Background The prognosis and recurrence patterns of early-diagnosed pancreatic ductal adenocarcinoma (PDAC), particularly following surgical resection, remain unclear. Methods This multicenter retrospective study analyzed patients who underwent surgical resection for PDAC between 2005 and 2023. Patients were categorized according to pathological stages 0, I, and II. Recurrence patterns and survival outcomes were compared among the three groups. Multivariate analysis was performed to identify independent risk factors for remnant pancreatic recurrence, including early-stage disease, postoperative follow-up of more than 5 years, and receipt of adjuvant chemotherapy. Results A total of 349 patients were included: 51 with stage 0, 77 with stage I, and 221 with stage II PDAC. The 5-year overall survival rates were 87%, 71%, and 49% for patients with stage 0, I, and II PDAC, respectively. Remnant pancreatic recurrence was observed in 10% of patients with stage 0 PDAC and 18% of patients with stage I PDAC, compared with 5% of those with stage II PDAC. Recurrence was significantly more frequent in stage I (P < 0.001) and tended to be higher in stage 0 (P = 0.062) than in stage II. Multivariate analysis identified pathological stage 0-I and postoperative follow-up of > 5 years as independent risk factors for remnant pancreatic recurrence. Conclusions Patients with early-stage PDAC exhibit a higher risk of remnant pancreatic recurrence than those with stage II disease. These findings underscore the importance of long-term pancreas-focused surveillance in early-stage PDAC to enable timely detection of late recurrence and potentially improve patients outcomes.
Background:The "terrible triad of the shoulder" (TTS) is a rare condition involving the simultaneous occurrence of shoulder dislocation, rotator cuff tear, and nerve palsy. The mechanism underlying its development remains unclear. This study aimed to examine the dislocation characteristics in patients with TTS. Methods:Eight patients with primary anterior shoulder dislocation, electromyography-confirmed axillary nerve palsy, and magnetic resonance imaging-verified rotator cuff tears were classified as the TTS group. Another 8 patients with primary anterior shoulder dislocation but without clinical evidence of brachial plexus palsy served as the control group. On anteroposterior radiographs taken during dislocation, the distance between the inferior glenoid margin and the medial anatomical neck of the humerus was measured as the dislocation distance. The superolateral tip of the greater tuberosity was assessed as being medial or inferior to the glenoid. The presence of Hill-Sachs lesions was evaluated on postreduction computed tomography scans. Results:The dislocation distance was significantly greater in the TTS group than in controls (49.3 ± 4.4 mm vs. 33.3 ± 3.6 mm, P = .0009). The greater tuberosity was positioned medial or inferior to the glenoid during dislocation in 75% of TTS cases and 0% of controls (P = .007). Hill-Sachs lesions were absent in all TTS cases, whereas they were observed in 62.5% of the control group (P = .026). Conclusion:Excessive displacement in anterior shoulder dislocation with rotator cuff tear may be associated with axillary nerve traction. Imaging performed at the time of dislocation may help predict the occurrence of TTS.
Background:Information on long-term outcomes of colorectal endoscopic submucosal dissection (ESD) in real-world clinical practice remains limited. This study aimed to evaluate long-term local recurrence and its predictors after colorectal ESD. Methods:This prospective, multicenter study was conducted at 11 institutions in Hiroshima, Japan, and included all consecutive colorectal ESD cases (1838 lesions from 1732 patients) between 2014 and 2018. The primary outcome was the cumulative local recurrence rate. The secondary outcomes included factors associated with local recurrence, overall survival, and cancer-specific survival. Factors associated with local recurrence were evaluated using cause-specific Cox proportional hazards models using Firth's penalized partial likelihood. Results:The cumulative local recurrence rates at 1, 3, and 5 years were 0.06%, 0.64%, and 0.75%, respectively. The longest interval to recurrence was 52 months. No local recurrence was observed in patients who achieved curative resection. Rectal lesions (hazard ratio [HR] 3.93; P = 0.04), high-risk pathologic features (HR 14.3; P < 0.001), R1 resection (HR 7.59; P = 0.003), and delayed bleeding (HR 7.72; P = 0.009) were associated with local recurrence. The 5-year overall survival and cancer-specific survival rates were 95.3% and 100%, respectively; however, 1/10 patients with local recurrence developed liver and lung metastases and subsequently died 64 months after ESD. Conclusions:Colorectal ESD had a very low long-term local recurrence rate in real-world clinical settings. No recurrence was observed in patients who underwent curative resection. Long-term surveillance is warranted after noncurative resection.
Background: With the growing older adult population in developed countries, the number of older adults with cancer is also rising. Selecting appropriate treatments for these patients is challenging, owing to difficulties in assessing their tolerance to invasive surgery. This study aimed to identify the prognostic factors in octogenarians undergoing first-time hepatectomy for hepatocellular carcinoma (HCC). Methods: We enrolled 229 consecutive patients with resected HCC between 2008 and 2018, excluding three who died within 90 days post-surgery. Univariate and multivariate analyses were performed to identify variables associated with overall survival (OS) and recurrence-free survival (RFS). Results: Participants were aged 80–93 years and included 163 males and 63 females, with the majority having hepatitis C virus. Liver function was well-preserved (Child–Pugh grade A: 215; grade B: 12). Laparoscopic hepatectomy was performed in 34 patients. The following factors showed significant association with OS in the univariate analysis: age-adjusted Charlson comorbidity index (ACCI) ≥ 10, neutrophil-to-lymphocyte ratio ≥ 3, alpha-fetoprotein (AFP) > 100 ng/mL, tumor size > 50 mm, and multiple tumors. Multivariate analysis confirmed ACCI ≥ 10, AFP > 100 ng/mL, tumor size > 50 mm, and multiple tumors as independent risk factors for OS. Regarding RFS, the significant factors identified in the univariate analysis included sex, indocyanine green retention rate at 15 min > 10%, des-gamma-carboxy prothrombin > 500 mAU/mL, intraoperative bleeding, tumor size, multiple tumors, and vascular invasion. Multivariate analysis identified sex, multiple tumors, and vascular invasion as independent risk factors for RFS. Conclusions: Elevated tumor markers, multiple tumors, and ACCI ≥ 10 are risk factors for poor OS in older adults with primary HCC. Both tumor-related factors and ACCI score should be considered when selecting treatment for octogenarian patients with HCC.
