Mesenteric Versus Conventional Approach During Pancreatoduodenectomy for Pancreatic Ductal Adenocarcinoma (MAPLE-PD trial): A Multicenter Randomized Controlled Trial.

Objective: This multicenter randomized controlled trial investigated whether the mesenteric approach, which is an infracolic superior mesenteric artery (SMA)-first approach during pancreatoduodenectomy (PD), can improve survival in patients with pancreatic ductal adenocarcinoma (PDAC), compared to the Kocher-first conventional approach.

Summary Background Data: The mesenteric approach might improve surgical outcomes through a non-touch isolation technique for PDAC.

Methods: This trial was conducted in 24 Japanese high-volume centers.

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.

Successful conversion surgery for patients with pancreatic cancer, positive peritoneal cytology, and liver metastasis who were treated with chemotherapy involving nanoliposomal irinotecan with fluorouracil and folinic acid.

A 67-year-old woman was diagnosed with pancreatic head cancer. Staging laparoscopy (SL) was performed, peritoneal cytology (CY) was positive (CY1), and a peritoneal access port was created. The patient was started on nab-paclitaxel plus gemcitabine therapy (GnP).

A multicenter prospective study to determine the optimal range of lymph node dissection in pancreatic cancer surgery after neoadjuvant chemotherapy (LYMRIN-Trial): Project study by the Japan Pancreas Society and JON 2302-P.

Introduction: Clear evidence regarding the optimal extent of lymph node dissection during pancreatectomy for pancreatic ductal adenocarcinoma (PDAC) is lacking. The index of estimated benefit of lymph node dissection is useful for evaluating the effectiveness of dissection at each lymph node station, but a prospective study is needed for accurate assessment. The aim of the LYMRIN trial is to determine the optimal station of lymph node dissection in pancreatectomy after neoadjuvant chemotherapy using gemcitabine and S-1 (GS) by evaluating the rate of lymph node metastasis and the index of estimated benefit of each type of lymph node dissection.

Late Graft Failure Due to Arterio-Venous Fistula in the Free Jejunal Graft Mesentery Following Total Pharyngo-Laryngo-Esophagectomy for Cervical Esophageal Cancer: A Case Report.

Introduction: Insufficient blood supply to free jejunal grafts after total pharyngo-laryngo-esophagectomy (TPLE) occurs primarily due to failure of the vascular anastomosis, often resulting in rapid graft necrosis. This report details a case of ischemic enteritis caused by an arteriovenous fistula (AVF) in the mesentery of the free jejunal graft, resulting in chronic stenosis and total removal of the jejunal graft.

Case Presentation: A 61-year-old woman diagnosed with squamous cell carcinoma of the cervical and thoracic esophagus underwent TPLE with gastric conduit and free jejunal graft reconstruction.

Gastrojejunostomy for Asymptomatic Gastric Outlet Obstruction in Pancreatic Cancer May Contribute to Early Recovery.

Background/aim: Gastric outlet obstruction (GOO) is common in patients with advanced pancreatic cancer. Previous reports have documented the efficacy of gastrojejunostomy (GJ) bypass and endoscopic procedures. However, the optimal timing for GJ bypass remains unclear.

Long-term outcomes of prophylactic right-half dissection of the superior mesenteric artery nerve plexus in pancreatoduodenectomy for pancreatic ductal adenocarcinoma: five-year results from a randomized phase II trial.

Purposes: In pancreaticoduodenectomy for pancreatic ductal adenocarcinoma (PDAC), Prophylactic right-half dissection of the superior mesenteric artery (SMA) nerve plexus has been attempted in pancreaticoduodenectomy for pancreatic ductal adenocarcinoma. In this study, we evaluated the significance of prophylactic right-half dissection of the SMA nerve plexus by extending the observation period to 5 years.

Methods: From April 2014 to June 2018, 74 patients with PDAC in the pancreatic head were randomly assigned to either the dissection group, in which the right half of the nerve plexus of the SMA was dissected (n = 37) or the preservation group, in which the nerve plexus of the SMA was completely preserved (n = 37).

A Case of Pleomorphic Adenoma and Ductal Carcinoma In Situ in the Same Mammary Gland.

Introduction: Pleomorphic adenoma is a benign tumor that frequently occurs in the salivary glands; however, it occurs in the breast rarely. There have been few reports of breast cancer complicated by pleomorphic adenoma of the mammary gland.

Case Presentation: A 70-year-old woman was found to have a mass lesion in her left breast during a medical examination.

[Conversion Surgery for Pancreatic Cancer].

Pancreatic cancer is known as a disease with an extremely poor prognosis. Although surgery is the only curative treatment, most pancreatic cancer is already advanced at the time of diagnosis. With advances in multidisciplinary treatment such as chemotherapy, radiation therapy, and heavy-ion therapy, more cases of unresectable(UR)pancreatic cancer are being treated with surgery in recent years.

Risk Factors for Early Liver Recurrence After Pancreatic Cancer Resection.

Background: Liver recurrence after resection is one of the most common types of recurrence and is a risk factor for poor prognosis. The aim of this study was to identify risk factors for initial liver recurrence.

Materials And Methods: A total of 109 patients with resectable pancreatic ductal adenocarcinoma who underwent resection between 2015 and 2022 were included.

A case of successful conversion surgery for unresectable gallbladder cancer treated with durvalumab in combination with gemcitabine plus cisplatin.

We report a rare case of a patient with initially unresectable gallbladder cancer who underwent conversion surgery with durvalumab in combination with gemcitabine plus cisplatin and achieved an R0 resection. A 68 year-old woman was found to have gallbladder cancer and multiple enlarged lymph nodes around the suprapancreatic rim and hepatic hilum invading the proper hepatic artery on computed tomography. The diagnosis was cT3cN2cM0, cStage IVB.

A case of MSI-high pancreatic body-tail cancer successfully treated with radical resection after pembrolizumab.

A 72-year-old woman was diagnosed with unresectable pancreatic body-tail cancer (cT4N1M1, cStage IV) with para-aortic lymph node metastasis. She underwent six courses of gemcitabine + nab-paclitaxel as first-line chemotherapy, 12 courses of oxaliplatin + irinotecan + levofolinate + fluorouracil as second-line chemotherapy, and five courses of albumin-suspended irinotecan + levofolinate + fluorouracil as third-line chemotherapy. After each chemotherapy regimen, the disease was determined to be progressive.

A case of BRCA1-mutated giant pancreatic acinar cell carcinoma successfully treated with modified FOLFIRINOX therapy and radical resection.

Pancreatic acinar cell carcinoma (PACC) is a rare type of pancreatic cancer; further, its pathogenesis and treatment strategies remain unclear. We report the case of a 70-year-old man who presented with a chief complaint of abdominal distention. Computed tomography scans revealed a large lobulated mass (tumor diameter: 150 mm) in the pancreatic body tail, which was diagnosed as a PACC through endoscopic ultrasonography fine needle aspiration.

Thoracoscopic enucleation of an esophageal glomus tumor in the prone position: a case report and literature review.

Background: Glomus tumors (GT) generally occur in the skin. However, esophageal GT, an extremely rare condition, has no established standardized treatment guidelines. Herein, we report the case of an esophageal GT successfully removed by thoracoscopic enucleation in the prone position using intra-esophageal balloon compression.

Novel choledochojejunostomy technique "T-shaped anastomosis" for preventing the development of postoperative cholangitis in pancreatoduodenectomy: A propensity score matching analysis.

Background: There have been few studies of countermeasures against postoperative cholangitis, a serious complication after pancreaticoduodenectomy (PD) that impairs quality of life.

Objective: To evaluate our recently developed, novel method of choledochojejunostomy with a larger anastomotic diameter, the "T-shaped anastomosis."

Methods: The study included 261 cases of PD.

Hepatocellular carcinoma in a transplanted donor liver and colon cancer developing in a patient with a complex background: A case report.

The development of tumors in livers transplanted from hepatitis B virus (HBV)-negative donors to patients with hepatitis B and cirrhosis is rare. The present study describes the case of a woman in her 60s who developed hepatocellular carcinoma (HCC) in her grafted liver, 19 years after transplantation, as well as a metachronous colorectal tumor. The pathological findings, including clinical, immunohistochemical and molecular results, are described in the present case report.

A multi-institutional randomized phase III study comparing minimally invasive distal pancreatectomy versus open distal pancreatectomy for pancreatic cancer; Japan Clinical Oncology Group study JCOG2202 (LAPAN study).

Background: Minimally invasive distal pancreatectomy (MIDP), including laparoscopic and robotic distal pancreatectomy, has gained widespread acceptance over the last decade owing to its favorable short-term outcomes. However, evidence regarding its oncologic safety is insufficient. In March 2023, a randomized phase III study was launched in Japan to confirm the non-inferiority of overall survival in patients with resectable pancreatic cancer undergoing MIDP compared with that of patients undergoing open distal pancreatectomy (ODP).

Evaluating staging laparoscopy indications for pancreatic cancer based on resectability classification and treatment strategies for patients with positive peritoneal washing cytology.

Introduction: The prognosis of pancreatic ductal adenocarcinoma (PDAC) in patients with positive peritoneal washing cytology (CY1) is poor. We aimed to evaluate the results of staging laparoscopy (SL) and treatment efficacy in CY1 patients based on a resectability classification.

Methods: We retrospectively reviewed 250 patients with PDAC who underwent SL before the initial treatment between 2017 and 2023 at the University of Toyama.

Efficacy of staging laparoscopy for resectable pancreatic cancer on imaging and the therapeutic effect of systemic chemotherapy for positive peritoneal cytology.

Background: The frequency and prognosis of positive peritoneal washing cytology (CY1) in resectable pancreatic ductal adenocarcinoma (R-PDAC) remains unclear. The objective of this study was to identify the clinical implications of CY1 in R-PDAC and staging laparoscopy (SL).

Methods: We retrospectively analyzed 115 consecutive patients with R-PDAC who underwent SL between 2018 and 2022.