Annals of hepato-biliary-pancreatic surgery最新文献

{"title":"Decreased use of red blood cell transfusion and associated factors for pancreatic cancer surgery.","authors":"Sunghee Hong, Yun Kyung Jung, Seonju Kim, Junghyun Yoon, Dongho Choi, Boyoung Park","doi":"10.14701/ahbps.25-072","DOIUrl":"https://doi.org/10.14701/ahbps.25-072","url":null,"abstract":"<p><strong>Backgrounds/aims: </strong>This study investigated perioperative patterns of red blood cell (RBC) transfusion and related determinants in pancreatic cancer surgery using a nationwide Korean database.</p><p><strong>Methods: </strong>We assessed data from the National Health Insurance Service (NHIS) from 2012 to 2020, including newly diagnosed pancreatic cancer patients aged ≥ 20 years who underwent pancreatic surgery within one-year of their diagnosis. Perioperative RBC transfusion was defined as receiving ≥ 1 unit of allogenic RBCs from one week before surgery through hospital discharge.</p><p><strong>Results: </strong>Of the 10,473 patients, 18% underwent perioperative RBC transfusions. The transfusion rate declined from 20.1% in 2012 to 12.7% in 2015, followed by an increase to 19.9% in 2020. In a multivariate analysis, each 10-year increase in age (odds ratio [OR], 1.30; 95% confidence interval [CI], 1.24-1.37), female sex (OR, 1.16; 95% CI, 1.05-1.29), and being in the lowest-income quartile compared to the highest (OR, 1.29; 95% CI, 1.11-1.49) were associated with an increased likelihood of requiring RBC transfusions. A higher Charlson comorbidity index was independently connected to a greater risk as well. Compared with pancreaticoduodenectomy, total pancreatectomy had higher odds (OR, 1.91; 95% CI, 1.56-2.35), whereas distal pancreatectomy had lower odds. Furthermore, general hospitals, compared with tertiary hospitals, were associated with higher transfusion probability (OR, 1.38; 95% CI, 1.22-1.56).</p><p><strong>Conclusions: </strong>Given rising RBC transfusion rates among low-income patients and limited NHIS coverage for new transfusion-sparing methods, Korea should prioritize broader adoption of multidisciplinary blood management over continued reliance on transfusion.</p>","PeriodicalId":72220,"journal":{"name":"Annals of hepato-biliary-pancreatic surgery","volume":" ","pages":""},"PeriodicalIF":1.7,"publicationDate":"2025-07-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144735812","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Incidence, mortality, and survival of gallbladder, extrahepatic bile duct, and pancreatic cancers in Korea: a population-based study from 1999 to 2022.","authors":"Mee Joo Kang, Eun Hye Park, E Hwa Yun, Hye-Jin Kim, Kyu-Won Jung, Sang-Jae Park","doi":"10.14701/ahbps.25-135","DOIUrl":"https://doi.org/10.14701/ahbps.25-135","url":null,"abstract":"<p><strong>Backgrounds/aims: </strong>Biliary tract and pancreatic cancers remain leading contributors to cancer-related mortality in Korea, even though their incidence rates are comparatively low. This study evaluates long-term national patterns in these malignancies utilizing population-based data.</p><p><strong>Methods: </strong>Information from the Korea Central Cancer Registry was used to assess 258,854 patients newly diagnosed with gallbladder (n = 52,712), extrahepatic bile duct (n = 76,787), and pancreatic (n = 129,355) cancers between 1999 and 2022.</p><p><strong>Results: </strong>During the period from 1999 to 2022, the crude incidence rates for gallbladder (2.8 to 5.6 per 100,000), extrahepatic bile duct (3.6 to 9.8), and pancreatic cancers (5.5 to 19.1) all showed an upward trend. For pancreatic cancer, the age-standardized incidence rate rose markedly (5.6 to 8.4), whereas it stabilized for extrahepatic bile duct cancer (3.7 to 3.8), and declined for gallbladder cancer (2.9 to 2.2). The distributions of localized and regional disease stages remained largely consistent throughout the study period. There was an increase in the proportion of patients undergoing surgical intervention within the first 4 months post-diagnosis for gallbladder (42.3% to 48.2%) and pancreatic cancer (22.5% to 23.7%), while this proportion slightly declined in extrahepatic bile duct cancer (47.8% to 46.0%). The overall 5-year relative survival rate improved significantly in gallbladder (21.9% to 32.1%) and pancreatic (8.6% to 15.5%) cancers, and showed a modest improvement in extrahepatic bile duct cancer (23.1% to 27.2%).</p><p><strong>Conclusions: </strong>The crude incidence rates for gallbladder, extrahepatic bile duct, and pancreatic cancers have continuously risen in Korea. While survival rates have improved, the persistently high mortality rates highlight the critical need for earlier diagnosis and advancements in therapeutic approaches.</p>","PeriodicalId":72220,"journal":{"name":"Annals of hepato-biliary-pancreatic surgery","volume":" ","pages":""},"PeriodicalIF":1.7,"publicationDate":"2025-07-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144735813","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Pancreatectomy with arterial resection following neoadjuvant FOLFIRINOX: a single-institution experience.","authors":"Fahim Kanani, Ester Ovdat, Mohammed Younis, Guy Meyerovich, Nir Messer, Alexander Barenboim, Yaacov Goykhman, Nir Lubezky","doi":"10.14701/ahbps.25-108","DOIUrl":"https://doi.org/10.14701/ahbps.25-108","url":null,"abstract":"<p><strong>Backgrounds/aims: </strong>Arterial resection in pancreatic cancer remains controversial. This study evaluates outcomes of pancreatic resection with arterial involvement following neoadjuvant chemotherapy.</p><p><strong>Methods: </strong>Retrospective analysis of 100 pancreatic adenocarcinoma patients undergoing resection after neoadjuvant FOLFIRINOX (2010-2024): 26 with arterial resection (ArP), 39 with portal-venous resection (PoP), and 35 without vascular involvement (NoP). Primary outcomes included perioperative morbidity, mortality, and survival.</p><p><strong>Results: </strong>ArP patients had significantly more stage III disease (73.1% vs 58.9% vs 28.6%, <i>p</i> < 0.001) but achieved acceptable R0 resection rates (76.9% vs 84.6% vs 91.4%, <i>p</i> = 0.04). ArP procedures required longer operative time (386 ± 71 minutes), greater blood loss (1,100 ± 560 mL), and more transfusions (57.7%; all <i>p</i> < 0.001). Major complications (Clavien-Dindo ≥ III) were higher in ArP (26.9% vs 21.6% vs 8.6%, <i>p</i> = 0.03), with extended ICU stays (3.5 ± 1.5 vs 2.0 ± 1.0 vs 1.0 ± 0.5 days). Ninety-day mortality was 0% (ArP), 2.5% (PoP), and 5.7% (NoP) (<i>p</i> = 0.78). Despite shorter disease-free survival in ArP (7.4 vs 9.7 vs 13.2 months, <i>p</i> = 0.01), median overall survival was comparable (ArP: 19.1, PoP: 18.3, NoP: 22.7 months; <i>p</i> = 0.0652).</p><p><strong>Conclusions: </strong>Arterial resection following neoadjuvant therapy in selected pancreatic cancer patients demonstrates acceptable perioperative risk and achieves survival outcomes comparable to less advanced cases. This approach is justified in experienced high-volume centers for appropriately selected patients with favorable response to neoadjuvant therapy, offering potential cure in rare circumstances.</p>","PeriodicalId":72220,"journal":{"name":"Annals of hepato-biliary-pancreatic surgery","volume":" ","pages":""},"PeriodicalIF":1.1,"publicationDate":"2025-07-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144700469","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The contribution of surgical data science to identifying intraoperative human errors and adverse events in elective liver surgery: A preliminary study.","authors":"Nesrine Mekhenane, Clement Cormi, Arnaud Allemang-Trivalle, Belkacem Acidi, Daniel Cherqui, Eric Vibert, Marc-Antoine Allard","doi":"10.14701/ahbps.25-089","DOIUrl":"https://doi.org/10.14701/ahbps.25-089","url":null,"abstract":"<p><strong>Backgrounds/aims: </strong>Surgical data science (SDS) is an emerging discipline that aims to enhance the quality of interventional healthcare by capturing and analyzing intraoperative data. Our study focused on identifying human errors (HEs) and adverse events (AEs) during elective liver surgery using an SDS-based approach.</p><p><strong>Methods: </strong>Intraoperative data from 15 patients undergoing elective open liver resection were collected using an operating room data system (audio, room, and operative field videos) over a 6-month period in a tertiary hepatobiliary surgical center. Two independent researchers analyzed the data to identify HEs and AEs according to two distinct classifications.</p><p><strong>Results: </strong>A total of 154 HEs (median number per intervention: 7) and 42 AEs (33 minor, 9 major) were identified. All except one major AE were associated with HEs, while 15 minor AEs had no identifiable underlying HEs. The type of HEs significantly varied depending on the presence or absence of AEs. The majority of HEs (n = 128, 83.1%), which did not result in any AEs, primarily involved lapses in attention, whereas approximately half of the AEs were linked to failures in recognition.</p><p><strong>Conclusions: </strong>This preliminary study indicates that failures in recognition were frequently associated with major AEs during elective liver resection, as per the SDS approach. Larger multicenter studies are necessary to confirm these findings and develop preventive strategies.</p>","PeriodicalId":72220,"journal":{"name":"Annals of hepato-biliary-pancreatic surgery","volume":" ","pages":""},"PeriodicalIF":1.1,"publicationDate":"2025-07-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144700470","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A narrative review on the evolution of islet isolation techniques and improving yields during total pancreatectomy and islet autotransplantation.","authors":"Javed Latif, Cristina Pollard, Ashley Dennison, Giuseppe Garcea","doi":"10.14701/ahbps.25-099","DOIUrl":"https://doi.org/10.14701/ahbps.25-099","url":null,"abstract":"<p><p>Total pancreatectomy with islet autotransplantation (TPIAT) is a specialized treatment for chronic pancreatitis (CP) patients experiencing intractable pain, aiming to preserve endocrine function and enhance quality of life. This narrative review explores the evolution of islet isolation techniques and their impact on yields and clinical outcomes in TPIAT. PubMed and Google Scholar were searched utilizing the keywords: total pancreatectomy, islet autotransplantation, islet transplantation, TPIAT, islet yields, islet isolation. This review underscores significant advances in islet isolation, from initial collagenase-based methods to the automated Ricordi technique and the enzyme Liberase, which have significantly improved islet yield and viability. Factors such as pancreatic fibrosis, preoperative nutritional status, and ischemia times are critical determinants of outcomes. Higher islet yields (> 5,000 islets/kg) correlate with substantially better insulin independence (20%-40% at 1 year), while pain relief (80%-90%) and quality of life improvements (60%-70%) are consistently observed. Variability in yields due to disease severity and levels of technical expertise continues to pose challenges. TPIAT has evolved into a widely accepted treatment option for CP, with advanced islet isolation techniques contributing to enhanced clinical success. Despite these advancements, variability in islet yields and outcomes highlights the need for standardized protocols and optimized preservation techniques. Future research should aim to address challenges associated with fibrosis and improve long-term graft function, thereby maximizing TPIAT's therapeutic potential.</p>","PeriodicalId":72220,"journal":{"name":"Annals of hepato-biliary-pancreatic surgery","volume":" ","pages":""},"PeriodicalIF":1.1,"publicationDate":"2025-07-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144700468","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Diagnosis, treatment and prognosis of simple hepatic cyst: Clinical practice guideline.","authors":"Seoung Yoon Rho, Jeong-Moo Lee, Min-Su Park, Woo-Hyoung Kang, Yoonhyeong Byun, Seung Jae Lee, Aesun Shin, Jeong Hee Yoon, Bohyun Kim, Nam-Joon Yi","doi":"10.14701/ahbps.25-070","DOIUrl":"https://doi.org/10.14701/ahbps.25-070","url":null,"abstract":"<p><p>Simple hepatic cysts are now diagnosed in over 8,000 individuals annually in South Korea, largely due to the widespread adoption of medical check-ups and advancements in imaging techniques. However, no appropriate clinical practice guideline has been established to address this condition. While international guidelines have recently been published, differences in clinical and epidemiological contexts have highlighted the need for a tailored guideline to assist domestic clinicians. To address this, the Clinical Practice Guideline Development Committee of Korea Association Hepato-Biliary-Pancreatic Surgery gathered input from surgeons, physicians, radiologists, pathologists, and epidemiology experts to adapt and modify pre-existing international guidelines to better suit domestic realities. This clinical practice guideline aims to provide a clear and appropriate pathway for the management of patients with simple hepatic cysts. It is anticipated that, based on this guideline, clinicians will have a practical framework for diagnosis and treatment. In the near future, it will be necessary to collect high-level evidences to further refine and strengthen recommendations for subsequent guideline updates.</p>","PeriodicalId":72220,"journal":{"name":"Annals of hepato-biliary-pancreatic surgery","volume":" ","pages":""},"PeriodicalIF":1.1,"publicationDate":"2025-07-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144627809","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Combined posterior and left-sided superior mesenteric artery-first approach to the TRIANGLE operation for pancreatic cancer.","authors":"Thanh Khiem Nguyen, Ham Hoi Nguyen, Tuan Hiep Luong, Pisey Chantha, Van Duy Le, Dinh Toi Do, Viet Anh Do, Hong Quang Pham","doi":"10.14701/ahbps.25-064","DOIUrl":"https://doi.org/10.14701/ahbps.25-064","url":null,"abstract":"<p><p>We herein present a novel combined posterior and left-sided superior mesenteric artery (SMA) first approach to facilitate the TRIANGLE operation for pancreatoduodenectomy (PD) or total pancreatectomy (TP) in pancreatic cancer. Patients who were diagnosed with resectable pancreatic ductal adenocarcinoma who underwent PD or TP using the combined posterior and left-sided SMA-first approach to the TRIANGLE operation between June 2021 and June 2024 were included in this study. General characteristics, technical details including operative techniques, short-term outcomes, and pathological results were analyzed retrospectively and compared with those from historic cohorts undergoing single SMA-first approach resections. Overall, 126 patients were analyzed (dual-approach PD-TP, n = 33; single-approach PD-TP, n = 93). The dual-approach resection yielded more lymph nodes than the single-approach (36.17 vs 26.53; <i>p</i> < 0.001). Additionally, the rate of tumor-positive resection margins, R1 (direct), was decreased. The duration of the operation was significantly longer, and blood loss was higher with the dual approach. There was no significant difference in postoperative mortality and complications between the two approaches. Utilizing the combined posterior and left-sided first approach to SMA in PD or TP with the TRIANGLE operation proved safe and effective for achieving R0 resection with favorable short-term outcomes in borderline resectable and locally advanced pancreatic cancer.</p>","PeriodicalId":72220,"journal":{"name":"Annals of hepato-biliary-pancreatic surgery","volume":" ","pages":""},"PeriodicalIF":1.1,"publicationDate":"2025-07-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144627808","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A comparative study of machine learning models predicting post-hepatectomy liver failure: enhancing risk estimation in over 25,000 National Surgical Quality Improvement Program patients.","authors":"Gautham Nair, Ali Hadi, Kartik Gupta, Edward Tran, Geerthan Srikantharajah, Evelyn Waugh, Ephraim Tang, Anton Skaro, Juan Glinka","doi":"10.14701/ahbps.25-046","DOIUrl":"https://doi.org/10.14701/ahbps.25-046","url":null,"abstract":"<p><strong>Backgrounds/aims: </strong>Post-hepatectomy liver failure (PHLF) is a significant complication with an incidence rate between 8% and 12%. Machine learning (ML) can analyze large datasets to uncover patterns not apparent through traditional methods, enhancing PHLF prediction and potentially mitigate complications.</p><p><strong>Methods: </strong>Using the National Surgical Quality Improvement Program (NSQIP) database, patients who underwent hepatectomy were randomized into training and testing sets. ML algorithms, including LightGBM, Random Forest, XGBoost, and Deep Neural Networks, were evaluated against logistic regression. Performance metrics included receiver operating characteristic area under the curve (ROC AUC) and Brier score loss. Shapley Additive exPlanations was used to identify individual variable relevance.</p><p><strong>Results: </strong>28,192 patients from 2013 to 2021 who underwent hepatectomy were included; PHLF occurred in 1,305 patients (4.6%). Preoperative and intraoperative factors most contributed to PHLF. Preoperative factors were international normalized ratio > 1.0, sodium < 139 mEq/L, albumin < 3.9 g/dL, American Society of Anesthesiologists score > 2, total bilirubin > 0.65 mg/dL. Intraoperative risks include transfusion requirements, trisectionectomy, operative time > 266.5 minutes, open surgical approach. The LightGBM model performed best with an ROC AUC of 0.8349 and a Brier Score loss of 0.0834.</p><p><strong>Conclusions: </strong>While topical, the role of ML models in surgical risk stratification is evolving. This paper shows the potential of ML algorithms in identifying important subclinical changes that could affect surgical outcomes. Thresholds explored should not be taken as clinical cutoffs but as a proof of concept of how ML models could provide clinicians more information. Such integration could lead to improved clinical outcomes and efficiency in patient care.</p>","PeriodicalId":72220,"journal":{"name":"Annals of hepato-biliary-pancreatic surgery","volume":" ","pages":""},"PeriodicalIF":1.1,"publicationDate":"2025-07-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144577106","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Minimally invasive approach versus open approach in the management of necrotizing acute pancreatitis: A systematic review and meta-analysis.","authors":"Matteo Matteucci, Maria Chiara Ranucci, Salvatore Guarino, Bruno Cirillo, Luca Properzi, Justin Davies, Pietro Ursi, Vito D'Andrea, Roberto Cirocchi","doi":"10.14701/ahbps.25-068","DOIUrl":"https://doi.org/10.14701/ahbps.25-068","url":null,"abstract":"<p><p>Acute pancreatitis is one of the most common gastrointestinal diseases, with necrotizing pancreatitis affecting 10% to 15% of patients. Over recent years, the management of pancreatic necrosis has evolved significantly, with a growing shift towards minimally invasive approaches. The aim of this study was to evaluate the effectiveness of minimally invasive approach compared to open surgical approach in managing necrotizing acute pancreatitis. A systematic review and meta-analysis were conducted, including 22 studies. Both fixed-effect and random-effect models were applied to analyze nine outcomes evaluated. Homogeneity among studies was assessed using χ² tests, I² statistics, and <i>p</i>-values. The risk of postoperative mortality, intra-abdominal bleeding, pancreatic and enteric fistulas, perforation, new-onset diabetes, and postoperative sepsis was significantly lower in the minimally invasive approach group than in the open surgical approach group. A minimally invasive approach to necrotizing acute pancreatitis might be associated with a lower risk of complications compared to an open surgical approach. However, most of the included studies were observational studies. Additional randomized trials are needed to further confirm these findings.</p>","PeriodicalId":72220,"journal":{"name":"Annals of hepato-biliary-pancreatic surgery","volume":" ","pages":""},"PeriodicalIF":1.1,"publicationDate":"2025-07-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144577107","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Laparoscopic omentopexy as a spacer for carbon-ion radiotherapy in locally advanced pancreatic cancer.","authors":"Sung Hyun Kim, Seo Hee Choi, Moon Jae Chung, Ik Jae Lee, Woong Sub Koom, Chang Moo Kang","doi":"10.14701/ahbps.25-044","DOIUrl":"https://doi.org/10.14701/ahbps.25-044","url":null,"abstract":"<p><p>Although half of the patients with pancreatic ductal adenocarcinoma (PDAC) are diagnosed at an advanced stage, surgical interventions needed at this stage are currently limited. Carbon-ion radiotherapy (CIRT) has emerged as a promising treatment modality for PDAC owing to its superior physical and radiobiological properties. However, a major challenge in this treatment is the proximity of the pancreas to radiosensitive organs including the stomach and duodenum, which limits dose escalation and increases the risk of severe complications, including ulceration and perforation. Herein, we report our experience with laparoscopic omentopexy as a spacer technique before CIRT in patients with locally advanced PDAC. A 55-year-old female with locally advanced PDAC, secondary to unreconstructible superior mesenteric vein involvement, who had planned to undergo CIRT. After 28 cycles of modified FOLFIRINOX, the tumor size demonstrated slight shrinkage. However, the tumor abutted the posterior wall of the stomach, raising concerns about ensuring a sufficient safety margin while delivering a curative dose of CIRT. Therefore, laparoscopic omentopexy was performed for spacer implantation between the pancreas and stomach. The patient was discharged on the postoperative day 2 without any complications. One month after the omentopexy, the patient completed all 12 fractions of the CIRT with no acute complications, except for grade 1 fatigue. After completing CIRT, the patient underwent regular follow-up evaluations. Laparoscopic omentopexy before CIRT in patients with locally advanced PDAC could enhance therapeutic efficacy.</p>","PeriodicalId":72220,"journal":{"name":"Annals of hepato-biliary-pancreatic surgery","volume":" ","pages":""},"PeriodicalIF":1.1,"publicationDate":"2025-06-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144499613","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}