A nationwide protocol in the Netherlands led to a significant increase in surgical resections for locally advanced pancreatic cancer (LAPC) while maintaining safety standards. Resection rates tripled from expected 53 to 155 patients, achieving an 86% resection rate among those explored. Major morbidity was 44% and mortality only 0.6%, both within safety benchmarks. Surgeons should […]
Category: HPB & Spleen
Liquid Biopsy Predicts Outcomes in Resected Pancreatic Cancer
In resected pancreatic ductal adenocarcinoma (PDAC), preoperative circulating tumor DNA (ctDNA) positivity is a strong predictor of poor overall and recurrence-free survival. Preoperative ctDNA positivity is linked to worse overall survival (hazard ratio [HR] 2.53) and recurrence-free survival (HR 2.28). Postoperative ctDNA positivity shows even stronger associations with worse survival outcomes (HR 5.15 overall, HR […]
Neighborhood Disadvantage Linked to 90-Day Mortality after Hepatectomy
An increased area deprivation index (ADI) correlates with a higher risk of 90-day mortality after major hepatectomy, particularly due to posthepatectomy liver failure. Patients in the upper tier of ADI had a 5.47-fold increased risk of 90-day mortality (p = .043) compared to lower tiers. 4.9% of patients died within 90 days post-surgery, predominantly from […]
Rural Patients with Colorectal Liver Metastases Face Care Gaps
Rural residency correlates with lower treatment rates and worse outcomes for colorectal liver metastases (CRLM). Among nearly 35,000 CRLM patients, 21.7% were rural dwellers; they had 12% lower odds of receiving curative-intent liver-directed therapy and 14% lower odds of systemic chemotherapy. Despite higher odds of primary tumor resection (12%), rural patients experience significantly poorer overall […]
KRAS and TP53 ctDNA Predict Survival in Localized Pancreatic Cancer
Detecting circulating tumor DNA (ctDNA) in patients with localized pancreatic ductal adenocarcinoma (PDAC) can help predict outcomes and guide surgical decision-making. Mutant KRAS ctDNA was present in 19% of patients at diagnosis, with levels dropping to 4.6% after neoadjuvant chemotherapy (NAC). The presence of both KRAS and TP53 ctDNA at diagnosis was associated with a […]
R1 Margins in Colorectal Liver Metastasis Surgery: A New Perspective
Microscopically positive margins (R1) after colorectal liver metastasis resection indicate worse outcomes but require context for interpretation regarding recurrence and repeat surgeries. Among 1,060 patients, R1 margins occurred in 21.5% and were linked to a higher crude risk of recurrence or death, with a hazard ratio of 1.34 after adjustments. Isolated liver recurrence was less […]
Comparative Evaluation of Fibrosis in Chronic Pancreatitis
A study found that fibrosis scores significantly differ among pancreatic surgery patients with and without chronic pancreatitis (CP), suggesting that reliance on fibrosis for diagnosis may lead to overdiagnosis of CP. Median fibrosis scores increased from controls (0.33) to indeterminate CP (2.8), recurrent acute pancreatitis (6.5), and definite CP (8.5), with all groups differing significantly. […]
Neoadjuvant Radiotherapy in Pancreatic Cancer Shows No Survival Benefit
Adding radiotherapy to neoadjuvant chemotherapy for resectable pancreatic ductal adenocarcinoma improved pathologic response rates but failed to enhance overall or event-free survival. Radiotherapy increased rates of pathologic complete response (6.6% vs. 4.4%) and R0 resections (85% vs. 52.2%). However, similar recurrence patterns were observed, with no significant difference in overall survival (HR 1.02) or event-free […]
Dual Nomograms Improve Prognostic Prediction in Pancreatic Cancer
A new set of dual nomograms can effectively predict overall survival and recurrence risk following pancreatic resection for ductal adenocarcinoma, aiding surgical decision-making and postoperative management. Median overall survival post-resection was 22.4 months, with a 5-year survival rate of 18%. The nomogram for overall survival showed excellent discrimination (AUC 0.780), while the recurrence nomogram also […]
Chronic Liver Disease Enhances Cholangiocarcinoma Outcomes
Patients with chronic liver disease (CLD) present with cholangiocarcinoma (CCA) at earlier stages and experience improved survival rates compared to non-CLD patients. CLD patients had a higher frequency of early-stage disease (57% localized vs. 43% in non-CLD) and more often qualified for curative-intent surgery (60% vs. 48%). Median overall survival was longer for CLD patients […]