Despite advancements in treating pancreatic ductal adenocarcinoma(PDAC),it remains the third leading cause of cancer-related deaths worldwide and is projected to become the second leading cause within the next decade(...Despite advancements in treating pancreatic ductal adenocarcinoma(PDAC),it remains the third leading cause of cancer-related deaths worldwide and is projected to become the second leading cause within the next decade(1).The 5-year overall survival(OS)rate remains low at just 12%(2),prompting significant efforts to develop new multimodal therapies.While adjuvant therapy has been shown to improve OS after pancreatic cancer resection,many patients are unable to receive it either because of major postoperative complications,poor functional status after surgery,or early cancer recurrence(3,4).Subsequently,the use of chemotherapy and/or chemoradiation therapy prior to surgery,known as neoadjuvant therapy(NT),has significantly increased in the United States and around the world over the past several decades(5).In addition to improving the delivery of multimodality therapy,this approach may also facilitate downstaging of borderline resectable(BR)or locally advanced(LA)cancers and increases the likelihood of a margin-negative resection.展开更多
Well-differentiated neuroendocrine tumors(NETs)are globally increasing in prevalence and the liver is the most common site of metastasis.Neuroendocrine liver metastases(NELM)are heterogeneous in clinical presentation ...Well-differentiated neuroendocrine tumors(NETs)are globally increasing in prevalence and the liver is the most common site of metastasis.Neuroendocrine liver metastases(NELM)are heterogeneous in clinical presentation and prognosis.Fortunately,recent advances in diagnostic techniques and therapeutic strategies have improved the multidisciplinary management of this challenging condition.When feasible,surgical resection of NELM offers the best long-term outcomes.General indications for hepatic resection include performance status acceptable for major liver surgery,grade 1 or 2 tumors,absence of extrahepatic disease,adequate size and function of future liver remnant,and feasibility of resecting>90%of metastases.Adjunct therapies including concomitant liver ablation are generally safe when used appropriately and may expand the number of patients eligible for surgery.Among patients with synchronous resectable NELM,resection of the primary either in a staged or combined fashion is recommended.For patients who are not surgical candidates,liver-directed therapies such as transarterial embolization,chemoembolization,and radioembolization can provide locoregional control and improve symptoms of carcinoid syndrome.Multiple systemic therapy options also exist for patients with advanced or progressive disease.Ongoing research efforts are needed to identify novel biomarkers that will define the optimal indications for and sequencing of treatments to be delivered in a personalized fashion.展开更多
Pancreatic ductal adenocarcinoma(PDAC)is a highly aggressive malignancy in which multimodality therapy is necessary to achieve good long-term outcomes.The recent seminar by Mizrahi et al.reported in The Lancet not onl...Pancreatic ductal adenocarcinoma(PDAC)is a highly aggressive malignancy in which multimodality therapy is necessary to achieve good long-term outcomes.The recent seminar by Mizrahi et al.reported in The Lancet not only summarizes the fundamental knowledge of PDAC but also provides a concise overview of landmark studies that guide modern clinical practice(1).展开更多
Background: Previous research has demonstrated that specific radiographic criteria, including the presence of calcifications and the enhancement pattern on computed tomography (CT) imaging, correlates with clinicopath...Background: Previous research has demonstrated that specific radiographic criteria, including the presence of calcifications and the enhancement pattern on computed tomography (CT) imaging, correlates with clinicopathologic features and outcomes of patients with gastroenteropancreatic neuroendocrine tumors (NET). We sought to investigate whether these radiographic characteristics were prognostic among patients with neuroendocrine liver metastases (NELM) undergoing surgical resection. Methods: The preoperative contrast-enhanced CT scans of all patients who underwent resection of NELM at a single institution between 2000-2015 were retrospectively reviewed. The presence of calcifications was determined on non-contrast phase imaging. Enhancement on the arterial phase scan was categorized as hyperenhancing, hypoenhancing, or mixed. Relevant clinicopathologic characteristics as well as recurrence-free survival (RFS) and overall survival (OS) were compared between groups. Results: Among 82 patients who underwent resection of NELM, 57 had available data on calcifications while 51 had data available on arterial enhancement patterns. Among all patients, median age was 58 (IQR:47-63) and the majority were female (N=48, 59.5%). The most common primary tumor locations were pancreas (N=25, 30.5%) and small bowel (N=27, 32.9%). The most commonly performed operations were right hepatectomy (N=29, 35.4%), bisegmentectomy (N=15, 18.3%), and segmentectomy (N=14, 17.1%). Median tumor number was 4 (IQR: 2-9), median Ki-67 was 5% (IQR: 2-10%), and median size of the largest liver metastasis was 4.5 (IQR: 2.8-7.7) cm. Twelve (21%) patients had tumor calcifications. Among patients with and without calcifications there were no differences in demographics, clinicopathologic characteristics, RFS (P=0.772) or OS (P=0.095). Arterial enhancement was hypoenhancing in 23 (45.1%), hyperenhancing in 10 (19.6%), and mixed in 18 (35.3%). Similarly, there were no differences between arterial enhancement groups in demographics, clinicopathologic characteristics, RFS (P=0.618) or OS (P=0.268). Conclusions: Radiographic characteristics on contrast-enhanced CT are not associated with the outcomes of patients undergoing resection of NELM. Future investigations should evaluate the prognostic impact of functional neuroendocrine imaging.展开更多
Post-operative pancreatic fistula(POPF)is a common and dangerous complication of pancreatic resection,occurring in 5-30%of patients.It is a significant source of morbidity and mortality,leading to prolonged hospital s...Post-operative pancreatic fistula(POPF)is a common and dangerous complication of pancreatic resection,occurring in 5-30%of patients.It is a significant source of morbidity and mortality,leading to prolonged hospital stays and increased healthcare costs(1).The most widely accepted definition of POPF comes from the International Study Group on Pancreatic Fistula(ISGPF).Initially created in 2005,this classification system for POPF was revised in 2016 such that POPF should be associated with a clinically relevant change in status,deeming what was originally defined as a Grade A fistula as a biochemical leak and grade B and C fistulas as clinically relevant(CR)fistulae(Table 1)(2).展开更多
Intrahepatic cholangiocarcinoma(ICC),the second most common primary liver malignancy,is an aggressive cancer occurring with increasing global incidence.Significant advances in our understanding of its pathogenesis and...Intrahepatic cholangiocarcinoma(ICC),the second most common primary liver malignancy,is an aggressive cancer occurring with increasing global incidence.Significant advances in our understanding of its pathogenesis and molecular underpinnings,diagnostic and staging capabilities,and locoregional and systemic treatment options have occurred over the past several decades(1).展开更多
文摘Despite advancements in treating pancreatic ductal adenocarcinoma(PDAC),it remains the third leading cause of cancer-related deaths worldwide and is projected to become the second leading cause within the next decade(1).The 5-year overall survival(OS)rate remains low at just 12%(2),prompting significant efforts to develop new multimodal therapies.While adjuvant therapy has been shown to improve OS after pancreatic cancer resection,many patients are unable to receive it either because of major postoperative complications,poor functional status after surgery,or early cancer recurrence(3,4).Subsequently,the use of chemotherapy and/or chemoradiation therapy prior to surgery,known as neoadjuvant therapy(NT),has significantly increased in the United States and around the world over the past several decades(5).In addition to improving the delivery of multimodality therapy,this approach may also facilitate downstaging of borderline resectable(BR)or locally advanced(LA)cancers and increases the likelihood of a margin-negative resection.
文摘Well-differentiated neuroendocrine tumors(NETs)are globally increasing in prevalence and the liver is the most common site of metastasis.Neuroendocrine liver metastases(NELM)are heterogeneous in clinical presentation and prognosis.Fortunately,recent advances in diagnostic techniques and therapeutic strategies have improved the multidisciplinary management of this challenging condition.When feasible,surgical resection of NELM offers the best long-term outcomes.General indications for hepatic resection include performance status acceptable for major liver surgery,grade 1 or 2 tumors,absence of extrahepatic disease,adequate size and function of future liver remnant,and feasibility of resecting>90%of metastases.Adjunct therapies including concomitant liver ablation are generally safe when used appropriately and may expand the number of patients eligible for surgery.Among patients with synchronous resectable NELM,resection of the primary either in a staged or combined fashion is recommended.For patients who are not surgical candidates,liver-directed therapies such as transarterial embolization,chemoembolization,and radioembolization can provide locoregional control and improve symptoms of carcinoid syndrome.Multiple systemic therapy options also exist for patients with advanced or progressive disease.Ongoing research efforts are needed to identify novel biomarkers that will define the optimal indications for and sequencing of treatments to be delivered in a personalized fashion.
文摘Pancreatic ductal adenocarcinoma(PDAC)is a highly aggressive malignancy in which multimodality therapy is necessary to achieve good long-term outcomes.The recent seminar by Mizrahi et al.reported in The Lancet not only summarizes the fundamental knowledge of PDAC but also provides a concise overview of landmark studies that guide modern clinical practice(1).
基金supported by Award Number Grant UL1TR002733 from the National Center for Advancing Translational Sciences.
文摘Background: Previous research has demonstrated that specific radiographic criteria, including the presence of calcifications and the enhancement pattern on computed tomography (CT) imaging, correlates with clinicopathologic features and outcomes of patients with gastroenteropancreatic neuroendocrine tumors (NET). We sought to investigate whether these radiographic characteristics were prognostic among patients with neuroendocrine liver metastases (NELM) undergoing surgical resection. Methods: The preoperative contrast-enhanced CT scans of all patients who underwent resection of NELM at a single institution between 2000-2015 were retrospectively reviewed. The presence of calcifications was determined on non-contrast phase imaging. Enhancement on the arterial phase scan was categorized as hyperenhancing, hypoenhancing, or mixed. Relevant clinicopathologic characteristics as well as recurrence-free survival (RFS) and overall survival (OS) were compared between groups. Results: Among 82 patients who underwent resection of NELM, 57 had available data on calcifications while 51 had data available on arterial enhancement patterns. Among all patients, median age was 58 (IQR:47-63) and the majority were female (N=48, 59.5%). The most common primary tumor locations were pancreas (N=25, 30.5%) and small bowel (N=27, 32.9%). The most commonly performed operations were right hepatectomy (N=29, 35.4%), bisegmentectomy (N=15, 18.3%), and segmentectomy (N=14, 17.1%). Median tumor number was 4 (IQR: 2-9), median Ki-67 was 5% (IQR: 2-10%), and median size of the largest liver metastasis was 4.5 (IQR: 2.8-7.7) cm. Twelve (21%) patients had tumor calcifications. Among patients with and without calcifications there were no differences in demographics, clinicopathologic characteristics, RFS (P=0.772) or OS (P=0.095). Arterial enhancement was hypoenhancing in 23 (45.1%), hyperenhancing in 10 (19.6%), and mixed in 18 (35.3%). Similarly, there were no differences between arterial enhancement groups in demographics, clinicopathologic characteristics, RFS (P=0.618) or OS (P=0.268). Conclusions: Radiographic characteristics on contrast-enhanced CT are not associated with the outcomes of patients undergoing resection of NELM. Future investigations should evaluate the prognostic impact of functional neuroendocrine imaging.
文摘Post-operative pancreatic fistula(POPF)is a common and dangerous complication of pancreatic resection,occurring in 5-30%of patients.It is a significant source of morbidity and mortality,leading to prolonged hospital stays and increased healthcare costs(1).The most widely accepted definition of POPF comes from the International Study Group on Pancreatic Fistula(ISGPF).Initially created in 2005,this classification system for POPF was revised in 2016 such that POPF should be associated with a clinically relevant change in status,deeming what was originally defined as a Grade A fistula as a biochemical leak and grade B and C fistulas as clinically relevant(CR)fistulae(Table 1)(2).
文摘Intrahepatic cholangiocarcinoma(ICC),the second most common primary liver malignancy,is an aggressive cancer occurring with increasing global incidence.Significant advances in our understanding of its pathogenesis and molecular underpinnings,diagnostic and staging capabilities,and locoregional and systemic treatment options have occurred over the past several decades(1).
