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BackgroundTo date, postoperative prognostic factors for intraductal papillary neoplasm of the bile duct (IPNB) have not been well-established. This study aimed to examine the histopathologic features and postoperative prognosis of the two IPNB subclassifications, as well as factors affecting prognosis, based on the authors’ experience at a single institution.MethodsThe study enrolled 83 patients who underwent surgical resection for pathologically diagnosed IPNB at the authors’ institution. The clinicopathologic features and postoperative outcomes for these patients were examined. The study also investigated postoperative prognostic factors for IPNB using uni- and multivariate analyses.ResultsMore than half of the tumors (64%) diagnosed as IPNB were early-stage cancer (UICC Tis or T1). However, none were diagnosed as benign. The multivariate analysis showed that lymph node metastasis (hazard ratio [HR], 5.78; p = 0.002) and bile duct margin status with carcinoma in situ (D-CIS; HR, 5.10; p = 0.002) were independent prognostic factors, whereas MUC6 expression showed only a marginal influence on prediction of prognosis (HR, 0.32; p = 0.07). The tumor recurrence rate and the proportion of locoregional recurrence were significantly greater among the patients with D-CIS than among those with negative bile duct margins, including those patients with low-grade dysplasia. The patients with D-CIS showed a significantly poorer prognosis than those with negative bile duct margins (5-year survival, 38% versus 87%; p = 0.0002).ConclusionsEvaluation of resected IPNBs showed cancer in all cases. Avoiding positive biliary stumps during surgery, including resection of carcinoma in situ, would improve the prognosis for patients with IPNB.

PurposeTo investigate the risk factors for post-pancreatectomy hemorrhage (PPH).MethodsThe incidence, outcome, and risk factors for PPH were evaluated in 1169 patients who underwent pancreatectomy.ResultsThe incidence and mortality rates of PPH were 3% and 11% in all pancreatectomies, 4% and 11% in pancreatoduodenectomy, 1% and 20% in distal pancreatectomy, and 3% and 0% in total pancreatectomy, respectively. Male sex [odds ratio (OR) 2.32], body mass index (BMI) ≥ 25 kg/m2 (OR 3.70), absence of diabetes mellitus (DM; HbA1c ≤ 6.2%; OR 3.62), and pancreatoduodenectomy (OR 3.06) were risk factors for PPH after all pancreatectomies. The PPH incidence was 0%, 1%, 2%, 6%, and 20% in patients with risk scores of 0 (n = 65), 1 (n = 325), 2 (n = 455), 3 (n = 299), and 4 (n = 25), respectively. The differences between risk-score groups 0–2 (2%) and 3–4 (7%) were significant (P < 0.05, OR 4.7). In patients who had undergone pancreatoduodenectomy, postoperative pancreatic fistula (POPF; OR 31.7) and absence of DM (OR 3.45) were risk factors for PPH. There was no significant association between POPF and PPH after distal pancreatectomy (P = 0.28). The incidence of POPF post-pancreatoduodenectomy was 20%. BMI ≥ 25 kg/m2 (OR 3.17), serum albumin < 3.5 g/dl (OR 1.77), absence of DM (OR 1.75), distal extrahepatic bile duct carcinoma (OR 4.05), and carcinoma of the papilla of Vater (OR 5.19) were risk factors for POPF post-pancreatoduodenectomy.ConclusionOur study clarified the preoperative risk factors for PPH and recommends using a risk scoring system that includes “absence of DM” for predicting PPH.

PurposeThe controlling nutritional status (CONUT) score is a useful biomarker to evaluate undernutrition. However, there have been few reports describing the correlation between postoperative complications and the CONUT score for pancreatic cancer. Therefore, this study aimed to assess the impact of the CONUT score on the postoperative complications of pancreaticoduodenectomy (PD) in patients with pancreatic cancer.MethodsWe retrospectively analyzed 206 consecutive patients with pancreatic cancer who underwent PD over a 12-year duration at our institution. The patients were divided into two groups based on preoperative CONUT scores; their clinicopathological characteristics and surgical outcomes were compared. Furthermore, we compared the CONUT score with preoperative clinical factors and several nutritional biomarkers for postoperative complications using univariate and multivariate analyses.ResultsPostoperative complications of Clavien–Dindo grade ≥ IIIa and those of Clavien–Dindo grade ≥ IIIb occurred in 29 (14.1%) and 9 (4.4%) patients, respectively. The high CONUT score (≥5) group indicated that patients with an undernutrition status had a higher postoperative complication rate, poorer relapse-free survival, and overall survival rates than the low CONUT score (≤4) group. Among preoperative clinical factors, a high CONUT score was an independent risk factor for severe postoperative complications.ConclusionsThe CONUT score may be a useful parameter in the identification of patients undergoing pancreatic surgery who are susceptible to postoperative complications.

BackgroundThe efficacy of different types of preoperative biliary drainage for cholangiocarcinoma has been debated over the past two decades. Controversy concerning the use of percutaneous transhepatic biliary drainage (PTBD) versus endoscopic biliary drainage (EBD) still exists. This study aimed to compare the long-term outcomes between PTBD and EBD in patients with distal cholangiocarcinoma. MethodsData of patients diagnosed with distal cholangiocarcinoma who underwent preoperative PTBD or EBD from January 1999 to December 2017 were analyzed retrospectively. Post-surgical outcomes, including the incidence of post-operative complications, peritoneal metastasis, disease-free survival, and overall survival, were analyzed. Survival analyses were also performed after propensity score matching in the PTBD and EBD groups.ResultsThe incidence of post-operative complications was similar in both groups. The 5-year estimated cumulative incidences for peritoneal metastasis were 14.7% and 7.2% in the PTBD and EBD groups, respectively (p = 0.192). The 5-year disease-free survival rates were 23.7% and 47.3% in the PTBD and EBD groups, respectively (p = 0.015). In the multi-variate analysis for overall survival, PTBD was an independent poor prognostic factor. The 5-year overall survival rates were 35.9% and 56.3% in the PTBD and EBD groups, respectively (hazard ratio 1.85, confidence interval 1.05–3.26, p = 0.035). The results after propensity score matching indicated a poorer prognosis in the PTBD group, with a 5-year survival rate of 35.9% in the PTBD group vs 56.0% in the EBD group (p = 0.044).ConclusionPTBD should be considered as a negative prognostic factor in distal cholangiocarcinoma patients.

Peritoneal metastasis is a lethal manifestation of gastric cancer, with poor prognosis and limited treatment options. A targeted drug delivery system minimizing systemic toxicity is urgently needed. Given that platelets form stable aggregates with gastric cancer cells, we explored their feasibility as a drug carrier. We engineered paclitaxel‐loaded platelets and assessed their antitumor efficacy using human gastric cancer cell lines. To evaluate therapeutic performance in vivo, a murine model of peritoneal metastasis was established with BALB/c‐Slc‐nu/nu mice. Paclitaxel was administered intraperitoneally at 25 mg/kg per week in both the free paclitaxel and paclitaxel‐loaded platelets groups, via injection every 7 days for a total of 8 times. Paclitaxel‐loaded platelets exhibited strong adhesion to gastric cancer cells, efficiently delivering paclitaxel intracellularly. Functional assays confirmed platelet activation capacity was preserved post drug loading. In vitro, paclitaxel‐loaded platelets significantly inhibited tumor cell viability (p < 0.001). In vivo, they markedly reduced systemic drug exposure (p < 0.047) and significantly improved antitumor efficacy and survival versus free paclitaxel (p < 0.001). Our findings highlight platelets as a novel drug delivery system for peritoneal metastasis in gastric cancer. Leveraging their tumor‐homing properties and biocompatibility, this approach enables targeted intraperitoneal chemotherapy, representing a promising strategy for this treatment‐refractory disease. Paclitaxel‐loaded platelets effectively target gastric cancer peritoneal metastasis, demonstrating enhanced antitumor efficacy, reduced systemic drug distribution, and improved survival, offering a promising novel treatment option.

Background Pancreaticoduodenectomy (PD) has recently been improved due to its increased safety. However, postoperative pancreatic fistula (POPF) remains a lethal complication of PD. Identifying novel clinicophysiological risk factors for POPF during the early post-PD period would help improve patient morbidity and mortality. Therefore, this retrospective study aimed to evaluate possible risk factors during the early postoperative period after pancreaticoduodenectomy (PD). Methods Data from 349 patients who underwent PD between 2007 and 2012 were examined retrospectively. All patients were classified into 2 groups: group A, patients without fistulae or biochemical leaks (288 patients), and group B, those with grade B or C POPF (61 patients). Data on various clinicophysiological parameters, including serum and drain laboratory data, were collected. Univariate and multivariate analyses were performed to evaluate POPF predictors. A predictive nomogram was established for these results. Results Univariate analysis showed that various serum and drain-related factors, such as white blood cell count, C-reactive protein levels, drain amylase (DAMY) levels, and drain lipase (DLIP) levels, were possible POPF risk factors. Multivariate analysis confirmed that postoperative day (POD) 1 DLIP levels (hazard ratio, 15.393; p  = 0.037) and decreased rate (POD3/1) of DAMY levels (hazard ratio, 4.415; p  = 0.028) were independent risk factors. Further, POD1 DLIP levels and decreased rate of DAMY levels were significantly lower in group A than in group B. The accuracy of nomogram was 0.810. Conclusions POD1 DLIP levels (> 245 U/mL) and decreased rate of DAMY levels (> 0.44) were POPF risk factors, making them possible biomarkers for POPF.

PurposeIt has been reported that there are left and right hepatic arterial arcades via the blood vessels around the hilar bile duct; therefore, when the hilar bile duct is preserved, hepatic artery reconstruction may not be necessary. We compared the short-term and long-term outcomes in patients with distal cholangiocarcinoma who underwent pancreatoduodenectomy (PD) with right hepatic artery resection without right hepatic artery reconstruction (RHAR group) with those patients who underwent conventional PD.MethodsAll data were retrospectively collected from patient records. A 1:4-propensity score-matched case-control study was conducted in patients with distal cholangiocarcinoma who received treatment at Tokyo Women’s Medical University from February 1985 to April 2015.ResultsThere was no statistical difference in the overall morbidity rate between the two groups. No patient in the RHAR group (10 patients) had liver failure, liver abscess, or cholangitis in the postoperative period; one patient died postoperatively because of a bleeding pseudoaneurysm in the gastroduodenal artery. The PD group (40 patients) had a significantly better median time regarding the recurrence (34 vs. 11 months, p=0.027) and 5-year disease-free survival (35% vs. 10%, p=0.027) rates than the RHAR group, which may be attributed to the presence of a more severe disease in patients in the RHAR group.ConclusionWe concluded that pancreaticoduodenectomy with right hepatic artery resection without reconstruction has a comparable overall morbidity rate with that of a conventional pancreaticoduodenectomy surgery and may be performed as an alternative procedure when tumor invasion of the right hepatic artery is suspected.

Background This retrospective study aimed to evaluate clinicopathological findings of remnant pancreatic cancers in survivors of invasive ductal adenocarcinomas of the pancreas (PDAC). Methods A group of 23 patients out of 826 who had curative resections for PDAC between 1980 and 2011 was identified and treated for metachronous pancreatic cancer. Results The following tubular adenocarcinomas were found at the first surgery: 3 well differentiated, 17 moderately differentiated, 1 papillary, and 1 poorly differentiated. Treatments for the remnant pancreas consisted of remnant pancreatectomy in 12 patients, chemotherapy in 6, and the best supportive care in 5. The mean time to treatment was 74.2 months. The 12 patients who received remnant resections had 10 PDACs and 2 intraductal papillary mucinous carcinomas. The median survival time was 31.6 months, and 8 patients are still alive. Conclusions Long-term survivors after curative resection for pancreatic cancer should receive follow-up for remnant pancreatic cancer, and aggressive resection should be considered for more favorable prognosis of PDAC.

Background Although, recently observation methods has been proposed as one of the treatment options for non-functioning pancreatic neuroendocrine neoplasms (NF-PanNENs), determining treatment strategies may be difficult for small and low-malignant NF-PanNENs; thus, clarifying the significance of lymphatic, microvascular, and perineural invasion in these patients is of great clinical importance. This study aimed to assess the incidence and role of lymphatic, microvascular, and perineural invasion in patients with NF-PanNENs based on tumor size and the 2022 World Health Organization classification. Methods From 2000 to 2023, we retrospectively investigated the incidence of lymphatic, microvascular, and perineural invasion and their impact on recurrence in 80 patients who underwent curative resection and were diagnosed with NF-PanNENs. Results Of the 80 patients, 14 (18%), 20 (25%), and six (9%) patients had lymphatic, microvascular, and perineural invasion. Patients with neuroendocrine tumor (NET) G1 had significantly fewer occurrences of lymphatic, microvascular, and perineural invasion than those with NET G2 (10%, 15%, and 7% vs. 40%, 55%, and 35%; all P  < 0.05.). Patients with a tumor size < 20 mm had significantly lower rates of lymphatic and microvascular invasions than those with a tumor size ≥ 20 mm (12% and 17% vs 33% and 48%; P  = 0.034 and 0.0073, respectively). In all patients, NET G2, tumor size ≥ 20 mm, local invasion T2–3, presence of lymph node metastasis, and presence of microvascular invasion were significant risk factors for shorter recurrence-free survival (RFS) (all P  < 0.05). In patients with NET G1 and tumor size < 20 mm, five (10%), eight (16%), and four (8%) patients had lymphatic, microvascular, and perineural invasion. The presence of microvascular invasion was also an independent risk factor for RFS ( P  < 0.05). Conclusions Information on the frequency and role of lymphatic, microvascular, and perineural invasion based on tumor size and malignancy on recurrence may be useful when considering treatment strategies for small- and low-grade NF-PanNENs.

Background This study investigated the incidence of postoperative complications following pancreatectomy in octogenarians. Methods This study included 291 patients who underwent pancreatic surgery (pancreatoduodenectomy [PD] or distal pancreatectomy [DP]) between 2019 and 2024 in a Japanese University Hospital. Perioperative outcomes were compared between octogenarians and non-octogenarians. The primary outcomes included the risk factors (including age) and incidence rates for postoperative complications. In addition, 1:3 propensity score matching (PSM) was conducted with standardized patient and perioperative factors, and the incidence of postoperative complications was compared. Finally, the clinical characteristics of octogenarians and non-octogenarians in open surgery and minimally invasive pancreatic surgery (MIPS) were compared. Results The median age was 82.0 and 71.0 years for octogenarians ( n  = 33) and non-octogenarians ( n  = 258). We found that a high body mass index (BMI) value, PD, laparotomy, high intraoperative blood loss (IBL) (≥ 320mL), and long operative times were associated with the incidence of postoperative complications in univariate analysis, although patient age (octogenarians) was not significantly correlated. PSM showed that the incidence of postoperative complications was similar between octogenarians and non-octogenarians. MIPS led to similar or lower postoperative complication rates in octogenarians compared with non-octogenarians, and both rates were notably lower than those in laparotomy. Conclusion Although this study was retrospective, single-center, and with small number of octogenarians, the incidence of postoperative complications after pancreatectomy might not be higher in octogenarians than in non-octogenarians, and it could be reduced with MIPS.