Pancreatic carcinoma constitutes to be a major unsolved health problems worldwide. Because of difficulties in diagnosis, the aggressiveness of pancreatic cancers, and the lack of effective systemic therapies, only less than 5% of patients with pancreatic cancer will be alive 5 years after diagnosis. At the time of diagnosis of pancreatic cancer, less than 20% of patients present with tumors that are confined to the pancreas, and therefore only 10~20% undergo resection with curative intent. The majority of patients present with locally advanced and metastatic disease, whose median survival is only 6~9 months and 3~6 months, respectively. The result of chemotherapy, mainly based on 5-FU, have documented low response rate and little impact on survival or quality of life. However, during the past 10 years, a real progress has been made in the area of chemotherapy for pancreatic cancer with the introduction of gemcitabine. Gemcitabine have shown improved overall survival (5.65 months vs. 4.41 months) and clinical benefit response (23.8% vs. 4.8%) compared with standard 5-FU-based chemotherapy. Therefore, gemcitabine has replaced 5-fluorouracil-based chemotherapy as the standard of care. Subsequent trials have also suggested that combinations of gemcitabine with other agents, such as cisplatin, irinotecan or capecitabine, may further improve clinical benefits in patients with advanced pancreatic cancers. One promising combination is gemcitabine plus oxaliplatin (GEMOX), that was reported in 2003. The response rate of GEMOX and gemcitabine alone was 25.8% and 16.1% (p=0.05). The time to progression was also significantly prolonged in GEMOX arm compared to gemctabine (25 weeks vs 16 weeks). In addition, other several efforts including alternative method of gemibitabine infusion as well as novel drug-combination have been made to improve the prognosis. Novel drugs include pemetrexed, S-1, cetuximab, and bevacizumab, etc. For instance, the response rate and 1-year survival of patients who treated with gemicitabine plus bevacizumab, a monoclonal blocking antibody of VEGF, was 38% and 54%, respectively. In conclusion, a shift in paradigms has occurred in the management of pancreatic cancer with respect to systemic therapy. The use of chemotherapy improved survival, reduced tumor-related symptoms, and achieved significant clinical benefit response in one third of patients. New targets for therapy through rapidly evolving understanding of the molecular biology of pancreatic cancer hold promise for even more effective treatment in the near future.
Arm ; Carcinoma, Pancreatic Ductal ; Cisplatin ; Diagnosis ; Drug Therapy* ; Fluorouracil ; Humans ; Molecular Biology ; Pancreas ; Pancreatic Neoplasms* ; Prognosis ; Quality of Life ; Standard of Care ; Vascular Endothelial Growth Factor A ; Bevacizumab ; Capecitabine ; Cetuximab ; Pemetrexed

In Korea, the incidence of pancreatic cancer was 9th and the mortality was 5th in 2002. The unique modality to cure is a surgery, however the resectability is around 10~20%. The survival data of pancreatic cancer after resection in '60s ~'70s were disappointing; operative mortalities were as high as 20~30% with 5-year survival rates were about 5%. However, from '90s, there have been several papers which reports the operative mortalities less than 5% and the 5-year survival rates over 20% after resection. However it is not clear whether survival in pancreatic cancer after surgery has been really improving or not. Prognostic factors in pancreatic cancer after resection can be classified into 3 categories; factors related to the patient, the tumor and the surgeon. At present, the most important prognostic factors are tumor factors such as tumor size, lymph node metastasis, depth of invasion, and histological differentiation. The factors related to the minimal residual disease or molecular biologic studies would get more concern. Staging in the malignancy is very important in predicting the prognosis and determining the adjuvant therapies. Good stages should be a good prognosis predictor and be simple as well. In pancreatic cancer, TNM staging from AJCC/UICC has been used worldwide and the 6th edition was published in 2001. JPS (Japanese pancreatic society) staging for pancreatic cancer, compared to AJCC staging, is better in predicting the prognosis but somewhat complicated. Studies for the prognostic factors and staging for Korean pancreatic cancer cases should be followed.
Humans ; Incidence ; Korea ; Lymph Nodes ; Mortality ; Neoplasm Metastasis ; Neoplasm Staging ; Neoplasm, Residual ; Pancreatic Neoplasms* ; Prognosis ; Survival Rate

Pancreatic cancer continues to pose a major problematic concerns of all forms of gastrointestinal malignancy because of its worst survival. Although the progressions were made in surgical treatment in terms of increasing resection rate and decreasing treatment related morbidity and mortality, the true survival rate remains below 3% today. Surgical options for surgrcal extent and types in pancreas cancer are based on its unique anatomy and physiology, catastrophic tumor biology, experience of surgeon, and status of patients or pancreas. Four main options exist for surgical extent and types in pancreas cancer. They include standard 'Whipple' pancreaticoduodenectomy (PD), pylorus preserving PD, distal pancreatectomy (left side pancreatectomy), and total pancreatectomy. Portal vein involvement with tumor is regarded as a anatomical extension of disease, and en bloc resection of portal vein with tumor is recommended if it is feasible technically, which is shown up in 2002 AJCC tumor staging for pancreas cancer. Comparing the survival times after standard and extended resection of pancreas head cancer no significant survival benefits demonstrated from the retro and prospective reports. PPPD may be superior to standard PD in respect to outcomes of nutrition and quality of life without any deleterious effect of long term survival or recurrence. Conclusively, in the future, multicenter prospective randomized trail should be carried out to clarify the effect of various options and to improve the survival times on th basis of standardization of surgical technique and evidence based data.
Biology ; Carcinoma, Pancreatic Ductal ; Head and Neck Neoplasms ; Humans ; Mortality ; Neoplasm Staging ; Pancreas ; Pancreatectomy ; Pancreatic Neoplasms* ; Pancreaticoduodenectomy ; Physiology ; Portal Vein ; Pylorus ; Quality of Life ; Recurrence ; Survival Rate

The ductal system of the pancreas, which is responsible for carrying acinar secretion to the duodenum, is perhaps the smallest epithelial component of the pancreas. However, most pancreatic tumors are of ductal origin, and a majority of these are ductal adenocarcinomas. Pancreatic carcinomas of ductal type can be separated into several categories: 1. Conventional ductal adenocarcinoma (tumors that form small tubular glands with luminal and intracellular mucin and are associated with marked stromal desmoplasia). 2. Unusual histological patterns of conventional ductal adenocarcinoma (e.g., foamy gland pattern, large duct pattern, vacuolated pattern, lobular carcinoma-like pattern). 3. Other carcinomas of ductal origin (e.g., colloid carcinoma, adenosquamous carinoma, squamous cell carcinoma, and undifferentiated carcioma). Most tumors in this last category usually have an associated component of conventional ductal adenocarcinoma, which provides evidence of their ductal origin. Precursors of pancreatic ductal adenocarcinoma have been recognized as proliferative epithelium of the ducts. Some lesions with minimal cytologic atypia were not regarded to be neoplastic and were designated hyperplasia or metaplasia, but molecular study revealed most ductal proliferative lesions as neoplastic. Thus the entire spectrum of ductal proliferative lesion is referred to as pancreatic intraepithelial neoplasia (PanIN).
Adenocarcinoma ; Adenocarcinoma, Mucinous ; Carcinoma, Pancreatic Ductal ; Carcinoma, Squamous Cell ; Classification* ; Duodenum ; Epithelium ; Hyperplasia ; Metaplasia ; Mucins ; Pancreas ; Pancreatic Ducts ; Pancreatic Neoplasms ; Phenobarbital ; Precancerous Conditions

Mesenchymal tumors of the pancreas are quite rare, accounting for less than 1% of all pancreatic tumors. Mesenchymal tumors in the gastrointestinal tract are mainly gastrointestinal stromal tumors (GISTs). GISTs are defined as KIT-positive mesenchymal spindle cells or epithelioid neoplasms originating from the interstitial cell of Cajal. GISTs occur mainly in the stomach, small intestine, colorectum and esophagus. However, extra-gastrointestinal stromal tumors in the bladder, gallbladder, omentum, and mesentery are rare. We report a case of GIST in the pancreas head. A 55-year-old female patient was referred to our hospital for a pancreas head mass detected by a CT scan checked for a fever with an unknown origin. She underwent Whipple's operation for the 5.5x4.4cm-sized mass located in the pancreas head. A microscopic examination revealed GIST showing positive c-KIT protein expression with <5/50 HPF mitosis. C-KIT gene analysis revealed a mutation in exon 9. To the best of our knowledge, this is the first case of extra-gastrointestinal stromal tumor of the pancreas demonstrated by histology, immunohistochemistry and genetic analysis in Korea.
Esophagus ; Exons ; Female ; Fever ; Gallbladder ; Gastrointestinal Stromal Tumors ; Gastrointestinal Tract ; Head ; Humans ; Immunohistochemistry ; Intestine, Small ; Korea ; Mesentery ; Middle Aged ; Mitosis ; Omentum ; Pancreas* ; Proto-Oncogene Proteins c-kit ; Stomach ; Tomography, X-Ray Computed ; Urinary Bladder

OBJECTIVE: To evaluate the impact of preoperative transarterial chemoembolization (TACE) for the treatment of patients undergoing curative liver resection for hepatocellular carcinoma (HCC). PATIENTS AND METHODS: Preoperative TACE was performed in 164 of 339 HCC patients that had a curative resection and follow-up. Retrospective clinico-pathological analysis was performed with regard to the safety and response to treatment, early and late incidence and the pattern of recurrence as well as survival. RESULTS: For 159 patients in the TACE group (96.9%), TACE was performed preoperatively only once. The mean waiting time from TACE to resection was 19.5 days. There was no difference in the operative time, postoperative mortality and duration of hospital stay after resection between the two groups (patients that underwent TACE and patients that did not undertake the procedure). Ed-highlight-you did not define the two groups-is the above description in parentheses accurate? Microvascular invasion was significantly decreased in the TACE group (p < 0.01) and complete necrosis of the tumor was induced in 21 patients (12.8%) of the TACE group. Early and late recurrence patterns were not different between patients in the two groups. Overall survival and disease-free survival rate was not different between patients in both groups. However, the 3 year disease-free survival rate was significantly improved in the TACE group (p = 0.04) and the 3 year disease-free survival rate was also improved (p = 0.06), especially for patients with AJCC stage I or II. Multivariate analysis showed microvascular invasion, large tumor size, the presence of daughter nodules, gross portal invasion, Child classification and histological stage of cirrhosis to be risk factors for HCC recurrence and poor survival. CONCLUSION: Preoperative TACE is a safe procedure and can improve early postoperative recurrence and survival, especially in stage I or II HCC patients.
Carcinoma, Hepatocellular* ; Child ; Classification ; Disease-Free Survival ; Fibrosis ; Follow-Up Studies ; Humans ; Incidence ; Length of Stay ; Liver ; Mortality ; Multivariate Analysis ; Necrosis ; Nuclear Family ; Operative Time ; Recurrence ; Retrospective Studies ; Risk Factors

PUROPSE: The liver is a major site for the metastatic spread of primary colorectal cancers.. Among the various modalities of treatment for hepatic metastasis of colorectal cancer, hepatic resection has been proven to be the most effective treatment. This analysis was intended to review our experience with hepatic resection for colorectal cancer liver metastases. MATERIALS AND METHODS: From 1989 to 2006, we retrospectively analyzed the clinical experience of 31 patients who were underwent hepatic resection for 20 synchronous and 11 metachronous hepatic metastases from colorectal cancer. The survival rate was calculated using the Kaplan-Meier method and the log rank test. The mean follow up period was 26.7 months. RESULTS: The mean survival length of the patients was 65.08 5.00 months. Resection mortality was not observed. Age, sex, the preoperative CEA level, location, differentiation, and the surgical method for the primary tumor did not influence the survival (p>0.05). The number, largest size, sum of the largest size, and surgical method (wedge resection, segmental resection, lobectomy) for the hepatic metastasis did not influence the survival (p>0.05).Considering the time from diagnosis of the primary tumor to detection of the metastatic lesion, patients that had metachronous lesions survived longer than patients that had synchronous lesions (p=0.05). Patients that had a longer disease free interval after hepatic resection had a longer survival period (p=0.04). CONCLUSIONS: Our results suggest that hepatic resection for colorectal cancer liver metastasis is a safe procedure with a survival benefit for the patients. We especially believe that hepatic resection for metachronous hepatic metastasis of colorectal cancer may offer a chance of longer survival to these patients.
Colorectal Neoplasms* ; Diagnosis ; Follow-Up Studies ; Humans ; Liver* ; Mortality ; Neoplasm Metastasis* ; Retrospective Studies ; Survival Rate

PURPOSE: In our experience, post-LT persistent isolated unconjugated hyperbilirubinemia (IUH) has been frequently observed even after liver transplantation (LT) from normal donors. The present study was performed to evaluate the incidence and clinical significance of post-LT IUH. METHODS: Eighty-five patients were enrolled, and they had undergone adult-to-adult living donor LT between Jan 1999 and Jun 2003 and they had been followed-up for more than 2 years. Persistent post-LT IUH was defined as the case that showed repeated IUH 3 times or more per year. We excluded those cases that had other liver function abnormality, biliary complication, active infection or hemolysis. The donor's condition and the long-term prognosis of the post-LT IUH patients were investigated. RESULTS: Sixteen patients (18.8%) showed post-LT IUH. Seven of them underwent LT from donors who had IUH preoperatively. Nine (10.6%) of them, however, underwent LT from normal donors, that is, there was newly developed IUH postoperatively. There was no clinical factor associated with post-LT IUH for those nine patients, yet they developed no graft failure and major complications. A gradual increasing tendency of the bilirubin level during follow-up duration was observed for 3 of these 9 patients. CONCLUSION: Although about 10% patients developed post-LT IUH from normal donors, they all showed a good prognosis. Therefore, post-LT IUH was likely to be benign. However, close observation may be required because a gradual increasing tendency of bilirubin level was observed in some patients.
Bilirubin ; Follow-Up Studies ; Gilbert Disease ; Hemolysis ; Humans ; Hyperbilirubinemia* ; Incidence ; Liver Transplantation* ; Liver* ; Living Donors ; Prognosis ; Tissue Donors ; Transplants

OBJECTIVE: The clinical features and prognosis of intraductal papillary mucinous tumor (IPMT) of the pancreas are diverse. We reviewed the clinicopathologic features and surgical results of patients who were treated for IMPT. METHODS: WE retrospectively reviewed seven cases that were surgically resected and pathologically diagnosed. RESULTS: The mean patient age was 63.7 years and there were 6 (85.7%) symptomatic patients. The diagnostic accuracy of abdominal CT was 57.1% (n=4) and the was 71.4% (n=5). (Ed note: the last part made no sense. Put in the correct terms.) The final diagnosis was benign IPMT in 4 cases (57.1%), malignancy in 3 cases (42.9%, and borderline malignancy, carcinoma in situ and invasive carcinoma in one case each, respectively). Three cases each of pylorus preserving panreaticoduodectomy (42.9%) and distal pancreatectomy were performed (42.(%), respectively, and 1 pancreatic wedge resection (14.3%) was performed for 1 case. Three patients (42.9%) were found to have associated malignancies. The median follow-up duration was 10 months (range: 3-25). Four patients are still alive and 3 patients have died, but only one patient died of systemic metastasis. CONCLUSION: The clinicopathological features, treatment, and prognosis of IPMT are still unclear, but the significant possibility of malignancy and associated malignancies should always kept in mind and further study is required
Carcinoma in Situ ; Diagnosis ; Follow-Up Studies ; Humans ; Mucins* ; Neoplasm Metastasis ; Pancreas* ; Pancreatectomy ; Pancreatic Neoplasms ; Prognosis ; Pylorus ; Retrospective Studies ; Tomography, X-Ray Computed

No abstract available.
Pancreaticojejunostomy*