An onco-geriatric approach to select older patients for optimal treatments of pancreatic adenocarcinoma.

Introduction: Pancreatic adenocarcinoma affects mainly older patients. Surgery is indicated for localized tumors while chemotherapy alone is proposed in advanced or metastatic tumors.

Objective: To evaluate the feasibility of standard of care oncologic treatments in this population, the accuracy of the geriatric evaluation to predict the ability of patients to tolerate the recommended treatments and to identify specific geriatric prognosis factors.

The short- and long-term outcomes of pancreaticoduodenectomy for cancer in Child A patients are acceptable: a patient-control study from the Surgical French Association report for pancreatic surgery.

Background: On the basis of now dated studies, cirrhosis is usually considered to be a contraindication in pancreatoduodenectomy (PD) for adenocarcinoma of the pancreatic head (APH).

Objective: Examine the outcomes of PD for APH in the presence of cirrhosis.

Methods: Retrospective, multicenter study of cirrhotic patients with APH having undergone PD between January 2004 and March 2012.

Extracellular lumican inhibits pancreatic cancer cell growth and is associated with prolonged survival after surgery.

Purpose: To evaluate the relevance between lumican expression patterns and the clinical course of patients with pancreatic ductal adenocarcinoma (PDAC), and to investigate the role of lumican in PDAC progression.

Experimental Design: One hundred thirty-one patient tumors were chosen for tissue microarray staining, and Cox regression analysis was used to test the associations between lumican expression and clinical, pathologic, and oncologic outcomes in all patients. Primary PDAC cells and recombinant human lumican protein were used to establish a working model to mimic the in vivo interactions between stromal lumican and PDAC cells.

SMAD4 regulates cell motility through transcription of N-cadherin in human pancreatic ductal epithelium.

Expression of the cellular adhesion protein N-cadherin is a critical event during epithelial-mesenchymal transition (EMT). The SMAD4 protein has been identified as a mediator of transforming growth factor-β (TGF-β) superfamily signaling, which regulates EMT, but the mechanisms linking TGF-β signaling to N-cadherin expression remain unclear. When the TGF-β pathway is activated, SMAD proteins, including the common mediator SMAD4, are subsequently translocated into the nucleus, where they influence gene transcription via SMAD binding elements (SBEs).

Pancreatic resection: drain or no drain?

Background: Despite reports of randomized, control trials and cohort studies that do not support the use of drains, most surgeons routinely place prophylactic, intraperitoneal drains at the time of pancreatic resections. We sought to evaluate the outcome of elective pancreatic resection with or without prophylactic peripancreatic drainage. The primary outcome was the rate of postoperative complications.

Neuroendocrine neoplasms of the jejunum: a heterogeneous group with distinctive proximal and distal subsets.

Neuroendocrine tumors (NETs) of the jejunum are rare and usually grouped with either duodenal or ileal NETs. We aimed at better evaluating their characteristics by studying 116 cases of small-bowel NETs for which a precise anatomical location was available. Thirty-four cases were duodenal.

Value of preoperative biliary drainage in a consecutive series of resectable periampullary lesions. From randomized studies to real medical practice.

Background: In cases with periampullary tumors, the practice of preoperative biliary drainage (PBD) is still debated without clear uniform indications. Our study focused on resectable cases with an obstructive jaundice candidate for curative surgery. Main endpoints were overall complication and mortality rates between patients treated with and without PBD.

Is the combination of chromogranin A and pancreatic polypeptide serum determinations of interest in the diagnosis and follow-up of gastro-entero-pancreatic neuroendocrine tumours?

Introduction: Chromogranin A (CgA) is the principal tumour marker for gastroenteropancreatic neuroendocrine tumours (GEPNET). Combining serum CgA and pancreatic polypeptide (PP) levels may increase the sensitivity of tumour markers in the diagnosis of GEPNET.

Objectives: (1) To evaluate the sensitivity of PP and CgA in GEPNET.

Effect of neoadjuvant chemoradiation and surgical technique on recurrence of localized pancreatic cancer.

Objectives: To determine the influence of neoadjuvant chemoradiation and standardized dissection of the superior mesenteric artery upon the oncologic outcome of patients with localized pancreatic adenocarcinoma.

Methods: One hundred ninety-four patients with pancreatic adenocarcinoma who underwent pancreaticoduodenectomy between 2004 and 2008 were evaluated. The retroperitoneal dissection was performed directly along the superior mesenteric artery in all cases.

Complete regression of locally advanced hepatocellular carcinoma induced by sorafenib allowing curative resection.

We report two cases of locally advanced hepatocellular carcinoma (HCC) with portal vein tumour thrombosis (PVTT) who complete regression by sorafenib treatment allowed curative resection. Two male adult (59 and 57 years) cirrhotic patients with HCC associated with PVTT including one with lymph node involvement had elevated α-fetoprotein level (AFP) (867 and 17 000) and were treated with standard sorafenib treatment during 10 and 12 months respectively. Size decrease of the main tumour, disappearance of PVTT and normalization of AFP allowed curative surgical resection.