Masato Katoh

Effect of billroth II or Roux-en-Y reconstruction for the gastrojejunostomy on delayed gastric emptying after pancreaticoduodenectomy: a randomized controlled study.

Objective:Delayed gastric emptying (DGE) is one of the major complications after pancreaticoduodenectomy (PD), occurring in 14% to 61% of cases. There have been no studies that compare the incidence of DGE in terms of the reconstruction method of gastrojejunostomy performed in subtotal stomach-preserving pancreaticoduodenectomy (SSPPD). The objective of this study was to evaluate the superiority of Billroth II (B-II) to Roux-en Y (R-Y) reconstruction on decreasing the incidence of delayed gastric emptying DGE after SSPPD by a prospective randomized controlled trial. Methods:Between April 2008 and August 2011, 101 patients who underwent SSPPD for pancreatic head or periampullary diseases were randomly allocated to B-II reconstruction (n = 52) and R-Y reconstruction (n = 49) groups. The primary endpoint was incidence of DGE. Results:DGE occurred in 5.7% of patients in the B-II group and in 20.4% of patients in the R-Y group (P = 0.028). Patients in the B-II group had a significantly shorter hospital stay after operation than patients in the R-Y group (31.6 ± 15.0 days vs. 41.4 ± 20.5 days, P = 0.037). In terms of postoperative complications, the incidence of pancreatic fistula was significantly higher in patients with DGE (38.5%) than in patients without DGE (14.8%) (P = 0.037). Conclusion:It is suggested that the incidence of DGE after SSPPD can be decreased by using B-II rather than R-Y reconstruction for gastrojejunostomy.(Clinical Trials Registry, UMIN-CTR: http://www.umin.ac.jp/ctr/, ref no. UMIN000003535),

The Glasgow Prognostic Score Is a Good Predictor of Treatment Outcome in Patients with Unresectable Pancreatic Cancer

Background: We analyzed the outcome of patients with advanced unresectable pancreatic cancer treated in our department from 2001 to 2008. Methods: Of the 83 patients included in this study, 50 patients received single-agent treatment with gemcitabine (GEM), 9 patients GEM combined with radiotherapy (GEM+R) and 24 patients had best supportive care (BSC). We analyzed survival rates among the groups and risk factors for each group. Results: The 3-year survival rates were dismal: GEM group 2.9%, GEM+R group 0% and BSC group 0%. Significant prognostic factors of the study were: performance status (PS), response rate and decrease in the CA19-9 level. Significant prognostic factors by the Cox proportional hazard model were the albumin level prior to treatment, CA19-9 levels before treatment, decrease in CA19-9 and response rate. Albumin levels and the Glasgow Prognostic Score (GPS) were found to be factors affecting survival in the GEM group. Conclusion: In this series of patients with unresectable pancreatic cancer, good PS, decrease in CA19-9 after treatment and good GPS determined prior to treatment were independent prognostic factors for better overall survival.

Randomized clinical trial of adjuvant chemotherapy with S‐1 versus gemcitabine after pancreatic cancer resection

Randomized studies of adjuvant chemotherapy using gemcitabine suggest a survival benefit after resection of pancreatic cancer. S‐1 has also been shown to prolong survival in patients with unresectable pancreatic cancer. This study compared the effects of adjuvant chemotherapy with S‐1 or gemcitabine after resection of pancreatic cancer in a randomized trial.

Estimated glomerular filtration rate is superior to measured creatinine clearance for predicting postoperative renal dysfunction in patients undergoing pancreatoduodenectomy.

Objective: A retrospective study was conducted to compare measured creatinine clearance (Ccr) with estimated glomerular filtration rate (eGFR) as a preoperative renal function test in patients undergoing pancreatoduodenectomy. Methods: The records of 139 patients undergoing pancreatoduodenectomy were enrolled, and preoperative Ccr, a 3-variable equation for eGFR (eGFR3) and a 5-variable equation for eGFR (eGFR5) were estimated. The maximum increases in the postoperative serum creatinine and urea nitrogen levels were compared between the groups with normal and abnormal levels relative to Ccr, eGFR3, and eGFR5. Results: There were 30 patients with abnormal Ccr levels, 17 with abnormal eGFR3 levels, and 16 with abnormal eGFR5 levels. Postoperative serum creatinine and urea nitrogen levels were significantly higher in patients with eGFR3 and eGFR5 abnormal levels than in patients with eGFR3 and eGFR5 normal levels. Postoperative serum creatinine and urea nitrogen levels tended to be higher in patients with Ccr abnormal level. The sensitivity and specificity of eGFR3 and eGFR5 for postoperative renal dysfunction were better than those of Ccr, and multivariate analysis showed that eGFR5 was the only independent predictive factor for postoperative renal dysfunction. Conclusions: The eGFR5 and eGFR3, rather than the Ccr, are recommended as preoperative renal function test in patients undergoing pancreatoduodenectomy.