佐久間 康成

BACKGROUND: Neoadjuvant therapy has been increasingly adopted for resectable pancreatic ductal adenocarcinoma (PDAC) in Japan following the Prep-02/JSAP-05 trial. However, real-world evidence regarding effectiveness and underlying pathological mechanisms remains limited. This retrospective study evaluated neoadjuvant chemotherapy with gemcitabine plus S-1 (NAC-GS) impacts on resectable PDAC patient oncological and pathological outcomes. METHODS: Consecutive resectable PDAC patients treated with NAC-GS (n = 60) or upfront surgery (UFS) (n = 101) between 2013 and 2023 were retrospectively analyzed (total diagnosed during the study period, n = 186). An intention-to-treat principle assessed overall survival (OS) and recurrence-free survival (RFS). Propensity score matching using six baseline variables (1:1) minimized selection bias. RESULTS: Fifty-four patients were included in each group. The NAC-GS group demonstrated significantly longer OS than the UFS group (hazard ratio [HR], 0.48; 95% confidence interval [CI], 0.25-0.90; P = 0.023). Among resected cases, NAC-GS was associated with improved OS (HR, 0.42; 95% CI, 0.20-0.90; P = 0.026). Pathologically, the NAC-GS group showed significantly lower lymph node stage and less lymphatic invasion. Pathological complete response was observed in 4.0% of NAC-GS patients. DISCUSSION: Neoadjuvant chemotherapy with GS was associated with prolonged survival in resectable PDAC, potentially through lymphatic spread suppression. Pathological complete response was rare but may represent a clinically meaningful benefit of neoadjuvant treatment in selected patients.

BACKGROUND/AIM: The Albumin-Bilirubin (ALBI) score was initially developed to estimate prognosis in patients with hepatocellular carcinoma. Recently, its prognostic relevance has been extended to intrahepatic cholangiocarcinoma; however, its impact on perihilar cholangiocarcinoma remains unclear. PATIENTS AND METHODS: A total of 71 patients who underwent hepatectomy for perihilar cholangiocarcinoma between 2007 and 2024 at Jichi Medical University were retrospectively analyzed. Preoperative blood samples were obtained within two weeks before surgery, after effective jaundice control. Survival outcomes were evaluated using the Kaplan-Meier method and compared with the log-rank test. Cox proportional hazards modeling was used to estimate hazard ratios (HR) and 95% confidence intervals (CI) for overall survival. RESULTS: Patients with ALBI Grade 1 had a significantly longer median survival time compared to those with ALBI Grade 2 or 3 (not reached vs. 45 months vs. 13 months, respectively; p=0.001). The prognostic nutritional index (PNI) was significantly lower in ALBI Grade 2/3 than in Grade 1 (41.6±5.7 vs. 49.5±5.9, p<0.001). Similarly, carbohydrate antigen 19-9 (CA19-9) levels were higher in ALBI Grade 2/3 compared to Grade 1 (493±129 vs. 98±176 U/mL, p=0.002). Multivariable analysis identified ALBI Grade 2/3 as an independent negative prognostic factor for overall survival (HR=2.14, 95% CI=1.01-4.54, p=0.047). Regression analysis showed a strong inverse correlation between ALBI score and serum albumin levels (R=-0.9624, p=0.001). CONCLUSION: ALBI score may provide valuable prognostic information for long-term outcomes in patients undergoing hepatectomy for perihilar cholangiocarcinoma.

BACKGROUND: Living donor hepatectomy carries a risk of bleeding, and allogeneic transfusion may cause adverse effects. Autologous blood preparation is therefore considered a safer strategy. While preoperative autologous donation (PAD) is widely used, acute normovolemic hemodilution (ANH) may overcome its limitations and offer a practical alternative. However, evidence supporting ANH in donor surgery remains limited. This study compared the clinical utility of ANH and PAD in living donor hepatectomy. METHODS: We retrospectively analyzed 60 consecutive cases of living donor right hepatectomy performed between 2017 and 2025. Among them, 58 donors who received either PAD or ANH were compared using 1:2 propensity score matching. Perioperative laboratory values, surgical outcomes, any allogeneic transfusion, and postoperative complications were evaluated. RESULTS: No unexpected intraoperative adverse events or allogeneic transfusions occurred. All ANH donors received autologous reinfusion, compared with only 6.5% of PAD donors. After matching, 27 donors (18 PAD, 9 ANH) were analyzed. Whole blood viscosity was higher in the ANH group. Weight-adjusted intraoperative bleeding was lower (2.6 vs. 4.6 mL/kg, p = .024; q = 0.106) and operative time was shorter (321 vs. 390 min, p = .007; q = 0.077) in the ANH group. Postoperative complication rates were comparable. Area under the curve analysis indicated better preservation of total protein (p = .038) and prothrombin time-international normalized ratio (p = .010) across the perioperative period in the ANH group. CONCLUSIONS: ANH maintained transfusion avoidance and donor safety comparable to PAD while improving operative efficiency, supporting ANH as a safe, effective alternative in living donor right hepatectomy.