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https://www.readbyqxmd.com/read/29629335/intraoperative-radiation-boost-to-the-surgical-resection-bed-following-pancreaticoduodenectomy-for-a-borderline-resectable-pancreatic-carcinoma-a-case-report
#1
Tarita O Thomas, William Small, Mark Fleming, Song Kang, Richard A Hoefer
Neoadjuvant therapy including chemotherapy alone or concurrent chemotherapy with external bream radiation is a standard treatment strategy for borderline resectable pancreatic adenocarcinoma and is also used routinely for primary operable cancers at some institutions (1). The use of intraoperative radiation therapy (IORT) has been limited largely because of the logistical issues in delivery of radiation during surgery (2). This is the first reported case of a borderline resectable pancreas cancer patient who underwent neoadjuvant chemo-radiation therapy followed by resection with the use of IORT using the mobile IntraBeam device to boost the resection bed and improve local control by dose escalation...
2018: Frontiers in Oncology
https://www.readbyqxmd.com/read/29485032/long-term-results-of-protocol-kidney-biopsy-directing-steroid-withdrawal-in-simultaneous-pancreas-kidney-transplant-patients
#2
Nemin Zhu, Neal E Rowe, Paul R Martin, Sean S Luke, Thomas B Mcgregor, Frank Myslik, Vivian C Mcalister, Alp Sener, Patrick P Luke
INTRODUCTION: We sought to determine whether protocol biopsies could be used to guide treatment and improve outcomes in simultaneous pancreas-kidney (SPK) patients. METHODS: Between 2004 and 2013, protocol biopsies were performed on SPK patients at 3-6 months and one year post-transplant. Maintenance immunosuppression consisted of a calcineurin inhibitor, anti-proliferative agent, and corticosteroid. Corticosteroid was withdrawn in negative early biopsies, maintained in subclinical/borderline biopsies, and increased if Banff IB or greater rejection was identified...
February 23, 2018: Canadian Urological Association Journal, Journal de L'Association des Urologues du Canada
https://www.readbyqxmd.com/read/29483443/-conversion-surgery-for-pancreatic-head-cancer-with-peritoneal-dissemination-following-chemotherapy-for-two-years-a-case-report
#3
Yuuri Hatsuzawa, Masamichi Mizuma, Fuyuhiko Motoi, Tatsuo Hata, Masahiro Iseki, Tatsuyuki Takadate, Hideo Ohtsuka, Naoaki Sakata, Takanori Morikawa, Kei Nakagawa, Hiroki Hayashi, Takeshi Naitoh, Atsushi Kanno, Tooru Shimosegawa, Michiaki Unno
Here we report a case of pancreatic cancer(PC)with peritoneal dissemination, underwent conversion surgery following chemotherapy for 2 years. A5 5-year-old woman was referred to our hospital for treatment of PC. Abdominal CT scan revealed 3.0 cm of a pancreatic head tumor with abutment of the portal vein and the hepatic artery, classified as borderline resectable. Staging laparoscopy(SL)showed positive peritoneal cytology(CY). Gemcitabine(Gem)plus S-1 therapy(GS) was performed. Ten months after initial GS, SL revealed the disseminated nodule and positive CY...
February 2018: Gan to Kagaku Ryoho. Cancer & Chemotherapy
https://www.readbyqxmd.com/read/29394759/-a-case-of-pathological-complete-response-following-neoadjuvant-chemotherapy-with-gemcitabine-plus-nab-paclitaxel-in-borderline-resectable-pancreatic-cancer
#4
Noriyuki Ohno, Makoto Ishida, Kenji Ohnishi, Katsuji Sawai, Shinsuke Tabata, Masaaki Deguchi, Tatsumi Kitajima, Yasuharu Kaizaki
We report a resected case with a pathological complete response(pCR)after neoadjuvant chemotherapy for borderline resectable pancreatic cancer(BRPC). A 67-year-old woman who had been treated for type 2 diabetes mellitus in our hospital presented with an exacerbation of diabetes. An abdominal CT scan confirmed a hypovascular mass in the pancreas body consistent with BRPC. After 3 courses of chemotherapy with gemcitabine plus nab-paclitaxel(GnP), her elevated DUPAN-2 level normalized. A follow up CT scan revealed that the tumor had decreased in size, and no distant metastasis was detected...
November 2017: Gan to Kagaku Ryoho. Cancer & Chemotherapy
https://www.readbyqxmd.com/read/29390555/predicting-new-onset-diabetes-after-minimally-invasive-subtotal-distal-pancreatectomy-in-benign-and-borderline-malignant-lesions-of-the-pancreas
#5
Ho Kyoung Hwang, Jiae Park, Sung Hoon Choi, Chang Moo Kang, Woo Jung Lee
The purpose of this study was to evaluate the time-dependent probability and risk factors of pancreatogenic diabetes mellitus (PDM) in patients who underwent minimally invasive subtotal distal pancreatectomy.Changes in glucose metabolic consequence of 34 patients (laparoscopic: 31, robotic: 3) who underwent surgery from December 2005 to December 2014 were estimated by assessing impaired fasting glucose, PDM, and PDM-free time analysis.A total of 22 patients showed glucose intolerance, including 13 (38.2%) with impaired fasting glucose and 9 (26...
December 2017: Medicine (Baltimore)
https://www.readbyqxmd.com/read/29334562/is-a-pathological-complete-response-following-neoadjuvant-chemoradiation-associated-with-prolonged-survival-in-patients-with-pancreatic-cancer
#6
Jin He, Alex B Blair, Vincent P Groot, Ammar A Javed, Richard A Burkhart, Georgios Gemenetzis, Ralph H Hruban, Kevin M Waters, Justin Poling, Lei Zheng, Daniel Laheru, Joseph M Herman, Martin A Makary, Matthew J Weiss, John L Cameron, Christopher L Wolfgang
OBJECTIVES: To describe the survival outcome of patients with borderline resectable or locally advanced pancreatic ductal adenocarcinoma (BR/LA-PDAC) who have a pathologic complete response (pCR) following neoadjuvant chemoradiation. BACKGROUND: Patients with BR/LA-PDAC are often treated with neoadjuvant chemoradiation in an attempt to downstage the tumor. Uncommonly, a pCR may result. METHODS: A retrospective review of a prospectively maintained database was performed at a single institution...
January 12, 2018: Annals of Surgery
https://www.readbyqxmd.com/read/29214453/neoadjuvant-therapy-versus-upfront-resection-for-pancreatic-cancer-the-actual-spectrum-and-clinical-burden-of-postoperative-complications
#7
Giovanni Marchegiani, Stefano Andrianello, Chiara Nessi, Marta Sandini, Laura Maggino, Giuseppe Malleo, Salvatore Paiella, Enrico Polati, Claudio Bassi, Roberto Salvia
BACKGROUND: Neoadjuvant therapy (NAT) is used for borderline-resectable or locally advanced pancreatic cancer (PDAC) and exhibits promising results in terms of pathological outcomes. However, little is known about its effect on surgical complications. METHODS: We analyzed 445 pancreatic resections for PDAC from 2014 to 2016 at The Pancreas Institute, Verona University Hospital. The Modified Accordion Severity Grading System and average complication burden (ACB) were used to compare patients treated with NAT with patients who underwent upfront surgery (UFS)...
March 2018: Annals of Surgical Oncology
https://www.readbyqxmd.com/read/29194971/the-causes-significance-and-consequences-of-inflammatory-fibrosis-in-kidney-transplantation-the-banff-i-ifta-lesion
#8
Brian J Nankivell, Meena Shingde, Karen L Keung, Caroline L-S Fung, Richard J Borrows, Philip J O'Connell, Jeremy R Chapman
Inflammation within areas of interstitial fibrosis and tubular atrophy (i-IFTA) is associated with adverse outcomes in kidney transplantation. We evaluated i-IFTA in 429 indication- and 2052 protocol-driven biopsy samples from a longitudinal cohort of 362 kidney-pancreas recipients to determine its prevalence, time course, and relationships with T cell-mediated rejection (TCMR), immunosuppression, and outcome. Sequential histology demonstrated that i-IFTA was preceded by cellular interstitial inflammation and followed by IF/TA...
February 2018: American Journal of Transplantation
https://www.readbyqxmd.com/read/29094173/imaging-of-post-operative-pancreas-and-complications-after-pancreatic-adenocarcinoma-resection
#9
Nima Hafezi-Nejad, Elliot K Fishman, Atif Zaheer
Pancreatic ductal adenocarcinoma is one of the leading causes of cancer-related deaths. With surgical resection being the only definitive treatment, improvements in technique has led to an increase in number of candidates undergoing resection by inclusion of borderline resectable disease patients to the clearly resectable group. Post-operative complications associated with pancreaticoduodenectomy and distal pancreatectomy include delayed gastric emptying, anastomotic failures, fistula formation, strictures, abscess, infarction, etc...
November 1, 2017: Abdominal Radiology
https://www.readbyqxmd.com/read/29073149/intrapancreatic-injection-of-human-bone-marrow-derived-mesenchymal-stem-stromal-cells-alleviates-hyperglycemia-and-modulates-the-macrophage-state-in-streptozotocin-induced-type-1-diabetic-mice
#10
Norimitsu Murai, Hirokazu Ohtaki, Jun Watanabe, Zhifang Xu, Shun Sasaki, Kazumichi Yagura, Seiji Shioda, Shoichiro Nagasaka, Kazuho Honda, Masahiko Izumizaki
Type 1 diabetes mellitus is a progressive disease caused by the destruction of pancreatic β-cells, resulting in insulin dependency and hyperglycemia. While transplanted bone marrow-derived mesenchymal stem/stromal cells (BMMSCs) have been explored as an alternative therapeutic approach for diseases, the choice of delivery route may be a critical factor determining their sustainability. This study evaluated the effects of intrapancreatic and intravenous injection of human BMMSCs (hBMMSCs) in streptozotocin (STZ)-induced type 1 diabetic mouse model...
2017: PloS One
https://www.readbyqxmd.com/read/28992935/initial-experience-in-the-treatment-of-borderline-resectable-pancreatic-adenocarcinoma
#11
Juli Busquets, Juan Fabregat, Helena Verdaguer, Berta Laquente, Núria Pelaez, Luis Secanella, David Leiva, Teresa Serrano, María Cambray, Rafael Lopez-Urdiales, Emilio Ramos
INTRODUCTION: A borderline resectable group (APBR) has recently been defined in adenocarcinoma of the pancreas. The objective of the study is to evaluate the results in the surgical treatment after neoadjuvancy of the APBR. METHOD: Between 2010 and 2014, we included patients with APBR in a neoadjuvant and surgery protocol, staged by multidetector computed tomography (MDCT). Treatment with chemotherapy was based on gemcitabine and oxaliplatin. Subsequently, MDCT was performed to rule out progression, and 5-FU infusion and concomitant radiotherapy were given...
October 2017: Cirugía Española
https://www.readbyqxmd.com/read/28948329/surgery-for-pancreatic-cancer-critical-radiologic-findings-for-clinical-decision-making
#12
Annabelle L Fonseca, Jason B Fleming
Pancreatic cancer is the fourth leading cause of cancer-related deaths in the United States, with an estimated 53,670 new cases diagnosed and an estimated 43,090 deaths in 2017. This high mortality rate is in part due to the small percentage of patients diagnosed with local disease, as well as the biologically aggressive nature of the disease. While only 10-20% of patients will present with surgically resectable disease, this is the only possible curative therapy. Five-year survival of resected pancreatic cancer ranges from 12 to 27%...
September 25, 2017: Abdominal Radiology
https://www.readbyqxmd.com/read/28833055/impact-of-portal-vein-infiltration-and-type-of-venous-reconstruction-in-surgery-for-borderline-resectable-pancreatic-cancer
#13
MULTICENTER STUDY
R Ravikumar, C Sabin, M Abu Hilal, A Al-Hilli, S Aroori, G Bond-Smith, S Bramhall, C Coldham, J Hammond, R Hutchins, C Imber, G Preziosi, A Saleh, M Silva, J Simpson, G Spoletini, D Stell, J Terrace, S White, S Wigmore, G Fusai
BACKGROUND: The International Study Group of Pancreatic Surgery (ISGPS) recommends operative exploration and resection of pancreatic cancers in the presence of reconstructable mesentericoportal axis involvement. However, there is no consensus on the ideal method of vascular reconstruction. The effect of depth of tumour invasion of the vessel wall on outcome is also unknown. METHODS: This was a retrospective cohort study of pancreaticoduodenectomy with vein resection for T3 adenocarcinoma of the head of the pancreas across nine centres...
October 2017: British Journal of Surgery
https://www.readbyqxmd.com/read/28750659/alliance-for-clinical-trials-in-oncology-alliance-trial-a021501-preoperative-extended-chemotherapy-vs-chemotherapy-plus-hypofractionated-radiation-therapy-for-borderline-resectable-adenocarcinoma-of-the-head-of-the-pancreas
#14
Matthew H G Katz, Fang-Shu Ou, Joseph M Herman, Syed A Ahmad, Brian Wolpin, Robert Marsh, Spencer Behr, Qian Shi, Michael Chuong, Lawrence H Schwartz, Wendy Frankel, Eric Collisson, Eugene J Koay, JoLeen M Hubbard, James L Leenstra, Jeffrey Meyerhardt, Eileen O'Reilly
BACKGROUND: Borderline resectable pancreatic cancers infiltrate into adjacent vascular structures to an extent that makes an R0 resection unlikely when pancreatectomy is performed de novo. In a pilot study, Alliance for Clinical Trials in Oncology Trial A021101, the median survival of patients who received chemotherapy and radiation prior to anticipated pancreatectomy was 22 months, and 64% of operations achieved an R0 resection. However, the individual contributions of preoperative chemotherapy and radiation therapy to therapeutic outcome remain poorly defined...
July 27, 2017: BMC Cancer
https://www.readbyqxmd.com/read/28708232/primary-signet-ring-cell-carcinoma-of-the-pancreas-with-a-good-response-to-chemotherapy-case-report-and-literature-review
#15
REVIEW
Milan Radojkovic, Dragana Ilic, Ivan Ilic
PURPOSE: Although pancreatic cancer is a common malignancy, signet ring cell carcinoma of the pancreas is a very rare histologic type with only 6 cases reported so far. We present a patient with primary signet ring cell carcinoma of the pancreas and a good response to neoadjuvant chemotherapy. CASE REPORT: A 67-year-old woman presented at a regional hospital with a 2-week history of painless progressive jaundice. Abdominal computed tomography showed a tumor in the head of the pancreas, 4...
November 15, 2017: Tumori
https://www.readbyqxmd.com/read/28705004/multimodality-management-of-borderline-resectable-pancreatic-adenocarcinoma
#16
Laura R Prakash, Matthew H G Katz
Patients with borderline resectable pancreatic adenocarcinoma have primary tumors within the pancreas that involve the mesenteric vasculature to a limited degree. Their tumors are nonetheless at high-risk for a microscopically positive surgical resection margin and/or early treatment failure when pancreatectomy is performed de novo. The optimal treatment strategy for these patients has not been established; however, relatively favorable outcomes can be achieved with systemic chemotherapy and radiation therapy (RT) prior to intended resection...
June 2017: Chinese Clinical Oncology
https://www.readbyqxmd.com/read/28655416/evaluation-and-proposal-of-novel-resectability-criteria-for-pancreatic-cancer-established-by-the-japan-pancreas-society
#17
Suguru Yamada, Tsutomu Fujii, Hideki Takami, Masamichi Hayashi, Naoki Iwata, Mitsuro Kanda, Chie Tanaka, Hiroyuki Sugimoto, Goro Nakayama, Masahiko Koike, Michitaka Fujiwara, Yasuhiro Kodera
BACKGROUND: The guidelines for the classification of the resectability of pancreatic cancer established by the National Comprehensive Cancer Network can be difficult to utilize in clinical practice. We evaluated novel criteria proposed by the Japan Pancreas Society. METHODS: We analyzed 382 patients with pancreatic cancer between 2001 and 2015 for survival differences among subgroups classified according to the Japan Pancreas Society classification. Overall survival and disease-free survival were expressed as median values and compared with data based on the National Comprehensive Cancer Network classification, and differences in initial patterns of recurrence were analyzed...
October 2017: Surgery
https://www.readbyqxmd.com/read/28646282/surgery-for-pancreatic-ductal-adenocarcinoma
#18
REVIEW
R Vera, L Díez, E Martín Pérez, J C Plaza, A Sanjuanbenito, A Carrato
Surgical resection is the only potentially curative option in the treatment of pancreatic ductal adenocarcinoma. Preoperative radiological imaging allows to rule out the presence of metastases. Three resectability categories are established based on the radiological findings depending on the degree of contact between the tumor and the blood vessels. Histological confirmation of malignancy is only required in cases of borderline or non-resectable tumors, prior to neoadjuvant treatment initiation. Diagnostic laparoscopy is recommended in the presence of large tumors of the body or tail and in borderline tumors to explore the possibility of resection and to apply treatment with curative intent, as well as in those cases with high level of biomarkers to rule out peritoneal involvement...
November 2017: Clinical & Translational Oncology
https://www.readbyqxmd.com/read/28620900/new-treatment-options-and-management-considerations-in-borderline-resectable-pancreatic-cancer
#19
REVIEW
Zeljka Jutric, Laleh G Melstrom
In the United States, cancer of the pancreas accounts for nearly 40,000 deaths annually and is the fourth leading cause of cancer-related mortality. The vast majority of patients present with metastatic or unresectable disease. Only 20% of patients are candidates for surgery, and therefore curable. The 5-year survival rate for patients with pancreatic adenocarcinoma is only 6%, with surgical resection being essential for long-term survival. Recent research has identified a precise subset of patients with borderline resectable pancreatic cancer for whom resection yielding durable survival is possible...
June 15, 2017: Oncology (Williston Park, NY)
https://www.readbyqxmd.com/read/28567455/laparoscopic-total-pancreatectomy-for-multiple-metastasis-of-renal-cell-carcinoma-of-the-pancreas-a-case-report-and-literature-review
#20
Yun Jong Choi, Jin Ho Lee, Cho Rok Lee, Woong Kyu Han, Chang Moo Kang, Woo Jung Lee
Advances in surgical techniques and laparoscopic instruments have resulted in the development of laparoscopic pancreatic surgery. Total pancreaticoduodenectomy is performed for treating benign and borderline pancreatic disease involving the whole pancreas. Here, we report a case of metastatic renal cell carcinoma in the pancreas, treated by laparoscopic pylorus-preserving total pancreaticoduodenectomy. A 59-year-old woman was diagnosed with metastatic renal cell carcinoma. Multiple metastatic lesions were found on routine follow-up...
May 2017: Annals of Hepato-Biliary-Pancreatic Surgery
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