1.Impact of sarcopenia on biliary drainage during neoadjuvant therapy for pancreatic cancer
Kunio KATAOKA ; Eizaburo OHNO ; Takuya ISHIKAWA ; Kentaro YAMAO ; Yasuyuki MIZUTANI ; Tadashi IIDA ; Hideki TAKAMI ; Osamu MAEDA ; Junpei YAMAGUCHI ; Yukihiro YOKOYAMA ; Tomoki EBATA ; Yasuhiro KODERA ; Hiroki KAWASHIMA
Clinical Endoscopy 2024;57(1):112-121
Background/Aims:
Since the usefulness of neoadjuvant chemo(radiation) therapy (NAT) for pancreatic cancer has been demonstrated, recurrent biliary obstruction (RBO) in patients with pancreatic cancer with a fully covered self-expandable metal stent (FCSEMS) during NAT is expected to increase. This study investigated the impact of sarcopenia on RBO in this setting.
Methods:
Patients were divided into normal and low skeletal muscle index (SMI) groups and retrospectively analyzed. Patient characteristics, overall survival, time to RBO (TRBO), stent-related adverse events, and postoperative complications were compared between the two groups. A Cox proportional hazard model was used to identify the risk factors for short TRBO.
Results:
A few significant differences were observed in patient characteristics, overall survival, stent-related adverse events, and postoperative complications between 38 patients in the normal SMI group and 17 in the low SMI group. The median TRBO was not reached in the normal SMI group and was 112 days in the low SMI group (p=0.004). In multivariate analysis, low SMI was the only risk factor for short TRBO, with a hazard ratio of 5.707 (95% confidence interval, 1.148–28.381; p=0.033).
Conclusions
Sarcopenia was identified as an independent risk factor for RBO in patients with pancreatic cancer with FCSEMS during NAT.
2.Clinical practice guidelines for the management of biliary tract cancers 2019: the 3rd English edition
Masato NAGINO ; Satoshi HIRANO ; Hideyuki YOSHITOMI ; Taku AOKI ; Katsuhiko UESAKA ; Michiaki UNNO ; Tomoki EBATA ; Masaru KONISHI ; Keiji SANO ; Kazuaki SHIMADA ; Hiroaki SHIMIZU ; Ryota HIGUCHI ; Toshifumi WAKAI ; Hiroyuki ISAYAMA ; Takuji OKUSAKA ; Toshio TSUYUGUCHI ; Yoshiki HIROOKA ; Junji FURUSE ; Hiroyuki MAGUCHI ; Kojiro SUZUKI ; Hideya YAMAZAKI ; Hiroshi KIJIMA ; Akio YANAGISAWA ; Masahiro YOSHIDA ; Yukihiro YOKOYAMA ; Takashi MIZUNO ; Itaru ENDO
Chinese Journal of Digestive Surgery 2021;20(4):359-375
The Japanese Society of Hepato-Biliary-Pancreatic Surgery launched the clinical practice guidelines for the management of biliary tract cancers (cholangiocarcinoma, gallbladder cancer, and ampullary cancer) in 2007, then published the 2nd version in 2014. In this 3rd version, clinical questions (CQs) were proposed on six topics. The recommendation, grade for recommendation, and statement for each CQ were discussed and finalized by an evidence-based approach. Recommendations were graded as grade 1 (strong) or grade 2 (weak) according to the concepts of the grading of recommendations assessment, development, and evaluation system. The 31 CQs covered the six topics: (1) prophylactic treatment, (2) diagnosis, (3) biliary drainage, (4) surgical treatment, (5) chemotherapy, and (6) radiation therapy. In the 31 CQs, 14 recommendations were rated strong and 14 recommendations weak. The remaining three CQs had no recommendation. Each CQ includes a statement of how the recommendations were graded. This latest guideline provides recommendations for important clinical aspects based on evidence. Future collaboration with the cancer registry will be key for assessing the guidelines and establishing new evidence.