Jun Sakata

Purpose Total pancreatectomy (TP) has attracted increasing attention because short-term outcomes have improved. However, long-term data remain limited. This study evaluated long-term outcomes after TP, focusing on actual 10-year survivors and causes of death. Methods This study included patients who underwent elective TP for pancreatic disease and were followed for at least 10 years or until death. Patients were classified as 10-year survivors or non-survivors. Clinicopathological characteristics, long-term survival, and causes of death were analyzed. Results Forty-nine patients were included. Single-stage TP was performed in 30 patients (61.2%) and completion TP in 19 (38.8%). Pancreatic ductal adenocarcinoma accounted for 57.1% of indications for TP. R0 resection was achieved in 87.8% of patients, with no in-hospital mortality. The actual 5- and 10-year overall survival rates were 28.6% and 18.4%, respectively. Nine patients (18.4%) were actual 10-year survivors; none underwent vascular resection and reconstruction (p = 0.019), multivisceral resection (p = 0.322), or R1/2 resection (p = 0.577). One-third of the 10-year survivors had non-invasive intraductal papillary mucinous neoplasms (p = 0.016). In multivariate analysis, vascular resection and reconstruction was associated with worse overall survival (p = 0.016). Most deaths occurred within 5 years after TP and were mainly attributable to disease progression. Conclusion Long-term outcomes after TP appear to be influenced predominantly by oncological factors. Actual 10-year survivors were observed mainly among patients with benign or more favorable tumor characteristics who did not require extended resection. Given the heterogeneity of underlying diseases and surgical indications, these findings should be interpreted as primarily descriptive.

Background: Gemcitabine plus cisplatin (GC) has been the global standard for advanced biliary tract cancer (BTC). The triplet regimen gemcitabine–cisplatin–S‐1 (GCS) demonstrated superiority in the MITSUBA trial, but its real‐world effectiveness remains unclear. We compared survival outcomes of GCS versus GC, focusing on conversion surgery (CS). Methods: We retrospectively analyzed 542 patients with unresectable BTC treated between 2017 and 2024 at 19 Japanese institutions. Patients received GC ( n = 310) or GCS ( n = 232). Survival was evaluated using multivariable Cox regression, 90‐day landmark analysis, and propensity score matching (PSM) to adjust for baseline imbalances. Results: Patients treated with GCS achieved greater tumor shrinkage (median −23.0% vs. –10.0%, p = 0.014) and a higher CS rate (16.4% vs. 4.5%, p < 0.001) than GC. Median progression‐free survival was 8.6 versus 5.4 months ( p = 0.002), and median overall survival (OS) was 17.2 versus 11.6 months ( p = 0.006). In multivariable analysis, GCS was associated with a lower risk of death (HR 0.80, 95% CI 0.65–0.98, p = 0.035), with consistent results after PSM. Fifty‐two patients underwent CS, with comparable perioperative safety and R0 resection rates between regimens. Patients who underwent CS achieved markedly longer OS; in the overall cohort, median OS was 31.0 months in the GCS with CS group and not reached in the GC with CS group ( p = 0.131). Conclusions: Treatment with GCS was associated with longer survival compared with GC in unresectable BTC, alongside a higher rate of conversion surgery, which was associated with favorable long‐term outcomes.

Background/Objectives: Pembrolizumab demonstrates a high response rate in patients with mismatch repair-deficient (dMMR) metastatic colorectal cancer (mCRC), with responses often sustained even after treatment cessation. However, the pathological complete response (pCR) rate in clinically responding cases remains unknown. This study aimed to evaluate the relationship between the radiological and pathological responses in patients with dMMR mCRC who responded to pembrolizumab. Methods: This retrospective study included 27 patients with dMMR mCRC treated with pembrolizumab. The radiological response was assessed using RECIST version 1.1 criteria. The pathological response was evaluated in patients who underwent metastasectomy, with pCR defined as the absence of residual cancer cells. Results: The median progression-free survival (PFS) of the cohort was 19 months. Among the 27 patients, 3 achieved clinical complete response (cCR), and 10 had clinical partial response (cPR), resulting in a response rate of 48%. All three patients with cCR maintained their responses without metastasectomy (2-year PFS: 100%). Among patients with cPR, eight maintained their responses, while two experienced progression (2-year PFS: 75%). Five patients with cPR underwent curative-intent metastasectomy, and four of them (80%) achieved pCR. Thus, at least 40% of patients with cPR in this cohort had no residual cancer histologically. Conclusions: Our findings demonstrate the significant discordance between the radiological and pathological responses to pembrolizumab in dMMR mCRC patients, with 80% of those with cPR achieving pCR upon metastasectomy. These observations highlight the need for improved response assessment methods for precision immunotherapy.