Hepatoid carcinoma (HC) is a rare type of malignant tumor that shared similar features of morphology and immunohistochemistry with hepatocellular carcinoma (HCC). Pancreatic HC exists as either pure or mixed type. Mixed pancreatic HC is extremely rare, with only a few cases reported in the literature to date. Because of the rarity of mixed pancreatic HC, its clinical features including incidence, characteristics, and prognosis remain unclear. We herein report a case of a 49-year-old man who was diagnosed with mixed pancreatic HC with neuroendocrine differentiation and was treated with pancreaticoduodenectomy and adjuvant chemotherapy. We also review the existing case reports in literature. A 49-year-old man was admitted to our hospital after a chronic abdominal pain in the upper right quadrant. Abdominal ultrasound revealed only one low-density retroperitoneal mass measured at 20 × 48mm in size in the pancreatic-duodenal junction, whereas contrast-enhanced computed tomography (CT) revealed three lymphatic neoplasms measured at 28 × 22 × 30 mm, 27 × 33 × 38 mm and 22 × 35 × 48 mm in size in the retroperitoneal pancreatic-duodenal junction. Ultrasound-guided tumor biopsy was performed. Pathological reading of tumor biopsy suspected of Paraganglioma/pheochromocytoma. Laparotomic retroperitoneal tumoral resection and lymphadenectomy was then performed. Histological reading was lymphatic metastasis of primary pancreatic hepatocellular carcinoma with neuroendocrine differentiation, which were immunohistochemically positive for CKAE1/AE3, Hepatocyte paraffin 1, Chromogranin. After three weeks of the first surgery, the patient was assigned with Positron Emission Tomography - Computed Tomography (PET-CT) before adjuvant chemotherapy, revealing a low-density high-metabolism mass, 26 × 28 mm in size within the parenchyma of pancreatic head. Laparotomic pancreaticoduodenectomy and standard lymphadenectomy was performed to resect one mass, which revealed the same immunohistology features with the first mass. The patient was followed up with FOLFIRINOX protocol, and after 12 cycles, there was no evidence of postoperative recurrence. There are few reported cases describing pancreatic hepatoid carcinoma, especially mixed form with other histological associated component. Neuroendocrine differentiation is the majority associated component with 62.5% of all cases of mixed - type form. Primary pancreatic hepatocellular carcinoma with neuroendocrine differentiation was rare, biopsy and immunohistochemistry appeared with high diagnostic value in this case. The prognosis of pancreatic HC depends on the extent and tumor eradication, and in this case we recorded no postoperative complications and no recurrence in the 6-month follow-up period.

Oxaliplatin is an anticancer drug used to treat colorectal and gastric cancers. In many cases, chemotherapy is discontinued due to adverse events caused by anticancer drugs. To address this challenge, we developed a sustained-release drug delivery system using polycaprolactone sheets embedded with oxaliplatin (oxaliplatin sheets) and evaluated their therapeutic potential in murine models of colon and gastric cancers. Antitumor efficacy was compared with conventional intraperitoneal administration by monitoring tumor volume, body weight, and systemic oxaliplatin concentrations over 21 days, along with histopathological assessment of tumors and hepatic tissue. Oxaliplatin sheets demonstrated superior tumor suppression, significantly reduced Ki-67 positivity, and mitotic indices. Additionally, antitumor effects and blood oxaliplatin levels were consistent regardless of implantation site. Notably, oxaliplatin sheets significantly decreased weight loss compared with intraperitoneal administration. In our analysis of liver pathology, we found that hepatic sinusoidal obstruction and hepatocellular degeneration were significantly increased after intraperitoneal administration compared with untreated mice and mice treated with oxaliplatin sheets. Furthermore, treatment with oxaliplatin sheets improved survival. Thus, our oxaliplatin sheets exhibited effective tumor control and reduced side effects, indicating their potential as a promising treatment for advanced gastric and colorectal cancers.

Background/Objectives: Postoperative analgesia is important for reducing biologically invasive reactions to surgery. In Japan, postoperative analgesia, including indices of analgesia, has not been adequately addressed. This study aimed to determine the relationship between postoperative pain and postoperative course and the importance of analgesia for early recovery. Methods: Patients who underwent any of seven surgical procedures in gastrointestinal, thoracic, and cardiac surgery were enrolled. The primary endpoint was a median Prince Henry Pain Scale score from postoperative days 1 to 3. Secondary endpoints were the quality of recovery on postoperative day 7 (Quality of Recovery-15 [QoR-15]) and the length of postoperative hospital stay. Results: Median postoperative pain levels among surgeries were 3 on day 1, 2 on days 2 and 3, 1 on day 7, and 1 at discharge. In both univariate and multivariate analyses, the use of postoperative epidural analgesia and intravenous patient-controlled analgesia (IV-PCA) were significant predictors of early postoperative pain. Only early postoperative pain was a significant predictor of QoR-15 score. Regular use of acetaminophen, early postoperative pain, no appetite, and postoperative complications were significant in affecting the length of postoperative hospital stay. In the comparison of early postoperative pain according to whether epidural analgesia and IV-PCA were used, the group that used both methods had the least pain. Conclusions: In Japan, early postoperative pain persists after major surgical procedures and affects postoperative quality of recovery and length of hospital stay. The use of epidural analgesia, IV-PCA, or both appeared to be effective in overcoming early postoperative pain, thereby enhancing early postoperative recovery.

Introduction: We investigated the association between the pretreatment cachexia index (CXI) and survival outcomes in patients with unresectable hepatocellular carcinoma (u-HCC) receiving atezolizumab plus bevacizumab (Atez/Bev). Methods: We conducted a retrospective analysis of 195 patients with u-HCC treated with Atez/Bev from September 2020 to December 2023. The skeletal muscle mass index (SMI) was calculated by normalizing the psoas muscle area by the square of the height (cm2/m2). The CXI was defined as the SMI × serum albumin level (g/dL)/neutrophil-to-lymphocyte ratio. Propensity score matching (PSM) was applied to minimize the effect of potential confounders. Associations between CXI, overall survival (OS), and progression-free survival (PFS) were assessed. Results: From the initial cohort, CXI cutoffs of 7.23 for males and 4.99 for females were established. PSM matched 60 pairs of patients with low and high CXI, showing no significant differences in confounding factors between groups. Kaplan-Meier analysis indicated that the low CXI group had shorter median OS (12.5 vs. 26.1 months, p = 0.009) and PFS (6.1 vs. 11.1 months, p = 0.045) compared with the high CXI group. No significant differences existed between groups in overall response rate (p = 0.994) and disease control rate (p = 0.090). Multivariate Cox proportional hazards analysis identified low CXI as an independent prognostic factor for OS (HR: 1.89, 95% CI: 1.11–3.22, p = 0.019) and PFS (HR: 1.53, 95% CI: 1.01–2.34, p = 0.047). Conclusions: The CXI may be a valuable prognostic tool for predicting survival outcomes in patients with u-HCC receiving Atez/Bev.

Background/Purpose: This study compared the efficacy of sequential hepatic vein embolization (HVE) following portal vein embolization (PVE) with PVE alone in promoting both the volume and function of the future remnant liver (FRL) before right‐sided major hepatectomy. Methods: All patients underwent preoperative PVE with or without sequential HVE, followed by right hepatectomy ± extended from 2018 to 2023. Changes in FRL volume and function were analyzed and compared between groups, with liver function assessed using technetium‐99m diethylenetriaminepentaacetic acid‐galactosyl‐human serum albumin ( ^99m Tc‐GSA) scintigraphy. Results: Eight patients underwent sequential PVE–HVE, while 24 underwent PVE alone. All patients underwent embolization without severe complications. The median regeneration rate of FRL volume was significantly higher in the sequential HVE–HVE group at 35.5% (20.6%–54.0%) compared with 26.2% (19.2%–31.0%) in the PVE group ( p = 0.017). Moreover, the median FRL function regeneration rate was 59.5% (41.6%–80.9%) in the sequential PVE–HVE group, markedly greater than the rate of 25.2% (1.2%–41.4%) in the PVE group ( p = 0.014). There was no significant difference in surgical outcomes between groups. Conclusions: Sequential PVE–HVE is safe and practical, leading to a significant increase in both the volume and function of the FRL.

To assess the effectiveness of home-based self-rehabilitation using a portable electrical muscle stimulation (EMS) device for improving severe sarcopenia by improving lower extremity function. The effect of 4 weeks of EMS training on improving lower extremity function was compared between patients divided into 2 groups based on baseline lower extremity function. Self-rehabilitation was carried out with a portable EMS device, the SIXPAD Foot Fit, and each session lasted 15-23 minutes. Lower extremity function was assessed with the Short Physical Performance Battery (SPPB). University hospital. The study included 50 older outpatients (N=50) with a mean age of 75 years; 98% had hepatobiliary cancer, and 38% were men. Not applicable. Patients were divided into 2 groups based on baseline SPPB value (SPPB ≤ 9 or SPPB >9). Lower extremity function was observed prospectively during 4 weeks of home-based self-rehabilitation. EMS was used consistently, with a median duration of use of 28 days. In the baseline SPPB>9 group, lower extremity function was not significantly improved (SPPB, 11.0-12.0; P=.290). In contrast, significant improvement was observed in the baseline SPPB ≤ 9 group, and the total score (SPPB score, 8.0-9.0; P=.001) and 2 of its 3 components, balance (balance score, 3.0-4.0; P=.009) and gait speed (gait speed score, 3.0-4.0; P=.002), improved significantly. Sit-to-stand ability did not improve (Sit-to-stand score, 1.0-2.0; P=.060). As a result, the proportion of patients with severe sarcopenia was initially 66.7% but decreased significantly to 36.4% (P=.002). A home-based, self-rehabilitation program using a portable EMS device may improve lower extremity function and attenuate sarcopenic status in older patients with cancer with reduced lower extremity function.