Search Results (69)

Background: Pancreatic cancer (PC) has a very poor 5-year survival and prognosis. Even when CT or MRI shows no metastasis, staging laparoscopy(SL) still detects tiny peritoneal deposits in 20–30% of patients, making them ineligible for surgery. SL is invasive, requiring general anesthesia and substantial resources. Endoscopic ultrasound (EUS) allows the observation of the bile ducts, pancreas, and abdominal cavity, and EUS-guided fine-needle aspiration (EUS-FNA) is essential for pathological diagnosis. Reports on using EUS to perform peritoneal lavage cytology are currently not available. We hypothesized that combining EUS-FNA with peritoneal lavage (EUS-lavage technique; EUS-LT) could enhance staging accuracy and avoid unnecessary surgical procedures. Methods: Ten in vivo porcine models underwent EUS-LT. Using a 19G FNA needle, 800 mL saline was instilled into the intraperitoneal cavity and then recovered. Two refinements were introduced sequentially: an ENBD catheter with additional side holes and, subsequently, a side-hole introducer (EndoSheather) that eliminated balloon dilation. The primary endpoint was procedural success. Secondary endpoints included safety, complications, recovered volume, duration of endoscopic procedure, and time required to instill 800 mL. Nonparametric tests compared outcomes across iterations. Results: Ten-model porcine in vivo model series were included, and all procedures were successful. No device malfunctions or unanticipated technical failures; one minor mucosal injury during saline injection resolved after re-puncture. The average procedure time was 31.1 min. Stepwise refinements shortened procedure and infusion times and increased recovered volume. Recovered volume approached the instilled amount in later cases, indicating efficient performance. Conclusions: In this ten-model in vivo series, EUS-LT demonstrated technical feasibility and short-term safety. Full article

Background and Objectives: Pancreatoduodenectomy (PD) is the primary treatment for patients with resectable, non-metastatic pancreatic adenocarcinoma and periampullary tumors. Although surgical methods and perioperative management have improved, the procedure still carries a high risk of complications, with postoperative pancreatic fistula (POPF) being the most significant. This study focuses on identifying current risk factors for POPF after PD in a single HPB center. Materials and Methods: We retrospectively analyzed prospectively collected data from patients undergoing PD in our department between October 2018 and April 2024. Data included demographics, comorbidities, lifestyle factors, preoperative tests (bilirubin, CA19-9, HbA1c), intraoperative variables (pancreatic texture, duct diameter), and postoperative outcomes. POPF was classified using the International Study Group of Pancreatic Surgery (ISGPS) criteria. Univariate and multivariate logistic regression analyses were performed. Results: A total of 118 patients underwent PD (82 males, 36 females; mean age 67 (45–85) years; mean body mass index (BMI) 26.6 kg/m²). POPF occurred in 37 patients (31%), with 27 Grade B (23%) and 10 Grade C (9%). The 30- and 90-day mortality rates were 5% and 12.7%, respectively. Univariate analysis showed associations between POPF and soft pancreas (p = 0.018), c-reactive protein (CRP) on postoperative day (POD) 5 (p = 0.004), and serum amylase on POD 0 (p = 0.008). Diabetes mellitus was associated with a lower incidence of POPF (p = 0.014). Multivariate analysis confirmed CRP on POD 5 (OR 1.007, p = 0.025) and DM (OR 0.254, p = 0.015), as independent factors. ROC analysis identified POD 0 amylase >113.5 U/L (AUC 0.717) and POD 5 CRP >125.3 mg/dL (AUC 0.669) as predictive values. Conclusions: POPF remains an important complication after PD. CRP > 126 mg/dL on POD 5 was associated with POPF and may serve as an adjunctive signal to guide further assessment, including imaging. The observed inverse association with diabetes mellitus is hypothesis-generating and should be interpreted cautiously, considering potential confounding and the influence of center volume, surgeon heterogeneity, and institutional protocols. Full article

Metastases to the pancreas (PM), although rare, have been increasingly identified in recent years, especially among high-volume pancreatic centers. They are often asymptomatic and incidentally detected during follow-up examinations, even several years after the treatment of the primary tumor. In this scenario, endoscopic ultrasound (EUS) has emerged as a crucial diagnostic tool for PM, being capable of providing a detailed morphological characterization and safe and effective tissue acquisition for cytohistological examination. The aim of our study was to extensively review the current evidence concerning the role of EUS in the diagnosis of PM, specifically focusing on its morphological features, contrast-enhancement patterns, and tissue acquisition techniques. Full article

Glucagon-like peptide-1 receptor agonists and lifestyle interventions effectively treat overt obesity, but the benefits/risks of their combined early intervention during middle age remain unclear. This study investigated whether submaximal-dose liraglutide combined with strength–endurance training improves metabolic and liver health, focusing on hepatic oxidative stress and lipid metabolism. Male Wistar rats (16 months old) received liraglutide (L; 0.186 mg/kg/day, s.c.), training (ladder climbing with weights, 3 times/week), both (L+E) or saline for control middle-aged (C) and young adults (CY; 3–4 months old) for 7 weeks (n = 8/group). Middle-aged rats exhibited age-related changes including higher body and visceral fat, increased hepatic and serum cholesterol, hepatic ALT and glutathione imbalance, and decreased soleus muscle (p < 0.05, vs. CY). Exercise increased hepatic glycogen and oxidative stress markers and downregulated lipogenic genes, consistent with liver adaptation to training. L+E synergistically reduced body and visceral fat, hepatic and serum triglycerides, and the triglyceride–glucose index, while reducing oxidative stress (p < 0.05 vs. E, C) and lipogenic gene expression (p < 0.05 vs. C), without affecting pancreas histopathology and function parameters, muscle mass or exercise load volume. In conclusion, submaximal liraglutide safely synergized with training to enhance metabolic health, improve hepatic redox balance and triglyceride metabolism in middle-aged rats, without mitigating cholesterol rise. Full article

Background and Aims: Solid pseudopapillary neoplasms (SPN) are rare neoplasms of the pancreatic gland. Despite the indolent behavior, surgical resection is required according to the risk of metastasis development. Few data are available on endoscopic ultrasound (EUS) features, comparison between the features described at EUS and contrast-enhanced, and diagnostic accuracy and safety of EUS-guided FNB in these tumors. Patients and Methods: All consecutive patients with a EUS-guided FNB-based pathological diagnosis of SPN were extrapolated from a prospectively maintained database. Demographic, radiologic, and echo-endoscopic features were collected. FNB specimens were re-evaluated from two expert pathologist and the main histological features of SPN were investigated. Results: Thirty-seven patients were included (32 females and 5 males), with a mean age of 35.8 ± 15.8 years. Contrast-enhanced imaging based diagnosis was accurate in 20 patients (54.1%). EUS features were significantly different compared to contrast-enhanced imaging in terms of cystic appearance (40.5% vs. 16.2%; p = 0.03) and vascular pattern (p = 0.01). FNB-based diagnosis of SPN was confirmed on surgical specimen in all, 37 patients, resulting in a diagnostic accuracy of EUS-guided FNB of 100%. Only one patient (2.6%) experienced a mild procedure-related adverse event. Discussion: Contrast-enhanced imaging based diagnosis of SPN is difficult. Despite the rarity of the disease, EUS-guided FNB with 22-gauge fork-tip needle has a very high diagnostic accuracy for SPN, with rare and mild adverse events. Full article

Background/Objectives: Accurate volumetry of the remnant pancreas after pancreatectomy is crucial for assessing postoperative endocrine and exocrine function but remains challenging due to anatomical variability and complex postoperative morphology. This study aimed to develop and validate a deep learning (DL)-based model for automatic segmentation and volumetry of the remnant pancreas using abdominal CT images. Methods: A total of 1067 CT scans from 341 patients who underwent pancreaticoduodenectomy and 512 scans from 184 patients who underwent distal pancreatectomy were analyzed. Ground truth masks were manually delineated and verified through multi-expert consensus. Six 3D segmentation models were trained and compared, including four convolution-based U-Net variants (basic, dense, residual, and residual dense) and two transformer-based models (Trans U-Net and Swin U-Net). Model performance was evaluated using five-fold cross-validation with sensitivity, specificity, precision, accuracy, and Dice similarity coefficient. Results: The Residual Dense U-Net achieved the best performance among convolutional models, with dice similarity coefficient (DSC) values of 0.7655 ± 0.0052 for pancreaticoduodenectomy and 0.8086 ± 0.0091 for distal pancreatectomy. Transformer-based models showed slightly higher DSCs (Swin U-Net: 0.7787 ± 0.0062 and 0.8132 ± 0.0101), with statistically significant but numerically small improvements (p < 0.01). Conclusions: The proposed DL-based approach enables accurate and reproducible postoperative pancreas segmentation and volumetry. Automated volumetric assessment may support objective evaluation of remnant pancreatic function and provide a foundation for predictive modeling in long-term clinical management after pancreatectomy. Full article

Background: Failure to rescue (FTR), defined as death after major postoperative complications, is a critical quality indicator in pancreatic cancer surgery. Despite advances in surgical techniques and perioperative care, FTR rates remain high and vary across institutions. Methods: This systematic review uses a narrative synthesis followed by PRISMA 2020. A PubMed search (1992–2025) identified 83 studies; after screening, 52 studies (2010–2025) were included. Eligible designs were registry-based, multicenter, single-center, or prospective audits. Given substantial heterogeneity in study designs, FTR definitions, and outcome measures, a narrative synthesis was performed; no formal risk-of-bias assessment or meta-analysis was conducted. Results: Definitions of FTR varied (in-hospital, 30-day, 90-day, severity-based, and complication-specific cases). Reported rates differed by definition: average reported rates were 13.2% for 90-day CD ≥ III (G1); 10.3% for in-hospital/30-day CD ≥ III (G3); and 7.4% for 30-day “serious/major” morbidity (G8). Absolute differences were +3.0 and +2.9 percentage points (exploratory, descriptive comparisons). Five domains were consistently associated with lower FTR: (i) centralization to high-volume centers; (ii) safe adoption/refinement of surgical techniques; (iii) optimized perioperative management including early imaging and structured escalation pathways; (iv) patient-level risk stratification and prehabilitation; and (v) non-technical skills (NTSs) such as decision-making, situational awareness, communication, teamwork, and leadership. Among NTS domains, stress and fatigue management were not addressed in any included study. Limitations: Evidence is predominantly observational with substantial heterogeneity in study designs and FTR definitions; the search was limited to PubMed; and no formal risk-of-bias, publication-bias assessment, or meta-analysis was performed. Consequently, estimates and associations are descriptive/associative with limited certainty and generalizability. Conclusions: NTSs were rarely used or measured across the included studies, with validated instruments; quantitative assessment was uncommon, and no study evaluated stress or fatigue management. Reducing the FTR after pancreatic surgery will require standardized, pancreas-specific definitions of FTR, process-level rescue metrics, and deliberate strengthening of NTS. We recommend a pancreas-specific operational definition with an explicit numerator/denominator: numerator = all-cause mortality within 90 days of surgery; denominator = patients who experience major complications (Clavien–Dindo grade III–V, often labeled “CD ≥ 3”). Addressing the gaps in stress and fatigue management and embedding behavioral metrics into quality improvement programs are critical next steps to reduce preventable mortality after complex pancreatic cancer procedures. Full article

Background: Metabolic dysfunction-associated steatotic liver disease (MASLD) is prevalent in adolescents with obesity and is linked to insulin resistance and cardiovascular disease (CVD). Pancreas steatosis might be associated with MASLD and early CVD. Imaging-based analyses of these associations have not been studied extensively in children. Objectives: To assess the reproducibility of liver and pancreatic steatosis and volume measurement on MRI in adolescents with obesity and MASLD and their association with homeostatic model assessment of insulin resistance (HOMA-IR) and subclinical vascular changes on ultrasound. Methods: This is an observational study on adolescents with MASLD and obesity. Hepatic and pancreatic steatosis, volume, and abdominal fat were assessed using magnetic resonance spectroscopy and proton density fat fraction. Reproducibility of these measurements was performed. Vascular markers included non-invasive vascular elastography (NIVE), carotid artery intima-media thickness (IMT), and pericardial fat thickness. Fasting blood tests measured the HOMA-IR. Bivariate correlation and simple linear regression were performed using SPSS. Results: We obtained 23 participants aged 12 to 17 years (78.3% male). Measurements were reproducible [ICC 0.807–0.998]. Liver steatosis was positively correlated with HOMA-IR (p = 0.015). Pancreas steatosis was positively correlated with HOMA-IR (p = 0.02), IMT/diameter (p = 0.002), and pericardial fat (p = 0.03). Liver steatosis was not significantly correlated with pancreas steatosis nor vascular markers. There were negative associations between NIVE metrics and visceral abdominal fat (p = 0.009) and intraperitoneal fat (p = 0.047). Conclusions: Liver and pancreas steatosis measurements on MRI are reproducible. In this exploratory study, adolescents with obesity and MASLD, pancreas steatosis, and pancreas volume show association with subclinical CVD markers. Visceral and intraperitoneal abdominal fat show association with increased vascular stiffness, suggesting a potential role of imaging-based cardiovascular risk assessment in this population if validated. These preliminary findings require validation in larger, diverse prospective cohorts. Full article

Background: Non-functional well-differentiated pancreatic neuroendocrine tumors (WD-PanNETs) are complex, heterogeneous malignancies with variable prognosis. Despite guideline recommendations, disparities in access to specialized care may impact survival. This study examines whether treatment facility type, geographic travel distance, and treatment modalities are associated with survival outcomes in patients diagnosed with WD-PanNETs. Results: Among 20,174 patients with WD-PanNETs, the median age was 62 years (IQR: 52–70), and 54% were men. The majority were treated at non-academic hospitals (76%), with 2.9% traveling >250 miles for care. Patients treated at non-academic hospitals (24%) had 50% lower 15-year survival rates compared to those treated at academic hospitals (58%) and integrated hospitals (56%) (p < 0.001). Patients traveling >250 miles had a 72% 15-year survival rate, compared to 43% for those traveling <12.5 miles (p < 0.001). In the context of facility-type and geographic distance, treatment at non-academic hospitals <250 miles was associated with a 21% higher mortality risk (HR 1.21, 95% CI 1.12–1.31, p < 0.001), and treatment at low-volume hospitals increased mortality risk by 25% (HR 1.25, 95% CI 1.14–1.37, p < 0.001). In contrast, primary tumor resection was associated with a 64% reduction in mortality risk (HR 0.36, 95% CI 0.33–0.38, p < 0.001), which remained significant at all disease stages. Conclusion: Treatment at academic or high-volume centers and longer travel distances were associated with improved OS in patients with WD-PanNETs. Primary tumor resection remains critical, while systemic therapies were primarily used in later-stage disease. These findings support policies that improve access to centralized, multidisciplinary care. Full article

Background/Objectives: MR-guided radiation therapy (MRgRT) has rapidly evolved into an important treatment modality, with the Elekta Unity and ViewRay MRIdian systems being two major MR-linac platforms. Despite the shared concept of MRgRT, the two platforms elected different system designs that could potentially impact the dosimetric characteristics and quality of a treatment. In this study, we aim to perform a comparative dosimetric investigation between these two MR-linac systems in prostate and pancreas cancers. Methods: Dosimetric characteristics were evaluated by retrospectively re-creating 20 clinical prostate and pancreas cases originally treated on MRIdian using the Unity system, adhering to MIRAGE and SMART clinical trial constraints. Treatment plans were re-created with matching planning images, structures, beam geometry, and dose parameters. To ensure comparison consistency, all Unity treatment plans were normalized to match the target coverage of the MRIdian counterparts, and the organ-at-risk (OAR) dose was investigated. Results: Most OARs’ dose-volume metrics showed no statistically significant differences. For prostate patients, Unity demonstrated lower rectum V36Gy (p = 0.0095), V38Gy (p = 0.0043), V40Gy (p = 0.0469), and lower left (p = 0.0137) and right femur V20Gy (p = 0.0020). For pancreas patients, Unity plans had a lower mean liver dose (p = 0.0371). All Unity plans had a Gamma passing rate > 90%, confirming the clinical deliverability. Mean delivery times were 12.78 ± 1.68 and 13.53 ± 1.88 min for MRIdian and Unity prostate plans, respectively, and 14.58 ± 2.78 and 17.40 ± 3.77 min for MRIdian and Unity pancreas plans, respectively. Conclusions: Overall, comparable treatment quality and delivery times were observed between the two platforms. Full article

Background: Graft-versus-host disease (GVHD) is a rare but serious complication following solid organ transplantation (SOT), particularly in transplants involving organs with a high volume of passenger donor T-lymphocytes. This case highlights the clinical course and diagnostic challenges of GVHD following simultaneous pancreas and pre-emptive kidney transplantation. Methods: A 51-year-old male with long-standing type 1 diabetes mellitus underwent simultaneous pancreas and kidney transplantation with induction therapy using rabbit anti-thymocyte globulin and methylprednisolone. Three months post-transplant, he presented with a diffuse lichenoid cutaneous eruption. Diagnostic evaluation included an extensive infectious workup, skin punch biopsy, liver and bone marrow biopsies, and microchimerism assay. Results: Skin biopsy revealed interface vacuolar dermatitis consistent with cutaneous GVHD. Subsequent liver and bone marrow biopsies confirmed GVHD involvement, with microchimerism assay showing 43% donor-origin T-cells in the bone marrow. Initial treatment with systemic and topical corticosteroids led to temporary improvement. However, the patient developed bone marrow suppression, recurrent bacteremia, and invasive fungal infection, resulting in a prolonged ICU stay and ultimately death. Conclusions: This case underscores the importance of considering SOT-GVHD in patients receiving organs rich in donor lymphocytes, such as pancreas transplants. Early recognition and multidisciplinary management are critical to improving outcomes in this rare but life-threatening condition. Full article

Background/Objectives: The aim of this study was to determine whether extracellular volume (ECV) fraction as determined by contrast-enhanced computed tomography (CECT) can help distinguish between autoimmune pancreatitis (AIP) and pancreatic ductal adenocarcinoma (PDAC). Methods: Participants comprised 101 patients, including 20 diagnosed with AIP (AIP group), 42 with histologically confirmed PDAC (PDAC group), and 39 without pancreatic disease (healthy group). Contrast enhancement (CE) was calculated as CT attenuation in Hounsfield units [HU] on equilibrium-phase CECT–CT attenuation on pre-contrast CT. The ECV fraction was calculated by measuring the region of interest within the pancreatic region and aorta on pre-contrast and equilibrium-phase CECT. CT measurements were compared among groups. CE and ECV fractions were also compared for diffuse (n = 12) and focal or segmental types (n = 8). Focal- or segmental-type AIP was defined as the involvement of one or two pancreas segments. Diagnostic efficacy was evaluated through receiver operating characteristic (ROC) analyses. Results: CE and ECV fractions differed significantly between the groups (p < 0.001 each). CE was significantly higher in the AIP group (56.8 ± 7.9 HU) than in the PDAC group (42.3 ± 17.0 HU, p < 0.001) or healthy group (32.2 ± 6.1 HU, p < 0.001). ECV fraction was significantly higher in the AIP group (47.2 ± 7.3%) than in the PDAC group (31.7 ± 12.0%, p < 0.001) or healthy group (27.5 ± 5.4%, p < 0.001). In the AIP group, no significant differences in CE (56.7 ± 8.2 HU vs. 56.9 ± 8.1 HU; p = 1.000) or ECV fraction (48.0 ± 5.6% vs. 46.6 ± 8.4%; p = 0.970) were seen between diffuse and focal or segmental types. Areas under the ROC curve for differentiating AIP from PDAC were 0.78 for CE and 0.86 for ECV fraction, showing no significant difference (p = 0.083). Conclusions: ECV fraction might be clinically useful in differentiating AIP from PDAC. Full article

Background/Objectives: Pancreatic ductal adenocarcinoma (PDAC) prediction in high-risk individuals is essential for early detection and improved outcome. While prior studies have utilized pancreatic radiomics for PDAC prediction, the added value of main pancreatic duct (MPD) features remains unclear. This study aims to assess the additional value of features of the main pancreatic duct (MPD) for predicting PDAC occurrence across different timeframes in advance. Methods: In total, 321 contrast-enhanced CT scans of the MPD and pancreas carried out across control, pre-diagnostic, and diagnostic cohorts were segmented, and radiomics were extracted. A support vector machine (SVM) classifier was used to classify the control and pre-diagnostic cohorts, with model performance assessed using area under the receiver operating characteristic (ROC) curves (AUCs) Results: The MPD diameter and volume significantly increased from the control to the pre-diagnostic and diagnostic CT scans (p < 0.05). The addition of features of the MPD to the pancreas improved the PDAC prediction AUC from 0.83 to 0.96 for subjects 6 months to 3 years in advance, from 0.81 to 0.94 for 3–6 years in advance, and 0.75 to 0.84 for 6–10 years in advance of diagnosis. Additionally, integrating MPD radiomics with diameter and volume significantly improved the AUC from 0.81 to 0.88 for subjects 6 months to 3 years in advance. Conclusions: Radiomic features from abdominal CT scans allow PDAC prediction up to 10 years in advance. Integrating MPD features, including diameter and volume, significantly improves PDAC prediction compared to using radiomics of the pancreas alone. Full article

The paper presents the design, manufacturing, and evaluation of a 3D-printed pancreas phantom model used for preoperative surgical planning and surgical training. Several manufacturing and design alternatives have been explored, leading to the final solution, which consisted of a transparent 3D printed elastic shell of the pancreas, resulting in an empty volume that was filled with a custom hydrogel to ensure an anatomically realistic behaviour. Additionally, specific vascular structures were printed using elastic material and specific colours. The hollow shell of the pancreas and the vascular structures were manufactured using photopolymerisation technology. The hydrogel, which replicates the internal structure of the pancreas, was made from a custom proportion of gelatine, agar, and glycerol. The phantom model of the pancreas was assessed by the surgical team and tested using the PARA-SILSROB parallel robot designed for single-incision surgical procedures. Full article

Background and Objectives: With physiological aging, the pancreas is expected to decrease in size as in every organ. The objective of this study was to examine the correlation between pancreas volume (PV), nutritional status, and glycolyzed hemoglobin A1c (HbA1c) in elderly patients with and without type 2 diabetes mellitus (DM). Materials and Methods: Between July 2020 and April 2022, 109 patients aged ≥ 65 years who applied to geriatrics clinics and outpatient clinics were included in the study. PV was measured from available abdominal contrast-enhanced computed tomography (CT) scans. Patients were divided into two groups according to the presence of DM. The relationship between PV; biochemical parameters, especially HbA1c; and Mini Nutritional Assessment Short Form (MNAsf) score was analyzed between groups. p < 0.05 was considered statistically significant. Results: The mean age of all participants was M: 77.40, with SD: 7.32. A total of 54.1% of the participants were female, and 55 had DM. There were no significant differences in age and gender between those with and without DM. Glucose (p < 0.001), HbA1C (p < 0.001), and triglycerides (p < 0.001) were significantly higher, and HDL (p < 0.001) was significantly lower in patients with DM. PV was also significantly lower in those with DM (p = 0.028). A correlation analysis revealed significant positive correlations between PV, the MNAsf score (rho (109)) = 0.413, p = 0.003), and lipase (rho (109)) = 0.297, p = 0.002). Conclusions: PV, which is expected to decrease with age, was found to be lower in patients with DM in our study in which we evaluated elderly patients with and without DM. We also found that PV was associated with malnutrition. Our study highlights the importance of determining the clinical effects of pancreatic volume in the geriatric population where organ atrophy is expected. Therefore, we believe that more comprehensive studies are needed to clarify the clinical implications of pancreatic volume on our diagnostic and therapeutic decisions. Full article