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.

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.

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.

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.

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.

Continuous preperitoneal versus thoracic epidural analgesia in open pancreatoduodenectomy: randomized clinical trial.

Background: Thoracic epidural analgesia (TEA), once the standard for pain management in major abdominal operations, is associated with postoperative complications, making preperitoneal continuous wound infiltration (CWI) a promising alternative. This study aimed to compare the effectiveness of CWI and TEA in managing postoperative pain after open pancreatoduodenectomy.

Methods: In a single-centre, randomized, open-label non-inferiority trial, adult patients undergoing elective open pancreatoduodenectomy were assigned to either CWI or TEA for pain management.

Comparing clinical and genomic features based on the tumor location in patients with resected pancreatic cancer.

Background: Pancreatic cancer is anatomically divided into pancreatic head and body/tail cancers, and some studies have reported differences in prognosis. However, whether this discrepancy is induced from the difference of tumor biology is hotly debated. Therefore, we aimed to evaluate the differences in clinical outcomes and tumor biology depending on the tumor location.

Re-evaluation of risk and oncological outcomes of resection of veins and arteries in the resection of pancreatic cancer.

Background: Advances in chemotherapy have led to increasing major vascular resection during pancreatectomy which has been contraindicated due to high morbidity. This study aimed to verify the safety and oncological outcomes of vascular resection during pancreatectomy in the era of neoadjuvant therapy.

Methods: Data from patients who underwent surgery for pancreatic cancer at Seoul National University Hospital between 2001 and 2021 were reviewed.

Long-Term Outcome of Proximal Gastrectomy for Upper-Third Advanced Gastric and Siewert Type II Esophagogastric Junction Cancer Compared With Total Gastrectomy: A Propensity Score-Matched Analysis.

Background: This study aimed to investigate the oncologic long-term safety of proximal gastrectomy for upper-third advanced gastric cancer (AGC) and Siewert type II esophagogastric junction (EGJ) cancer.

Methods: The study enrolled patients who underwent proximal gastrectomy (PG) or total gastrectomy (TG) with standard lymph node (LN) dissection for pathologically proven upper-third AGC and EGJ cancers between January 2007 and December 2018. Propensity score-matching with a 1:1 ratio was performed to reduce the influence of confounding variables such as age, sex, tumor size, T stage, N stage, and tumor-node-metastasis (TNM) stage.

Optimal Surveillance Interval of Branch Duct Intraductal Papillary Mucinous Neoplasm of the Pancreas.

Importance: Despite the increasing prevalence of intraductal papillary mucinous neoplasm (IPMN), data on the growth and malignant conversion rates based on long-term surveillance cohorts are limited. Many international guidelines recommend surveillance for benign lesions, but the optimal interval and duration are unclear.

Objective: To determine the optimal surveillance protocol for IPMN and propose which patients may be exempted from surveillance.