ABSTRACT Objectives A sufficient amount of cancer tissue for next‐generation sequencing (NGS) is difficult to obtain from patients with unresectable cholangiocarcinoma. We evaluated whether bile cell block (CB) samples provide a DNA source of sufficient quantity and quality for NGS compared with surgical specimens. Methods NGS results of paired bile CB and surgical specimens from 14 patients were compared. Results Median number of malignant cells on one glass slide of CB specimen was 50. Although median DNA concentration and amount of extracted DNA were significantly lower in the CB than those in the surgical specimens, NGS success rate did not differ significantly (CB, 64%; surgical specimen, 86%). In a pair‐wise comparison of eight patients with successful NGS of both bile CB and surgical specimens, median gene matching rate was 99%, and median coverage rate of surgical genes based on CB genes was 100%. The presence of ≥ 30 malignant cells on a single slide was identified as a practical indicator of successful NGS of CB using receiver operating characteristic curve, and this threshold increased the NGS success rate to 80%. Conclusions As bile CB is easy to prepare in general hospitals, bile cell‐based NGS may help address the difficulty of obtaining surgical NGS samples for cholangiocarcinoma.
ABSTRACT Background/Purpose Optimal perioperative antithrombotic therapy (ATT) management during emergency cholecystectomy for acute cholecystitis remains controversial. We examined whether continuing single‐agent ATT is associated with hemorrhagic risk compared with no ATT. Methods This retrospective cohort study included 1018 patients (826 without ATT, 192 continued on single‐agent ATT) at seven institutions (2020–2023). Propensity score overlap weighting balanced 12 baseline covariates. The primary outcome was intraoperative blood loss > 100 mL; risk ratios and 95% confidence intervals were estimated via modified Poisson regression, with upper confidence bound compared against a pre‐specified risk ratio (1.5). Results The primary outcome occurred in 27.3% and 25.4% of the non‐ATT and continued‐ATT groups, respectively (risk ratio: 0.93, 95% confidence interval: 0.69–1.26). The upper bound of the confidence interval was within the pre‐specified margin. No significant differences were observed in perioperative bleeding complications or hospital stay. Secondary outcomes, sensitivity analyses, and drug‐specific subgroup analyses (including direct oral anticoagulants) yielded consistent results. Conclusions Continuing single‐agent ATT was comparable to no ATT regarding bleeding during cholecystectomy for acute cholecystitis. These findings suggest that emergency cholecystectomy can be performed without meaningful increases in hemorrhagic risk in patients for whom adequate preoperative ATT washout is not feasible.
ABSTRACT Background/Purpose Differentiating between the monoclonal spread of a single tumor and multicentric carcinogenesis in perihilar cholangiocarcinoma (PHC) with multiple nodules is a major clinical challenge. The clonal origins of these multifocal tumors remain unclear. This study used multi‐regional comprehensive genomic profiling (CGP) to investigate its biological basis. Methods We retrospectively identified 5 patients with extensive PHC and multiple nodules from 175 resected cases. Fourteen spatially distinct tumor nodules were collected from surgical specimens. Each underwent CGP using a 216‐gene panel to compare driver gene alterations and assess clonal relationships. Results Multi‐regional analysis revealed a monoclonal origin in 4 of 5 cases, with identical driver mutations in KRAS , TP53 , and ARID1A across nodules within each patient. One case was a polyclonal tumor (a possible collision‐type process), with distinct mutation profiles ( TP53 / BRAF vs. KDM6A / SMARCA4 ) in separate nodules. Conclusions In this five‐patient series, four tumors were monoclonal, likely spreading via intraductal seeding or intramural metastasis, whereas one was a polyclonal tumor not reliably distinguished by pathology alone. Although routine multi‐regional genomic analysis is not yet feasible, these hypothesis‐generating findings suggest two distinct biological pathways and require validation in larger cohorts.
ABSTRACT Introduction Gallbladder cancer is a rare but aggressive malignancy with poor prognosis even after curative‐intent surgery. Conventional survival estimates provide fixed probabilities from diagnosis and fail to reflect the evolving prognosis of patients who have already survived several years. Conditional survival (CS) offers time‐updated prognostic information, but evidence in gallbladder cancer remains limited. Methods We retrospectively analyzed 641 patients who underwent curative‐intent resection for gallbladder cancer at a tertiary referral center (2005–2019). Five‐year conditional overall survival (COS) and conditional recurrence‐free survival were estimated up to 5 years postoperatively. Analyses were stratified by age, stage, comorbidity, surgical extent, and adjuvant therapy. Results Baseline 5‐year COS was 69.4% and increased to 74.0% among patients surviving 5 years. Stage III patients showed the largest improvement (45.9%–69.4%), whereas Stage I patients remained stable. In Stage II–III disease, extended cholecystectomy was associated with improved COS (63.2%–74.3%), while simple cholecystectomy showed a decline (65.7%–48.0%). Adjuvant therapy was associated with greater COS improvement (50.4%–69.2%) than no adjuvant therapy. Older patients (≥ 70 years) and those with diabetes showed poorer outcomes. Conclusion CS provides a dynamic framework for prognostication in gallbladder cancer and may support risk‐stratified follow‐up.
ABSTRACT Pancreas–intestine composite transplantation (PITx) is a therapeutic option for patients with irreversible loss of both pancreatic and intestinal function. We report a case of PITx in a 16‐year‐old male who developed fulminant Type 1 diabetes mellitus complicated by non‐occlusive mesenteric ischemia, resulting in extensive intestinal necrosis. Despite intensive surgical and critical care management, the patient ultimately required total small intestinal resection and total pancreatectomy. After recovery from sepsis and multiorgan dysfunction, the patient's general condition stabilized, and PITx was considered an appropriate therapeutic option. The composite graft consisted of the pancreas, duodenum, small intestine, and right colon. Arterial inflow was reconstructed using a single Carrel patch incorporating the celiac axis and superior mesenteric artery, and venous outflow was established by portal vein anastomosis. Postoperatively, pancreatic endocrine function was restored, allowing stable glycemic control without exogenous insulin, and intestinal graft function enabled the gradual advancement of enteral and oral nutrition. This report highlights the key technical considerations and anatomical principles of PITx and demonstrates that tailored composite graft transplantation can restore both pancreatic and intestinal function while preserving unaffected abdominal organs in highly selected patients with combined pancreatic and intestinal failure.
