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| 1 | Computed tomography-based diagnostics might be insufficient in the determination of pancreatic cancer unresectability显示文摘AIM: To inquire into a question of an overestimation of arterial involvement in patients with pancreatic cancer (PC). METHODS: Radiology data were compared with the findings from 51 standard, 58 extended and 17 total pancreaticoduodenectomies; 9 distal resections with celiac artery (CA) excision; and 28 palliations for PC. The survival of 11 patients with controversial computed tomography (CT) and endoscopic ultrasound data with regard to arterial invasion, after R0/R1 procedures (false-positive CT results, Group A), was compared to survival after eight R2 resections (false-negative CT results, Group B) and after 12 bypass procedures for locally advanced cancer (true-positive CT results, Group C).RESULTS: In all of the cases in group A, operative exploration revealed no arterial invasion, which was predicted by CT. The one-year survival in Group A was 88.9%, and the two-year survival was 26.7%, with a median follow-up of 22 mo. One-year survival was not attained in groups B and C, with a significant difference in survival (P a-b = 0.0029, P b-c = 0.003).CONCLUSION: Arterial encasement on CT does not necessarily indicate arterial invasion. Whenever PC is considered unresectable, endoUS should be used. In patients with controversial CT an EUS data for peripan-creatic arteries involvement radical resection might be possible, providing survival benefits as compared to R2-resections or palliative surgery. | Vyacheslav I Egorov Roman V Petrov Elena N Solodinina Gregory G Karmazanovsky Natalia S Starostina Natalia A Kuruschkina | 2013 | World Journal of Gastrointestinal Surgery2013，5，4： | 4 |
| 2 | Pancreatic adenocarcinoma:Outstanding problems显示文摘Pancreatic adenocarcinoma remains the fourth leading cause of cancer-related death and is one of the most aggressive malignant tumors with an overall 5-year survival rate of less than 4%.Surgical resection remains the only potentially curative treatment but is only possible for 15%-20% of patients with pancreatic adenocarcinoma.About 40% of patients have locally advanced nonresectable disease.In the past,determination of pancreatic cancer resectability was made at surgical exploration.The development of modern imaging techniques has allowed preoperative staging of patients.Institutions disagree about the criteria used to classify patients.Vascular invasion in pancreatic cancers plays a very important role in determining treatment and prognosis.There is no evidence-based consensus on the optimal preoperative imaging assessment of patients with suspected pancreatic cancer and a unified definition ofborderline resectable pancreatic cancer is also lacking.Thus,there is much room for improvement in all aspects of treatment for pancreatic cancer.Multi-detector computed tomography has been widely accepted as the imaging technique of choice for diagnosing and staging pancreatic cancer.With improved surgical techniques and advanced perioperative management,vascular resection and reconstruction are performed more frequently;patients thought once to be unresectable are undergoing radical surgery.However,when attempting heroic surgery,a realistic approach concerning the patient's age and health status,probability of recovery after surgery,perioperative morbidity and mortality and life quality after tumor resection is necessary. | Olga P Zakharova Grigory G Karmazanovsky Viacheslav I Egorov | 2012 | World Journal of Gastrointestinal Surgery2012，4，5： | 4 |
| 3 | Role of imaging in evaluating the response after neoadjuvant treatment for pancreatic ductal adenocarcinoma显示文摘Pancreatic ductal adenocarcinoma(PDAC)is a highly aggressive malignancy.Despite the development of multimodality treatments,including surgical resection,radiotherapy,and chemotherapy,the long-term prognosis of patients with PDAC remains poor.Recently,the introduction of neoadjuvant treatment(NAT)has made more patients amenable to surgery,increasing the possibility of R0 resection,treatment of occult micro-metastasis,and prolongation of overall survival.Imaging plays a vital role in tumor response evaluation after NAT.However,conventional imaging modalities such as multidetector computed tomography have limited roles in the assessment of tumor resectability after NAT for PDAC because of the similar appearance of tissue fibrosis and tumor infiltration.Perfusion computed tomography,using blood perfusion as a biomarker,provides added value in predicting the histopathologic response of PDAC to NAT by reflecting the changes in tumor matrix and fibrosis content.Other imaging technologies,including diffusion-weighted imaging of magnetic resonance imaging and positron emission tomography,can reveal the tumor response by monitoring the structural changes in tumor cells and functional metabolic changes in tumors after NAT.In addition,with the renewed interest in data acquisition and analysis,texture analysis and radiomics have shown potential for the early evaluation of the response to NAT,thus improving patient stratification to achieve accurate and intensive treatment.In this review,we briefly introduce the application and value of NAT in resectable and unresectable PDAC.We also summarize the role of imaging in evaluating the response to NAT for PDAC,as well as the advantages,limitations,and future development directions of current imaging techniques. | Yun Zhang Zi-Xing Huang Bin Song | 2021 | World Journal of Gastroenterology2021，27，22： | 2 |
| 4 | Computed tomography-based radiomic to predict resectability in locally advanced pancreatic cancer treated with chemotherapy and radiotherapy显示文摘BACKGROUND Surgical resection after neoadjuvant treatment is the main driver for improved survival in locally advanced pancreatic cancer(LAPC).However,the diagnostic performance of computed tomography(CT)imaging to evaluate the residual tumour burden at restaging after neoadjuvant therapy is low due to the difficulty in distinguishing neoplastic tissue from fibrous scar or inflammation.In this context,radiomics has gained popularity over conventional imaging as a complementary clinical tool capable of providing additional,unprecedented information regarding the intratumor heterogeneity and the residual neoplastic tissue,potentially serving in the therapeutic decision-making process.AIM To assess the capability of radiomic features to predict surgical resection in LAPC treated with neoadjuvant chemotherapy and radiotherapy.METHODS Patients with LAPC treated with intensive chemotherapy followed by ablative radiation therapy were retrospectively reviewed.One thousand six hundred and fifty-five radiomic features were extracted from planning CT inside the gross tumour volume.Both extracted features and clinical data contribute to create and validate the predictive model of resectability status.Patients were repeatedly divided into training and validation sets.The discriminating performance of each model,obtained applying a LASSO regression analysis,was assessed with the area under the receiver operating characteristic curve(AUC).The validated model was applied to the entire dataset to obtain the most significant features.RESULTS Seventy-one patients were included in the analysis.Median age was 65 years and 57.8%of patients were male.All patients underwent induction chemotherapy followed by ablative radiotherapy,and 19(26.8%)ultimately received surgical resection.After the first step of variable selections,a predictive model of resectability was developed with a median AUC for training and validation sets of 0.862(95%CI:0.792-0.921)and 0.853(95%CI:0.706-0.960),respectively.The validated model was applied to the entire dataset and 4 features were selected to build the model with predictive performance as measured using AUC of 0.944(95%CI:0.892-0.996).CONCLUSION The present radiomic model could help predict resectability in LAPC after neoadjuvant chemotherapy and radiotherapy,potentially integrating clinical and morphological parameters in predicting surgical resection. | Gabriella Rossi Luisa Altabella Nicola Simoni Giulio Benetti Roberto Rossi Martina Venezia Salvatore Paiella Giuseppe Malleo Roberto Salvia Stefania Guariglia Claudio Bassi Carlo Cavedon Renzo Mazzarotto | 2022 | World Journal of Gastrointestinal Oncology2022，14，3： | 1 |
| 5 | Sequential tumor-directed and lobar radioembolization before major hepatectomy for hepatocellular carcinoma显示文摘Preoperative radioembolization may improve the resectability of liver tumor by inducing tumor shrinkage, atrophy of the embolized liver and compensatory hypertrophy of non-embolized liver. We describe the case of a cirrhotic Child-Pugh A patient with a segment Ⅳ hepatocellular carcinoma requiring a left hepatectomy. Preoperative angiography demonstrated 2 separated left hepatic arteries, for segment Ⅳ and segments Ⅱ-Ⅲ. This anatomic variant allowed sequential radioembolizations, delivering high-dose ^(90)Yttrium(160 Gy) to the tumor, followed 28 d later by lower dose(120 Gy) to segments Ⅱ-Ⅲ. After 3 mo, significant tumor response and atrophy of the future resected liver were obtained, allowing uneventful left hepatectomy. This case illustrates that, when anatomic disposition permits it, sequential radioembolizations, delivering different ^(90)Yttrium doses to the tumor and the future resected liver, could represent a new strategy to prepare major hepatectomy in cirrhotic patients, allowing optimal tumoricidal effect while reducing the toxicity of the global procedure. | Michael Vouche Thierry Degrez Fikri Bouazza Philippe Delatte Maria Gomez Galdon Alain Hendlisz Patrick Flamen Vincent Donckier | 2017 | World Journal of Hepatology2017，9，36： | 0 |
| 6 | Comprehensive multimodal management of borderline resectable pancreatic cancer:Current status and progress显示文摘Borderline resectable pancreatic cancer(BRPC)is a complex clinical entity with specific biological features.Criteria for resectability need to be assessed in combination with tumor anatomy and oncology.Neoadjuvant therapy(NAT)for BRPC patients is associated with additional survival benefits.Research is currently focused on exploring the optimal NAT regimen and more reliable ways of assessing response to NAT.More attention to management standards during NAT,including biliary drainage and nutritional support,is needed.Surgery remains the cornerstone of BRPC treatment and multidisciplinary teams can help to evaluate whether patients are suitable for surgery and provide individualized management during the perioperative period,including NAT responsiveness and the selection of surgical timing. | Hong-Yu Wu Jin-Wei Li Jin-Zheng Li Qi-Long Zhai Jing-Yuan Ye Si-Yuan Zheng Kun Fang | 2023 | World Journal of Gastrointestinal Surgery2023，15，2： | 0 |
| 7 | Value of Multi-slice Spiral CT in the Diagnosis and Resectability of Pancreatic Cancer显示文摘Objective:To analyze the value of multislice spiral CT in the diagnosis and resectability of pancreatic cancer.Method:56 patients with pancreatic cancer treated in our hospital from January 2018 to October 2019 were selected as the research subjects.All patients underwent multi-phase scanning by multislice spiral CT.According to the results of the images,observe whether the pancreatic cancer has affected the blood vessels surrounding the pancreas,evaluate the resectability based on the results of the examination,and analyze the final results of the operation which was taken as the standard.Results:all the 56 cases presented slightly low density or equal density,and 28 cases had complete outline.Multi-slice spiral assessment of patients’vascular invasion types found that 192 branches can be resected with 70 branches cannot;Multi-slice spiral assessment of the main arterial and venous invasion grades around the pancreas of the patients found that 212 branches can be resected with 50 branches cannot;Multi-slice spiral CT was used to evaluate the resectability of pancreatic cancer compared with surgical results.The accuracy of resectable types of vascular invasion was 72.52%;the accuracy of resectable vascular invasion grades was 79.39%.Conclusion:the application of multi-slice spiral CT in the diagnosis of pancreatic cancer can provide a clear understanding of the condition of vascular invasion and distant metastasis,and the accuracy of assessing resection can reach more than 70.00%,which provides a reference for clinical application. | Ruishu Wang | 2020 | Proceedings of Anticancer Research2020，4，1： | 0 |
| 8 | Redefining resectability in pancreatic cancer after neoadjuvant therapy: are we any closer?显示文摘Pancreatic resection with negative margins offers the only potential cure within a multimodal treatment strategy that includes chemotherapy with or without radiotherapy for patients with pancreatic cancer.Traditionally the definition of resectability in pancreatic cancer was focused on the location of the tumour to major vascular structures surrounding the head of pancreas as described by a variety of organisations around the world,with subtle differences in definitions for resectable,borderline resectable and locally advanced pancreatic cancers(1). | Francis P.Robertson Sanjay Pandanaboyana | 2023 | Hepatobiliary Surgery and Nutrition2023，12，1： | 0 |
| 9 | Accuracy of preoperative serum CA19-9 levels in predicting the resectability of patients with pancreatic adenocarcinoma显示文摘Objective To assess the accuracy of preoperative serum CA19-9 levels in predicting the resectability of pancreatic adenocarcinoma.Methods Patients with biopsy-proven pancreatic adenocarcinoma who had preoperative serum CA19-9 level data were enrolled in the present retrospective analysis. Receiver operating characteristics(ROC) curve analysis was used to determine the optimal cut-off value of CA19-9. The sensitivity, specificity, positive predictive value, and negative predictive value were calculated at this cut-off point.Results Seventy-six patients with pancreatic adenocarcinoma that was considered potentially resectable according to radiological imaging were included. Of all 76 patients, 44 received complete resection of the pancreatic adenocarcinoma. The preoperative serum CA19-9 level was significantly higher in the unresectable tumor group than in the resectable tumor group(P = 0.0036). The area under the ROC curve was 0.749(95% confidence interval [CI]: 0.637–0.842). When the cut-off value of CA19-9 was set to 359.1 U/m L, the sensitivity, specificity, positive and negative predictive values were 71.9%(95% CI: 53.3%–86.3%), 70.5%(95% CI: 54.8%–83.2%), 63.9%(95% CI: 46.0%–79.4%), and 77.5%(95% CI: 61.5%–89.2%), respectively.Conclusion The preoperative serum CA19-9 level is useful for predicting the resectability of pancreatic adenocarcinoma. | Ying Li Xiaojuan Yang Zhanzhan Zhang Xiaoning Kang Shanglong Liu | 2018 | Oncology and Translational Medicine2018，4，1： | 0 |
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