Is Perineural Invasion More Accurate Than Other Factors to Predict Early Recurrence after Pancreatoduodenectomy for Pancreatic Head Adenocarcinoma?

Background: The prognosis of patients with pancreatic ductal adenocarcinoma (PDAC) of pancreatic head remains poor, even after potentially curative R0 resection. The aim of this study was to develop an accurate model to predict patients’ prognosis for PDAC of pancreatic head following pancreaticoduodenectomy. Methods: We retrospectively reviewed 112 patients with PDAC of pancreatic head after pancreaticoduodenectomy in Guangdong Provincial People’s Hospital between 2014 and 2018. Results: Five prognostic factors were identified using univariate Cox regression analysis, including age, histologic grade, American Joint Committee on Cancer (AJCC) Stage 8th, total bilirubin (TBIL), CA19-9. Using all subset analysis and multivariate Cox regression analysis, we developed a nomogram consisted of age, AJCC Stage 8th, perineural invasion, TBIL, and CA19-9, which had higher C-indexes for OS (0.73) and RFS (0.69) compared with AJCC Stage 8th alone (OS: 0.66; RFS: 0.67). The area under the curve (AUC) values of the receiver operating characteristic (ROC) curve for the nomogram for OS and RFS were significantly higher than other single parameter, which are AJCC Stage 8th, age, perineural invasion, TBIL, and CA19-9. Importantly, our nomogram displayed higher C-index for OS than previous reported models, indicating a better predictive value of our model. Conclusions: A simple and practical nomogram for patient prognosis in PDAC of pancreatic head following pancreaticoduodenectomy was established, which shows satisfactory predictive efficacy and deserves further evaluation in the future.

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Comment on “Implications of Perineural Invasion on Disease Recurrence and Survival After Pancreatectomy for Pancreatic Head Ductal Adenocarcinoma by Crippa et al.”

Annals of Surgery ◽

10.1097/sla.0000000000005275 ◽

2021 ◽

Vol Publish Ahead of Print ◽

Author(s):

Ingrid Garajová ◽

Rita Balsano ◽

Valentina Donati ◽

Letizia Gnetti ◽

Mjriam Capula ◽

...

Keyword(s):

Perineural Invasion ◽

Pancreatic Head ◽

Disease Recurrence ◽

Ductal Adenocarcinoma

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Efficacy of intravascular embolization in profuse hemorrhage from complicated duodenal ulcers

Klinicheskaia khirurgiia ◽

10.26779/2522-1396.2021.5-6.12 ◽

2021 ◽

Vol 88 (5-6) ◽

pp. 12-17

Author(s):

D. V. Maksymchuk ◽

V. І. Mamchich ◽

V. D. Maksymchuk

Keyword(s):

Duodenal Ulcer ◽

Surgical Treatment ◽

Pancreatic Head ◽

Early Recurrence ◽

Main Group ◽

Treatment Quality ◽

Duodenal Fistula ◽

Duodenal Ulcers ◽

Standard Methods ◽

Profuse Hemorrhage

Objective. To estimate the efficacy of intravascular embolization in profuse hemorrhage from complicated duodenal ulcers. Materials and methods. Into the investigation 80 patients were included, operated for the profuse hemorrhage complication of duodenal ulcers, penetrating into pancreatic head. The patients were distributed into two groups: the control - 40 patients, in whom the standard methods of the hemorrhage arrest were applied, and the main - 40 patients, in whom the method elaborated was used. Results. In the main group in postoperative period the complications have had occur in 1 (2.5±0.2%) patients (p<0.001) only - the duodenal fistula development. There was verified, that the best results of hemostasis in hemorrhage from penetrating duodenal ulcers were obtained in the patients of the main group, in whom іntraoperative endovascular arrest of the hemorrhage together with the ulcer suturing was applied, because in 100% of patients of this group the definite hemostasis was achieved. Conclusion. The proposed method of intraoperative endovascular arrest of hemorrhage from penetrating duodenal ulcer guarantees a qualitative hemostasis, lowers the rate of the hemorrhage early recurrence and the need for relaparotomy performance, and raises the surgical treatment quality.

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Developing a preoperative serum metabolome-based recurrence-predicting nomogram for patients with resected pancreatic ductal adenocarcinoma

Scientific Reports ◽

10.1038/s41598-019-55016-x ◽

2019 ◽

Vol 9 (1) ◽

Author(s):

Seoung Yoon Rho ◽

Sang-Guk Lee ◽

Minsu Park ◽

Jinae Lee ◽

Sung Hwan Lee ◽

...

Keyword(s):

Pancreatic Cancer ◽

Pancreatic Ductal Adenocarcinoma ◽

Area Under The Curve ◽

Pancreatic Head ◽

Cancer Recurrence ◽

Disease Free Survival ◽

Early Recurrence ◽

Ductal Adenocarcinoma ◽

Free Survival ◽

Preoperative Serum

AbstractWe investigated the potential application of preoperative serum metabolomes in predicting recurrence in patients with resected pancreatic cancer. From November 2012 to June 2014, patients who underwent potentially curative pancreatectomy for pancreatic ductal adenocarcinoma were examined. Among 57 patients, 32 were men; 42 had pancreatic head cancers. The 57 patients could be clearly categorized into two main clusters using 178 preoperative serum metabolomes. Patients within cluster 2 showed earlier tumor recurrence, compared with those within cluster 1 (p = 0.034). A nomogram was developed for predicting the probability of early disease-free survival in patients with resected pancreatic cancer. Preoperative cancer antigen (CA) 19–9 levels and serum metabolomes PC.aa.C38_4, PC.ae.C42_5, and PC.ae.C38_6 were the most powerful preoperative clinical variables with which to predict 6-month and 1-year cancer recurrence-free survival after radical pancreatectomy, with a Harrell’s concordance index of 0.823 (95% CI: 0.750–0.891) and integrated area under the curve of 0.816 (95% CI: 0.736–0.893). Patients with resected pancreatic cancer could be categorized according to their different metabolomes to predict early cancer recurrence. Preoperative detectable parameters, serum CA 19–9, PC.aa.C38_4, PC.ae.C42_5, and PC.ae.C38_6 were the most powerful predictors of early recurrence of pancreatic cancer.

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Implications of Perineural Invasion on Disease Recurrence and Survival After Pancreatectomy for Pancreatic Head Ductal Adenocarcinoma

Annals of Surgery ◽

10.1097/sla.0000000000004464 ◽

2020 ◽

Vol Publish Ahead of Print ◽

Author(s):

Stefano Crippa ◽

Ilaria Pergolini ◽

Ammar A. Javed ◽

Kim C. Honselmann ◽

Matthew J. Weiss ◽

...

Keyword(s):

Perineural Invasion ◽

Pancreatic Head ◽

Disease Recurrence ◽

Ductal Adenocarcinoma

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Immunohistochemical analysis of perineural invasion to common hepatic artery plexus in resected pancreatic head cancer

Pancreatology ◽

10.1016/j.pan.2016.06.311 ◽

2016 ◽

Vol 16 (4) ◽

pp. S87

Author(s):

Kazuhide Urabe ◽

Yoshiaki Murakami ◽

Kenichiro Uemura ◽

Naru Kondo ◽

Naoya Nakagawa ◽

...

Keyword(s):

Hepatic Artery ◽

Perineural Invasion ◽

Pancreatic Head ◽

Immunohistochemical Analysis ◽

Common Hepatic Artery ◽

Head Cancer ◽

Pancreatic Head Cancer

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Perineural Invasion and Postoperative Complications are Independent Predictors of Early Recurrence and Survival Following Curative Resection of Gastric Cancer

Cancer Management and Research ◽

10.2147/cmar.s264582 ◽

2020 ◽

Vol Volume 12 ◽

pp. 7601-7610

Author(s):

Ling Chen ◽

Jing Lin ◽

Li-Zhu Chen ◽

Yu Chen ◽

Xiao-Jie Wang ◽

...

Keyword(s):

Gastric Cancer ◽

Postoperative Complications ◽

Curative Resection ◽

Perineural Invasion ◽

Early Recurrence

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Evaluation of Perioperative Factors of Early Recurrence after Pancreaticoduodenectomy in Resectable Pancreatic Head Cancer

Journal of the American College of Surgeons ◽

10.1016/j.jamcollsurg.2018.08.471 ◽

2018 ◽

Vol 227 (4) ◽

pp. e173

Author(s):

Shinichiro Ono ◽

Tomohiko Adachi ◽

Masaaki Hidaka ◽

Akihiko Soyama ◽

Hajime H. Matsushima ◽

...

Keyword(s):

Pancreatic Head ◽

Early Recurrence ◽

Head Cancer ◽

Pancreatic Head Cancer

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Preoperative CT-based detection of extrapancreatic perineural invasion in pancreatic cancer

Scientific Reports ◽

10.1038/s41598-021-81322-4 ◽

2021 ◽

Vol 11 (1) ◽

Author(s):

Ekaterina Khristenko ◽

Igor Shrainer ◽

Galia Setdikova ◽

Oxana Palkina ◽

Valentin Sinitsyn ◽

...

Keyword(s):

Diagnostic Accuracy ◽

Predictive Value ◽

Perineural Invasion ◽

Preoperative Evaluation ◽

Area Under The Curve ◽

Pancreatic Head ◽

Ductal Adenocarcinoma ◽

K Value ◽

Institutional Review ◽

Preoperative Ct

AbstractAccuracy for computed tomography (CT) diagnosis of extrapancreatic perineural invasion (EPNI) in pancreatic ductal adenocarcinoma (PDAC), which is a significant cause of recurrence, has not been established. The aim of the study was to evaluate the diagnostic accuracy of CT in detecting EPNI preoperatively in resectable PDAC of the pancreatic head. Retrospective study design was approved by institutional review board. Preoperative CT-series of 46 patients with resectable PDAC were evaluated by two independent observers. Plexus Pancreaticus Capitalis-II (PPC-II) was assessed as this area is more susceptible for EPNI. All patients underwent surgery with dedicated histopathology, which served as the reference standard. Histologically EPNI was confirmed in 63.1%. Sensitivity of MDCT was 93.1% (95% confidence interval (CI) 77.23% to 99.15%), specificity 64.7% (95% CI 38.33% to 85.79%) with area under the curve (AUC) 0.789 for the first observer. Positive predictive value (PPV) was 81.82% (95% CI 70.12% to 89.62%), negative predictive value (NPV—84.62% (95% CI 57.98% to 95.64%) with diagnostic accuracy of 82.61% (95% CI 68.58% to 92.18%). Interobserver agreement showed k-value of 0.893 ($${p} < 0.001$$ p < 0.001 ), which represents very good agreement between observers. Median actual survival in patients without EPNI was 30 months (95% CI 18.284–41.716), in patients with EPNI—13 months (95% CI 12.115–13.885). CT provides sufficient diagnostic information to detect PPC-II invasion in patients with resectable PDAC of the pancreatic head. Preoperative detection of EPNI might be an additional argument to perform neoadjuvant chemotherapy in patients with resectable PDAC. It should be included in preoperative evaluation form of CT-findings.

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