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Jin-young Jang - One of the best experts on this subject based on the ideXlab platform.
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multinational validation of the american joint committee on Cancer 8th edition pancreatic Cancer staging system in a pancreas Head Cancer cohort
Journal of Hepato-biliary-pancreatic Sciences, 2018Co-Authors: Woo Il Kwon, Jin He, Ryota Higuchi, Christopher L Wolfgang, John L Cameron, Masakazu Yamamoto, Jin-young JangAbstract:BACKGROUND: The aim of the present study was to compare the 7th and 8th editions of the American Joint Committee on Cancer (AJCC) staging system for pancreas Head Cancer and to validate the 8th edition using three multinational tertiary center data. METHODS: Data of 2,864 patients with pancreas Head Cancer were collected from Korea (571), Japan (824), and the USA (1,469). Survival analysis was performed to compare the 7th and 8th editions. Validation was performed by log-rank tests and test for trend repeated 1,000 times with random sets. RESULTS: In the 7th edition, 4.1%, 3.1%, 18.6%, 67.5%, 3.6%, and 3.1% were stage IA, IB, IIA, IIB, III, and IV. In the 8th edition, 8.8%, 13.9%, 3.1%, 38.2%, 32.9%, and 3.1% were stage IA, IB, IIA, IIB, III, and IV, respectively. The change in T category downstaged 459 patients from IIA to the new IA and IB. The new N2 category upstaged 856 patients from the former IIB to III. The 7th edition reversely stratified IA and IB. The 8th edition corrected this mis-stratification of the 7th edition, but lacked discriminatory power between IB and IIA (P = 0.271). Validation using the log-rank showed that the 8th edition provided better discrimination in 6.387 test sets among 10 tests. The test for trend validated the 8th edition to stratify stages in correct order more often (7.815/10). CONCLUSION: The 8th edition provides more even distribution with more powerful discrimination compared to the 7th edition.
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Surgical resection of pancreatic Head Cancer: What is the optimal extent of surgery?
Cancer letters, 2016Co-Authors: Mee Joo Kang, Jin-young Jang, Sun Whe KimAbstract:Extent of surgery should depend on curability. Improvements in surgical techniques have resulted in surgeons seeking to perform more radical surgery. To date, five randomized controlled trials (RCT) have analyzed the benefits of extended lymphadenectomy for pancreatic Head Cancer, but none has shown that extended lymphadenectomy enhances patient survival. As most patients with pancreatic Cancer have microscopic, locally advanced disease that cannot be cured by surgery alone, local tumor control by extended lymphadenectomy cannot overcome the negative aspects of pre-existing lymph node metastasis. The most important factor improving overall survival following pancreatoduodenectomy in patients with pancreatic Head Cancer is proper systemic control of the disease rather than extensive local control. The long-term survival outcomes following adjuvant treatment in a large multi-center RCT suggest the need for aggressive systemic treatment. More attention must be paid to the benefits of adjuvant treatment, not only focusing on technical R0 resection. Surgical strategies for patients with pancreatic Head Cancer require more flexibility, with extent of surgery customized to individual patients, depending on tumor location and disease severity.
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comparison of the long term outcomes of uncinate process Cancer and non uncinate process pancreas Head Cancer poor prognosis accompanied by early locoregional recurrence
Langenbeck's Archives of Surgery, 2010Co-Authors: Mee Joo Kang, Jin-young JangAbstract:Purpose The embryologic and anatomic peculiarity of the uncinate process may result in distinct clinical features, but few studies have addressed the uncinate process Cancer. The purpose of this study was to compare the clinicopathologic characteristics and identify the prognostic factors that affect the survival and recurrence of pancreatic Head Cancer by tumor location.
Jun Ho Shin - One of the best experts on this subject based on the ideXlab platform.
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Surgical palliation of unresectable pancreatic Head Cancer in elderly patients
World journal of gastroenterology, 2009Co-Authors: Sang Il Hwang, Hyung Ook Kim, Byung Ho Son, Chang Hak Yoo, Hungdai Kim, Jun Ho ShinAbstract:AIM: To determine if surgical biliary bypass would provide improved quality of residual life and safe palliation in elderly patients with unresectable pancreatic Head Cancer. METHODS: Nineteen patients, 65 years of age or older, were managed with surgical biliary bypass (Group A). These patients were compared with 19 patients under 65 years of age who were managed with surgical biliary bypass (Group B). In addition, the results for group A were compared with those obtained from 17 patients, 65 years of age or older (Group C), who received percutaneous transhepatic biliary drainage to evaluate the quality of residual life. RESULTS: Five patients (26.0%) in Group A had complications, including one intraabdominal abscess, one pulmonary atelectasis, and three wound infections. One death (5.3%) occurred on postoperative day 3. With respect to morbidity, mortality, and postoperative hospitalization, no statistically significant difference was noted between Groups A and B. The number of readmissions and the rate of recurrent jaundice were lower in Group A than in Group C, to a statistically significant degree (P = 0.019, P = 0.029, respectively). The median hospital-free survival period and the median overall survival were also significantly longer in Group A (P = 0.001 and P < 0.001, respectively). CONCLUSION: Surgical palliation does not increase the morbidity or mortality rates, but it does increase the survival rate and improve the quality of life in elderly patients with unresectable pancreatic Head Cancer.
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Quality of survival in patients treated for malignant biliary obstruction caused by unresectable pancreatic Head Cancer: surgical versus non-surgical palliation.
Hepatobiliary & pancreatic diseases international : HBPD INT, 2008Co-Authors: Hyung Ook Kim, Sang Il Hwang, Hungdai Kim, Jun Ho ShinAbstract:BACKGROUND: Appropriate palliation for unresectable pancreatic Head Cancer is most important. This study was undertaken to compare the survival of patients with biliary obstruction caused by unresectable pancreatic Head Cancer after surgical and non-surgical palliation. METHODS: We retrospectively reviewed 69 patients who underwent palliative treatment for unresectable pancreatic Head Cancer. Fifty-two patients with locally advanced disease (local vascular invasion) and 17 with distant metastatic disease were included. The patients were divided into two groups, surgical and non-surgical palliation. RESULTS: Thirty-eight patients underwent biliary bypass surgery and 31 had percutaneous transhepatic biliary drainage (PTBD). There was no significant difference in the early complications, successful biliary drainage, recurrent jaundice, and 30-day mortality between surgical palliation and PTBD. However, in 52 patients whose tumor was unresectable secondary to local vascular invasion, the rate of recurrent jaundice after successful surgical biliary palliation was lower than that in patients who had non- surgical palliation (P＜0.05). The patients who underwent surgical palliation had a longer hospital-free survival rate (P＜0.001), although they had a longer postoperative hospital stay (P=0.004) during the first admission period. CONCLUSIONS: In patients with preoperative evaluations showing potentially resectable tumors and/or no metastatic lesions, surgical exploration should be performed. Thus, in patients who have unresectable Cancer or limited metastatic disease on exploration, surgical palliation should be performed for longer survival and better quality of survival.
Ziad T Awad - One of the best experts on this subject based on the ideXlab platform.
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totally laparoscopic pancreaticoduodenectomy for pancreatic Head Cancer with involvement of the superior mesenteric vein portal vein confluence
Annals of Surgical Oncology, 2014Co-Authors: Ziad T AwadAbstract:Laparoscopic pancreaticoduodenectomy is a technically demanding procedure. In this video, we dem- onstrate the technical aspects of performing the procedure. In a 50-year-old male with ascending cholangitis, endo- scopic retrograde cholangiopancreatography was unsuccessful, and percutaneous transhepatic cholangiog- raphy was carried out for biliary decompression. Endoscopic ultrasound plus fine-needle aspiration showed pancreatic Head adenocarcinoma. The procedure was car- ried out using five trocars, and extensive lymphadenectomy was undertaken. The uncinate process was skeletonized off the superior mesenteric artery. The right lateral aspect of the superior mesenteric vein-portal vein confluence was involved with the Cancer. The laparoscopic linear stapler was used to transect part of the vein en bloc with the specimen. All margins were negative and all the anasto- moses were done using laparoscopic intracorporeal suturing. Operative time was 8 h 20 min, and hospital stay was 5 days. Final pathology was T3 N1 (one lymph node out of 40 was positive). Conclusion. Laparoscopic pancreaticoduodenectomy can be performed safely in selected cases of pancreatic Head Cancer with vascular involvement. Skilled laparoscopic skills are necessary to execute such procedures safely.
Mee Joo Kang - One of the best experts on this subject based on the ideXlab platform.
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En bloc proximal peri-mesenteric clearance for pancreatic Head Cancer surgery.
Annals of hepato-biliary-pancreatic surgery, 2020Co-Authors: Mee Joo Kang, Sun Whe KimAbstract:The superior mesenteric artery (SMA) first approach and meso-pancreas excision (MPE) during pancreatoduodenectomy (PD) for pancreatic Head Cancer have been suggested for complete local tumor control, less operative blood loss, and early determination of resectability. However, SMA-first approach is merely a mode of approach and the concept of MPE has been challenged due to its anatomical obscurity. Dissection around proximal mesenteric vessels, superior mesenteric vein and SMA, is a critical procedure point for local tumor control as tumor infiltration is frequently observed both at the time of initial diagnosis and recurrence. The meso-pancreas, which encompasses the soft tissue between the uncinated process and SMA, does not include all the aforementioned points of proximal mesenteric areas. Therefore, the authors propose a new terminology named, "en bloc proximal peri-mesenteric clearance (PPMC)", to describe the removal of all the lymph nodes including soft tissue around proximal mesenteric vessels, especially the SMA, to ensure complete local tumor control of pancreatic Head Cancer. The SMA-first approach applied either by the mesenteric approach or supra-colic approach can make this procedure more feasible. The extent of the circumferential dissection of the peri-SMA nerve plexus can be adjusted according to the primary disease. PPMC including the removal of all lymph nodes around the proximal SMA may be considered as a standard extent of PD for pancreatic Head Cancer.
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Surgical resection of pancreatic Head Cancer: What is the optimal extent of surgery?
Cancer letters, 2016Co-Authors: Mee Joo Kang, Jin-young Jang, Sun Whe KimAbstract:Extent of surgery should depend on curability. Improvements in surgical techniques have resulted in surgeons seeking to perform more radical surgery. To date, five randomized controlled trials (RCT) have analyzed the benefits of extended lymphadenectomy for pancreatic Head Cancer, but none has shown that extended lymphadenectomy enhances patient survival. As most patients with pancreatic Cancer have microscopic, locally advanced disease that cannot be cured by surgery alone, local tumor control by extended lymphadenectomy cannot overcome the negative aspects of pre-existing lymph node metastasis. The most important factor improving overall survival following pancreatoduodenectomy in patients with pancreatic Head Cancer is proper systemic control of the disease rather than extensive local control. The long-term survival outcomes following adjuvant treatment in a large multi-center RCT suggest the need for aggressive systemic treatment. More attention must be paid to the benefits of adjuvant treatment, not only focusing on technical R0 resection. Surgical strategies for patients with pancreatic Head Cancer require more flexibility, with extent of surgery customized to individual patients, depending on tumor location and disease severity.
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comparison of the long term outcomes of uncinate process Cancer and non uncinate process pancreas Head Cancer poor prognosis accompanied by early locoregional recurrence
Langenbeck's Archives of Surgery, 2010Co-Authors: Mee Joo Kang, Jin-young JangAbstract:Purpose The embryologic and anatomic peculiarity of the uncinate process may result in distinct clinical features, but few studies have addressed the uncinate process Cancer. The purpose of this study was to compare the clinicopathologic characteristics and identify the prognostic factors that affect the survival and recurrence of pancreatic Head Cancer by tumor location.
Sang Il Hwang - One of the best experts on this subject based on the ideXlab platform.
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Surgical palliation of unresectable pancreatic Head Cancer in elderly patients
World journal of gastroenterology, 2009Co-Authors: Sang Il Hwang, Hyung Ook Kim, Byung Ho Son, Chang Hak Yoo, Hungdai Kim, Jun Ho ShinAbstract:AIM: To determine if surgical biliary bypass would provide improved quality of residual life and safe palliation in elderly patients with unresectable pancreatic Head Cancer. METHODS: Nineteen patients, 65 years of age or older, were managed with surgical biliary bypass (Group A). These patients were compared with 19 patients under 65 years of age who were managed with surgical biliary bypass (Group B). In addition, the results for group A were compared with those obtained from 17 patients, 65 years of age or older (Group C), who received percutaneous transhepatic biliary drainage to evaluate the quality of residual life. RESULTS: Five patients (26.0%) in Group A had complications, including one intraabdominal abscess, one pulmonary atelectasis, and three wound infections. One death (5.3%) occurred on postoperative day 3. With respect to morbidity, mortality, and postoperative hospitalization, no statistically significant difference was noted between Groups A and B. The number of readmissions and the rate of recurrent jaundice were lower in Group A than in Group C, to a statistically significant degree (P = 0.019, P = 0.029, respectively). The median hospital-free survival period and the median overall survival were also significantly longer in Group A (P = 0.001 and P < 0.001, respectively). CONCLUSION: Surgical palliation does not increase the morbidity or mortality rates, but it does increase the survival rate and improve the quality of life in elderly patients with unresectable pancreatic Head Cancer.
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Quality of survival in patients treated for malignant biliary obstruction caused by unresectable pancreatic Head Cancer: surgical versus non-surgical palliation.
Hepatobiliary & pancreatic diseases international : HBPD INT, 2008Co-Authors: Hyung Ook Kim, Sang Il Hwang, Hungdai Kim, Jun Ho ShinAbstract:BACKGROUND: Appropriate palliation for unresectable pancreatic Head Cancer is most important. This study was undertaken to compare the survival of patients with biliary obstruction caused by unresectable pancreatic Head Cancer after surgical and non-surgical palliation. METHODS: We retrospectively reviewed 69 patients who underwent palliative treatment for unresectable pancreatic Head Cancer. Fifty-two patients with locally advanced disease (local vascular invasion) and 17 with distant metastatic disease were included. The patients were divided into two groups, surgical and non-surgical palliation. RESULTS: Thirty-eight patients underwent biliary bypass surgery and 31 had percutaneous transhepatic biliary drainage (PTBD). There was no significant difference in the early complications, successful biliary drainage, recurrent jaundice, and 30-day mortality between surgical palliation and PTBD. However, in 52 patients whose tumor was unresectable secondary to local vascular invasion, the rate of recurrent jaundice after successful surgical biliary palliation was lower than that in patients who had non- surgical palliation (P＜0.05). The patients who underwent surgical palliation had a longer hospital-free survival rate (P＜0.001), although they had a longer postoperative hospital stay (P=0.004) during the first admission period. CONCLUSIONS: In patients with preoperative evaluations showing potentially resectable tumors and/or no metastatic lesions, surgical exploration should be performed. Thus, in patients who have unresectable Cancer or limited metastatic disease on exploration, surgical palliation should be performed for longer survival and better quality of survival.
