Background:The efficacy of adjuvant treatment(AT)in ampullary cancer(AmC)remains controversial.This systematic review and meta-analysis aimed to evaluate the role of AT for AmC.Data sources:A comprehensive systematic ...Background:The efficacy of adjuvant treatment(AT)in ampullary cancer(AmC)remains controversial.This systematic review and meta-analysis aimed to evaluate the role of AT for AmC.Data sources:A comprehensive systematic search was performed in PubMed,EMBASE,Cochrane Library,and Web of Science databases.Studies comparing overall survival(OS)and recurrence-free survival(RFS)of patients who underwent AT or not following AmC resection were included.Results:A total of 3971 patients in 21 studies were analyzed.Overall pooled data showed no significant difference in effect on the OS by AT[hazard ratio(HR)=0.998,95%confidence interval(CI):0.768–1.297].No significant difference in recurrence between the AT and non-AT(nAT)groups was noted(HR=1.158,95%CI:0.764–1.755).In subgroup analysis,patients who received AT showed favorable outcomes in the OS compared with those who received nAT in nodal-positive AmC(HR=0.627,95%CI:0.451–0.870).Neither AT consisted of adjuvant chemotherapy with radiotherapy(HR=0.804,95%CI:0.563–1.149)nor AT with adjuvant chemotherapy(HR=0.883,95%CI:0.642–1.214)showed any significant effect on the OS.Conclusions:The effect of AT in AmC on survival and recurrence did not show a significant benefit.Furthermore,effectiveness according to AT strategies did not show enhancement in survival.AT had an advantage in survival compared with nAT strategy in nodal-positive AmC.In cases of AmC with positive lymph nodal involvement,AT may be warranted regardless of detailed strategies.展开更多
Background:Endoscopic papillectomy(EP)is an effective method to remove an ampulla of Vater(AoV)adenoma with minimal invasiveness.We reviewed the clinical outcomes and prognosis of patients undergoing EP,including tumo...Background:Endoscopic papillectomy(EP)is an effective method to remove an ampulla of Vater(AoV)adenoma with minimal invasiveness.We reviewed the clinical outcomes and prognosis of patients undergoing EP,including tumor recurrence and adverse events.Methods:A total of 196 patients who underwent EP from January 2004 to December 2017 were included.Clinical information was collected through electronic medical records,and risk factors to predict postprocedural bleeding were analyzed using a multivariate logistic regression model.Results:A total of 93.9%patients(184/196)underwent complete resection.During the follow-up period,14.7%patients(27/184)experienced tumor recurrence,and two of seven surgically resected tumors were malignant.A total of 45.4%patients(89/196)experienced adverse events related to EP.Delayed bleeding occurred in 16.3%of the patients(32/196),and they were all successfully treated with endoscopic hemostasis and conservative management.The most frequent site of delayed bleeding was the distal end of the papillary orifice,and 56.3%(18/32)patients of delayed bleeding were classified as having mild severity,the others had moderate severity.Familial adenomatous polyposis(FAP)[odds ratio(OR)=3.80,95%confidence interval(CI):1.01-14.29;P<0.05]and male sex(OR=2.82,95%CI:1.04-7.63;P=0.04)showed statistical significance in predicting delayed post-EP bleeding.Conclusions:EP for AoV adenoma was a highly effective and safe procedure.The risk of post-EP delayed bleeding was increased in patients with FAP syndrome and male patients,and post-EP bleeding occurred most commonly in the distal part of the AoV.展开更多
Background:Endoscopic ultrasound-guided ethanol ablation(EUS-EA)for pancreatic cystic lesions(PCLs)has been used in recent years as a feasible treatment modality for low malignant probability PCLs or patients consider...Background:Endoscopic ultrasound-guided ethanol ablation(EUS-EA)for pancreatic cystic lesions(PCLs)has been used in recent years as a feasible treatment modality for low malignant probability PCLs or patients considered high-risk for surgery.The present study aimed to confirm the safety of EUS-EA and to find predictive factors for adverse event(AE).Methods:A retrospective review was performed from the prospectively maintained database of patients who underwent EUS-EA for PCLs from June 2006 to April 2018 at Seoul National University Hospital.The primary outcomes of the study were the rates of AEs and severe AEs by EUS-EA.The secondary outcome was the predictive factors of AEs including acute pancreatitis and abdominal pain.Results:A total of 214 patients were evaluated and the diagnoses of PCLs according to cystic fluid analysis and clinical features were as follows:serous cystic neoplasm(32.2%),mucinous cystic neoplasm(26.6%),branch duct type intraductal papillary mucinous neoplasm(BD-IPMN)(29.4%),and pseudocyst(11.7%).Three patients(1.4%)experienced severe AEs.Overall,AEs occurred in 71(33.2%)patients.BD-IPMN(OR:2.87;95%CI:1.05–7.84;P=0.040),multilocular cysts(OR:3.59;95%CI:1.09–11.85;P=0.036),suspected ethanol leakage during procedure(OR:10.68;95%CI:1.98–57.53;P=0.006),and sticky cystic fluid(OR:3.83;95%CI:1.20–12.24;P=0.024)were predictive factors for post-procedural acute pancreatitis.PCLs of uncinate process(OR:2.99;95%CI:1.22–7.35;P=0.017)and PCLs with exophytic portion(OR:3.70;95%CI:1.96–7.01;P<0.001)were predictive factors for post-procedural abdominal pain.Conclusions:EUS-EA is a safe procedure with a very low rate of severe AEs.It seems possible to predict the AEs according to the features of the procedure and PCLs.展开更多
Background:Stent insertion for biliary decompression to relieve jaundice and subsequent biliary infection is necessary for patients with biliary obstruction caused by pancreatic cancer,and it is important to keep the ...Background:Stent insertion for biliary decompression to relieve jaundice and subsequent biliary infection is necessary for patients with biliary obstruction caused by pancreatic cancer,and it is important to keep the stent patent as long as possible.However,few studies have compared stent patency in terms of chemotherapy in patients with pancreatic cancer.This study aimed to evaluate the differences in stent patency in terms of recently evolving chemotherapy.Methods:Between January 2015 and May 2017,161 patients with pancreatic cancer who had undergone biliary stent insertion with a metal stent were retrospectively analyzed.The relationship between chemotherapy and stent patency was assessed.Additionally,overall survival according to the treatment,risk factors for stent patency,and long-term adverse events were evaluated.Results:Median stent patency was 42 days for patients with the best supportive care and 217 days for patients with chemotherapy(conventional gemcitabine-based chemotherapy and folfirinox)(P<0.001).Furthermore,the folfirinox group showed the longest median stent patency and overall survival,with 283 days and 466 days,respectively(P<0.001)despite higher adverse events rate.Patients who underwent folfirinox chemotherapy after stent insertion had better stent patency in multivariate analysis(HR=0.26;95%CI:0.12–0.60;P=0.001).Conclusions:Compared with patients who received best supportive care only,patients who underwent chemotherapy after stent insertion had better stent patency.More prolonged stent patency can be expected for patients with folfirinox than conventional gemcitabine-based chemotherapy.展开更多
Background:Endoscopic biliary drainage is the treatment of choice for patients with malignant distal common bile duct obstruction.Self-expandable metal stents have clinical advantages including an increased duration o...Background:Endoscopic biliary drainage is the treatment of choice for patients with malignant distal common bile duct obstruction.Self-expandable metal stents have clinical advantages including an increased duration of patency that may be prolonged by acetylsalicylic acid(ASA)use.The aim of this study was to investigate whether ASA had a positive effect on the patency of self-expandable metal stents compared with placebo.Methods:This prospective,multicenter,double-blinded,and randomized placebo-controlled trial was conducted from October 2017 to May 2020 in Korea.Patients who underwent palliative endoscopic biliary drainage with self-expandable metal stents for malignant distal bile duct obstruction were enrolled,and allocated to ASA treatment or placebo.The study outcomes were the rate of stent dysfunction at 6 months,duration of stent patency,risk factors for stent dysfunction,and any adverse events.Results:Interim analysis included 24 and 28 patients in the ASA and placebo groups,respectively.There was no significant difference between the ASA and placebo groups in stent dysfunction(25.0%vs.20.7%,P=0.761)or the duration of stent patency(150.97±10.55 vs.158.07±8.70 days,P=0.497).Six patients experienced suspected ASA-related adverse events,and there was one lethal case.Conclusions:ASA did not prolong stent patency.This study was terminated early because of the possibility of serious adverse events related to ASA treatment of these patients receiving palliative care.展开更多
文摘Background:The efficacy of adjuvant treatment(AT)in ampullary cancer(AmC)remains controversial.This systematic review and meta-analysis aimed to evaluate the role of AT for AmC.Data sources:A comprehensive systematic search was performed in PubMed,EMBASE,Cochrane Library,and Web of Science databases.Studies comparing overall survival(OS)and recurrence-free survival(RFS)of patients who underwent AT or not following AmC resection were included.Results:A total of 3971 patients in 21 studies were analyzed.Overall pooled data showed no significant difference in effect on the OS by AT[hazard ratio(HR)=0.998,95%confidence interval(CI):0.768–1.297].No significant difference in recurrence between the AT and non-AT(nAT)groups was noted(HR=1.158,95%CI:0.764–1.755).In subgroup analysis,patients who received AT showed favorable outcomes in the OS compared with those who received nAT in nodal-positive AmC(HR=0.627,95%CI:0.451–0.870).Neither AT consisted of adjuvant chemotherapy with radiotherapy(HR=0.804,95%CI:0.563–1.149)nor AT with adjuvant chemotherapy(HR=0.883,95%CI:0.642–1.214)showed any significant effect on the OS.Conclusions:The effect of AT in AmC on survival and recurrence did not show a significant benefit.Furthermore,effectiveness according to AT strategies did not show enhancement in survival.AT had an advantage in survival compared with nAT strategy in nodal-positive AmC.In cases of AmC with positive lymph nodal involvement,AT may be warranted regardless of detailed strategies.
文摘Background:Endoscopic papillectomy(EP)is an effective method to remove an ampulla of Vater(AoV)adenoma with minimal invasiveness.We reviewed the clinical outcomes and prognosis of patients undergoing EP,including tumor recurrence and adverse events.Methods:A total of 196 patients who underwent EP from January 2004 to December 2017 were included.Clinical information was collected through electronic medical records,and risk factors to predict postprocedural bleeding were analyzed using a multivariate logistic regression model.Results:A total of 93.9%patients(184/196)underwent complete resection.During the follow-up period,14.7%patients(27/184)experienced tumor recurrence,and two of seven surgically resected tumors were malignant.A total of 45.4%patients(89/196)experienced adverse events related to EP.Delayed bleeding occurred in 16.3%of the patients(32/196),and they were all successfully treated with endoscopic hemostasis and conservative management.The most frequent site of delayed bleeding was the distal end of the papillary orifice,and 56.3%(18/32)patients of delayed bleeding were classified as having mild severity,the others had moderate severity.Familial adenomatous polyposis(FAP)[odds ratio(OR)=3.80,95%confidence interval(CI):1.01-14.29;P<0.05]and male sex(OR=2.82,95%CI:1.04-7.63;P=0.04)showed statistical significance in predicting delayed post-EP bleeding.Conclusions:EP for AoV adenoma was a highly effective and safe procedure.The risk of post-EP delayed bleeding was increased in patients with FAP syndrome and male patients,and post-EP bleeding occurred most commonly in the distal part of the AoV.
文摘Background:Endoscopic ultrasound-guided ethanol ablation(EUS-EA)for pancreatic cystic lesions(PCLs)has been used in recent years as a feasible treatment modality for low malignant probability PCLs or patients considered high-risk for surgery.The present study aimed to confirm the safety of EUS-EA and to find predictive factors for adverse event(AE).Methods:A retrospective review was performed from the prospectively maintained database of patients who underwent EUS-EA for PCLs from June 2006 to April 2018 at Seoul National University Hospital.The primary outcomes of the study were the rates of AEs and severe AEs by EUS-EA.The secondary outcome was the predictive factors of AEs including acute pancreatitis and abdominal pain.Results:A total of 214 patients were evaluated and the diagnoses of PCLs according to cystic fluid analysis and clinical features were as follows:serous cystic neoplasm(32.2%),mucinous cystic neoplasm(26.6%),branch duct type intraductal papillary mucinous neoplasm(BD-IPMN)(29.4%),and pseudocyst(11.7%).Three patients(1.4%)experienced severe AEs.Overall,AEs occurred in 71(33.2%)patients.BD-IPMN(OR:2.87;95%CI:1.05–7.84;P=0.040),multilocular cysts(OR:3.59;95%CI:1.09–11.85;P=0.036),suspected ethanol leakage during procedure(OR:10.68;95%CI:1.98–57.53;P=0.006),and sticky cystic fluid(OR:3.83;95%CI:1.20–12.24;P=0.024)were predictive factors for post-procedural acute pancreatitis.PCLs of uncinate process(OR:2.99;95%CI:1.22–7.35;P=0.017)and PCLs with exophytic portion(OR:3.70;95%CI:1.96–7.01;P<0.001)were predictive factors for post-procedural abdominal pain.Conclusions:EUS-EA is a safe procedure with a very low rate of severe AEs.It seems possible to predict the AEs according to the features of the procedure and PCLs.
基金the Institutional Review Board of Seoul National University Hospital(No.1711–107–901).
文摘Background:Stent insertion for biliary decompression to relieve jaundice and subsequent biliary infection is necessary for patients with biliary obstruction caused by pancreatic cancer,and it is important to keep the stent patent as long as possible.However,few studies have compared stent patency in terms of chemotherapy in patients with pancreatic cancer.This study aimed to evaluate the differences in stent patency in terms of recently evolving chemotherapy.Methods:Between January 2015 and May 2017,161 patients with pancreatic cancer who had undergone biliary stent insertion with a metal stent were retrospectively analyzed.The relationship between chemotherapy and stent patency was assessed.Additionally,overall survival according to the treatment,risk factors for stent patency,and long-term adverse events were evaluated.Results:Median stent patency was 42 days for patients with the best supportive care and 217 days for patients with chemotherapy(conventional gemcitabine-based chemotherapy and folfirinox)(P<0.001).Furthermore,the folfirinox group showed the longest median stent patency and overall survival,with 283 days and 466 days,respectively(P<0.001)despite higher adverse events rate.Patients who underwent folfirinox chemotherapy after stent insertion had better stent patency in multivariate analysis(HR=0.26;95%CI:0.12–0.60;P=0.001).Conclusions:Compared with patients who received best supportive care only,patients who underwent chemotherapy after stent insertion had better stent patency.More prolonged stent patency can be expected for patients with folfirinox than conventional gemcitabine-based chemotherapy.
基金supported by a grant from the Seoul National University Hospital Research Fund(0620173640)。
文摘Background:Endoscopic biliary drainage is the treatment of choice for patients with malignant distal common bile duct obstruction.Self-expandable metal stents have clinical advantages including an increased duration of patency that may be prolonged by acetylsalicylic acid(ASA)use.The aim of this study was to investigate whether ASA had a positive effect on the patency of self-expandable metal stents compared with placebo.Methods:This prospective,multicenter,double-blinded,and randomized placebo-controlled trial was conducted from October 2017 to May 2020 in Korea.Patients who underwent palliative endoscopic biliary drainage with self-expandable metal stents for malignant distal bile duct obstruction were enrolled,and allocated to ASA treatment or placebo.The study outcomes were the rate of stent dysfunction at 6 months,duration of stent patency,risk factors for stent dysfunction,and any adverse events.Results:Interim analysis included 24 and 28 patients in the ASA and placebo groups,respectively.There was no significant difference between the ASA and placebo groups in stent dysfunction(25.0%vs.20.7%,P=0.761)or the duration of stent patency(150.97±10.55 vs.158.07±8.70 days,P=0.497).Six patients experienced suspected ASA-related adverse events,and there was one lethal case.Conclusions:ASA did not prolong stent patency.This study was terminated early because of the possibility of serious adverse events related to ASA treatment of these patients receiving palliative care.
