Background: The incidence of portal vein/superior mesenteric vein (PV/SMV) resection during pancreatoduodenectomy is increasing in clinical practice. This study investigated the clinical significance of preoperative PV/SMV assessment and intraoperative resection and their correlation with pathological results and long-term survival outcomes. Methods: We analyzed 443 patients undergoing pancreatoduodenectomy at a tertiary center from 2012 to 2017 based on PV/SMV resection. Subgroup analyses were performed based on preoperative PV/SMV involvement, resection, and margin status. Results: Total of 441 patients were analyzed; 175 had PV/SMV involvement on preoperative radiological assessments and 128 underwent PV/SMV resection. True pathological invasion was observed in 78 patients (60.9%), with 34.3% showing no invasion and negative margins. The positive predictive value for preoperative PV/SMV involvement was 61.7%, with a false-negative value of 28.9%. Overall survival of patients who underwent PV/SMV resection was worse than those who did not (2-year survival rate, 38.1% vs 54.9%, P < 0.001). Patients without PV/SMV resection with an rR1/R1 margin showed no decrease in survival compared to those with PV/SMV resection and R0 margins (54.9% vs 40.3%, P = 0.029). Prognostic factors included hypertension, PV/SMV resection, PV/SMV R2 margin, T stage, N stage, cell differentiation, adjuvant treatment, and recurrence. Conclusion: PV/SMV resection could ensure R0 resection but may lead to unnecessary resection. Careful consideration is essential in determining the need for PV/SMV resection. Poor survival in such patients highlights the need for tailored treatments, including neoadjuvant therapy, for those who are expected to undergo PV/SMV resections.

(1) Background: Patients with pancreatic exocrine insufficiency (PEI) have an increased risk of malnutrition, which in turn increases morbidity and mortality and is frequent in pancreatic head cancer. This study aimed to analyze the utility of PEI measured using the stool elastase (SE) level to predict the prognosis of patients with pancreatic head cancer. (2) Methods: Patients who underwent pancreaticoduodenectomy for pancreatic cancer at our institution between 2011 and 2015 were included. Only patients with data on preoperative SE levels were analyzed. Patients were classified into low and high SE groups based on preoperative SE levels (low < 100 µg/g < high). (3) Results: The median preoperative SE level was 67.2 µg/g, and 84 of 143 (58.7%) patients were included in the low SE group. The two groups had significantly different overall survival (OS) and disease-free survival (DFS), and the low SE group had a worse prognosis. In multivariate analysis, SE level < 100 µg/g and lymph node metastasis were independent poor prognostic factors for OS and DFS. (4) Discussion: PEI measured using SE levels is an independent prognostic factor in patients with pancreatic head cancer undergoing pancreaticoduodenectomy. Since poor nutritional status may be related to prognosis in patients with low levels of stool elastase preoperatively, aggressive treatment may be required.

Littles is known about the role of serum carcinoembryonic antigen (CEA) and carbohydrate antigen (CA) 19-9 on the detection of extrahepatic bile duct cancer (EBDC). This study evaluated the diagnostic accuracy of these biomarkers. A total of 710 patients who underwent surgery for EBDC at a tertiary center between 1995 and 2018 were included, with 23 patients excluded owing to concurrent pancreatobiliary diseases, which could affect serum CEA or CA19-9. For a control group, 2,310 patients who underwent cholecystectomy for benign gallbladder diseases during the same period were used. Diagnostic accuracy was evaluated using sensitivity, specificity, and area under the receiver operating characteristics curve (AUC). After excluding patients, 687 qualifying patients consisted of 488 men and 199 women with a mean age of 65.8 years. Median serum levels of CEA and CA19-9 were 1.8 ng/mL and 47.0 U/mL, respectively. CEA (cut-off: 5.0 ng/mL) showed AUC of 0.541, sensitivity of 9.0%, and specificity of 99.2%, and CA19-9 (cut-off: 37 U/mL) had AUC of 0.753, sensitivity of 56.2%, and specificity of 94.5%. According to AJCC stage, early T stage (stage 0-2) had lower sensitivity in CA19-9 (47.0% vs. 64.9%) than advanced T stage (stage 3 and 4). In addition, N0 stage showed lower sensitivity (50.1% vs. 68.8%) than lymph node metastasis. Serum CEA and CA19-9 have limited usefulness for the diagnosis of EBDC, particularly in early detection, because of their quite low sensitivity. A novel biomarker for the diagnosis of cancer will also be needed in the future.

Background/Objectives: Although local treatment has been increasingly applied to oligometastatic pancreatic ductal adenocarcinoma (PDAC), it remains unclear whether radiologically defined oligometastatic disease identifies patients who benefit from local treatment. We evaluated the survival impact of local treatment according to recurrence burden after curative resection of PDAC. Methods: We retrospectively reviewed patients who developed isolated liver or lung recurrence after curative-intent resection for PDAC between 2012 and 2021. Overall survival (OS) was compared according to metastatic organ, metastatic burden, and treatment strategy. Results: Among 269 patients (194 with liver and 75 with lung recurrences), those with lung recurrence, including those with oligometastatic disease, had significantly longer OS than those with liver recurrence. Although oligometastatic recurrence was associated with more favorable survival than multiple recurrences, no significant association between local treatment and longer OS was observed in either the liver or lung oligometastatic group in the conventional analysis. In patients with solitary lung recurrence, local treatment was associated with longer OS in the conventional analysis, but this association did not reach statistical significance in the time-dependent Cox analysis. Conclusions: Radiologically defined oligometastatic recurrence was associated with a favorable prognosis but was insufficient to identify patients likely to benefit from local treatment. Although an association between local treatment and longer survival was observed in patients with solitary lung recurrence, this finding was not statistically significant in the time-dependent Cox analysis and requires further validation.