Review
Oncology
Julie Navez, Christelle Bouchart, Diane Lorenzo, Maria Antonietta Bali, Jean Closset, Jean-Luc Van Laethem
Summary: Complete surgical resection with perioperative chemotherapy is the only chance for cure in pancreatic cancer, with R0 resection being a key factor for survival. Proximity of mesenteric vessels increases the risk of vein involvement, leading to the need for concomitant venous resection to reduce the risk of positive margins. Surgeons must balance the technical difficulty of venous resection with the hope for absence of perivascular tumor infiltration to achieve optimal surgical outcomes in pancreatic cancer cases.
ANNALS OF SURGICAL ONCOLOGY
(2021)
Article
Multidisciplinary Sciences
Sarah Borsekofsky, Shlomo Tsuriel, Rami R. Hagege, Dov Hershkovitz
Summary: The study aimed to develop a PNI detection algorithm to improve accuracy and efficiency in identifying PNI in PDAC specimens. The algorithm accurately identifies PNI in PDAC by imitating pathologist thought processes, even with a small training cohort.
SCIENTIFIC REPORTS
(2023)
Article
Oncology
Stefano Crippa, Fabio Giannone, Marco Schiavo Lena, Giulio Belfiori, Stefano Partelli, Domenico Tamburrino, Roberto Delpini, Michele Pagnanelli, Nicolo Pecorelli, Gianpaolo Balzano, Claudio Doglioni, Massimo Falconi
Summary: The presence of positive resection margins, especially R1 direct and R1 <= 1 mm definitions, is an independent predictor of disease-free survival and disease-specific survival in patients with PDAC. The involvement of multiple margins increases the risk of cancer recurrence and poor survival outcomes. Different surgical margins may have different prognostic roles in PDAC.
ANNALS OF SURGICAL ONCOLOGY
(2021)
Article
Surgery
Bo Li, Shiwei Guo, Xiaoyi Yin, Chenming Ni, Suizhi Gao, Gang Li, Canrong Ni, Hui Jiang, Wan Yee Lau, Gang Jin
Summary: The present study identified the independent risk factors of R1 resection in pancreaticoduodenectomy (PD) and distal pancreatosplenectomy (DP) and found that tumor location, lymphovascular invasion, N staging, and TNM staging were risk factors for R1 resection in PD, while T staging and TNM staging were risk factors for R1 resection in DP. These findings can help surgeons make reasonable decisions on surgical strategies for patients with pancreatic ductal adenocarcinoma to achieve R0 resection.
ASIAN JOURNAL OF SURGERY
(2023)
Article
Radiology, Nuclear Medicine & Medical Imaging
Yun Bian, Zhilin Zheng, Xu Fang, Hui Jiang, Mengmeng Zhu, Jieyu Yu, Haiyan Zhao, Ling Zhang, Jiawen Yao, Le Lu, Jianping Lu, Chengwei Shao
Summary: In this study, an automated preoperative artificial intelligence algorithm was developed and validated for the segmentation of tumor and lymph nodes in patients with pancreatic ductal adenocarcinoma (PDAC) using CT imaging. The performance of the algorithm was compared to radiologists and clinical models, and it was found that the AI model outperformed the other models in predicting lymph node metastasis. The AI model-predicted positive LN metastasis was also associated with worse survival.
Article
Surgery
Jiabin Jin, Shih-min Yin, Yuanchi Weng, Mengmin Chen, Yusheng Shi, Xiayang Ying, Georgios Gemenetzis, Kai Qin, Jun Zhang, Xiaxing Deng, Chenghong Peng, Baiyong Shen
Summary: This study compared the outcomes of venous resection and reconstruction (VR) in robotic-assisted and open pancreaticoduodenectomy (OPD) in patients with pancreatic ductal adenocarcinoma (PDAC). The results showed similar reconstructed venous patency, postoperative complications, and 90-day mortality between the two groups, but the robotic group had a lower lymph node resection rate.
LANGENBECKS ARCHIVES OF SURGERY
(2022)
Article
Oncology
Zheng Li, Xiaojie Zhang, Chunguang Guo, Chongyuan Sun, Zefeng Li, He Fei, Yingtai Chen, Dongbing Zhao
Summary: This study aimed to investigate the appropriate number of examined lymph nodes (ELNs) for elderly patients with pancreatic ductal adenocarcinoma (PDAC). The results showed that extended lymphadenectomy is suitable for elderly patients undergoing curative-intent surgery, as it allows for an accurate assessment of nodal involvement and improves long-term prognosis.
AMERICAN JOURNAL OF CANCER RESEARCH
(2023)
Article
Multidisciplinary Sciences
Dennis Obonyo, Verena Nicole Uslar, Johanna Muending, Dirk Weyhe, Andrea Tannapfel
Summary: The impact of resection margin (RM) status and RM distance on overall survival (OS), disease-free survival (DFS) and recurrence in curative resected pancreatic ductal adenocarcinoma (PDAC) was investigated. It was found that a medial RM clearance of >=2mm had a significant impact on OS and DFS. Age, medial RM >= 2mm, lymph node status, and chemotherapy were identified as prognostic factors for OS and DFS.
Article
Multidisciplinary Sciences
Jieliang Zuo, Chenhe Yi, Zhenmei Chen, Bo Zhou, Tingsong Yang, Jing Lin
Summary: This study reveals the prognostic role of pyroptosis and inflammasome-related genes in pancreatic ductal adenocarcinoma (PDAC) for the first time, while also demonstrating the biological and prognostic heterogeneity of PDAC.
SCIENTIFIC REPORTS
(2022)
Article
Multidisciplinary Sciences
Toshitaka Sugawara, Daisuke Ban, Jo Nishino, Shuichi Watanabe, Aya Maekawa, Yoshiya Ishikawa, Keiichi Akahoshi, Kosuke Ogawa, Hiroaki Ono, Atsushi Kudo, Shinji Tanaka, Minoru Tanabe
Summary: The model utilizing multiple preoperative factors can enhance the prediction of early resectable PDAC recurrence, aiding in the adjustment of treatment strategies.
Article
Oncology
Danilo Hackner, Mirianna Hobbs, Susanne Merkel, Timo Siepmann, Christian Krautz, Georg F. Weber, Robert Gruetzmann, Maximilian Brunner
Summary: This retrospective study aimed to evaluate the impact of age on postoperative short-term and long-term outcomes in patients undergoing curative pancreatic resection for pancreatic ductal adenocarcinoma (PDAC). The study found that despite older age, pancreatic resections had comparable short-term outcomes. However, age significantly influenced overall and disease-free survival in PDAC patients undergoing primary resection in curative intent, emphasizing the importance of individualizing treatment decisions based on age.
Article
Biochemistry & Molecular Biology
Andrew Armstrong, Muhammad R. Haque, Sina Mirbagheri, Usman Barlass, Douglas Z. Gilbert, Jaimin Amin, Ajaypal Singh, Ankur Naqib, Faraz Bishehsari
Summary: Pancreatic ductal adenocarcinoma (PDA) is a deadly cancer with limited treatment options. This study developed a patient-derived organoid (PDO) based drug screening assay to model treatment response, revealing variability in patient responses to different therapies and identifying transcriptome signatures associated with treatment response and survival outcomes.
Article
Surgery
Xiu-Ping Zhang, Shuai Xu, Yuan-Xing Gao, Zhi-Ming Zhao, Guo-Dong Zhao, Ming-Gen Hu, Xiang-Long Tan, Wan Yee Lau, Rong Liu
Summary: The risk factors, patterns, and long-term prognosis for early recurrence (ER) and late recurrence (LR) after pancreaticoduodenectomy (PD) in pancreatic ductal adenocarcinoma (PDAC) patients were studied. Patients who developed ER had worse prognosis compared to those with LR.
INTERNATIONAL JOURNAL OF SURGERY
(2023)
Article
Gastroenterology & Hepatology
Hironobu Suto, Minoru Oshima, Yasuhisa Ando, Hiroyuki Matsukawa, Shigeo Takahashi, Toru Shibata, Hideki Kamada, Hideki Kobara, Tsutomu Masaki, Kensuke Kumamoto, Yasuyuki Suzuki, Keiichi Okano
Summary: The benefit of preoperative treatment followed by pancreatic resection in older patients with PDAC remains unclear. This study showed that preoperative treatment followed by curative resection could be safely performed in older patients, with similar outcomes as younger patients. Although older patients had a higher frequency of postoperative complications, the prognosis was similar.
Article
Biochemistry & Molecular Biology
Liwei Cao, Chen Huang, Daniel Cui Zhou, Yingwei Hu, T. Mamie Lih, Sara R. Savage, Karsten Krug, David J. Clark, Michael Schnaubelt, Lijun Chen, Felipe da Veiga Leprevost, Rodrigo Vargas Eguez, Weiming Yang, Jianbo Pan, Bo Wen, Yongchao Dou, Wen Jiang, Yuxing Liao, Zhiao Shi, Nadezhda Terekhanova, Song Cao, Rita Jui-Hsien Lu, Yize Li, Ruiyang Liu, Houxiang Zhu, Peter Ronning, Yige Wu, Matthew A. Wyczalkowski, Hariharan Easwaran, Ludmila Danilova, Arvind Singh Mer, Seungyeul Yoo, Joshua M. Wang, Wenke Liu, Benjamin Haibe-Kains, Mathangi Thiagarajan, Scott D. Jewell, Galen Hostetter, Chelsea J. Newton, Qing Kay Li, Michael H. Roehr, David Fenyo, Pei Wang, Alexey Nesvizhskii, D. R. Mani, Gilbert S. Omenn, Emily S. Boja, Mehdi Mesri, Ana Robles, Henry Rodriguez, Oliver F. Bathe, Daniel W. Chan, Ralph H. Hruban, Li Ding, Bing Zhang, Hui Zhang
Summary: This study conducted comprehensive proteogenomic analysis of PDAC to understand the molecular alterations that drive oncogenesis. Multiple analyses were performed on tissues from patients, providing valuable resources for early detection and identification of therapeutic targets.
Article
Immunology
Arpit Amin, Alfonso Molina, Lisa Quach, Takahiro Ito, Robert McMillan, Joseph DiNorcia, Vatche G. Agopian, Fady M. Kaldas, Douglas G. Farmer, Ronald W. Busuttil, Drew J. Winston
Summary: A retrospective study of liver transplant recipients with pretransplant Aspergillus colonization at Ronald Reagan UCLA Medical Center showed that these patients can still undergo successful liver transplantation with appropriate antifungal prophylaxis, and posttransplant outcome is mainly determined by noninfectious complications rather than fungal infection. Pretransplant Aspergillus colonization alone should not necessarily preclude or delay liver transplantation.
Article
Surgery
Takahiro Ito, Bita V. Naini, Daniela Markovic, Antony Aziz, Stephanie Younan, Michelle Lu, Hirofumi Hirao, Kentaro Kadono, Hidenobu Kojima, Joseph DiNorcia, Vatche G. Agopian, Hasan Yersiz, Douglas G. Farmer, Ronald W. Busuttil, Jerzy W. Kupiec-Weglinski, Fady M. Kaldas
Summary: This study investigated the correlation between the severity of IRI and short-term graft outcomes, demonstrating that severe IRI was associated with higher incidence of EAD and inferior survival. Independent risk factors for moderate to severe IRI and EAD were identified, providing valuable insights for optimizing donor-recipient matching and patient management in liver transplantation.
AMERICAN JOURNAL OF TRANSPLANTATION
(2021)
Article
Gastroenterology & Hepatology
Vatche G. Agopian, Daniela Markovic, Goran B. Klintmalm, Giovanna Saracino, William C. Chapman, Neeta Vachharajani, Sander S. Florman, Parissa Tabrizian, Brandy Haydel, David Nasralla, Peter J. Friend, Yuri L. Boteon, Rutger Ploeg, Michael P. Harlander-Locke, Victor Xia, Joseph DiNorcia, Fady M. Kaldas, Hasan Yersiz, Douglas G. Farmer, Ronald W. Busuttil
Summary: This study validated the accuracy and superiority of the L-GrAFT7 risk score in multicenter cohorts, which can accurately predict early liver graft function and post-transplant complications.
JOURNAL OF HEPATOLOGY
(2021)
Article
Oncology
Siddharth A. Padia, Guy E. Johnson, Vatche G. Agopian, Joseph DiNorcia, Ravi Srinivasa, James Sayre, David Shin
Summary: Y-90 radiation segmentectomy for hepatic metastases shows high rates of tumor control and minimal toxicity. This treatment should be considered for patients with metastatic hepatic malignancy who are not candidates for surgical resection.
JOURNAL OF SURGICAL ONCOLOGY
(2021)
Article
Surgery
Antony Aziz, Takahiro Ito, Stephanie Younan, Joseph DiNorcia, Vatche G. Agopian, Douglas G. Farmer, Ronald W. Busuttil, Fady M. Kaldas
Summary: The impact of previous abdominal surgery (PAS) on liver transplant (LT) outcomes is not significant, with careful consideration necessary for patients with multiple comorbidities who had PAS, especially those with upper abdominal surgery (UAS) or PAS <= 90 days.
JOURNAL OF SURGICAL RESEARCH
(2021)
Article
Surgery
Jacob Guorgui, Takahiro Ito, Daniela Markovic, Antony Aziz, Stephanie Younan, Alyscia Severance, Michelle Lu, Jane Lee, Joseph DiNorcia, Vatche G. Agopian, Douglas G. Farmer, Ronald W. Busuttil, Fady M. Kaldas
Summary: The study found that marijuana use did not have a significant adverse impact on post-liver transplant outcomes, but further research using larger cohorts is needed to validate this finding.
CLINICAL TRANSPLANTATION
(2021)
Article
Gastroenterology & Hepatology
Krystal L. Karunungan, Yas Sanaiha, Roland A. Hernandez, Holly Wilhalme, Sarah Rudasill, Joseph Hadaya, Joseph DiNorcia, Peyman Benharash
Summary: The study found that candidates listed for liver transplantation in the United States with Medicare or Medicaid had a higher risk of delisting due to death or deterioration compared to those with private insurance. By identifying these disparities, targeted waitlist management protocols can potentially help mitigate the increased risk for delisting in this population.
LIVER TRANSPLANTATION
(2021)
Article
Surgery
Esteban Aguayo, Joseph Hadaya, Morcos Nakhla, Catherine G. Williamson, Vishal Dobaria, Ava Mandelbaum, Ronald W. Busuttil, Peyman Benharash, Joseph DiNorcia
Summary: Liver transplantation is a life-saving treatment for end-stage liver disease patients, but it requires significant resources. The study found that over time, the cost of LT has increased and factors such as renal dysfunction, regional practice patterns, and patient acuity were associated with greater resource use. Transplanting patients before health deterioration may help contain costs, mitigate resource use, and improve LT outcomes.
CLINICAL TRANSPLANTATION
(2021)
Article
Surgery
Jacob Guorgui, Takahiro Ito, Stephanie Younan, Vatche G. Agopian, Joseph Dinorcia, Douglas G. Farmer, Ronald W. Busuttil, Fady M. Kaldas
Summary: The study suggests that high acuity ECD liver graft recipients have similar short- and long-term patient survival compared to SL recipients, indicating that ECD livers present a viable method to expand the donor pool for this group of patients.
Article
Gastroenterology & Hepatology
Takahiro Ito, James R. Butler, Daisuke Noguchi, Minah Ha, Antony Aziz, Vatche G. Agopian, Joseph DiNorcia, Hasan Yersiz, Douglas G. Farmer, Ronald W. Busuttil, Johnny C. Hong, Fady M. Kaldas
Summary: This study analyzed the impact of era, tumor size, and neoadjuvant therapy strategies on the outcomes of liver transplantation for cholangiocarcinoma patients. The results showed that outcomes of LT for CCA seem to have improved over time, and multimodal neoadjuvant therapy is associated with improved survival in both iCCA and hCCA patients, regardless of tumor size.
LIVER TRANSPLANTATION
(2022)
Article
Surgery
Takahiro Ito, Jacob Guorgui, Daniela Markovic, Heidi Coy, Stephanie M. Younan, Joseph I. I. I. I. I. I. DiNorcia, Vatche G. Agopian, Douglas G. Farmer, Steven S. Raman, Ronald W. Busuttil, Fady M. Kaldas
Summary: This study retrospectively assessed the impact of sarcopenia in high MELD score patients undergoing liver transplantation. Lower SMI was associated with higher rates of bacteremia and longer hospital stay in male and female patients with MELD >= 35, but did not affect patient survival. The findings suggest that while SMI may not aid in patient selection for LT, it can guide perioperative care-planning in this challenging patient population.
CLINICAL TRANSPLANTATION
(2022)
Article
Surgery
Jazlyn Chong, Jacob Guorgui, Heidi Coy, Takahiro Ito, Michelle Lu, Joseph DiNorcia, Vatche G. Agopian, Douglas G. Farmer, Steven S. Raman, Ronald W. Busuttil, Fady M. Kaldas
Summary: The study found that a decrease in patient muscle mass perioperatively is associated with inferior patient and graft survival in high-acuity LT recipients. Pre- and post-operative patient care and rehabilitation efforts are crucial for this challenging patient population.
JOURNAL OF SURGICAL RESEARCH
(2022)
Editorial Material
Pediatrics
Joseph DiNorcia, John C. Bucuvalas
PEDIATRIC TRANSPLANTATION
(2022)
Review
Pediatrics
Swati Antala, Joseph DiNorcia, John Bucuvalas
Summary: The goal in the care of pediatric liver transplant recipients is to optimize allograft and patient health. Precision medicine and individualized immunosuppression play a crucial role in balancing allograft health and medication side effects. Challenges include predicting allograft health and identifying operational tolerance. More research is needed to determine the clinical utility of innovative tools. Strategies to safely minimize immunosuppression and tailor it in a personalized way are possible, but immunosuppression-free transplant is not yet a reality. This review focuses on progress made in individualizing immunosuppression in pediatric liver transplantation for optimal outcomes.
PEDIATRIC TRANSPLANTATION
(2023)
Meeting Abstract
Critical Care Medicine
B. H. Patel, K. Melamed, H. Wilhalme, G. L. Day, T. S. Wang, D. Farmer, J. DiNorcia, I. Barjaktarevic
AMERICAN JOURNAL OF RESPIRATORY AND CRITICAL CARE MEDICINE
(2021)