Jin-Young Jang

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Background: Although right-sided lymph node dissection (RLND) is commonly performed during left-sided pancreatectomy for pancreatic ductal adenocarcinoma (PDAC), its oncological benefit remains controversial. In this study, we investigated whether the survival benefit of RLND depends on the tumor location in patients with left-sided PDAC. Materials and methods: Data on patients who underwent curative-intent left-sided pancreatectomy for PDAC between 2010 and 2023 were retrospectively analyzed. Patients were stratified into pancreatic body (Pb) and pancreatic tail (Pt) groups. Within each group, propensity score matching (PSM) was applied to compare patients undergoing RLND with those undergoing left-sided lymph node dissection (LLND) only. The primary endpoints were overall survival (OS) and recurrence-free survival (RFS). Results: After PSM, data from 180 patients with Pb tumors and 122 patients with Pt tumors were analyzed. The baseline characteristics of the patients were well-balanced between the groups. In the Pt group, RLND showed no significant benefit in OS (median 43 vs. 55 months; P = 0.947) or RFS (median 23 vs. 22 months; P = 0.544). In the Pb group, RLND significantly improved OS (median 95 vs. 42 months; P < 0.001) and RFS (median 65 vs. 22 months; P = 0.012). Multivariable Cox regression identified RLND as an independent protective factor for both OS [hazard ratio (HR), 0.42; 95% confidence interval (CI), 0.27–0.66; P < 0.001] and RFS (HR, 0.54; 95% CI, 0.37–0.80; P = 0.002) in the Pb group, whereas RLND was not a significant prognostic factor in the Pt group in univariable analysis (OS: HR, 0.89; 95% CI, 0.53–1.50; P = 0.665; RFS: HR, 0.83; 95% CI, 0.54–1.29; P = 0.406). Conclusion: The survival benefit of RLND in left-sided PDAC appears to be location-dependent, being more evident in tumors of the pancreatic body than in those of the pancreatic tail, thereby supporting a tailored, site-specific approach to lymphadenectomy.

Background: Intrathecal morphine (ITM) and continuous wound infiltration (CWI) are two alternatives to thoracic epidural analgesia in major abdominal surgery, but direct comparative studies are lacking. We evaluated whether ITM is non-inferior to CWI after open pancreatoduodenectomy. Methods: An open-label, randomised, non-inferiority clinical trial was conducted at a tertiary hospital. Adult patients undergoing elective open pancreatoduodenectomy were randomised 1:1 to receive either a single-shot ITM (0.2 mg) or bilateral preperitoneal CWI. Both groups received standardised multimodal and intravenous patient-controlled analgesia (IV-PCA). The primary outcome was mean coughing pain score, averaged across 24, 48, and 72 h following surgery, analysed for non-inferiority using the 95% confidence interval (non-inferiority margin: 1.0). Secondary outcomes included the mean resting pain score, pain score at each time point (2, 24, 48, and 72 h), IV-PCA fentanyl consumption, EuroQol 5-Dimension 5-Level utility score, and postoperative complications. Results: In the per-protocol population (n = 92), ITM was non-inferior to CWI for the primary outcome (ITM: 5.7 ± 1.7 versus CWI: 6.1 ± 1.5; mean difference −0.5, 95% c.i. −1.1 to 0.2). ITM was also non-inferior to CWI regarding the mean resting pain score. ITM provided significantly lower pain scores at 2 h following surgery, both at rest and on coughing, with a sustained reduction on coughing at 24 h and reduced fentanyl consumption. Otherwise comparable, ITM increased respiratory depression and pruritus within 24 h. Conclusion: ITM provides non-inferior overall and superior early analgesia to CWI after open pancreatoduodenectomy, although careful monitoring for early side effects is warranted. Trial registration: ClinicalTrials.gov Identifier (No. NCT06761989, https://clinicaltrials.gov/study/NCT06761989) registered on 30 December 2024

Although recent randomized controlled trials have reported the efficacy of adjuvant chemotherapy for resected biliary tract cancer, discrepancies remain between recommendations and real-world practice. Therefore, we aimed to assess the efficacy of adjuvant chemotherapy in patients with gallbladder cancer and used machine learning-based risk stratification to predict recurrence to avoid unnecessary chemotherapy. Patients who underwent surgery between 2005 and 2022 and were histologically diagnosed with stage 2 or above gallbladder cancer were included. The patients were stratified by risk of early recurrence according to the machine learning-based algorithm suggested by Catalano and colleagues. Among 395 patients, 204 (51.6%) and 191 (48.4%) were determined to have a low and high risk of early recurrence, respectively. Although the 5-year overall survival rates were not significantly different between the adjuvant chemotherapy and surveillance groups (87.2% vs 83.3%; p=0.233) in the low-risk patients, the adjuvant chemotherapy was associated with a significantly higher 5-year overall survival rate in the high-risk patients (52.1% vs 37.8%; p=0.003). Machine learning-based prediction of early recurrence is helpful in selecting patients who may benefit from adjuvant chemotherapy. These findings may help reduce medical expenses by avoiding unnecessary adjuvant chemotherapy in patients with low risk of early recurrence.

Recent randomized controlled trials (RCTs) regarding the outcomes of neoadjuvant chemotherapy for patients with resectable pancreatic cancer (PC) reported

Young Jae Cho, Yoon Soo Chae, Go-Won Choi, Inhyuck Lee, Younsoo Seo, Seulah Park, Youngmin Han, Hye-sol Jung, Wooil Kwon, Jin-Young Jang, Joon Seong Park. Ann Hepatobiliary Pancreat Surg -0001;0:. https://doi.org/10.14701/ahbps.25-198

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