• Elderly patients
• Inflammatory nutritional status
• Over 80 years old
• Pancreatic ductal adenocarcinoma
• Postoperative treatment

• Humans
• Nutritional Status
• Pancreatic Neoplasms/surgery
• Male
• Female
• Retrospective Studies
• Aged, 80 and over
• Carcinoma, Pancreatic Ductal/surgery
• Feasibility Studies
• Aged
• Pancreatectomy
• Chemotherapy, Adjuvant
• Nutrition Assessment
• Middle Aged
• Age Factors
• Preoperative Period
• Survival Rate

• Humans
• Pancreatic Neoplasms/surgery
• Pancreatic Neoplasms/mortality
• Pancreatic Neoplasms/blood
• Pancreatic Neoplasms/therapy
• Pancreatic Neoplasms/pathology
• Male
• Female
• Neoadjuvant Therapy/methods
• CA-19-9 Antigen/blood
• Aged
• Middle Aged
• Prognosis
• Pancreatectomy
• Retrospective Studies
• Neoplasm Recurrence, Local/blood
• Neoplasm Recurrence, Local/epidemiology
• Adult
• Aged, 80 and over

• GEM+S-1
• GEM+nPTX
• NAC
• R-PDAC
• R/BR-PDAC

• Humans
• Deoxycytidine/analogs & derivatives
• Deoxycytidine/administration & dosage
• Gemcitabine
• Female
• Male
• Paclitaxel/administration & dosage
• Antineoplastic Combined Chemotherapy Protocols/therapeutic use
• Pancreatic Neoplasms/drug therapy
• Pancreatic Neoplasms/pathology
• Pancreatic Neoplasms/surgery
• Tegafur/administration & dosage
• Albumins/administration & dosage
• Oxonic Acid/administration & dosage
• Carcinoma, Pancreatic Ductal/drug therapy
• Carcinoma, Pancreatic Ductal/pathology
• Carcinoma, Pancreatic Ductal/surgery
• Neoadjuvant Therapy/mortality
• Middle Aged
• Drug Combinations
• Aged
• Survival Rate
• Follow-Up Studies
• Prognosis
• Adult
• Adenocarcinoma/drug therapy
• Adenocarcinoma/pathology
• Adenocarcinoma/mortality

• Osaka University

• Arterial connective tissues
• Borderline resectable
• Distant metastasis
• Indocyanine green
• Lymphatic flow
• Pancreatic cancer

• Humans
• Pancreatic Neoplasms/surgery
• Adenocarcinoma
• Pancreas
• Carcinoma, Pancreatic Ductal/surgery
• Aorta, Abdominal

• Humans
• Neoadjuvant Therapy
• Pancreatic Neoplasms
• Prognosis
• Retrospective Studies
• Survival Analysis

• neoadjuvant chemoradiotherapy
• neoadjuvant chemotherapy
• pancreatic cancer

• Humans
• Chemoradiotherapy
• Gemcitabine
• Neoadjuvant Therapy/adverse effects
• Pancreatic Neoplasms

• Taiho Pharmaceutical
• Yakult Honsha

• bile duct cancer
• neoadjuvant therapy
• sarcopenia
• skeletal muscle mass index

• Gemcitabine plus S-1
• Gemcitabine plus nab-paclitaxel
• Neoadjuvant chemotherapy
• Pancreatic cancer

• INC280
• Metastasis
• Phosphorylated-met
• c-Met inhibitor

• Animals
• Benzamides/pharmacology
• Cell Movement/radiation effects
• Humans
• Imidazoles/pharmacology
• Mice
• Mice, Inbred NOD
• Neoplasms, Radiation-Induced/drug therapy
• Neoplasms, Radiation-Induced/enzymology
• Neoplasms, Radiation-Induced/pathology
• Pancreatic Neoplasms/drug therapy
• Pancreatic Neoplasms/enzymology
• Pancreatic Neoplasms/pathology
• Protein Kinase Inhibitors/pharmacology
• Proto-Oncogene Proteins c-met/antagonists & inhibitors
• Triazines/pharmacology
• Pancreatic Neoplasms

• Chemoradiotherapy
• Chemotherapy
• Neoadjuvant therapy
• Pancreatic ductal adenocarcinoma
• Resectable disease

• CA19‐9
• FDG‐PET
• chemoradiotherapy
• neoadjuvant
• pancreatic cancer

• gene therapy
• modular peptide
• ovarian cancer
• photodynamic therapy
• surgical management

• Cell Line, Tumor
• Female
• Gene Expression Regulation, Neoplastic
• Humans
• MicroRNAs
• Ovarian Neoplasms/drug therapy
• Ovarian Neoplasms/surgery
• Peptides

• Digestive varices
• NODM
• PD-PVR
• Splenic artery ligation

Preoperative neoadjuvant chemoradiation therapy (NACRT) is applied for resectable pancreatic cancer (RPC). To maximize the efficacy of NACRT, it is essential to ensure the accurate placement of fiducial markers for image-guided radiation. However, no standard method for delivering fiducial markers has been established to date, and the nature of RPC during NACRT remains unclear.

To determine the feasibility, safety and benefits of endoscopic ultrasound-guided (EUS) fiducial marker placement in patients with RPC.

This was a prospective case series of 29 patients (mean age, 67.5 years; 62.1% male) with RPC referred to our facility for NACRT. Under EUS guidance, a single gold marker was placed into the tumor using either a 19- or 22-gauge fine-needle aspiration needle. The differences in daily marker positioning were measured by comparing simulation computed tomography and treatment computed tomography.

In all 29 patients (100%) who underwent EUS fiducial marker placement, fiducials were placed successfully with only minor, self-limiting bleeding during puncture observed in 2 patients (6.9%). NACRT was subsequently administered to all patients and completed in 28/29 (96.6%) cases, with one patient experiencing repeat cholangitis. Spontaneous migration of gold markers was observed in 1 patient. Twenty-four patients (82.8%) had surgery with 91.7% (22/24) R0 resection, and two patients experienced complete remission. No inflammatory changes around the marker were observed in the surgical specimen. The daily position of gold markers showed large positional changes, particularly in the superior-inferior direction. Moreover, tumor location was affected by food and fluid intake as well as bowel gas, which changes daily.

EUS fiducial marker placement following NACRT for RPC is feasible and safe. The RPC is mobile and is affected by not only aspiration, but also food and fluid intake and bowel condition.

• Endoscopic ultrasound-guided fine-needle aspiration
• Interventional endoscopic ultrasound
• Pancreatic cancer
• Fiducial marker
• Chemoradiation
• Resectable

• CA19-9
• Gemcitabine
• Neoadjuvant treatment
• Pancreatic cancer
• Preoperative chemoradiation therapy

• Gemcitabine
• Neoadjuvant chemoradiotherapy
• Pancreatic cancer
• Preoperative chemoradiotherapy
• Renal dysfunction

• Aged
• Antimetabolites, Antineoplastic/therapeutic use
• Carcinoma, Pancreatic Ductal/drug therapy
• Carcinoma, Pancreatic Ductal/pathology
• Carcinoma, Pancreatic Ductal/radiotherapy
• Chemoradiotherapy/methods
• Deoxycytidine/analogs & derivatives
• Deoxycytidine/therapeutic use
• Female
• Humans
• Male
• Neoadjuvant Therapy/methods
• Pancreatectomy/methods
• Pancreatic Neoplasms/drug therapy
• Pancreatic Neoplasms/pathology
• Pancreatic Neoplasms/radiotherapy
• Preoperative Care/methods
• Prognosis
• Prospective Studies
• Renal Insufficiency/pathology
• Survival Rate
• Gemcitabine
• Pancreatic Neoplasms

• intraductal carcinoma component
• pancreatic ductal adenocarcinoma
• pathological complete response

Objectives: Colorectal cancer (CRC) surgery after pancreaticoduodenectomy (PD) is difficult to perform, because PD involves dissection and complex reconstruction of the digestive tract. We evaluated the clinical outcomes of CRC surgery in patients with prior PD. Methods: Between January 2008 and March 2018, a total of 1727 patients received CRC surgery at our institution. Of these, 10 had previously undergone PD (PD group). As a control group, 280 patients were collected who had undergone resection without any history of previous abdominal surgery. The PD and control groups were further subdivided into four groups by right or left side. Outcomes of colorectal surgery were investigated in the PD and control groups. Results: The number of harvested lymph nodes was significantly lower in the PD group. In the right colectomy group, distance from the surgical margin was significantly shorter in the PD group. The rate of postoperative complications was higher in the PD group. Peritoneal dissemination originating from pancreatic cancer was found during CRC surgery for one patient, and one patient developed refractory ascites. Three patients died of pancreatic cancer, rectal cancer, and other disease. Seven patients were alive without recurrence. Conclusions: CRC surgery for patients with prior PD can involve difficulty in dissecting lymph nodes and higher postoperative morbidity rates but can provide sufficiently curative resection for CRC.

• colorectal cancer
• dissecting lymph node
• pancreaticoduodenectomy

We aimed to evaluate the efficacy and safety of 5-fluorouracil-based neoadjuvant chemoradiotherapy (NACRT) in patients with resectable/borderline resectable pancreatic ductal adenocarcinoma (PDAC).

This retrospective study investigated the clinicopathological features and > 5-year survival of patients with T3/T4 PDAC who underwent NACRT at our institute between 2003 and 2012.

Seventeen resectable and eight borderline resectable patients were included. The protocol treatment completion and resection rates were 92.0% and 68.0%, respectively. Two patients failed to complete chemotherapy owing to cholangitis or anorexia. Common grade 3 toxicities included anorexia (12%), neutropenia (4%), thrombocytopenia (4%), anemia (4%), and leukopenia (12%). Pathologically negative margins were achieved in 94.1% of patients who underwent pancreatectomy. Pathological response according to Evans’ classification was grade IIA in 10 patients (58.8%), IIB in 5 patients (29.4%), and IV in 2 patients (11.8%). Postoperative pancreatic fistulas were observed in four patients (23.5%), delayed gastric emptying in one patient (5.9%), and other operative morbidities in four patients (23.5%). The 1-, 2-, 5-, and 10-year overall survival rates were 73.9%, 60.9%, 60.9%, and 39.1%, respectively (median follow-up period, 80.3 months).

NACRT is tolerable and beneficial for resectable/borderline resectable PDAC, even in the long-term.

• Chemoradiotherapy
• Follow-up studies
• Neoadjuvant therapy
• Pancreatic carcinoma

• EPA
• Immunonutrition
• Pancreatic cancer
• Preoperative chemoradiotherapy
• RCT

Carbohydrate antigen (CA) 19–9 levels after resection are considered to predict prognosis; however, the significance of decreased CA19–9 levels after neoadjuvant therapy has not been clarified. This study aimed to define the prognostic significance of decreased CA19–9 levels after neoadjuvant therapy in patients with pancreatic adenocarcinoma.

Between 2001 and 2012, 240 consecutive patients received neoadjuvant therapy and subsequent resection at seven high-volume institutions in Japan. These patients were divided into three groups: Normal group (no elevation [≤37 U/ml] before and after neoadjuvant therapy), Responder group (elevated levels [> 37 U/ml] before neoadjuvant therapy but decreased levels [≤37 U/ml] afterwards), and Non-responder group (elevated levels [> 37 U/ml] after neoadjuvant therapy). Analyses of overall survival and recurrence patterns were performed. Uni- and multivariate analyses were performed to clarify the clinicopathological factors influencing overall survival. The initial metastasis sites were also evaluated in these groups.

The Responder group received a better prognosis than the Non-responder group (3-year overall survival: 50.6 and 41.6%, respectively, P = 0.026), but the prognosis was comparable to the Normal group (3-year overall survival: 54.2%, P = 0.934). According to the analysis of the receiver operating characteristic curve, the CA19–9 cut-off level defined as no elevation after neoadjuvant therapy was ≤103 U/ml. The multivariate analysis revealed that a CA19–9 level ≤ 103 U/ml, (P = 0.010, hazard ratio: 1.711; 95% confidence interval: 1.133–2.639), tumor size ≤27 mm (P = 0.040, 1.517; (1.018–2.278)), a lack of lymph node metastasis (P = 0.002, 1.905; (1.276–2.875)), and R0 status (P = 0.045, 1.659; 1.012–2.627) were significant predictors of overall survival. Moreover, the Responder group showed a lower risk of hepatic recurrence (18%) compared to the Non-responder group (31%), though no significant difference in loco-regional, peritoneal or other distant recurrence were observed between groups (P = 0.058, P = 0.700 and P = 0.350, respectively).

Decreased CA19–9 levels after neoadjuvant therapy predicts a better prognosis, with low incidence of hepatic recurrence after surgery.

The online version of this article (10.1186/s12885-019-5460-4) contains supplementary material, which is available to authorized users.

• Carbohydrate antigen 19–9
• Neoadjuvant therapy
• Pancreatic cancer

• Aggressive surgical resection
• Borderline resectable pancreatic cancer
• Degree of PV contact
• Portal venous patency

• Aged
• Antineoplastic Agents/therapeutic use
• Carcinoma, Pancreatic Ductal/therapy
• Chemoradiotherapy
• Female
• Humans
• Male
• Middle Aged
• Neoadjuvant Therapy
• Pancreatectomy
• Pancreatic Neoplasms/therapy
• Portal Vein/pathology
• Portal Vein/surgery
• Retrospective Studies
• Survival Rate
• Pancreatic Neoplasms

• Aged
• Antimetabolites, Antineoplastic/administration & dosage
• Ascitic Fluid/pathology
• Carcinoembryonic Antigen/analysis
• Carcinoma, Pancreatic Ductal/mortality
• Carcinoma, Pancreatic Ductal/pathology
• Carcinoma, Pancreatic Ductal/therapy
• Chemoradiotherapy, Adjuvant
• Deoxycytidine/administration & dosage
• Deoxycytidine/analogs & derivatives
• Female
• Humans
• Incidence
• Japan/epidemiology
• Male
• Middle Aged
• Neoadjuvant Therapy
• Neoplasm Recurrence, Local/epidemiology
• Pancreatectomy
• Pancreatic Neoplasms/mortality
• Pancreatic Neoplasms/pathology
• Pancreatic Neoplasms/therapy
• Peritoneal Lavage
• Prospective Studies
• Reverse Transcriptase Polymerase Chain Reaction
• Risk Assessment
• Gemcitabine

Studies comparing upfront surgery with neoadjuvant treatment in pancreatic cancer may report only patients who underwent resection and so survival will be skewed. The aim of this study was to report survival by intention to treat in a comparison of upfront surgery versus neoadjuvant treatment in resectable or borderline resectable pancreatic cancer.

MEDLINE, Embase and the Cochrane Library were searched for studies reporting median overall survival by intention to treat in patients with resectable or borderline resectable pancreatic cancer treated with or without neoadjuvant treatment. Secondary outcomes included overall and R0 resection rate, pathological lymph node rate, reasons for unresectability and toxicity of neoadjuvant treatment.

In total, 38 studies were included with 3484 patients, of whom 1738 (49·9 per cent) had neoadjuvant treatment. The weighted median overall survival by intention to treat was 18·8 months for neoadjuvant treatment and 14·8 months for upfront surgery; the difference was larger among patients whose tumours were resected (26·1 versus 15·0 months respectively). The overall resection rate was lower with neoadjuvant treatment than with upfront surgery (66·0 versus 81·3 per cent; P < 0·001), but the R0 rate was higher (86·8 (95 per cent c.i. 84·6 to 88·7) versus 66·9 (64·2 to 69·6) per cent; P < 0·001). Reported by intention to treat, the R0 rates were 58·0 and 54·9 per cent respectively (P = 0·088). The pathological lymph node rate was 43·8 per cent after neoadjuvant therapy and 64·8 per cent in the upfront surgery group (P < 0·001). Toxicity of at least grade III was reported in up to 64 per cent of the patients.

Neoadjuvant treatment appears to improve overall survival by intention to treat, despite lower overall resection rates for resectable or borderline resectable pancreatic cancer.

PROSPERO registration number: CRD42016049374.

Improved survival with neoadjuvant treatment

Single-agent immunotherapy is ineffective against poorly immunogenic cancers, including pancreatic ductal adenocarcinoma (PDAC). The aims of this study were to demonstrate the feasibility of production of novel autologous tumor lysate vaccines from resected PDAC tumors, and verify vaccine safety and efficacy.

Fresh surgically resected tumors obtained from human patients were processed to enzymatically synthesize α-gal epitopes on the carbohydrate chains of membrane glycoproteins. Processed membranes were analyzed for the expression of α-gal epitopes and the binding of anti-Gal, and vaccine efficacy was assessed in vitro and in vivo.

Effective synthesis of α-gal epitopes was demonstrated after processing of PDAC tumor lysates from 10 different patients, and tumor lysates readily bound an anti-Gal monoclonal antibody. α-gal(+) PDAC tumor lysate vaccines elicited strong antibody production against multiple tumor-associated antigens and activated multiple tumor-specific T cells. The lysate vaccines stimulated a robust immune response in animal models, resulting in tumor suppression and a significant improvement in survival without any adverse events.

Our data suggest that α-gal(+) PDAC tumor lysate vaccination may be a practical and effective new immunotherapeutic approach for treating pancreatic cancer.

• Chemoradiotherapy
• FDG-PET
• Neoadjuvant
• Pancreatic cancer

Objective. The incidence of pancreatic cancer is estimated to be 48,960 in 2015 in the US and projected to become the second and third leading causes of cancer-related deaths by 2030. The mean costs in 2015 may be assumed to be $79,800 per patient and for each resection $164,100. Attempt is made to evaluate the results over the last 80 years, the number of survivors, and the overall survival percentage. Methods. Altogether 1230 papers have been found which deal with resections and reveal survival information. Only 621 of these report 5-year survivors. Reservation about surgery was first expressed in 1964 and five-year survival of nonresected survivors is well documented. Results. The survival percentage depends not only on the number of survivors but also on the subset from which it is calculated. Since the 1980s the papers have mainly reported the number of resections and survival as actuarial percentages, with or without the actual number of survivors being reported. The actuarial percentage is on average 2.75 higher. Detailed information on the original group (TN), number of resections, and actual number of survivors is reported in only 10.6% of the papers. Repetition occurs when the patients from a certain year are reported several times from the same institution or include survivors from many institutions or countries. Each 5-year survivor may be reported several times. Conclusion. Assuming a 10% resection rate and correcting for repetitions and the life table percentage the overall actual survival rate is hardly more than 0.3%.

• Neoadjuvant chemoradiation
• Neoadjuvant chemotherapy
• Pancreatic ductal adenocarcinoma