Background:The extent of pancreatoduodenectomy for pancreatic head cancer remains controversial,and more high-level clinical evidence is needed.This study aimed to evaluate the outcome of extended pancreatoduodenectom...Background:The extent of pancreatoduodenectomy for pancreatic head cancer remains controversial,and more high-level clinical evidence is needed.This study aimed to evaluate the outcome of extended pancreatoduodenectomy(EPD)with retroperitoneal nerve resection in pancreatic head cancer.Methods:This multicenter randomized trial was performed at 6 Chinese highvolume hospitals that enrolled patients between October 3,2012,and September 21,2017.Four hundred patients with stage I or II pancreatic head cancer and without specific pancreatic cancer treatments(preoperative chemotherapy or chemoradiation)within three months were randomly assigned to undergo standard pancreatoduodenectomy(SPD)or EPD,with the latter followed by dissection of additional lymph nodes(LNs),nerves and soft tissues 270◦on the right side surrounding the superior mesenteric artery and celiac axis.The primary endpoint was overall survival(OS)by intention-to-treat(ITT).The secondary endpoints were disease-free survival(DFS),mortality,morbidity,and postoperative pain intensity.Results:TheR1 ratewas slightly lower with EPD(8.46%)thanwith SPD(12.56%).The morbidity and mortality rates were similar between the two groups.The median OS was similar in the EPD and SPD groups by ITT in the whole study cohort(23.0 vs.20.2 months,P=0.100),while the median DFS was superior in the EPD group(16.1 vs.13.2 months,P=0.031).Patients with preoperative CA19–9<200.0 U/mL had significantly improved OS and DFS with EPD(EPD vs.SPD,30.8 vs.20.9 months,P=0.009;23.4 vs.13.5 months,P<0.001).The EPD group exhibited significantly lower locoregional(16.48%vs.35.20%,P<0.001)andmesenteric LNrecurrence rates(3.98%vs.10.06%,P=0.022).The EPD group exhibited less back pain 6 months postoperation than the SPD group.Conclusions:EPD for pancreatic head cancer did not significantly improve OS,but patients with EPD treatment had significantly improved DFS.In the subgroup analysis,improvements in bothOS and DFS in the EPD armwere observed in patients with preoperative CA19–9<200.0 U/mL.EPD could be used as an effective surgical procedure for patients with pancreatic head cancer,especially those with preoperative CA19–9<200.0 U/mL.展开更多
Objective:We aimed to develop a predictive model for the clinical diagnosis of ischemic colitis(IC).Methods:Clinical data were collected from patients with acute IC lesions who were diagnosed and admitted to Beijing T...Objective:We aimed to develop a predictive model for the clinical diagnosis of ischemic colitis(IC).Methods:Clinical data were collected from patients with acute IC lesions who were diagnosed and admitted to Beijing Tsinghua Changgung Hospital from January 2016 to December 2022.These patients were included in the IC case group in this retrospective observational study.The control group comprised patients aged≥40 years who were diagnosed with abdominal pain during the same period,excluding those with IC.All patients were divided into a training and test sets based on the time window.Least absolute shrinkage and selection operator regression was used to screen risk factors for the occurrence of IC.Logistic stepwise regression(maximum likelihood ratio method)was performed in multifactorial analysis,and a diagnostic prediction model for IC was established using R language.The area under the receiver operating characteristic(ROC)curve(AUC)was examined to assess differentiation using working ROC curves.We used bootstrap resampling(1000 times)for internal validation.Model calibration curves and decision curve analysis(DCA)were also applied.Results:Our study indicates that constipation,hematochezia,neutrophil counts,and specific abdominal computed tomography(CT)(plain scan)findings,including intestinal wall edema and thickening,intestinal lumen stenosis,and dilation,are independent predictors of IC.The predictive model exhibited high discriminative ability with an AUC of 0.9788 in the training set,and the calibration and DCA curves demonstrated excellent model performance.After validation,the AUC remained robust at 0.9868,underscoring the model's reliability in predicting IC.Conclusion:According to our model,constipation accompanied by hematochezia necessitates careful consideration of IC.Abdominal CT(plain scan)is an effective diagnostic tool for IC,and it is common for patients to exhibit elevated neutrophil counts.The predictive model,demonstrating high discriminative ability and accuracy,shows promise for practical application in clinical settings,aiding in the early diagnosis and management of IC.展开更多
基金Sun Yat-sen University Clinical Research 5010 Program,Grant/Award Number:2012007National Natural Science Foundation of China,Grant/Award Number:81871945National Key Clinical Specialty Construction Project,Grant/Award Number:2022YW030009。
文摘Background:The extent of pancreatoduodenectomy for pancreatic head cancer remains controversial,and more high-level clinical evidence is needed.This study aimed to evaluate the outcome of extended pancreatoduodenectomy(EPD)with retroperitoneal nerve resection in pancreatic head cancer.Methods:This multicenter randomized trial was performed at 6 Chinese highvolume hospitals that enrolled patients between October 3,2012,and September 21,2017.Four hundred patients with stage I or II pancreatic head cancer and without specific pancreatic cancer treatments(preoperative chemotherapy or chemoradiation)within three months were randomly assigned to undergo standard pancreatoduodenectomy(SPD)or EPD,with the latter followed by dissection of additional lymph nodes(LNs),nerves and soft tissues 270◦on the right side surrounding the superior mesenteric artery and celiac axis.The primary endpoint was overall survival(OS)by intention-to-treat(ITT).The secondary endpoints were disease-free survival(DFS),mortality,morbidity,and postoperative pain intensity.Results:TheR1 ratewas slightly lower with EPD(8.46%)thanwith SPD(12.56%).The morbidity and mortality rates were similar between the two groups.The median OS was similar in the EPD and SPD groups by ITT in the whole study cohort(23.0 vs.20.2 months,P=0.100),while the median DFS was superior in the EPD group(16.1 vs.13.2 months,P=0.031).Patients with preoperative CA19–9<200.0 U/mL had significantly improved OS and DFS with EPD(EPD vs.SPD,30.8 vs.20.9 months,P=0.009;23.4 vs.13.5 months,P<0.001).The EPD group exhibited significantly lower locoregional(16.48%vs.35.20%,P<0.001)andmesenteric LNrecurrence rates(3.98%vs.10.06%,P=0.022).The EPD group exhibited less back pain 6 months postoperation than the SPD group.Conclusions:EPD for pancreatic head cancer did not significantly improve OS,but patients with EPD treatment had significantly improved DFS.In the subgroup analysis,improvements in bothOS and DFS in the EPD armwere observed in patients with preoperative CA19–9<200.0 U/mL.EPD could be used as an effective surgical procedure for patients with pancreatic head cancer,especially those with preoperative CA19–9<200.0 U/mL.
文摘Objective:We aimed to develop a predictive model for the clinical diagnosis of ischemic colitis(IC).Methods:Clinical data were collected from patients with acute IC lesions who were diagnosed and admitted to Beijing Tsinghua Changgung Hospital from January 2016 to December 2022.These patients were included in the IC case group in this retrospective observational study.The control group comprised patients aged≥40 years who were diagnosed with abdominal pain during the same period,excluding those with IC.All patients were divided into a training and test sets based on the time window.Least absolute shrinkage and selection operator regression was used to screen risk factors for the occurrence of IC.Logistic stepwise regression(maximum likelihood ratio method)was performed in multifactorial analysis,and a diagnostic prediction model for IC was established using R language.The area under the receiver operating characteristic(ROC)curve(AUC)was examined to assess differentiation using working ROC curves.We used bootstrap resampling(1000 times)for internal validation.Model calibration curves and decision curve analysis(DCA)were also applied.Results:Our study indicates that constipation,hematochezia,neutrophil counts,and specific abdominal computed tomography(CT)(plain scan)findings,including intestinal wall edema and thickening,intestinal lumen stenosis,and dilation,are independent predictors of IC.The predictive model exhibited high discriminative ability with an AUC of 0.9788 in the training set,and the calibration and DCA curves demonstrated excellent model performance.After validation,the AUC remained robust at 0.9868,underscoring the model's reliability in predicting IC.Conclusion:According to our model,constipation accompanied by hematochezia necessitates careful consideration of IC.Abdominal CT(plain scan)is an effective diagnostic tool for IC,and it is common for patients to exhibit elevated neutrophil counts.The predictive model,demonstrating high discriminative ability and accuracy,shows promise for practical application in clinical settings,aiding in the early diagnosis and management of IC.
