Dataset Information

Selective extended dissection for pancreaticoduodenectomy is associated with better survival in pancreatic cancer patients: retrospective cohort study.

ABSTRACT:

Background

Pancreatic ductal adenocarcinoma is a highly malignant tumor with relatively poor survival. Surgery is the first choice for treating patients with early pancreatic cancer. However, the surgical approach and the extent of resection for patients with pancreatic cancer are currently controversial.

Methods

The authors optimized the procedure of standard pancreaticoduodenectomy to selective extended dissection (SED), which is based on the extrapancreatic nerve plexus potentially invaded by the tumor. The authors retrospectively analyzed the clinicopathological data of patients with pancreatic adenocarcinoma who underwent radical surgery in our center from 2011 to 2020. Patients who underwent standard dissection (SD) were matched 2:1 to those who underwent SED using propensity score matching. The log-rank test and Cox regression model were used to analyze survival data. In addition, statistical analyses were performed for the perioperative complications, postoperative pathology, and recurrence pattern.

Results

A total of 520 patients were included in the analysis. Among patients with extrapancreatic perineural invasion (EPNI), disease-free survival was significantly longer in those who received SED than in those who received SD (14.5 months vs. 10 months, P <0.05). The incidence of metastasis in No. 9 and No. 14 lymph nodes was significantly higher in patients with EPNI. In addition, there was no significant difference in the incidence rate of perioperative complications between the two surgical procedures.

Conclusion

Compared with SD, SED exhibits a significant prognostic benefit for patients with EPNI. The SED procedure aiming at specific nerve plexus dissection displayed particular efficacy and safety in resectable pancreatic ductal adenocarcinoma patients.

SUBMITTER: Guo X

PROVIDER: S-EPMC10389680 | biostudies-literature | 2023 Jul

REPOSITORIES: biostudies-literature

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Publications

Selective extended dissection for pancreaticoduodenectomy is associated with better survival in pancreatic cancer patients: retrospective cohort study.

Guo Xiaofan X Song Yuning Y Xu Peijun P Zhu Wenbo W Wang Hongwei H Zhou Yucheng Y Huang Chongbiao C Hao Jihui J Gao Song S

International journal of surgery (London, England) 20230701 7

<h4>Background</h4>Pancreatic ductal adenocarcinoma is a highly malignant tumor with relatively poor survival. Surgery is the first choice for treating patients with early pancreatic cancer. However, the surgical approach and the extent of resection for patients with pancreatic cancer are currently controversial.<h4>Methods</h4>The authors optimized the procedure of standard pancreaticoduodenectomy to selective extended dissection (SED), which is based on the extrapancreatic nerve plexus potenti ...[more]

PMID: 37195787

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Project description:Assessing the perioperative outcomes of pancreaticoduodenectomy (PD) based solely on individual complications is not comprehensive, and the association between perioperative outcomes and the long-term prognosis of individuals diagnosed with pancreatic ductal adenocarcinoma (PDAC) remains uncertain. Our study is designed to evaluate the impact of a novel composite indicator, textbook outcomes (TO), on the long-term prognosis of patients undergoing PD for PDAC. This study conducted a retrospective analysis of 139 patients who underwent PD for pathologically confirmed PDAC at our hospital between January 2018 and December 2021. After applying exclusion criteria, a total of 111 patients were included in the subsequent analysis. These patients were categorized into two groups: the non-TO group (n=42) and the TO group (n=69). The Kaplan-Meier survival curve was employed to describe the relationship between TO and disease-free survival (DFS) and overall survival (OS). Cox regression was employed to assess the impact of achieving TO on long-term survival. Logistic regression was employed to investigate the risk factors affecting the achievement of TO. Out of the 111 PDAC patients, 69 (62.2%) achieved TO following PD. The achievement of TO significantly improved the OS of PDAC patients [P=0.03; hazard ratio (HR) =0.60; 95% confidence interval (CI): 0.37-0.83]. Cox regression analysis indicated that achieving TO was a protective factor for OS (P=0.04; HR =4.08; 95% CI: 1.07-15.61). Logistic regression analysis indicated that high amylase in drainage fluid on the third day after surgery (>1,300 U/L) was detrimental to achieve TO [odds ratio (OR) =0.10; 95% CI: 0.02-0.58; P=0.01], longer surgery durations (≥6.25 hours) was detrimental to achieve TO (OR =0.19; 95% CI: 0.06-0.54; P=0.002), and soft pancreatic texture was detrimental to achieve TO (OR =0.31; 95% CI: 0.10-0.93, P=0.04). Achievement of TO significantly improves the OS of PDAC patients and has the potential to serve as a robust prognostic indicator. Looking ahead, it is highly necessary for TO to become a standard surgical quality control measure in hospitals.

Project description:BackgroundThis study aimed to assess the prognosis of T1-2N0 stage tongue cancer patients who underwent surgery for the primary lesion without elective neck dissection and to identify the risk factors for prognosis.MethodsWe retrospectively analyzed early-stage tongue cancer patients in our center. Statistical analyses were performed using SPSS and R software.ResultsThe study reviewed 168 patients, revealing a 3-year overall survival rate of 90.5%, a 3-year cervical lymph node metastasis-free survival rate of 73.2%, and a 3-year disease-specific survival rate of 89.3%. A depth of invasion of 3 mm showed significant prognostic value for overall survival (P = 0.001), cervical lymph node metastasis-free survival (P = 0.002), and disease-specific survival (P < 0.001). Patients were categorized into four subgroups (thick T1, thin T1, thick T2, and thin T2) to further explore the prognostic significance of depth of invasion across different T stage categories. The combination of T stage and a 3 mm depth of invasion demonstrated significant prognostic value in univariate analysis for overall survival (P = 0.002), cervical lymph node metastasis-free survival (P = 0.010), and disease-specific survival (P < 0.001). COX regression analysis confirmed the statistical significance of T stage combined with a 3 mm depth of invasion for overall survival (OR = 10.653; 95% CI, 2.394 to 47.404; P = 0.002) and lymph node metastasis-free survival (OR = 3.016; 95% CI, 1.365 to 6.667; P = 0.006).ConclusionsThe findings highlight depth of invasion and T stage as key prognostic factors in early-stage tongue squamous cell carcinoma. Consideration of elective neck dissection is advised for patients with T2 tumors and a depth of invasion exceeding 3 mm to potentially enhance their prognosis.Trial registrationThe current research was registered in Chinese Clinical Trial Registry on April 8, 2021. The trial registration number is ChiCTR2100045188.

Dataset Information

Selective extended dissection for pancreaticoduodenectomy is associated with better survival in pancreatic cancer patients: retrospective cohort study.

Background

Methods

Results

Conclusion

Publications

Selective extended dissection for pancreaticoduodenectomy is associated with better survival in pancreatic cancer patients: retrospective cohort study.

Similar Datasets

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