Appropriate extent of lymph node dissection in patients with muscle-invasive gallbladder cancer.

Background: The appropriate extent of lymph node dissection has not yet been standardized in muscle-invasive gallbladder cancer.

Methods: Patients who underwent surgery, and were histologically diagnosed with muscle-invasive gallbladder cancer were included. Patients were classified as having Na, Nb, or Nc disease if their nodal metastases were limited to the porta hepatis and extended to the posterosuperior pancreatic head lymph nodes (PSPLNs), nodes along the celiac axis, or superior mesenteric vessels.

Concept of Depth of Invasion can Improve Staging Performance in Patients with Resected Distal Cholangiocarcinoma: Validation of the American Joint Committee on Cancer Staging System.

Purpose: The American Joint Committee on Cancer (AJCC) staging system for distal cholangiocarcinoma (dCC) has evolved significantly. However, the prognostic correlation of the newly proposed staging system remains unclear. Therefore, we aimed to compare the staging performance between AJCC 7th and 8th editions for dCC.

Evaluating Tumor Regression and Survival Outcomes in Pancreatic Ductal Adenocarcinoma After Neoadjuvant Treatment according to CAP Grading System: Clinical Usefulness and Limitations.

Background: Neoadjuvant treatment (NAT) is increasingly employed for pancreatic ductal adenocarcinoma (PDAC), necessitating reliable methods to assess tumor response. The College of American Pathologists (CAP) grading system is widely used to predict chemo-responsiveness and survival, but consensus on the most effective grading system and treatment regimen remains elusive.

Patients And Methods: This retrospective study included 462 patients with PDAC who underwent resection after NAT between 2009 and 2023.

Evaluation of feasibility and clinical outcomes of robot-assisted pancreaticoduodenectomy after neoadjuvant treatment for patients with advanced pancreatic ductal adenocarcinoma: a retrospective propensity score-matched cohort study.

Purpose: With neoadjuvant treatment (NAT) broadening the surgical indication for advanced pancreatic cancer, the growing use of robotic platforms in pancreaticoduodenectomy (PD) necessitates the evaluation of its feasibility in advanced pancreatic cancer patients who have undergone NAT.

Methods: We compared clinicopathological outcomes of advanced pancreatic cancer patients who received either robot-assisted or open PD after NAT at a tertiary hospital from 2015 to 2023. Propensity score matching was performed based on age, sex, and TNM staging.

Effect of Double Layer Polyglycolic Acid Felt for Reducing Pancreatic Fistula After Pancreatoduodenectomy: Results of a Multicenter Randomized Control Trial (PLANET-PJ trial).

Objective: To evaluate the usefulness of a double coating of polyglycolic acid (PGA) felt for pancreaticojejunostomy in reducing the incidence of clinically relevant postoperative pancreatic fistula (POPF) in patients with a normal pancreas.

Summary Background Data: Despite pancreaticojejunostomy being an advanced procedure in patients undergoing pancreatoduodenectomy (PD), few studies have reported a satisfactory reduction in the incidence of POPF.

Methods: This study was an international multicenter randomized controlled trial conducted between October 2018 and December 2021.

Comparison of 5-Fluorouracil/Leucovorin and Capecitabine as Adjuvant Therapies in Biliary Tract Cancer.

Background: The prognosis of biliary tract cancer (BTC) is poor, and recurrence rates remain high even after curative resection. This study aimed to compare the efficacy and safety of capecitabine and 5-fluorouracil/leucovorin (FL) as adjuvant treatments following curative resection in patients with BTC.

Methods: We retrospectively reviewed the medical records of patients with BTC (including gallbladder and extrahepatic and intrahepatic bile duct cancers) who underwent curative surgical resection and adjuvant chemotherapy between 2011 and 2023.

Long-term oncologic outcomes of robot-assisted pancreaticoduodenectomy versus open pancreaticoduodenectomy for pancreatic cancer.

Background: Robot-assisted pancreaticoduodenectomy (RPD) has been gaining attention for its potential benefits in short-term surgical outcomes compared with open pancreaticoduodenectomy (OPD) in pancreatic cancer. However, the evidence of its long-term oncological efficacy is limited.

Methods: This retrospective study compared the long-term outcomes of RPD and OPD in patients with pancreatic cancer at Seoul National University Hospital between January 2015 and October 2023.

Comparison of Pancreatic Fistula Between Robotic-Assisted and Open Pancreatoduodenectomy: A Comprehensive Evaluation Using an Alternative Fistula Risk Score.

Background: Robotic-assisted pancreatoduodenectomy (RPD) offers ergonomic advantages, yet its effect on pancreatic fistula risk remains unclear. This study evaluated RPD safety using the alternative fistula risk score (aFRS).

Methods: We retrospectively reviewed the pancreatoduodenectomy database at Seoul National University Hospital (2014-2023), comparing RPD with open pancreatoduodenectomy (OPD) in a 1:1 aFRS probability-matched analysis.

Role of Adjuvant Chemotherapy in Distal Cholangiocarcinoma.

Background: Recent studies addressing the role of adjuvant chemotherapy (AC) in cholangiocarcinoma (CCA) have been published; however, there are challenges in generalizing the findings due to different prognostic characteristics depending on tumor location and resectability. Therefore, this study aimed to investigate the role of AC in distal cholangiocarcinoma (dCCA), a common tumor subtype of CCA.

Method: Data from 497 patients with dCCA who underwent curative surgery at Seoul National University Hospital between 2000 and 2019 were reviewed using prospectively collected clinicopathologic information.

Changing Clinical Meaning of Resection Margin Status According to the Treatment Paradigm and the Potential Role of Perioperative Radiotherapy for Patients with Pancreatic Ductal Adenocarcinoma: An Updated Multicenter Retrospective Cohort Study.

Background: Surgeons have focused on obtaining microscopically negative margins and developing perioperative treatment strategies for pancreatic head cancer. However, the clinical significance of resection margin and radiotherapy remains unclear, particularly in neoadjuvant chemotherapy (NAC) settings. Therefore, this study aimed to evaluate the prognostic impact of margin status and perioperative radiotherapy.

Prognostic implications of resection margin status in distal pancreatectomy for pancreatic ductal adenocarcinoma.

Background: Curative resection is a well known prognostic factor in pancreatectomy. However, definition and clinical significance of resection margin in distal pancreatectomy remains controversial.

Methods: From 2010 to 2018, 203 patients with pancreatic cancer undergoing distal pancreatectomies were included.

Global survey on surgeon preference and current practice for pancreatic neck and body cancer with portomesenteric venous involvement.

Background: Evidence regarding the optimal surgical approach for pancreatic neck/body cancer with portomesenteric vein (PV) involvement is scarce. We aimed to clarify the current practice using an international survey.

Methods: An online survey was distributed to members of nine international associations and study groups.

The FOXP1-ABCG2 axis promotes the proliferation of cancer stem cells and induces chemoresistance in pancreatic cancer.

Pancreatic cancer is an aggressive disease with low survival and high recurrence rates. A major obstacle in treating pancreatic cancer is the frequent development of chemoresistance to the standard therapeutic drug, gemcitabine. One mechanism by which pancreatic cancer develops chemoresistance is through the proliferation of cancer stem cells (CSC).

Machine learning models for pancreatic cancer diagnosis based on microbiome markers from serum extracellular vesicles.

Pancreatic cancer (PC) is a fatal disease with an extremely low 5-year survival rate, mainly because of its poor detection rate in early stages. Given emerging evidence of the relationship between microbiota composition and diseases, this study aims to identify microbiome markers linked to the diagnosis of pancreatic cancer. We utilized extracellular vesicles (EVs) data obtained from blood samples of 38 pancreatic cancer patients and 51 health controls.

Impact of Resection Margin Status on Recurrence and Possible Candidates for Adjuvant Radiotherapy in Resected Distal Cholangiocarcinoma.

Objective: To evaluate the prognostic impact of resection margin in distal cholangiocarcinoma (dCC).

Background: Due to the relatively low prevalence of dCC in Western countries and the use of various definitions of resection margin status, the prognostic impact of bile duct resection margin status remains unclear.

Methods: This study included consecutive patients who underwent curative surgery and were diagnosed with dCC between 2000 and 2022.

Personalized Surveillance Intervals for Intraductal Papillary Mucinous Neoplasm (IPMN): Multicenter Study Using Parametric Models.

Objective: The aim was to build a calculator for personalized surveillance of BD-IPMNs.

Summary Background Data: The interval time for surveillance of low-risk branch duct intraductal papillary mucinous neoplasms (BD-IPMNs) has not been established yet.

Methods: The study included an international cohort of BD-IPMNs without worrisome features (WFs) or high-risk stigmata (HRS).

SLC5A3 depletion promotes apoptosis by inducing mitochondrial dysfunction and mitophagy in gemcitabine-resistant pancreatic cancer cells.

Pancreatic ductal adenocarcinoma (PDAC) is a highly aggressive cancer with poor prognosis, largely due to the rapid development of chemoresistance in patients. Mitochondrial dynamics play a crucial role in cancer cell survival. Currently, the specific mechanisms underlying gemcitabine resistance in PDAC remain unknown.

Inter-rater variability for the American Society of Anesthesiologists classification in patients undergoing hepato-pancreato-biliary surgery (MILESTONE-2): international survey among surgeons and anaesthesiologists.

Background: Patients undergoing hepato-pancreato-biliary surgery are typically preoperatively assessed using the American Society of Anesthesiologists (ASA) classification, which is also used for case-mix adjustment when comparing centre outcomes. Studies determining the inter-rater variability of the ASA classification within hepato-pancreato-biliary surgery are currently lacking.

Methods: An international survey was collected and a case-vignette study was performed (November 2022-April 2023) regarding the ASA classification in patients undergoing hepato-pancreato-biliary surgery among anaesthesiologists and surgeons from (inter)national societies.

Metabolic response during preoperative chemotherapy can predict prognosis in pancreatic cancer.

Background: With the evolving treatment paradigms for pancreatic cancer, there is an increasing need for reliable markers to evaluate the effectiveness of preoperative chemotherapy. Due to the limitations of current indicators, this study aimed to evaluate the prognostic value of metabolic response based on the changes in the maximum standardized uptake value (SUV) on fluorine-18-fluorodeoxyglucose positron emission tomography.

Methods: This study included 210 patients with pancreatic cancer who underwent post-chemotherapy curative surgery between 2013 and 2022.

Impact of Nutritional Changes on the Prognosis in Pancreatic Cancer Patients Underwent Curative Surgery After Neoadjuvant Chemotherapy.

Background: Pancreatic cancer is a highly aggressive malignancy with a poor prognosis. Neoadjuvant chemotherapy (NAC) is increasingly used to improve survival in patients with pancreatic cancer; however, it often results in nutritional deterioration, which may negatively impact patient outcomes. Therefore, this study aimed to assess the effect of changes in nutritional status on the long-term outcomes of patients with pancreatic cancer who underwent curative surgery after NAC.

Comprehensive molecular analysis of 26 newly established human pancreatic ductal adenocarcinoma cell lines reveals two clusters with variating drug sensitivities.

Background: Pancreatic ductal adenocarcinoma (PDAC) is a malignant form of cancer with the worst survival rate and an extremely low rate of response to treatments. The development and molecular characterization of pancreatic cancer cell lines (PCCLs) are essential for studying the biology of highly aggressive pancreatic adenocarcinoma.

Methods: We applied whole exome sequencing (WES) and RNA-seq to identify molecular characteristics of 26 newly established PCCLs.

Novel Predictive Strategy Using CA19-9 and Fecal Elastase Levels to Make Treatment Decisions for Resectable Pancreatic Cancer: A Retrospective Study.

: Carbohydrate antigen 19-9 (CA19-9) is used as a marker to predict recurrence and survival of patients with pancreatic ductal adenocarcinoma (PDAC). Recently, fecal elastase-1 (FE-1) has been shown to correlate with prognosis in patients with PDAC. : A total of 536 patients who underwent curative intent surgery between 2010 and 2019 were included in the study.

Efficacy of Neoadjuvant Radiotherapy After Chemotherapy and the Optimal Interval from Radiotherapy to Surgery for Borderline Resectable and Resectable Pancreatic Cancer.

Background: Benefits of neoadjuvant treatment for pancreatic cancer with major vessel invasion has been demonstrated through randomized controlled trials; however, the optimal neoadjuvant treatment strategy remains controversial, especially for radiotherapy. Therefore, we aimed to evaluate the efficacy and safety of neoadjuvant radiotherapy followed by chemotherapy and the optimal time interval to undergo surgery after radiotherapy in (borderline) resectable pancreatic cancer.

Methods: Between 2013 and 2022, patients with (borderline) resectable pancreatic cancer with vessel contact who received 5-fluorouracil with leucovorin, oxaliplatin, and irinotecan or gemcitabine and nanoparticle albumin-bound paclitaxel as initial treatment following surgery were included.

Multiomic quantification of the KRAS mutation dosage improves the preoperative prediction of survival and recurrence in patients with pancreatic ductal adenocarcinoma.

Most cancer mutation profiling studies are laboratory-based and lack direct clinical application. For clinical use, it is necessary to focus on key genes and integrate them with relevant clinical variables. We aimed to evaluate the prognostic value of the dosage of the KRAS G12 mutation, a key pancreatic ductal adenocarcinoma (PDAC) variant and to investigate the biological mechanism of the prognosis associated with the dosage of the KRAS G12 mutation.