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Pancreatic Neoplasms: HELP
Articles by Jin Young Jang
Based on 70 articles published since 2010
(Why 70 articles?)
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Between 2010 and 2020, Ji Young Jang wrote the following 70 articles about Pancreatic Neoplasms.
 
+ Citations + Abstracts
Pages: 1 · 2 · 3
1 Guideline Pathologic Evaluation and Reporting of Intraductal Papillary Mucinous Neoplasms of the Pancreas and Other Tumoral Intraepithelial Neoplasms of Pancreatobiliary Tract: Recommendations of Verona Consensus Meeting. 2016

Adsay, Volkan / Mino-Kenudson, Mari / Furukawa, Toru / Basturk, Olca / Zamboni, Giuseppe / Marchegiani, Giovanni / Bassi, Claudio / Salvia, Roberto / Malleo, Giuseppe / Paiella, Salvatore / Wolfgang, Christopher L / Matthaei, Hanno / Offerhaus, G Johan / Adham, Mustapha / Bruno, Marco J / Reid, Michelle D / Krasinskas, Alyssa / Klöppel, Günter / Ohike, Nobuyuki / Tajiri, Takuma / Jang, Kee-Taek / Roa, Juan Carlos / Allen, Peter / Fernández-del Castillo, Carlos / Jang, Jin-Young / Klimstra, David S / Hruban, Ralph H / Anonymous6721124. ·*Department of Pathology, Emory University School of Medicine and Winship Cancer Institute, Atlanta, GA †Department of Pathology, Massachusetts General Hospital, Boston, MA ‡Department of Pathology, Tokyo Women's Medical University, Tokyo, Japan §Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, NY ¶Department of Pathology, University of Verona, Verona, Italy ||Department of Surgery, Massachusetts General Hospital, Boston, MA **Department of Surgery, University of Verona, Verona, Italy ††Department of Surgery, Sol Goldman Pancreatic Cancer Research Center, Johns Hopkins University School of Medicine, Baltimore, MD ‡‡Departments of Surgery, University of Bonn, Bonn, Germany §§Departments of Pathology, University Medical Center Utrecht, Utrecht, The Netherlands ¶¶Department of Surgery, Edouard Herriot Hospital, HCL, Lyon, France ||||Department of Gastroenterology and Hepatology, Erasmus University Medical Center, Rotterdam, The Netherlands ***Departments of Pathology, Technical University, Munich, Germany †††Department of Pathology, Showa University Fujigaoka Hospital, Yokohama, Japan ‡‡‡Department of Pathology, Tokai University Hachioji Hospital, Tokyo, Japan §§§Department of Pathology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea ¶¶¶Department of Pathology, Pontificia Universidad Católica de Chile, Santiago, Chile ||||||Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY ****Department of Surgery, Massachusetts General Hospital, Boston, MA ††††Department of Surgery, Seoul National University Hospital, Seoul, Korea ‡‡‡‡Department of Pathology, Sol Goldman Pancreatic Cancer Research Center, Johns Hopkins University School of Medicine, Baltimore, MD. ·Ann Surg · Pubmed #25775066.

ABSTRACT: BACKGROUND: There are no established guidelines for pathologic diagnosis/reporting of intraductal papillary mucinous neoplasms (IPMNs). DESIGN: An international multidisciplinary group, brought together by the Verona Pancreas Group in Italy-2013, was tasked to devise recommendations. RESULTS: (1) Crucial to rule out invasive carcinoma with extensive (if not complete) sampling. (2) Invasive component is to be documented in a full synoptic report including its size, type, grade, and stage. (3) The term "minimally invasive" should be avoided; instead, invasion size with stage and substaging of T1 (1a, b, c; ≤ 0.5, > 0.5-≤ 1, > 1 cm) is to be documented. (4) Largest diameter of the invasion, not the distance from the nearest duct, is to be used. (5) A category of "indeterminate/(suspicious) for invasion" is acceptable for rare cases. (6) The term "malignant" IPMN should be avoided. (7) The highest grade of dysplasia in the non-invasive component is to be documented separately. (8) Lesion size is to be correlated with imaging findings in cysts with rupture. (9) The main duct diameter and, if possible, its involvement are to be documented; however, it is not required to provide main versus branch duct classification in the resected tumor. (10) Subtyping as gastric/intestinal/pancreatobiliary/oncocytic/mixed is of value. (11) Frozen section is to be performed highly selectively, with appreciation of its shortcomings. (12) These principles also apply to other similar tumoral intraepithelial neoplasms (mucinous cystic neoplasms, intra-ampullary, and intra-biliary/cholecystic). CONCLUSIONS: These recommendations will ensure proper communication of salient tumor characteristics to the management teams, accurate comparison of data between analyses, and development of more effective management algorithms.

2 Guideline International consensus guidelines 2012 for the management of IPMN and MCN of the pancreas. 2012

Tanaka, Masao / Fernández-del Castillo, Carlos / Adsay, Volkan / Chari, Suresh / Falconi, Massimo / Jang, Jin-Young / Kimura, Wataru / Levy, Philippe / Pitman, Martha Bishop / Schmidt, C Max / Shimizu, Michio / Wolfgang, Christopher L / Yamaguchi, Koji / Yamao, Kenji / Anonymous6680728. ·Department of Surgery and Oncology, Graduate School of Medical Sciences, Kyushu University, Fukuoka 812-8582, Japan. masaotan@med.kyushu-u.ac.jp ·Pancreatology · Pubmed #22687371.

ABSTRACT: The international consensus guidelines for management of intraductal papillary mucinous neoplasm and mucinous cystic neoplasm of the pancreas established in 2006 have increased awareness and improved the management of these entities. During the subsequent 5 years, a considerable amount of information has been added to the literature. Based on a consensus symposium held during the 14th meeting of the International Association of Pancreatology in Fukuoka, Japan, in 2010, the working group has generated new guidelines. Since the levels of evidence for all items addressed in these guidelines are low, being 4 or 5, we still have to designate them "consensus", rather than "evidence-based", guidelines. To simplify the entire guidelines, we have adopted a statement format that differs from the 2006 guidelines, although the headings are similar to the previous guidelines, i.e., classification, investigation, indications for and methods of resection and other treatments, histological aspects, and methods of follow-up. The present guidelines include recent information and recommendations based on our current understanding, and highlight issues that remain controversial and areas where further research is required.

3 Review Clinical significance of defining borderline resectable pancreatic cancer. 2018

Kang, Mee Joo / Jang, Jin-Young / Kwon, Wooil / Kim, Sun-Whe. ·Korea International Cooperation Agency, Republic of Korea. · Department of Surgery and Cancer Research Institute, Seoul National University College of Medicine, Seoul, Republic of Korea. · Department of Surgery and Cancer Research Institute, Seoul National University College of Medicine, Seoul, Republic of Korea. Electronic address: sunkim@snu.ac.kr. ·Pancreatology · Pubmed #29274720.

ABSTRACT: Since the introduction of the concept of borderline resectable pancreatic cancer (BRPC), various definitions of this disease entity have been suggested. However, there are several obstacles in defining this disease category. The current diagnostic criteria of BRPC mainly focuses on its expanded 'technical resectability'; however, they are difficult to interpret because of their ambiguity using potential subjective or arbitrary terminology, In addition, limitations in current imaging technology and a lack of evidence in radiological-pathological-clinical correlation make it difficult to refine the criteria. On the other hand, neoadjuvant treatment is usually applied to increase the R0 resection rate of BRPC focusing on the 'oncological curability'. However, evidence is needed concerning the effect of neoadjuvant treatment by quality-controlled prospective randomized clinical trials based on a standardized radiologic and pathologic reporting system. In conclusion, there are two aspects in the current concept of BRPC, which are technical resectability and oncological curability. Although the recent evolution of surgical techniques is expanding the scope of technical resectability, it should not be overlooked that the disease entity must be defined based on the evidence of oncological curability.

4 Review Revisions of international consensus Fukuoka guidelines for the management of IPMN of the pancreas. 2017

Tanaka, Masao / Fernández-Del Castillo, Carlos / Kamisawa, Terumi / Jang, Jin Young / Levy, Philippe / Ohtsuka, Takao / Salvia, Roberto / Shimizu, Yasuhiro / Tada, Minoru / Wolfgang, Christopher L. ·Department of Surgery, Shimonoseki City Hospital, Shimonoseki, Japan. Electronic address: masaotan@med.kyushu-u.ac.jp. · Pancreas and Biliary Surgery Program, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA. · Department of Gastroenterology, Komagome Metropolitan Hospital, Tokyo, Japan. · Division of Hepatobiliary-Pancreatic Surgery, Department of Surgery, Seoul National University College of Medicine, Seoul, South Korea. · Pôle des Maladies de l'Appareil Digestif, Service de Gastroentérologie-Pancréatologie, Hopital Beaujon, Clichy Cedex, France. · Department of Surgery and Oncology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan. · Department of General and Pancreatic Surgery, The Pancreas Institute, University of Verona Hospital Trust, Verona, Italy. · Dept. of Gastroenterological Surgery, Aichi Cancer Center, Nagoya, Japan. · Department of Gastroenterology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan. · Cameron Division of Surgical Oncology and The Sol Goldman Pancreatic Cancer Research Center, Department of Surgery, Johns Hopkins University, Baltimore, MD, USA. ·Pancreatology · Pubmed #28735806.

ABSTRACT: The management of intraductal papillary mucinous neoplasm (IPMN) continues to evolve. In particular, the indications for resection of branch duct IPMN have changed from early resection to more deliberate observation as proposed by the international consensus guidelines of 2006 and 2012. Another guideline proposed by the American Gastroenterological Association in 2015 restricted indications for surgery more stringently and recommended physicians to stop surveillance if no significant change had occurred in a pancreatic cyst after five years of surveillance, or if a patient underwent resection and a non-malignant IPMN was found. Whether or not it is safe to do so, as well as the method and interval of surveillance, has generated substantial debate. Based on a consensus symposium held during the meeting of the International Association of Pancreatology in Sendai, Japan, in 2016, the working group has revised the guidelines regarding prediction of invasive carcinoma and high-grade dysplasia, surveillance, and postoperative follow-up of IPMN. As the working group did not recognize the need for major revisions of the guidelines, we made only minor revisions and added most recent articles where appropriate. The present guidelines include updated information and recommendations based on our current understanding, and highlight issues that remain controversial or where further research is required.

5 Review Surgical resection of pancreatic head cancer: What is the optimal extent of surgery? 2016

Kang, Mee Joo / Jang, Jin-Young / Kim, Sun-Whe. ·Department of Surgery and Cancer Research Institute, Seoul National University College of Medicine, Seoul, Republic of Korea. · Department of Surgery and Cancer Research Institute, Seoul National University College of Medicine, Seoul, Republic of Korea. Electronic address: sunkim@snu.ac.kr. ·Cancer Lett · Pubmed #26828131.

ABSTRACT: Extent of surgery should depend on curability. Improvements in surgical techniques have resulted in surgeons seeking to perform more radical surgery. To date, five randomized controlled trials (RCT) have analyzed the benefits of extended lymphadenectomy for pancreatic head cancer, but none has shown that extended lymphadenectomy enhances patient survival. As most patients with pancreatic cancer have microscopic, locally advanced disease that cannot be cured by surgery alone, local tumor control by extended lymphadenectomy cannot overcome the negative aspects of pre-existing lymph node metastasis. The most important factor improving overall survival following pancreatoduodenectomy in patients with pancreatic head cancer is proper systemic control of the disease rather than extensive local control. The long-term survival outcomes following adjuvant treatment in a large multi-center RCT suggest the need for aggressive systemic treatment. More attention must be paid to the benefits of adjuvant treatment, not only focusing on technical R0 resection. Surgical strategies for patients with pancreatic head cancer require more flexibility, with extent of surgery customized to individual patients, depending on tumor location and disease severity.

6 Clinical Trial Oncological Benefits of Neoadjuvant Chemoradiation With Gemcitabine Versus Upfront Surgery in Patients With Borderline Resectable Pancreatic Cancer: A Prospective, Randomized, Open-label, Multicenter Phase 2/3 Trial. 2018

Jang, Jin-Young / Han, Youngmin / Lee, Hongeun / Kim, Sun-Whe / Kwon, Wooil / Lee, Kyung-Hun / Oh, Do-Youn / Chie, Eui Kyu / Lee, Jeong Min / Heo, Jin Seok / Park, Joon Oh / Lim, Do Hoon / Kim, Seong Hyun / Park, Sang Jae / Lee, Woo Jin / Koh, Young Hwan / Park, Joon Seong / Yoon, Dong Sup / Lee, Ik Jae / Choi, Seong Ho. ·Department of Surgery, Seoul National University Hospital, Seoul, Republic of Korea. · Department of Internal Medicine, Seoul National University Hospital, Seoul, Republic of Korea. · Department of Radiation Oncology, Seoul National University Hospital, Seoul, Republic of Korea. · Department of Radiology, Seoul National University Hospital, Seoul, Republic of Korea. · Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea. · Department of Internal Medicine Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea. · Department of Radiation Oncology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea. · Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea. · Center for Liver Cancer, Research Institute and Hospital, National Cancer Center, Goyang, Republic of Korea. · Department of Surgery, Gangnam Severance Hospital, Yonsei University Health System, Seoul, Republic of Korea. · Department of Radiation Oncology, Yonsei University Health System, Seoul, Republic of Korea. ·Ann Surg · Pubmed #29462005.

ABSTRACT: OBJECTIVE: This study was performed to determine whether neoadjuvant treatment increases survival in patients with BRPC. SUMMARY BACKGROUND DATA: Despite many promising retrospective data on the effect of neoadjuvant treatment for borderline resectable pancreatic cancer (BRPC), no high-level evidence exists to support the role of such treatment. METHODS: This phase 2/3 multicenter randomized controlled trial was designed to enroll 110 patients with BRPC who were randomly assigned to gemcitabine-based neoadjuvant chemoradiation treatment (54 Gray external beam radiation) followed by surgery or upfront surgery followed by chemoradiation treatment from four large-volume centers in Korea. The primary endpoint was the 2-year survival rate (2-YSR). Interim analysis was planned at the time of 50% case enrollment. RESULTS: After excluding the patients who withdrew consent (n = 8) from the 58 enrolled patients, 27 patients were allocated to neoadjuvant treatment and 23 to upfront surgery groups. The overall 2-YSR was 34.0% with a median survival of 16 months. In the intention-to-treat analysis, the 2-YSR and median survival were significantly better in the neoadjuvant chemoradiation than the upfront surgery group [40.7%, 21 months vs 26.1%, 12 months, hazard ratio 1.495 (95% confidence interval 0.66-3.36), P = 0.028]. R0 resection rate was also significantly higher in the neoadjuvant chemoradiation group than upfront surgery (n = 14, 51.8% vs n = 6, 26.1%, P = 0.004). The safety monitoring committee decided on early termination of the study on the basis of the statistical significance of neoadjuvant treatment efficacy. CONCLUSION: This is the first prospective randomized controlled trial on the oncological benefits of neoadjuvant treatment in BRPC. Compared to upfront surgery, neoadjuvant chemoradiation provides oncological benefits in patients with BRPC.

7 Clinical Trial Improved Insulin Secretion by Autologous Islet Transplantation, Compared to Oral Antidiabetic Agents, After Distal Pancreatectomy. 2015

Yoon, Ji Won / Jung, Hye Seung / Jang, Jin Young / Kim, Min Joo / Kim, Jung Hee / Ohn, Jung Hun / Kim, Jae Hyeon / Lee, Hak Mo / Kim, Hyo Cheol / Lee, Kyoung Bun / Choi, Seung A / Kim, Sun-Whe / Park, Kyong Soo. ·Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea. ·Cell Transplant · Pubmed #24978858.

ABSTRACT: In this study, the effects of autologous islet transplantation (ITx) were compared to those of oral antidiabetic drugs (OAD) after distal pancreatectomy (NCT01922492). We enrolled nondiabetic patients who underwent distal pancreatectomy for benign tumors. In the ITx group, islets were isolated from the normal part of the resected pancreas and implanted via the portal vein. Patients who did not receive ITx were regularly monitored and were enrolled in the OAD group if diabetes mellitus developed. The OAD group was treated with metformin with or without vildagliptin. Metabolic parameters were monitored for 12 months postoperatively. Nine patients in the ITx group and 10 in the OAD group were included in the analysis. After 12 months, hemoglobin A1c significantly increased by 5% of the baseline in each group. Area under the curve for blood glucose (AUCglucose) of the 75-g oral glucose tolerance test increased similarly in the immediate postoperative period in both groups but significantly reduced only in the ITx group thereafter. Insulinogenic index (INSindex) significantly decreased from 25.6 ± 18.9 to 4.7 ± 3.7 in the OAD group, while no significant change was observed in the ITx group (from 15.0 ± 4.5 to 11.0 ± 8.2). In the multiple regression analysis, ITx was an independent factor for changes in AUCglucose and INSindex. In addition, changes in INSindex in the ITx group after postoperative 6 months were associated with the efficacy of islet isolation, amount of grafts, and peak serum HMGB1 and VEGF levels after ITx. ITx was superior to OAD in maintaining insulin secretory capacity and glucose tolerance after distal pancreatectomy.

8 Article International validation and update of the Amsterdam model for prediction of survival after pancreatoduodenectomy for pancreatic cancer. 2019

van Roessel, Stijn / Strijker, Marin / Steyerberg, Ewout W / Groen, Jesse V / Mieog, J Sven / Groot, Vincent P / He, Jin / De Pastena, Matteo / Marchegiani, Giovanni / Bassi, Claudio / Suhool, Amal / Jang, Jin-Young / Busch, Olivier R / Halimi, Asif / Zarantonello, Laura / Groot Koerkamp, Bas / Samra, Jaswinder S / Mittal, Anubhav / Gill, Anthony J / Bolm, Louisa / van Eijck, Casper H / Abu Hilal, Mohammed / Del Chiaro, Marco / Keck, Tobias / Alseidi, Adnan / Wolfgang, Christopher L / Malleo, Giuseppe / Besselink, Marc G. ·Department of Surgery, Cancer Center Amsterdam, Amsterdam UMC, University of Amsterdam, the Netherlands. · Department of Biomedical Data Sciences, Leiden University Medical Center, Leiden, the Netherlands. · Department of Surgery, Leiden University Medical Center, Leiden, the Netherlands. · Department of Surgery, The Sol Goldman Pancreatic Cancer Research Center, The Johns Hopkins University School of Medicine, Baltimore, MD, USA. · Department of Surgery, Pancreas Institute, University and Hospital Trust of Verona, Verona, Italy. · Department of Surgery, University Hospital Southampton NHS Foundation Trust, Southampton, UK. · Department of Surgery and Cancer Research Institute, Seoul National University College of Medicine, Seoul, South Korea. · Pancreatic Surgery Unit, Division of Surgery, Karolinska Institute at Center for Digestive Diseases, Karolinska University Hospital, Stockholm, Sweden. · Department of Surgery, Erasmus Medical Center, Erasmus University Rotterdam, Rotterdam, the Netherlands. · Department of Surgery, Royal North Shore Hospital, St Leonards, University of Sydney, Sydney, NSW, Australia. · Cancer Diagnosis and Pathology Group Kolling Institute of Medical Research and University of Sydney, Sydney, NSW, Australia. · Department of Surgery, Universitätsklinikum Schleswig-Holstein, Lübeck, Germany. · Division of Surgical Oncology, Department of Surgery, University of Colorado at Denver-Anschutz Medical Campus, Aurora, CO, USA. · Section of Hepato-Pancreato-Biliary & Endocrine Surgery, Virginia Mason Medical Center, Seattle, WA, USA. · Department of Surgery, Cancer Center Amsterdam, Amsterdam UMC, University of Amsterdam, the Netherlands. Electronic address: m.g.besselink@amsterdamumc.nl. ·Eur J Surg Oncol · Pubmed #31924432.

ABSTRACT: BACKGROUND: The objective of this study was to validate and update the Amsterdam prediction model including tumor grade, lymph node ratio, margin status and adjuvant therapy, for prediction of overall survival (OS) after pancreatoduodenectomy for pancreatic cancer. METHODS: We included consecutive patients who underwent pancreatoduodenectomy for pancreatic cancer between 2000 and 2017 at 11 tertiary centers in 8 countries (USA, UK, Germany, Italy, Sweden, the Netherlands, Korea, Australia). Model performance for prediction of OS was evaluated by calibration statistics and Uno's C-statistic for discrimination. Validation followed the TRIPOD statement. RESULTS: Overall, 3081 patients (53% male, median age 66 years) were included with a median OS of 24 months, of whom 38% had N2 disease and 77% received adjuvant chemotherapy. Predictions of 3-year OS were fairly similar to observed OS with a calibration slope of 0.72. Statistical updating of the model resulted in an increase of the C-statistic from 0.63 to 0.65 (95% CI 0.64-0.65), ranging from 0.62 to 0.67 across different countries. The area under the curve for the prediction of 3-year OS was 0.71 after updating. Median OS was 36, 25 and 15 months for the low, intermediate and high risk group, respectively (P < 0.001). CONCLUSIONS: This large international study validated and updated the Amsterdam model for survival prediction after pancreatoduodenectomy for pancreatic cancer. The model incorporates readily available variables with a fairly accurate model performance and robustness across different countries, while novel markers may be added in the future. The risk groups and web-based calculator www.pancreascalculator.com may facilitate use in daily practice and future trials.

9 Article Lymph node ratio as valuable predictor in pancreatic cancer treated with R0 resection and adjuvant treatment. 2019

You, Min Su / Lee, Sang Hyub / Choi, Young Hoon / Shin, Bang-Sup / Paik, Woo Hyun / Ryu, Ji Kon / Kim, Yong-Tae / Jang, Dong Kee / Lee, Jun Kyu / Kwon, Wooil / Jang, Jin-Young / Kim, Sun-Whe. ·Department of Internal Medicine and Liver Research Institute, Seoul National University College of Medicine, Seoul National University Hospital, 101, Daehak-ro, Jongno-gu, 03080, Seoul, Republic of Korea. · Department of Internal Medicine and Liver Research Institute, Seoul National University College of Medicine, Seoul National University Hospital, 101, Daehak-ro, Jongno-gu, 03080, Seoul, Republic of Korea. gidoctor@snuh.org. · Department of Internal Medicine, Dongguk University Ilsan Hospital, Gyeonggi-do, Goyang-si, South Korea. · Department of Surgery, Seoul National University College of Medicine, Seoul National University Hospital, Seoul, South Korea. ·BMC Cancer · Pubmed #31615457.

ABSTRACT: BACKGROUND: Lymph-node (LN) metastasis is an important prognostic factor in resected pancreatic cancer. In this study, the prognostic value of American Joint Committee on Cancer (AJCC) 8th edition N stage, lymph-node ratio (LNR), and log odds of positive lymph nodes (LODDS) in resected pancreatic cancer was investigated. METHODS: Between January 2005 and December 2017, there were 351 patients with pancreatic cancer treated with R0 resection and adjuvant therapy at Seoul National University Hospital. Relationships between the three LN parameters and overall survival (OS) and recurrence-free survival (RFS) were evaluated using a log-rank test and Cox proportional hazard regression model. Each multivariate-adjusted LN parameter was internally validated by bootstrap-corrected Harrell's C-index. RESULTS: The mean duration from surgery to adjuvant therapy was 47.6 ± 17.4 days. In total, the median OS and RFS was 31.7 (95% CI, 27.2-37.2) and 15.4 (95% CI, 13.5-17.7) months. The three LN classification systems were significantly correlated with OS and RFS in log-rank tests and multivariate-adjusted models (all p < 0.05). When internally validated, LNR showed the highest discrimination ability in predicting OS and RFS (each C-index = 0.65). LNR also showed the highest C-index in subgroup analysis, classified by adjuvant therapy modality. LNR and the AJCC 8th edition LN classification system were significantly associated with loco-regional recurrence (p = 0.026 and p = 0.027, respectively). CONCLUSIONS: LNR, which showed the best prognostic performance and significant relationship with loco-regional recurrence, can help further stratify the patients and establish an active treatment plan.

10 Article Malignant conversion and peritoneal dissemination after endoscopic ultrasound-guided ethanol ablation in intraductal papillary mucinous neoplasm of the pancreas. 2019

Jang, Jin-Young / Byun, Yoonhyeong / Han, Youngmin / Kim, Hongbeom / Kwon, Wooil. ·Department of Surgery, Cancer Research Institute, Seoul National University Hospital, Seoul National University College of Medicine, 28 Yongon-dong, Chongno-gu, Seoul, 110-744, Korea. ·J Hepatobiliary Pancreat Sci · Pubmed #31419024.

ABSTRACT: BACKGROUND: With the increasing detection of pancreatic cysts, many centers have applied endoscopic ultrasound-guided pancreatic cyst ablation (EUS-PCA), even in intraductal papillary mucinous neoplasms (IPMNs) of the pancreas based on early promising outcomes. However, long-term effects of ethanol ablation have been rarely reported, especially regarding oncologic outcomes. METHODS AND RESULTS: We report eight cases of malignancy conversion after EUS-PCA in patients with IPMNs who had worrisome features. Moreover, two patients showed tumor spillage or peritoneal seeding (carcinomatosis) after EUS-PCA. CONCLUSIONS: Endoscopic ultrasound-guided pancreatic cyst ablation must not be performed as a treatment for IPMNs, considering adverse results such as tumor spillage and the lack of oncological therapeutic effect.

11 Article Role of surgical resection in the era of FOLFIRINOX for advanced pancreatic cancer. 2019

Byun, Yoonhyeong / Han, Youngmin / Kang, Jae Seung / Choi, Yoo Jin / Kim, Hongbeom / Kwon, Wooil / Kim, Sun-Whe / Oh, Do-Youn / Lee, Sang Hyub / Ryu, Ji Kon / Kim, Yong-Tae / Jang, Jin-Young. ·Department of Surgery, Seoul National University Hospital, Seoul, Korea. · Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea. ·J Hepatobiliary Pancreat Sci · Pubmed #31218836.

ABSTRACT: BACKGROUND: The introduction of FOLFIRINOX regimen greatly changed the treatment for advanced pancreatic cancers. However, detailed studies on the clinical effects and factors affecting the prognosis are insufficient. We performed this study to evaluate the effects of FOLFIRINOX and the surgical resection in advanced pancreatic cancer. METHODS: Three hundred and thirty-seven patients with advanced pancreatic cancer who initially received FOLFIRINOX, from January 2011 to December 2017, were retrospectively reviewed. Patients were evaluated according to the National Comprehensive Cancer Network guideline, responses after four to six cycles of FOLFIRINOX were re-evaluated according to the response evaluation criteria in solid tumors, and further treatment was decided in the multidisciplinary meeting. RESULTS: Sixty-seven (19.9%) patients had borderline resectable pancreatic cancer, 135 (40.1%) locally advanced pancreatic cancer, and 135 (40.1%) metastatic pancreatic cancer. The median survival period was significantly longer in the surgical group than in the nonsurgical group in each clinical stage, even in metastatic pancreatic cancer (32 vs. 14, P = 0.012). In multivariate analysis, metastatic status at diagnosis, progressive disease after FOLFIRINOX, surgical resection, and declined CA19-9 after FOLFIRINOX were significant prognostic factors. CONCLUSIONS: Surgical treatment greatly affects survival outcomes in advanced pancreatic cancer treated with FOLFIRINOX. Further studies on the optimal indication of operation and the protocol are needed.

12 Article Defective Localization With Impaired Tumor Cytotoxicity Contributes to the Immune Escape of NK Cells in Pancreatic Cancer Patients. 2019

Lim, Seon Ah / Kim, Jungwon / Jeon, Seunghyun / Shin, Min Hwa / Kwon, Joonha / Kim, Tae-Jin / Im, Kyungtaek / Han, Youngmin / Kwon, Wooil / Kim, Sun-Whe / Yee, Cassian / Kim, Seong-Jin / Jang, Jin-Young / Lee, Kyung-Mi. ·Department of Biochemistry and Molecular Biology, Korea University College of Medicine, Seoul, South Korea. · Department of Surgery and Cancer Research Institute, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, South Korea. · Department of Melanoma Medical Oncology and Immunology, MD Anderson Cancer Center, Houston, TX, United States. · Precision Medicine Research Center, Advanced Institutes of Convergence Technology, Seoul National University, Suwon, South Korea. · Center for Bio- Integrated Electronics, Simpson Querrey Institute, Evanston, IL, United States. ·Front Immunol · Pubmed #31024520.

ABSTRACT: Tumor-infiltrating lymphocytes (TILs), found in patients with advanced pancreatic ductal adenocarcinoma (PDAC), are shown to correlate with overall survival (OS) rate. Although majority of TILs consist of CD8

13 Article Validation of the 8th AJCC Cancer Staging System for Pancreas Neuroendocrine Tumors Using Korean Nationwide Surgery Database. 2019

You, Yunghun / Jang, Jin-Young / Kim, Song Cheol / Yoon, Yoo-Seok / Park, Joon Seong / Cho, Chol Kyoon / Park, Sang-Jae / Yang, Jae Do / Lee, Woo Jung / Hong, Tae Ho / Ahn, Keun Soo / Jeong, Chi-Young / Lee, Hyeon Kook / Lee, Seung Eun / Roh, Young Hoon / Kim, Hee Joon / Kim, Hongbeom / Han, In Woong. ·Department of Surgery, Konkuk University Choongju Hospital, Konkuk University School of Medicine, Chungju, Korea. · Department of Surgery, Seoul National University College of Medicine, Seoul, Korea. · Department of Surgery, Asan Medical Center, Ulsan University College of Medicine, Seoul, Korea. · Department of Surgery, Seoul National University Bundang Hospital, Seongnam, Korea. · Department of Surgery, Gangnam Severance Hospital, Yonsei University, Seoul, Korea. · Department of Surgery, Chonnam National University Hwasun Hospital, Hwasun, Korea. · Department of Surgery and Center for Liver Cancer, National Cancer Center, Goyang, Korea. · Department of Surgery, Chonbuk National University Medical School and Hospital, Jeonju, Korea. · Department of Surgery, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea. · Department of Hepatobiliary and Pancreas Surgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea. · Department of Surgery, Keimyung University Dongsan Medical Center, Daegu, Korea. · Department of Surgery, Gyeongsang National University School of Medicine, Jinju, Korea. · Department of Surgery, Ewha Womans University Mokdong Hospital, Ewha Womans University School of Medicine, Seoul, Korea. · Department of Surgery, Chung-Ang University Hospital, Chung-Ang University, College of Medicine, Seoul, Korea. · Department of Surgery, Dong-A University College of Medicine, Busan, Korea. · Department of Surgery, Chonnam National University Hospital, Gwangju, Korea. · Department of Surgery, Dongguk University Ilsan Hospital, Dongguk University College of Medicine, Goyang, Korea. · Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea. ·Cancer Res Treat · Pubmed #30999719.

ABSTRACT: PURPOSE: The 8th edition of the American Joint Committee on Cancer (AJCC) staging system for pancreatic neuroendocrine tumor (PNET) included several significant changes. We aim to evaluate this staging system compared to the 7th edition AJCC staging system and European Neuroendocrine Tumors Society (ENETS) system. Materials and Methods: We used Korean nationwide surgery database (2000-2014). Of 972 patients who had undergone surgery for PNET, excluding patients diagnosed with ENETS/World Health Organization 2010 grade 3 (G3), only 472 patients with accurate stage were included. RESULTS: Poor discrimination in overall survival rate (OSR) was noted between AJCC 8th stage III and IV (p=0.180). The disease-free survival (DFS) curves of 8th AJCC classification were well separated between all stages. Compared with stage I, the hazard ratio of II, III, and IV was 3.808, 13.928, and 30.618, respectively (p=0.007, p < 0.001, and p < 0.001). The curves of OSR and DFS of certain prognostic group in AJCC 7th and ENETS overlapped. In ENETS staging system, no significant difference in DFS between stage IIB versus IIIA (p=0.909) and IIIA versus IIIB (p=0.291). In multivariable analysis, lymphovascular invasion (p=0.002), perineural invasion (p=0.003), and grade (p < 0.001) were identified as independent prognostic factors for DFS. CONCLUSION: This is the first large-scale validation of the AJCC 8th edition staging system for PNET. The revised 8th system provides better discrimination compared to that of the 7th edition and ENETS TNM system. This supports the clinical use of the system.

14 Article Core Set of Patient-reported Outcomes in Pancreatic Cancer (COPRAC): An International Delphi Study Among Patients and Health Care Providers. 2019

van Rijssen, Lennart B / Gerritsen, Arja / Henselmans, Inge / Sprangers, Mirjam A / Jacobs, Marc / Bassi, Claudio / Busch, Olivier R / Fernández-Del Castillo, Carlos / Fong, Zhi Ven / He, Jin / Jang, Jin-Young / Javed, Ammar A / Kim, Sun-Whe / Maggino, Laura / Mitra, Abhishek / Ostwal, Vikas / Pellegrini, Silvia / Shrikhande, Shailesh V / Wilmink, Johanna W / Wolfgang, Christopher L / van Laarhoven, Hanneke W / Besselink, Marc G / Anonymous531066. ·Department of Surgery, Cancer Center Amsterdam, Academic Medical Center, Amsterdam, The Netherlands. · Department of Surgery, Gelre Hospital, Apeldoorn, The Netherlands. · Department of Medical Psychology, Cancer Center Amsterdam, Academic Medical Center, Amsterdam, The Netherlands. · General and Pancreatic Surgery, The Pancreas Institute, University of Verona Hospital Trust, Verona, Italy. · Department of Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA. · Department of Surgery, Johns Hopkins Medical Institutions, Baltimore, MD. · Department of Surgery, Seoul National University Hospital, Seoul, Korea. · GI and HPB Service, Department of Surgical Oncology, Tata Memorial Hospital, Mumbai, India. · Department of Medical Oncology, Tata Memorial Hospital, Mumbai, India. · Department of Medical Psychology, University of Verona Hospital Trust, Verona, Italy. · Department of Medical Oncology, Cancer Center Amsterdam Academic Medical Center, Amsterdam, The Netherlands. ·Ann Surg · Pubmed #29261524.

ABSTRACT: OBJECTIVE: To establish an international core set of patient-reported outcomes (PROs) selected by both patients and healthcare providers (HCPs) from the United States (US), Europe, and Asia. SUMMARY BACKGROUND DATA: PROs are increasingly recognized in pancreatic cancer studies. There is no consensus on which of the many available PROs are most important. METHODS: A multicenter Delphi study among patients with pancreatic cancer (curative- and palliative-setting) and HCPs in 6 pancreatic centers in the US (Baltimore, Boston), Europe (Amsterdam, Verona), and Asia (Mumbai, Seoul) was performed. In round 1, participants rated the importance of 56 PROs on a 1 to 9 Likert scale. PROs rated as very important (scores 7-9) by the majority (≥80%) of curative- and/or palliative-patients as well as HCPs were included in the core set. PROs not fulfilling these criteria were presented again in round 2, together with feedback on individual and group ratings. Remaining PROs were ranked based on the importance ratings. RESULTS: In total 731 patients and HCPs were invited, 501 completed round 1, and 420 completed both rounds. This included 204 patients in curative-setting, 74 patients in palliative-setting, and 142 HCPs. After 2 rounds, 8 PROs were included in the core set: general quality of life, general health, physical ability, ability to work/do usual activities, fear of recurrence, satisfaction with services/care organization, abdominal complaints, and relationship with partner/family. CONCLUSIONS: This international Delphi study among patients and HCPs established a core set of PROs in pancreatic cancer, which should facilitate the design of future pancreatic cancer trials and outcomes research.

15 Article Recent treatment patterns and survival outcomes in pancreatic cancer according to clinical stage based on single-center large-cohort data. 2018

Lee, Doo-Ho / Jang, Jin-Young / Kang, Jae Seung / Kim, Jae Ri / Han, Youngmin / Kim, Eunjung / Kwon, Wooil / Kim, Sun-Whe. ·Department of Surgery and Cancer Research Institute, Seoul National University College of Medicine, Seoul, Korea. ·Ann Hepatobiliary Pancreat Surg · Pubmed #30588531.

ABSTRACT: Backgrounds/Aims: We performed a retrospective, single-center cohort study to evaluate the impact of various treatment modalities and recent changes in treatment modalities, including the increased application of chemotherapy, on survival in patients with pancreatic cancer. Methods: All patients with pancreatic cancer who were diagnosed and treated at Seoul National University Hospital between January 2007 and December 2014 were registered in a prospective clinical database and included in this retrospective study. All patients' radiologic imaging diagnoses were re-reviewed according to the National Cancer Center Network guidelines. The patients were divided into four groups according to their clinical stage, and each clinical stage group was further divided into four groups according to treatment modality. Results: Overall, 475 (28.9%) patients had resectable pancreatic cancer, 129 (7.8%) patients borderline resectable pancreatic cancer, 384 (23.3%) patients locally advanced pancreatic cancer, and 658 (40.0%) patients metastatic pancreatic cancer. Among the patients with borderline resectable pancreatic cancer, the median survival was significantly longer in the neoadjuvant therapy (NAT)+surgery groups (24 months) than the surgery without NAT (16 months) group ( Conclusions: This retrospective cohort study showed that the rates of resectable and surgically treatable pancreatic cancer were 29.1% and 32.2%, which are higher than those reported previously, and aggressive NAT for select advanced-stage patients could lead to better survival outcomes.

16 Article Multinational validation of the American Joint Committee on Cancer 8th edition pancreatic cancer staging system in a pancreas head cancer cohort. 2018

Kwon, Wooil / He, Jin / Higuchi, Ryota / Son, Donghee / Lee, Seung Yeoun / Kim, Jaeri / Kim, Hongbeom / Kim, Sun-Whe / Wolfgang, Christopher L / Cameron, John L / Yamamoto, Masakazu / Jang, Jin-Young. ·Department of Surgery, Cancer Research Institute, Seoul National University College of Medicine, Seoul, Korea. · Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA. · Department of Surgery, Institute of Gastroenterology, Tokyo Women's Medical University, Tokyo, Japan. · Department of Mathematics and Statistics, Sejong University College of Natural Sciences, Seoul, Korea. ·J Hepatobiliary Pancreat Sci · Pubmed #30118171.

ABSTRACT: BACKGROUND: The aim of the present study was to compare the 7th and 8th editions of the American Joint Committee on Cancer (AJCC) staging system for pancreas head cancer and to validate the 8th edition using three multinational tertiary center data. METHODS: Data of 2,864 patients with pancreas head cancer were collected from Korea (571), Japan (824), and the USA (1,469). Survival analysis was performed to compare the 7th and 8th editions. Validation was performed by log-rank tests and test for trend repeated 1,000 times with random sets. RESULTS: In the 7th edition, 4.1%, 3.1%, 18.6%, 67.5%, 3.6%, and 3.1% were stage IA, IB, IIA, IIB, III, and IV. In the 8th edition, 8.8%, 13.9%, 3.1%, 38.2%, 32.9%, and 3.1% were stage IA, IB, IIA, IIB, III, and IV, respectively. The change in T category downstaged 459 patients from IIA to the new IA and IB. The new N2 category upstaged 856 patients from the former IIB to III. The 7th edition reversely stratified IA and IB. The 8th edition corrected this mis-stratification of the 7th edition, but lacked discriminatory power between IB and IIA (P = 0.271). Validation using the log-rank showed that the 8th edition provided better discrimination in 6.387 test sets among 10 tests. The test for trend validated the 8th edition to stratify stages in correct order more often (7.815/10). CONCLUSION: The 8th edition provides more even distribution with more powerful discrimination compared to the 7th edition.

17 Article Hierarchical structural component modeling of microRNA-mRNA integration analysis. 2018

Kim, Yongkang / Lee, Sungyoung / Choi, Sungkyoung / Jang, Jin-Young / Park, Taesung. ·Department of Statistics, Seoul National University, Seoul, Korea. · Interdisciplinary program in Bioinformatics, Seoul National University, Seoul, Korea. · Department of Surgery and Cancer Research Institute, Seoul National University College of Medicine, Seoul, Korea. · Department of Statistics, Seoul National University, Seoul, Korea. tspark@stats.snu.ac.kr. · Interdisciplinary program in Bioinformatics, Seoul National University, Seoul, Korea. tspark@stats.snu.ac.kr. ·BMC Bioinformatics · Pubmed #29745843.

ABSTRACT: BACKGROUND: Identification of multi-markers is one of the most challenging issues in personalized medicine era. Nowadays, many different types of omics data are generated from the same subject. Although many methods endeavor to identify candidate markers, for each type of omics data, few or none can facilitate such identification. RESULTS: It is well known that microRNAs affect phenotypes only indirectly, through regulating mRNA expression and/or protein translation. Toward addressing this issue, we suggest a hierarchical structured component analysis of microRNA-mRNA integration ("HisCoM-mimi") model that accounts for this biological relationship, to efficiently study and identify such integrated markers. In simulation studies, HisCoM-mimi showed the better performance than the other three methods. Also, in real data analysis, HisCoM-mimi successfully identified more gives more informative miRNA-mRNA integration sets relationships for pancreatic ductal adenocarcinoma (PDAC) diagnosis, compared to the other methods. CONCLUSION: As exemplified by an application to pancreatic cancer data, our proposed model effectively identified integrated miRNA/target mRNA pairs as markers for early diagnosis, providing a much broader biological interpretation.

18 Article Exact association test for small size sequencing data. 2018

Lee, Joowon / Lee, Seungyeoun / Jang, Jin-Young / Park, Taesung. ·Department of Statistics, Seoul National University, Seoul, South Korea. · Department of Applied Statistics, Sejong University, Seoul, South Korea. · Department of Surgery, Seoul National University College of Medicine, Seoul, South Korea. · Department of Statistics, Seoul National University, Seoul, South Korea. tspark@stats.snu.ac.kr. ·BMC Med Genomics · Pubmed #29697368.

ABSTRACT: BACKGROUND: Recent statistical methods for next generation sequencing (NGS) data have been successfully applied to identifying rare genetic variants associated with certain diseases. However, most commonly used methods (e.g., burden tests and variance-component tests) rely on large sample sizes. Notwithstanding, due to its-still high cost, NGS data is generally restricted to small sample sizes, that cannot be analyzed by most existing methods. METHODS: In this work, we propose a new exact association test for sequencing data that does not require a large sample approximation, which is applicable to both common and rare variants. Our method, based on the Generalized Cochran-Mantel-Haenszel (GCMH) statistic, was applied to NGS datasets from intraductal papillary mucinous neoplasm (IPMN) patients. IPMN is a unique pancreatic cancer subtype that can turn into an invasive and hard-to-treat metastatic disease. RESULTS: Application of our method to IPMN data successfully identified susceptible genes associated with progression of IPMN to pancreatic cancer. CONCLUSIONS: Our method is expected to identify disease-associated genetic variants more successfully, and corresponding signal pathways, improving our understanding of specific disease's etiology and prognosis.

19 Article Preoperative MDCT Assessment of Resectability in Borderline Resectable Pancreatic Cancer: Effect of Neoadjuvant Chemoradiation Therapy. 2018

Joo, Ijin / Lee, Jeong Min / Lee, Eun Sun / Ahn, Su Joa / Lee, Dong Ho / Kim, Sun-Whe / Ryu, Ji Kon / Oh, Do-Youn / Kim, Kyubo / Lee, Kyoung-Bun / Jang, Jin-Young. ·1 Department of Radiology, Seoul National University Hospital, 101 Daehak-Ro, Jongno-gu, Seoul 03080, Korea. · 2 Department of Radiology, Seoul National University College of Medicine, Seoul, Korea. · 3 Institute of Radiation Medicine, Seoul National University Hospital, Seoul, Korea. · 4 Department of Radiology, Chung-Ang University Hospital, Seoul, Korea. · 5 Department of Surgery, Seoul National University Hospital, Seoul, Korea. · 6 Department of Internal Medicine and Liver Research Institute, Seoul National University College of Medicine, Seoul, Korea. · 7 Department of Internal Medicine and Cancer Research Institute, Seoul National University College of Medicine, Seoul, Korea. · 8 Department of Radiation Oncology, Ewha Woman's University School of Medicine, Seoul, Korea. · 9 Department of Pathology, Seoul National University Hospital, Seoul, Korea. ·AJR Am J Roentgenol · Pubmed #29489408.

ABSTRACT: OBJECTIVE: The purpose of this study is to evaluate the diagnostic performance of MDCT in assessing tumor resectability in patients with borderline resectable pancreatic cancers after receiving neoadjuvant chemoradiation therapy (CRT) in comparison with those undergoing upfront surgery. SUBJECTS AND METHODS: Thirty-seven patients with borderline resectable pancreatic cancers were randomly allocated to the neoadjuvant CRT group (arm 1; n = 18) or up-front surgery group (arm 2; n = 19). Three radiologists rated the likelihood of local resectability on a 5-point scale at preoperative MDCT in two separate sessions (session 1: post-CRT of arm 1, baseline of arm 2; session 2: using new imaging criteria reflecting the changes during CRT of arm 1). The AUC of each reviewer, as well as sensitivity, specificity, and accuracy based on consensus interpretation, were compared between arms and sessions. RESULTS: For local resectability (n = 30), AUC values at session 1 were 0.664, 0.669, and 0.588 for reviewers 1, 2, and 3, respectively, and were not significantly different between arms 1 (n = 15; 0.759, 0.713, and 0.593) and 2 (n = 15; 0.852, 0.685, and 0.722) (p > 0.05). In arm 1, MDCT sensitivity, specificity, accuracy were 22%, 100%, and 53%, respectively, at session 1 versus 78%, 67%, and 73%, respectively, at session 2 (p > 0.05). CONCLUSION: In patients with borderline resectable pancreatic cancers, neoadjuvant CRT did not significantly decrease the performance of MDCT for the prediction of local resectability. However, by considering post-CRT changes, such as nonprogression in tumor-vascular contact, MDCT may provide better sensitivity for locally resectable disease.

20 Article Magnetic resonance with diffusion-weighted imaging improves assessment of focal liver lesions in patients with potentially resectable pancreatic cancer on CT. 2018

Jeon, Sun Kyung / Lee, Jeong Min / Joo, Ijin / Lee, Dong Ho / Ahn, Su Joa / Woo, Hyunsik / Lee, Myoung Seok / Jang, Jin-Young / Han, Joon Koo. ·Department of Radiology, Seoul National University Hospital, 101 Daehangno, Jongno-gu, Seoul, 03080, Korea. · Seoul National University College of Medicine, Seoul, Korea. · Department of Radiology, Seoul National University Hospital, 101 Daehangno, Jongno-gu, Seoul, 03080, Korea. jmsh@snu.ac.kr. · Seoul National University College of Medicine, Seoul, Korea. jmsh@snu.ac.kr. · Institute of Radiation Medicine, Seoul National University Medical Research Cente, Seoul, Korea. jmsh@snu.ac.kr. · Department of Radiology, Seoul Metropolitan Government - Seoul National University Boramae Medical Center, Seoul, Korea. · Department of Surgery, Seoul National University Hospital, Seoul, Korea. · Institute of Radiation Medicine, Seoul National University Medical Research Cente, Seoul, Korea. ·Eur Radiol · Pubmed #29352379.

ABSTRACT: PURPOSE: To investigate added value of MRI to preoperative staging MDCT for evaluation of focal liver lesions (FLLs) in potentially resectable pancreatic ductal adenocarcinomas (PDACs). MATERIALS AND METHODS: In patients with potentially resectable PDACs after staging MDCT (n=167), characteristics of FLLs were scored as benign, indeterminate or metastases on an MDCT set and combined MDCT and MRI set by two readers, independently. Size of hepatic lesions was measured and detection rate of hepatic metastasis unsuspected by MDCT and diagnostic yield of MRI for FLLs were assessed. RESULTS: Reader-averaged figure-of-merit (FOM) of the combined set was significantly higher than that of MDCT alone (0.94 vs. 0.86, p=.028). In the negative-on-CT group, the diagnostic yield of MRI was 1.5-2.3% (2/133 and 3/133 for readers 1 and 2, respectively). In the indeterminate-on-CT group, MRI yield was 10.5-13.6% (2/19 and 3/22) and in patients with suspicious-metastasis-on-CT, 8.3-26.7% (1/12 and 4/15). All lesions with false-positive and false-negative CT findings were ≤1 cm. CONCLUSION: In potentially resectable PDACs, addition of MRI with DWI can provide significantly better diagnostic performance in characterization of focal liver lesions, especially for small-sized (≤ 1 cm) MDCT-indeterminate or suspicious metastasis lesions, aiding in determination of appropriate operation candidates. KEY POINTS: • Addition of MRI provides better diagnostic performance in characterization of liver lesions. • Combined interpretation of MRI and MDCT provided less frequent indeterminate liver lesions. • Diagnostic yield of MRI was high in CT-indeterminate or suspicious metastatic lesions. • Operation candidates can be determined with greater confidence in potentially resectable PDACs.

21 Article Comparison of surgical outcomes between open and robot-assisted minimally invasive pancreaticoduodenectomy. 2018

Kim, Hyeong Seok / Han, Youngmin / Kang, Jae Seung / Kim, Hongbeom / Kim, Jae Ri / Kwon, Wooil / Kim, Sun-Whe / Jang, Jin-Young. ·Department of Surgery, Seoul National University College of Medicine, 101 Daehak-Ro, Jongro-Gu, Seoul 110-744, Korea. · Department of Surgery, Dongguk University College of Medicine, Ilsan, Korea. ·J Hepatobiliary Pancreat Sci · Pubmed #29117639.

ABSTRACT: BACKGROUND: Robot surgery is a new method that maintains advantages and overcomes disadvantages of conventional methods, even in pancreatic surgery. This study aimed to evaluate safety and benefits of robot-assisted minimally invasive pancreaticoduodenectomy (robot PD). METHODS: This study included 237 patients who underwent PD between 2015 and 2017. Demographics and surgical outcomes were evaluated. RESULTS: Fifty-one patients underwent robot PD and 186 underwent open PD. Robot PD group had younger age (60.7 vs. 65.4 years, P = 0.006) and lower body mass index (22.7 vs. 24.0, P = 0.007). Robot PD group had lower proportion of patients with firm or hard pancreatic texture (15.7% vs. 38.2%, P = 0.004) and smaller pancreatic duct size (2.3 vs. 3.3 mm, P = 0.002). Two groups had similar operation time (robot vs. open: 335.6 vs. 330.1 min) and complications (15.7% vs. 21.0%), including postoperative pancreatic fistula rate (6.0% vs. 12.0%). Robot PD group had lower postoperative pain score (3.7 vs. 4.1 points, P = 0.008), and shorter postoperative stay (10.6 vs. 15.3 days, P = 0.001). CONCLUSION: Robot PD is comparable to open PD in early outcomes. Robot PD is safe and feasible and enables early recovery; indication for robot PD is expected to expand in the near future.

22 Article Progression of Pancreatic Branch Duct Intraductal Papillary Mucinous Neoplasm Associates With Cyst Size. 2018

Han, Youngmin / Lee, Hongeun / Kang, Jae Seung / Kim, Jae Ri / Kim, Hyeong Seok / Lee, Jeong Min / Lee, Kyoung-Bun / Kwon, Wooil / Kim, Sun-Whe / Jang, Jin-Young. ·Department of Surgery and Cancer Research Institute, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea. · Department of Radiology, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea. · Department of Pathology, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea. · Department of Surgery and Cancer Research Institute, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea. Electronic address: jangjy4@snu.ac.kr. ·Gastroenterology · Pubmed #29074452.

ABSTRACT: BACKGROUNDS & AIMS: Most guidelines for management of patients with intraductal papillary mucinous neoplasms (IPMN) vary in proposed surveillance intervals and durations-these are usually determined based on expert opinions rather than substantial evidence. The progression of and optimal surveillance intervals for branch-duct IPMNs (BD-IPMN) has not been widely studied. We evaluated the progression of BD-IPMN under surveillance at a single center, and determined optimal follow-up intervals and duration. METHODS: We performed a retrospective analysis of 1369 patients with BD-IPMN seen at Seoul National University Hospital in Korea from January 2001 through December 2016. We included only patients whose imaging studies showed classical features of BD-IPMN, and collected data from each patient over time periods of at least 3 years. We reviewed radiologic and pathologic findings, and performed linear and binary logistic regressions to estimate cyst growth. RESULTS: The median annual growth rate of the cyst was 0.8 mm over a median follow-up time of 61 months. During surveillance, 46 patients (3.4%) underwent surgery because of disease progression after a median follow-up time (in this group) of 62 months. Worrisome features were observed in 209 patients (15.3%) during surveillance, including cyst size of 3 cm or more (n = 109, 8.0%), cyst wall thickening (n = 51, 3.7%), main pancreatic duct dilatation (n = 77, 5.6%), and mural nodule (n = 43, 3.1%). Along with annual rate of cyst growth, incidences of main pancreatic duct dilatation and mural nodules associated with the sizes of cysts at detection (P < .001). CONCLUSIONS: In a retrospective analysis of patients with BD-IPMN followed for more than 5 years, we found most cysts to be indolent, but some rapidly grew and progressed. Surveillance protocols should therefore be individualized based on initial cyst size and rate of growth.

23 Article Diagnostic performance enhancement of pancreatic cancer using proteomic multimarker panel. 2017

Park, Jiyoung / Choi, Yonghwan / Namkung, Junghyun / Yi, Sung Gon / Kim, Hyunsoo / Yu, Jiyoung / Kim, Yongkang / Kwon, Min-Seok / Kwon, Wooil / Oh, Do-Youn / Kim, Sun-Whe / Jeong, Seung-Yong / Han, Wonshik / Lee, Kyu Eun / Heo, Jin Seok / Park, Joon Oh / Park, Joo Kyung / Kim, Song Cheol / Kang, Chang Moo / Lee, Woo Jin / Lee, Seungyeoun / Han, Sangjo / Park, Taesung / Jang, Jin-Young / Kim, Youngsoo. ·Department of Biomedical Sciences, Seoul National University College of Medicine, Seoul, Korea. · Department of Biomedical Engineering, Seoul National University College of Medicine, Seoul, Korea. · Immunodiagnostics R&D Team, IVD Business Unit 5, SK Telecom, Seoul, Korea. · Department of Statistics, Seoul National University, Seoul, Korea. · Department of Surgery and Cancer Research Institute, Seoul National University College of Medicine, Seoul, Korea. · Department of Internal Medicine and Cancer Research Institute, Seoul National University Hospital, Seoul, Korea. · Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea. · Internal Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea. · Department of Internal Medicine, Seoul National University Hospital Healthcare System Gangnam Center, Seoul, Korea. · Department of Surgery, University of Ulsan College of Medicine and Asan Medical Center, Seoul, Korea. · Department of Surgery, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea. · Center for Liver Cancer, National Cancer Center, Seoul, Korea. · Department of Mathematics and Statistics, Sejong University, Seoul, Korea. ·Oncotarget · Pubmed #29190982.

ABSTRACT: Due to its high mortality rate and asymptomatic nature, early detection rates of pancreatic ductal adenocarcinoma (PDAC) remain poor. We measured 1000 biomarker candidates in 134 clinical plasma samples by multiple reaction monitoring-mass spectrometry (MRM-MS). Differentially abundant proteins were assembled into a multimarker panel from a training set (n=684) and validated in independent set (n=318) from five centers. The level of panel proteins was also confirmed by immunoassays. The panel including leucine-rich alpha-2 glycoprotein (LRG1), transthyretin (TTR), and CA19-9 had a sensitivity of 82.5% and a specificity of 92.1%. The triple-marker panel exceeded the diagnostic performance of CA19-9 by more than 10% (AUC

24 Article Survival outcome and prognostic factors of neoadjuvant treatment followed by resection for borderline resectable pancreatic cancer. 2017

Kim, Hyeong Seok / Jang, Jin-Young / Han, Youngmin / Lee, Kyoung Bun / Joo, Ijin / Lee, Doo-Ho / Kim, Jae Ri / Kim, Hongbeom / Kwon, Wooil / Kim, Sun-Whe. ·Department of Surgery and Cancer Research Institute, Seoul National University College of Medicine, Seoul, Korea. · Department of Pathology, Seoul National University College of Medicine, Seoul, Korea. · Department of Radiology, Seoul National University College of Medicine, Seoul, Korea. ·Ann Surg Treat Res · Pubmed #29094028.

ABSTRACT: Purpose: Neoadjuvant treatment may provide improved survival outcomes for patients with borderline resectable pancreatic cancer (BRPC). The purpose of this study is to evaluate the clinical outcomes of neoadjuvant treatment and to identify prognostic factors. Methods: Forty patients who met the National Comprehensive Cancer Network definition of BRPC and received neoadjuvant treatment followed by surgery between 2007 and 2015 were evaluated. Prospectively collected clinicopathological outcomes were analyzed retrospectively. Results: The mean age was 61.7 years and the male-to-female ratio was 1.8:1. Twenty-six, 3, and 11 patients received gemcitabine-based chemotherapy, 5-fluorouracil, and FOLFIRINOX, respectively. The 2-year survival rate (2YSR) was 36.6% and the median overall survival (OS) was 20 months. Of the 40 patients, 34 patients underwent resection and the 2YSR was 41.2% while the 2YSR of patients who did not undergo resection was 16.7% (P = 0.011). The 2YSR was significantly higher in patients who had partial response compared to stable disease (60.6% Conclusion: Neoadjuvant treatment followed by resection is effective for BRPC. Pancreatectomy and neoadjuvant treatment response may affect survival. Effective systemic therapy is needed to improve long-term survival since systemic metastasis accounts for a high proportion of recurrence.

25 Article Clinicopathologic and survival differences in younger patients with pancreatic ductal adenocarcinoma-A propensity score-matched comparative analysis. 2017

Kang, Jae Seung / Jang, Jin-Young / Kwon, Wooil / Han, Youngmin / Kim, Sun-Whe. ·Department of Surgery and Cancer Research Institute, Seoul National University College of Medicine, Seoul, South Korea. · Department of Surgery and Cancer Research Institute, Seoul National University College of Medicine, Seoul, South Korea. Electronic address: jangjy4@snu.ac.kr. ·Pancreatology · Pubmed #28870389.

ABSTRACT: BACKGROUND/OBJECTIVES: Early-onset pancreatic cancer (EOPC) is not optimally characterized because of its extremely low incidence. We investigated clinicopathologic differences between younger or older patients with pancreatic cancer, and compared their outcomes. METHODS: We enrolled 699 consecutive patients who were diagnosed with pancreatic ductal adenocarcinoma and admitted to our surgical department between 2000 and 2014. We compared demographics and clinical outcomes in patients who were younger and older than 45 years at diagnosis. We estimated 1:2 case propensity score matching (PSM) by a logistic regression model based on patients' ASA scores, postoperative AJCC stages, adjuvant chemotherapy and radiotherapy. RESULTS: At diagnosis 34 patients (4.9%) were younger than 45 years. After PSM, tested variables and median survival periods were not significantly different between two groups. Some 441 patients (63.1%) suffered postoperative recurrence, but did not significantly differ by age for local (14.7 vs. 18.5%, P = 0.658) or systemic recurrence (70.6 vs. 54.4%, P = 0.077). There was a significant difference of disease-free survival (DFS) after PSM (8.9 vs. 29.3%, P = 0.011). CONCLUSIONS: Five-year OS and recurrence patterns did not significantly differ between two groups. But five-year DFS was significantly worse after PSM and systemic recurrence tended to be more frequent in the younger group.

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