR = 3.212, 95%CI: 1.147-8.999, P = 0.026). Patients with long-term diabetes mellitus(HR = 15.019, 95%CI: 1.278-176.211, P= 0.031) and alcohol history(B = 1.985, SE = 0.860, P = 0.025) tended to have poor glycemic control and lower body mass index levels after TP, *** At least 3 mo are required after TP to adapt to diabetes and recover nutritional status. Glycemic control appears to have more influence over nutritional status on longterm outcomes after TP. Improvement in glycemic control and nutritional status after TP is important to prevent early complications and tumor recurrence, and improve survival.

关键词： Total pancreatectomy Glycemic control Nutritional status Complication Tumor recurrence Prognosis

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Unraveling the enigma:A comprehensive review of solid pseudopapillary tumor of the pancreas

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World Journal of Gastrointestinal Oncology 2024年第3期16卷 614-629页

作者： Ye-Cheng Xu De-Liang Fu Feng Yang department of pancreatic surgery Pancreatic Disease InstituteHuashan HospitalFudan UniversityShanghai 200040China

Solid pseudopapillary tumor of the pancreas(SPTP)is a rare neoplasm predom-inantly observed in young ***,CTNNB1 mutations,β-catenin nuclear accumulation,and subsequent Wnt-signaling pathway activation are the leading molecular *** preoperative diagnosis often relies on imaging techniques and endoscopic *** resection remains the mainstay *** models,such as the Fudan Prognostic Index,show promise as predictive tools for assessing the prognosis of *** three types of metachronous liver metastasis can be beneficial in tailoring individu-alized treatment and follow-up *** advancements,challenges persist in understanding its etiology,establishing standardized treatments for unresectable or metastatic diseases,and developing a widely recognized grading *** comprehensive review aims to elucidate the enigma by consolidating current knowledge on the epidemiology,clinical presentation,pathology,molecular characteristics,diagnostic methods,treatment options,and prognostic factors.

关键词： Pancreas Solid pseudopapillary tumor β-catenin Endoscopic ultrasound surgery Recurrence Liver metastasis Prognostic prediction

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Mesenterico-portal vein invasion should be an important factor in TNM staging for pancreatic ductal adenocarcinoma: Proposed modification of the 8th edition of the American Joint Committee on Cancer staging system

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World Journal of Gastroenterology 2019年第46期25卷 6752-6766页

作者： Hong-Yu Chen Xing Wang Hao Zhang Xu-Bao Liu Chun-Lu Tan department of pancreatic surgery West China HospitalSichuan University

BACKGROUND The 8^th edition of the American Joint Committee on Cancer(AJCC)staging system for pancreatic ductal adenocarcinoma(PDAC)excludes extrapancreatic extension from the assessment of T stage and restages tumors with mesenterico-portal vein(MPV)invasion into T1-3 diseases according to tumor ***,MPV invasion is believed to be correlated with a poor *** To analyze whether the inclusion of MPV invasion can further improve the 8th edition of the AJCC staging system for *** This study retrospectively included 8th edition AJCC T1-3N0-2M0 patients undergoing pancreaticoduodenectomy/total pancreatectomy from two cohorts and analyzed survival *** the first cohort,a total of 7539 patients in the surveillance,epidemiology,and end results database was included,and in the second cohort,689 patients from the West China Hospital database were *** Cox regression analysis showed that MPV invasion is an independent prognostic factor in both *** the MPV-group,all pairwise comparisons between the survival functions of patients with different stages were significant except for the comparison between patients with stage IIA and those with stage ***,in the MPV+group,pairwise comparisons between the survival functions of patients with stage IA,stage IB,stage IIA,stage IIB,and stage III were not significant.T1-3N0 patients in the MPV+group were compared with the T1N0,T2N0,and T3N0 subgroups of the MPV-group;only the survival of MPV-T3N0 and MPV+T1-3N0 patients had no significant *** comparisons of patients with stage IIA and subgroups of stage IIB showed(1)no significant difference between the survival of T2N1 and T3N0 patients;(2)a longer survival of T1N1 patients that was shorter than the survival of T2N0 patients;and(3)and a shorter survival of T3N1 patients that was similar to that of T1-3N2 *** The modified 8th edition of the AJCC staging system for PDAC proposed in this study,which i

关键词： pancreatic ductal adenocarcinoma Portal vein Mesenteric veins Neoplasm staging pancreaticoduodenectomy

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mi R-1181 inhibits invasion and proliferation via STAT3 in pancreatic cancer

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World Journal of Gastroenterology 2017年第9期23卷 1594-1601页

作者： Jie Wang Xing-Jun Guo You-Ming Ding Jian-Xin Jiang department of Hepatic-Biliary-pancreatic surgery The Affiliated Hospital of Guizhou Medical University department of Biliary-pancreatic surgery Affiliated Tongji Hospital Tongji Medical College Huazhong University of Science and Technology department of Hepatic-Biliary-pancreatic surgery Renmin Hospital of Wuhan University

AIM To examine the role of microRNA 1181 (miR-1181) in invasion and proliferation in pancreatic cancer. METHODS We analyzed the expression of miR-1181 in several pancreatic cancer cell lines and generated stable MIA- PaCa- 2 and PANC-1 cell lines with up-regulated miR-1181 expression using an adenovirus delivery system. We then investigated miR-1181 ' s effect on invasion and proliferation of pancreatic cancer cells by transwell assay, wound healing assay, cell counting kit-8 assay and colony-forming assay, and explored any underlying mechanisms by western bolt. Beyond that, we observed the change of the PANC-1 cell ' s cytoskeleton by immunofluorescence staining. RESULTS Our data showed that miR-1181 was relatively downregulated in pancreatic cancer cell lines compared with normal pancreatic ductal epithelial cells. And miR-1181 inhibited the migration, invasion and proliferation activities of MIA-PaCa-2 and PANC-1 cells. Notably,after over-expressing of miR-1181 in PANC-1 cells, F-actin depolymerized. Immunofluorescence staining shows decreased F-actin and beta-tubulin expression in PANC-1 cells over-expressing miR- 1181 compared with the control cells. Furthermore, we found that over-expressing miR- 1181 inhibited the expression of signal transducer and activator of transcription 3(STAT3) while knocking- down miR-1181 up-regulated the expression of STAT3. Knocking-down miR-1181 promoted the invasion and proliferation of pancreatic cancer cells. And inhibition of STAT3 blocked the promotion effects of knocking- down miR-1181 on proliferation and invasion in pancreatic cancer. CONCLUSION Together our findings suggest that miR-1181 may be involved in pancreatic cancer cell invasion and proliferation by targeting STAT3 and indicate that miR-1181 may be a potential therapeutic agent for pancreatic cancer.

关键词： pancreatic cancer miR-1181 Proliferation Invasion STAT3

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Role of original and modified Frey's procedures in chronic pancreatitis

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World Journal of Gastroenterology 2016年第47期22卷 10415-10423页

作者： Chun-Lu Tan Hao Zhang Min Yang Shao-Jun Li Xu-Bao Liu Ke-Zhou Li department of pancreatic surgery West China Hospital of Sichuan University

AIM To retrospectively review patients with chronic pancreatitis(CP) treated with Frey's procedures between January 2009 and January *** A retrospective review was performed of patients with CP treated with Frey's procedures between January 2009 and January 2014 in the department of pancreatic surgery. A cross-sectional study of postoperative pain relief, quality of life(Qo L), and alcohol and nicotine abuse was performed by clinical interview, letters and telephone interview in January 2016. Qo L of patients was evaluated with the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire(EORTC QLQ-C30) version 3.0. The patients were requested to fill in the questionnaires by themselves via correspondence or clinical *** A total of 80 patients were enrolled for analysis, including 44 who underwent the original Frey's procedure and 36 who underwent a modified Frey's procedure. The mean age was 46 years in the original group and 48 years in the modified group. Thirtyfive male patients(80%) were in the original group and 33(92%) in the modified group. There were no differences in the operating time, blood loss, and postoperative morbidity and mortality between the two groups. The mean follow-up was 50.3 mo in the original group and 48.7 mo in the modified group. There were no differences in endocrine and exocrine function preservation between the two groups. The original Frey's procedure resulted in significantly betterpain relief, as shown by 5-year follow-up(P = 0.032), better emotional status(P = 0.047) and fewer fatigue symptoms(P = 0.028). When stratifying these patients by the M-ANNHEIM severity index, no impact was found on pain relief after the two types of *** The original Frey's procedure is as safe as the modified procedure, but the former yields better pain relief. The severity of CP does not affect postoperative pain relief.

关键词： Chronic pancreatitis Frey’s procedure M-ANNHEIM severity index Pain relief Quality of life

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Risk factors of infected pancreatic necrosis secondary to severe acute pancreatitis

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Hepatobiliary & pancreatic Diseases International 2016年第4期15卷 428-433页

作者： Liang Ji Jia-Chen Lv Zeng-Fu Song Mai-Tao Jiang Le Li Bei Sun department of pancreatic and Biliary surgery First Affiliated Hospital of Harbin Medical University

BACKGROUND： Severe acute pancreatitis（SAP） remains a clinical challenge with considerable morbidity and *** early identification of infected pancreatic necrosis（IPN）, a life-threatening evolution secondary to SAP, is obliged for a more preferable prognosis. Thus, the present study was conducted to identify the risk factors of IPN secondary to SAP. METHODS： The clinical data of patients with SAP were retrospectively analyzed. Univariate and multivariate logistic regression analyses were sequentially performed to assess the associations between the variables and the development of IPN secondary to SAP. A receiver operating characteristic（ROC） curve was created for each of the qualified independent risk factors. RESULTS： Of the 115 eligible patients, 39（33.9%） progressed to IPN, and the overall in-hospital mortality was 11.3%（13/115）.The early enteral nutrition（EEN）（P=0.0092, OR=0.264）, maximum intra-abdominal pressure（IAP）（P=0.0398, OR=1.131）and maximum D-dimer level（P=0.0001, OR=1.006） in the first three consecutive days were independent risk factors associated with IPN secondary to SAP. The area under ROC curve（AUC） was 0.774 for the maximum D-dimer level in the first three consecutive days and the sensitivity was 90% and the specificity was 58% at a cut-off value of 933.5 μg/L; the AUC was 0.831 for the maximum IAP in the first three consecutive days and the sensitivity was 95% and specificity was 58%at a cut-off value of 13.5 mm Hg. CONCLUSIONS： The present study suggested that the maximum D-dimer level and/or maximum IAP in the first three consecutive days after admission were risk factors of IPN secondary to SAP; an EEN might be helpful to prevent the progression of IPN secondary to SAP.

关键词： D-dimer enteral nutrition infected pancreatic necrosis intra-abdominal pressure risk factor severe acute pancreatitis

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Development and multicenter validation of a nomogram for preoperative prediction of lymph node positivity in pancreatic cancer(NeoPangram)

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Hepatobiliary & pancreatic Diseases International 2021年第2期20卷 163-172页

作者： Jie Hua Xue-Min Chen Yun-Jie Chen Bao-Chun Lu Jin Xu Wei Wang Si Shi Xian-Jun Yu department of pancreatic surgery Fudan University Shanghai Cancer CenterShanghai 200032China department of Oncology Shanghai Medical College of Fudan UniversityShanghai 200032China Shanghai pancreatic Cancer Institute Shanghai 200032China department of Hepatobiliary and pancreatic surgery The First People’s Hospital of ChangzhouChangzhou 213004China department of Minimally Invasive Hepatobiliary and pancreatic surgery Ningbo No.2 HospitalNingbo 315010China department of Hepatobiliary and pancreatic surgery Shaoxing People’s HospitalShaoxing 312000China

Background:Neoadjuvant therapy is associated with nodal downstaging and improved oncological outcomes in patients with lymph node(LN)-positive pancreatic *** study aimed to develop and validate a nomogram to preoperatively predict LN-positive ***:A total of 558 patients with resected pancreatic cancer were randomly and equally divided into development and internal validation *** logistic regression analysis was used to construct the *** performance was evaluated by discrimination,calibration,and clinical *** independent multicenter cohort consisting of 250 patients was used for external ***:A four-marker signature was built consisting of carbohydrate antigen 19–9(CA19–9),CA125,CA50,and CA242.A nomogram was constructed to predict LN metastasis using three predictors identified by multivariate analysis:risk score of the four-marker signature,computed tomography-reported LN status,and clinical tumor *** prediction model exhibited good discrimination ability,with C-indexes of 0.806,0.742 and 0.763 for the development,internal validation,and external validation cohorts,*** model also showed good calibration and clinical usefulness.A cut-off value(0.72)for the probability of LN metastasis was determined to separate low-risk and high-risk ***-Meier survival analysis revealed a good agreement of the survival curves between the nomogram-predicted status and the true LN ***:This nomogram enables the identification of pancreatic cancer patients at high risk for LN positivity who may have more advanced disease and thus could potentially benefit from neoadjuvant therapy.

关键词： Lymph node metastasis pancreatic ductal adenocarcinoma Nomogram Neoadjuvant therapy

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Single center experience in selecting the laparoscopic Frey procedure for chronic pancreatitis

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World Journal of Gastroenterology 2015年第44期21卷 12644-12652页

作者： Chun-Lu Tan Hao Zhang Ke-Zhou Li department of pancreatic surgery West China Hospital Sichuan University

AIM: To share our experience regarding the laparoscopic Frey procedure for chronic pancreatitis(CP) and patient ***: All consecutive patients undergoingduodenum-preserving pancreatic head resection from July 2013 to July 2014 were reviewed and those undergoing the Frey procedure for CP were included in this study. Data on age, gender, body mass index(BMI), American Society of Anesthesiologists score, imaging findings, inflammatory index(white blood cells, interleukin(IL)-6, and C-reaction protein), visual analogue score score during hospitalization and outpatient visit, history of CP, operative time, estimated blood loss, and postoperative data(postoperative mortality and morbidity, postoperative length of hospital stay) were obtained for patients undergoing laparoscopic surgery. The open surgery cases in this study were analyzed for risk factors related to extensive bleeding, which was the major reason for conversion during the laparoscopic procedure. Age, gender, etiology, imaging findings, amylase level, complications due to pancreatitis, functional insufficiency, and history of CP were assessed in these ***: Nine laparoscopic and 37 open Frey procedures were analyzed. Of the 46 patients, 39 were male(85%) and seven were female(16%). The etiology of CP was alcohol in 32 patients(70%) and idiopathic in 14 patients(30%). Stones were found in 38 patients(83%). An inflammatory mass was found in five patients(11%). The time from diagnosis of CP to the Frey procedure was 39 ± 19(9-85) mo. The BMI of patients in the laparoscopic group was 20.4 ± 1.7(17.8-22.4) kg/m2 and was 20.6 ± 2.9(15.4-27.7) kg/m2 in the opengroup. Allpatientsrequired analgesic medication for abdominal pain. Frequent acute pancreatitis or severe abdominal pain due to acute exacerbation occurred in 20 patients(43%). Pre-operative complications due to pancreatitis were observed in 18 patients(39%). pancreatic functional insufficiency was observed in 14 patients(30%). Two lap

关键词： Chronic pancreatitis Frey procedure Laparoscopic s

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Conversion therapy in liver transplantation for hepatocellular carcinoma:What's new in the era of molecular and immune therapy?

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Hepatobiliary & pancreatic Diseases International 2023年第1期22卷 7-13页

作者： Chao Jiang Xiao-Dong Sun Wei Qiu Yu-Guo Chen Da-Wei Sun Guo-Yue Lv General surgery Center Department of Hepatobiliary and Pancreatic Surgerythe First Hospital of Jilin UniversityChangchun 130021China

Background:Hepatocellular carcinoma(HCC)is the sixth most common cancer globally,with limited therapies and unsatisfactory prognosis once in the advanced *** promising advances in locoregional and systematic treatments,fast development of targeted drugs,the success of immunotherapy,as well as the emergence of the therapeutic alliance,conversion therapy has recently become more well developed and an effective therapeutic *** article aimed to review recent developments in conversion therapy in liver transplantation(LT)for *** sources:We searched for relevant publications on Pub Med before September 2022,using the terms“HCC”,“liver transplantation”,“downstaging”,“bridging treatment”and“conversion therapy.”Results:Conversion therapy was frequently represented as a combination of multiple treatment modalities to downstage HCC and make patients eligible for *** combining various local and systematic treatments in conversion therapy is still controversial,growing evidence has suggested that multimodal combined treatment strategies downstage HCC in a shorter time,which ultimately increases the opportunities for ***,the recent breakthrough of immunotherapy and targeted therapy for HCC also benefit patients with advanced-stage ***:In the era of targeted therapy and immunotherapy,applying the thinking of transplant oncology to benefit HCC patients receiving LT is a new topic that has shed light on advanced-stage *** the expansion of conversion therapy concepts,further investigation and research is required to realize the full potential of conversion treatment strategies,including accurately selecting candidates,determining the timing of surgery,improving the conversion rate,and guaranteeing the safety and long-term efficacy of treatment.

关键词： Liver transplantation Hepatocellular carcinoma Conversion therapy Targeted therapy Immunotherapy Combination therapy

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Huge primary dedifferentiated pancreatic liposarcoma mimicking carcinosarcoma in a young female: A case report

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World Journal of Clinical Cases 2019年第11期7卷 1344-1350页

作者： Zhe Liu Wu-Feng Fan Gui-Chen Li Jin Long Yuan-Hong Xu Gang Ma department of pancreatic-Biliary surgery First Hospital of China Medical University

BACKGROUND pancreatic liposarcoma is a rare tumor. According to a literature review, the patient described in this study is the seventh case of pancreatic liposarcoma reported in the English literature and the third case of dedifferentiated liposarcoma. Furthermore, this case had the largest primary tumor volume, and a primary pancreatic liposarcoma was diagnosed based on sufficient evidence. CASE SUMMARY We here report a rare case of a 28-year-old female with a huge dedifferentiated liposarcoma in the pancreatic tail. In June 2015, the patient underwent distal pancreatectomy with splenectomy. During the operation, a huge liposarcoma of approximately 28.0 cm × 19.0 cm × 8.0 cm was found, which had a yellow and white fish-like incisal surface. Based on both pathology and MDM2 gene amplification, the tumor was diagnosed as a dedifferentiated liposarcoma. The patient was treated with surgery but declined postoperative chemotherapy. She was well at the 26-mo follow-up, and no relapse was observed. CONCLUSION pancreatic liposarcoma has a low incidence. Chemotherapy should be included in the treatment regimens. Complete resection is the only effective treatment.

关键词： pancreatic liposarcoma Huge tumor Distal pancreatectomy and splenectomy Chemotherapy Case report

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