Background: Pancreatic cancer is a highly aggressive malignancy with a poor prognosis. Neoadjuvant chemotherapy (NAC) is increasingly used to improve survival in patients with pancreatic cancer; however, it often results in nutritional deterioration, which may negatively impact patient outcomes. Therefore, this study aimed to assess the effect of changes in nutritional status on the long-term outcomes of patients with pancreatic cancer who underwent curative surgery after NAC. Methods: This retrospective single-center study included 148 patients with pancreatic cancer who underwent curative surgery after NAC between 2010 and 2020. The Controlled Nutritional Status (CONUT) score was used to determine the nutritional status of the patients. Patients were categorized into worsened, maintained, and improved groups based on the changes in their CONUT scores before and after NAC. We compared differences in overall survival (OS) and disease-free survival (DFS) between the groups. Results: The worsened nutritional status group exhibited the shortest median OS (28 months) compared to the maintained and improved groups (39 and 66 months, respectively; p = 0.01). Additionally, the worsened group demonstrated the shortest DFS compared to the other two groups (13, 22, and 39 months, respectively; p = 0.02). Multivariate analysis identified nutritional deterioration as an independent prognostic factor for OS (hazard ratios (HR), 2.11; 95% confidence intervals (CI), 1.31–3.40; p < 0.01). Conclusions: Nutritional deterioration after NAC is a significant prognostic factor of poor survival outcomes in patients with pancreatic cancer. These findings indicate that serial nutritional assessments and treatment during NAC are crucial for improving patient outcomes.

Background: Recent studies addressing the role of adjuvant chemotherapy (AC) in cholangiocarcinoma (CCA) have been published; however, there are challenges in generalizing the findings due to different prognostic characteristics depending on tumor location and resectability. Therefore, this study aimed to investigate the role of AC in distal cholangiocarcinoma (dCCA), a common tumor subtype of CCA.Method: Data from 497 patients with dCCA who underwent curative surgery at Seoul National University Hospital between 2000 and 2019 were reviewed using prospectively collected clinicopathologic information.Results: The median overall survival (OS) and recurrence‐free survival (RFS) in the entire cohort were 62.9 and 44.0 months, respectively. AC was associated with improved five‐year OS (58.5% vs. 46.4%; p < 0.001) and RFS (49.9% vs. 40.7%; p = 0.005), particularly in patients with advanced T stages (≥ T3). Multivariate analysis revealed that AC was an independent positive prognostic factor for survival. Furthermore, adjuvant radiotherapy (RT) alone provides no survival benefit, whereas AC combined with RT (AC + RT) offers greater benefits, particularly for patients with positive resection margins.Conclusion: AC improved the postoperative survival outcomes of patients with dCCA who underwent curative surgery. Furthermore, AC + RT appears to provide greater benefits, especially for patients with positive resection margins.

To determine the safety and feasibility of totally laparoscopic distal gastrectomy (TLDG) with modified delta-shaped anastomosis, we compared the short-term outcomes of TLDG to those of laparoscopy-assisted distal gastrectomy (LADG) with Billroth I anastomosis. We analyzed the characteristics of 85 patients with gastric cancer who underwent laparoscopic distal gastrectomy with Billroth I anastomosis between January 2013 and December 2018. After propensity score matching, each group had 35 patients. Of these 85 patients, 44 underwent TLDG and 41 underwent LADG. Propensity score matching was performed with three covariates (age, underlying disease, and hypertension), and 35 patients from each group were matched 11. After matching, the TLDG group was older than the LADG group (64.5 ± 10.6 years vs. 56.3 ± 11.2 years, p = 0.003) and had more patients with hypertension (57.1% vs. 22.9%, p = 0.003). Tumors were larger in the TLDG group than in the LADG group (23.4 ± 16.2 mm vs. 16.0 ± 7.9 mm, p = 0.018). A greater proportion of patients had fever in the TLDG group than the LADG group (42.9% vs. 20.0%, p = 0.039), and C-reactive protein from postoperative days 3 to 6 was greater in the TLDG group (11.4 ± 5.7 mg/dL vs. 7.0 ± 5.0 mg/dL, p = 0.001). Although our data represent only our early experience performing TLDG with modified delta-shaped anastomosis, this procedure is relatively safe and feasible. Nevertheless, compared to LADG, which is the conventional method, the operative time for TLDG was longer. Surgeons must also watch out for anastomotic complications.

Background: Although right-sided lymph node dissection (RLND) is commonly performed during left-sided pancreatectomy for pancreatic ductal adenocarcinoma (PDAC), its oncological benefit remains controversial. In this study, we investigated whether the survival benefit of RLND depends on the tumor location in patients with left-sided PDAC. Materials and methods: Data on patients who underwent curative-intent left-sided pancreatectomy for PDAC between 2010 and 2023 were retrospectively analyzed. Patients were stratified into pancreatic body (Pb) and pancreatic tail (Pt) groups. Within each group, propensity score matching (PSM) was applied to compare patients undergoing RLND with those undergoing left-sided lymph node dissection (LLND) only. The primary endpoints were overall survival (OS) and recurrence-free survival (RFS). Results: After PSM, data from 180 patients with Pb tumors and 122 patients with Pt tumors were analyzed. The baseline characteristics of the patients were well-balanced between the groups. In the Pt group, RLND showed no significant benefit in OS (median 43 vs. 55 months; P = 0.947) or RFS (median 23 vs. 22 months; P = 0.544). In the Pb group, RLND significantly improved OS (median 95 vs. 42 months; P < 0.001) and RFS (median 65 vs. 22 months; P = 0.012). Multivariable Cox regression identified RLND as an independent protective factor for both OS [hazard ratio (HR), 0.42; 95% confidence interval (CI), 0.27–0.66; P < 0.001] and RFS (HR, 0.54; 95% CI, 0.37–0.80; P = 0.002) in the Pb group, whereas RLND was not a significant prognostic factor in the Pt group in univariable analysis (OS: HR, 0.89; 95% CI, 0.53–1.50; P = 0.665; RFS: HR, 0.83; 95% CI, 0.54–1.29; P = 0.406). Conclusion: The survival benefit of RLND in left-sided PDAC appears to be location-dependent, being more evident in tumors of the pancreatic body than in those of the pancreatic tail, thereby supporting a tailored, site-specific approach to lymphadenectomy.