Authorship：Lead author   Language：English   Publishing type：Research paper (scientific journal)   Publisher：Journal of Clinical Oncology  

PURPOSE Circulating carbohydrate antigen 19-9 (CA19-9) levels reflect FUT3 and FUT2 fucosyltransferase activity. Measuring the related glycan, DUPAN-2, can be useful in individuals unable to synthesize CA19-9. We hypothesized that similar to CA19-9, FUT functional groups determined by variants in FUT3 and FUT2 influence DUPAN-2 levels, and having tumor marker reference ranges for each functional group would improve diagnostic performance. MATERIALS Using a training/validation study design, FUT2/FUT3 genotypes were deter-AND METHODS mined in 938 individuals from Johns Hopkins Hospital: 607 Cancer of the Pancreas Screening (CAPS) study subjects with unremarkable pancreata and 331 with pancreatic ductal adenocarcinoma (PDAC). Serum DUPAN-2 and CA19-9 levels were measured by immunoassay. RESULTS In controls, three functional FUT groups were identified with significant differences in DUPAN-2 levels: FUT3-intact, FUT3-null/FUT2-intact, and FUT3-null/FUT2-null. DUPAN-2 training set diagnostic cutoffs for each FUT group yielded higher diagnostic sensitivity in the validation set for patients with stage I/II PDAC than uniform cutoffs (60.4% [95% CI, 50.2 to 70.0] v 39.8% [30.0 to 49.8]), at approximately 99% (96.7 to 99.6) specificity. Combining FUT/CA19-9 and FUT/DUPAN-2 tests yielded 78.4% (72.3 to 83.7) sensitivity for stage I/II PDAC, at 97.7% (95.3 to 99.1) specificity in the combined sets, with higher AUC (stage I/II: 0.960 v 0.935 for CA19-9 1 DUPAN-2 without the FUT test; P < .001); for stage I PDAC, sensitivity was 62.0% (49.1 to 73.2; AUC, 0.919 v 0.883; P 5 .03). CA19-9 levels in FUT3-null/FUT2-null PDAC subjects were higher than in FUT3-null/FUT2-intact subjects (median/IQR; 24.9/57.4 v <1/2.3 U/mL; P 5 .0044). In a simulated CAPS cohort, AUC precision recall (AUC<inf>PR</inf>) scores were 0.51 for CA19-9 alone, 0.64 for FUT/CA19-9, 0.73 for CA19-9/DUPAN-2, and 0.84 for FUT/CA19-9/DUPAN-2. CONCLUSION Using a tumor marker gene test to individualize CA19-9 and DUPAN-2 reference ranges achieves high diagnostic performance for stage I/II pancreatic cancer.

DOI： 10.1200/JCO.23.01573

Scopus

Language：English   Publishing type：Research paper (scientific journal)   Publisher：Surgical Laparoscopy Endoscopy and Percutaneous Techniques  

Background: – Robot-assisted surgery has been widely adopted in digestive, urological, and gynecologic procedures, leading to its application in complex operations such as pelvic exenteration (PE). However, limited data are available regarding the perioperative outcomes of robotic PE compared directly to conventional laparoscopic PE in the treatment of colorectal cancer. Methods: – To assess the feasibility of robotic PE compared with laparoscopic PE for locally advanced colorectal cancer invading the anterior pelvic organs, we retrospectively reviewed patients who underwent either robotic or laparoscopic PE with curative intent (R0 resection) between May 2012 and August 2024. Results: – A total of 24 patients were included in the study (12 in the robotic group and 12 in the laparoscopic group). Patient characteristics revealed that the robotic group had an older median age and a lower prognostic nutritional index. In terms of surgical outcomes, no significant differences were observed in PE type, total operative time, estimated blood loss, or the number of retrieved lymph nodes. Conversion to open surgery occurred in 3 patients in the laparoscopic group, whereas no conversions were noted in the robotic group (P = 0.032). The reasons for conversion in the laparoscopic group included uncontrollable bleeding and technical difficulty due to large tumor size. Conclusions: – Robotic surgery may offer greater suitability for complex procedures such as PE, compared with conventional laparoscopic surgery, particularly in challenging cases involving large tumors.

DOI： 10.1097/SLE.0000000000001424

Web of Science

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PubMed

Language：English   Publishing type：Research paper (scientific journal)   Publisher：シュプリンガー・ジャパン(株)  

局所再発直腸癌(LRRC)に対する腹腔鏡下骨盤内臓器全摘術(Lap PE)の技術的安全性を検討した。2013～2023年の当施設63例を原発群41例と再発群22例に分類し後ろ向きに比較した。再発群では他臓器合併切除を要する症例が14例(63.6%)と原発群10例(24.4%)より有意に多かった。手術時間は再発群(633分)と原発群(714分)に有意差は認めず、術中出血量にも有意な群間差は認めなかった(580 vs. 650g)。開腹移行はいずれも認めなかった。R0切除率は再発群(81.8%)、原発群(95.1%)で有意差は認めなかった。Clavien-Dindo分類GradeIII以上の合併症は再発群18.2%、原発群29.3%で有意差は認めなかった。以上より、原発と再発で短期成績は概ね同等であった。

Language：English   Publishing type：Research paper (scientific journal)   Publisher：Surgery Today  

Purpose: Pelvic exenteration (PE) is sometimes the only curative option for primary rectal cancer as well as locally recurrent rectal cancer (LRRC). However, data on laparoscopic PE (Lap-PE) for LRRC are limited. This study aimed to evaluate the technical safety of Lap-PE in LRRC cases. Methods: We retrospectively analyzed 63 patients who underwent Lap-PE between January 2013 and December 2023. Patients were categorized into primary (n = 41) and recurrent (n = 22) groups, and short-term outcomes, including operative details and postoperative complications, were compared. Results: The recurrent group had a significantly higher number of cases of multiple organs resected beyond PE (24.4% vs. 63.6%, p = 0.001). There were no significant differences in the operative time (714 vs. 633 min, p = 0.91) or blood loss (650 vs. 580 g, p = 0.98) between the groups. Clavien-Dindo Grade 3 complications occurred in 29.3% of primary cases and 18.2% of recurrent cases (p = 0.47). R0 resection was achieved in 95.1% of primary cases and 81.8% of recurrent cases (p = 0.10). Conclusion: Lap PE for LRRC, when performed by an experienced laparoscopic surgical team with careful patient selection, was shown to be safe, with comparable short-term outcomes to those of PE for primary rectal cancer and an acceptable R0 resection rate.

DOI： 10.1007/s00595-025-03048-4

Scopus

Authorship：Lead author   Language：English   Publishing type：Research paper (scientific journal)   Publisher：JCO Precision Oncology  

PURPOSEInherited cancer susceptibility is often not suspected in the absence of a significant cancer family history. Pathogenic germline variants in pancreatic cancer are well-studied, and routine genetic testing is recommended in the guidelines. However, data on rare periampullary cancers other than pancreatic cancer are insufficient. We compared the prevalence of germline susceptibility variants in patients with pancreatic cancer and nonpancreatic periampullary cancers.MATERIALS AND METHODSSix hundred and eight patients who had undergone pancreaticoduodenal resection at a tertiary referral hospital were studied, including 213 with pancreatic ductal adenocarcinoma, 172 with ampullary cancer, 154 with distal common bile duct cancer, and 69 with duodenal adenocarcinoma. Twenty cancer susceptibility and candidate susceptibility genes were sequenced, and variant interpretation was assessed by interrogating ClinVar and PubMed.RESULTSPathogenic or likely pathogenic, moderate- to high-penetrant germline variants were identified in 46 patients (7.7%), including a similar percentage of patients with pancreatic (8.5%) and nonpancreatic periampullary cancer (7.1%). Low-penetrant variants were identified in an additional 11 patients (1.8%). Eighty-nine percent of the moderate- to high-penetrant variants involved the major cancer susceptibility genes BRCA2, ATM, BRCA1, CDKN2A, MSH2/MLH1, and PALB2; the remaining 11% involved other cancer susceptibility genes such as BRIP1, BAP1, and MSH6. Almost all pathogenic variant carriers had a family history of cancer.CONCLUSIONPatients with pancreatic and nonpancreatic periampullary cancer have a similar prevalence of pathogenic cancer susceptibility variants. Germline susceptibility testing should be considered for patients with any periampullary cancer.

DOI： 10.1200/PO.24.00101

Scopus

Language：Japanese  

Language：Japanese  

Language：Japanese  

Language：Japanese  

Language：Japanese  

Language：English   Publisher：Colorectal Disease  

DOI： 10.1111/codi.70506

Scopus

PubMed