Pancreatic cancer with chronic portal vein (PV) occlusion presents technical challenges because interruption of collateral venous circulation may result in mesenteric venous congestion, bowel edema, and excessive blood loss. Here, we report a case of locally advanced pancreatic cancer with complete PV occlusion that was successfully treated with pancreaticoduodenectomy and PV resection using temporary intraoperative mesocaval bypass.

A 79-year-old man was diagnosed with unresectable, locally advanced pancreatic cancer involving the PV and major peripancreatic arteries. After chemo- and chemoradiotherapy, the tumor showed a favorable biological response without disease progression, and conversion surgery was planned. During laparotomy, complete PV occlusion with extensive collateral venous circulation was confirmed. After curative resection was deemed feasible, a temporary mesocaval bypass was established between the superior mesenteric vein and inferior vena cava using an 8-mm ringed expanded polytetrafluoroethylene graft, allowing continuous mesenteric venous drainage during prolonged dissection and PV resection. Pancreaticoduodenectomy with PV resection was successfully completed, and direct PV-superior mesenteric vein reconstruction was performed after tumor removal. No intraoperative bowel congestion, edema, or ischemia was observed. The patient experienced no major postoperative complications.

Temporary intraoperative mesocaval bypass may facilitate safe radical resection in select patients with locally advanced pancreatic cancer complicated by PV occlusion and extensive collateral circulation.

Ewing sarcoma (ES) is a rare tumor, but one of the most common primary bone tumors of the foot and ankle. The aim of this study was to review long-term outcomes of ES of the foot or ankle.

We reviewed 21 patients (16 male, 5 female, mean age 20±14 years) treated for ES of the foot or ankle. Local control consisted of surgical resection alone (n=16), surgery with radiotherapy (n=1), or definitive radiotherapy (n=4). Of the patients who underwent surgical resection, 11 underwent amputation and 6 underwent limb salvage.

The 5-, and 10-year disease-specific survival rates were 65%, and 46%, respectively. Patients who presented with metastatic disease were not at increased risk of death due to disease [hazard ratio (HR)=2.45, p=0.14] but were more likely to be treated with definitive radiotherapy [odds ratio (OR)=22.5, p=0.01]. Patients with tumors arising in the hind-foot had the worst 5-year overall survival (16%, p=0.003). There was no difference in the 5-year Musculoskeletal Tumor Society Score comparing patients who underwent a primary amputation or limb salvage (79% vs. 78%, p=0.14).

Ewing sarcoma of the foot and ankle demonstrates poor survival in patients with tumors arising in the hindfoot. The results of this study indicate that decision between surgery and radiotherapy is based on the patient's status. In patients who undergo primary limb salvage, the majority retain their limb at long-term follow-up.

Pancreatic cancer remains one of the most fatal malignancies worldwide, mainly because most patients present with advanced disease; however, little is known about regional variations in patient demographics, socioeconomic-status and stage at diagnosis. This study evaluated these variations to improve early detection and equitable healthcare delivery.

This cross-sectional study analyzed National Cancer Database (NCDB) data on patients with pancreatic cancer between 2004 and 2020. Patients were divided into six geographic regions of the United States: Northeast, Southeast, Midwest, Southwest, Mountain, and Pacific, based on treating hospital location. Regional patient characteristics were compared, including age, sex, race and ethnicity, insurance type, income, city versus rural residence, and American Joint Committee on Cancer (AJCC) cancer-stage.

Among 1,043,035 patients (mean age, 69.0 years; 50.9% male) significant regional differences were observed. Blacks were prevalent in Southeast (19.9%) and Southwest (16.5%) cohorts compared with 2.6% in the mountain regions. Asians were prevalent in the Pacific region (11.5%), while Hispanics were concentrated in the Pacific (11.5%) and Southwest (7.1%) regions. Lower-income households (< $63,000) were most common in the Southwest (82.0%) and Southeast (73.7%). In contrast, the Northeast region had higher-income households (49.3%) and metropolitan residents (91.8%). Overall, 51.4% of patients were diagnosed at stage IV, highlighting late-stage presentation as a universal challenge, irrespective of demographic and socioeconomic composition.

Patients with pancreatic cancer across the United States show significant demographic and socioeconomic differences, with only modest variation in stage at diagnosis. These findings suggest that, unlike many screen-detectable malignancies, socioeconomic disadvantage primarily influences access to timely treatment and specialty care rather than early detection. Targeted interventions are needed to improve equitable access to multidisciplinary pancreatic cancer care.

Relapsed diffuse large B-cell lymphoma (DLBCL) with central nervous system (CNS) involvement carries a poor prognosis and is underrepresented in clinical trials.

In this study, we analyzed outcomes of 174 patients with relapsed DLBCL over a 14-year period, involving 20 individuals (10 male and 10 female) with secondary CNS involvement.

The median age was 64 years. Twelve patients had isolated CNS relapse whereas eight had concurrent systemic relapse. Median time to relapse was 14 months. CNS International Prognostic Index (CNS-IPI) scores at initial diagnosis ranged from low to high risk. Although 8 patients had low risk, all of them had extranodal disease. Median progression-free survival (PFS) was 16.6 months; overall survival (OS) was 19.5 months. Patients receiving aggressive therapy (mainly ESHAP), including stem cell transplantation, had significantly improved outcomes (PFS, 79.4 vs. 7.1 months; OS, 135.0 vs. 7.5 months). All palliative patients (two R-COP and eight only supportive) died.

Intensive treatment may substantially improve survival in relapsed DLBCL patients with CNS involvement. A potential bias is likely with the present sample size and further studies are warranted.

Although the incidence of gastric cancer has been declining worldwide, it remains a major cause of cancer-related mortality. Given the invasive nature of gastrectomy, perioperative nutritional status may critically influence postoperative recovery and long-term outcomes. This study aimed to investigate the prognostic impact of the preoperative prognostic nutritional index (PNI) on long-term outcomes after curative gastrectomy for gastric cancer.

This retrospective cohort study analyzed 901 consecutive patients who underwent curative gastrectomy, including distal gastrectomy (DG), total gastrectomy (TG), or proximal gastrectomy (PG), between 2009 and 2020. PNI was calculated using a standard formula, and patients were stratified into high-PNI (≥45) and low-PNI (<45) groups. Overall survival (OS) and recurrence-free survival (RFS) were compared using Kaplan-Meier analysis and Cox proportional hazards models.

Baseline clinicopathological characteristics were compared between the low- and high-PNI groups. The 5-year OS rates were 84.3% in the high-PNI group and 64.1% in the low-PNI group (p<0.001). The 5-year RFS rates were 88.4% and 81.3%, respectively (p=0.005). In multivariable Cox proportional hazards analysis, low preoperative PNI was independently associated with poorer OS [hazard ratio (HR)=1.81, 95% confidence interval (CI)=1.31-2.51, p<0.001] and RFS (HR=1.69, 95%CI=1.24-2.32, p=0.001). Subgroup analyses showed no statistically significant interaction between PNI and surgical approach.

Preoperative PNI is a useful predictor of long-term outcomes after curative gastrectomy for gastric cancer and may facilitate risk stratification and individualized perioperative management.

The prognostic significance of post-hepatectomy-related disseminated intravascular coagulation (DIC) in patients undergoing hepatic resection for colorectal liver metastases (CRLM) remains unclear.

This single-center retrospective study included 89 patients who underwent hepatic resection for CRLM between December 2003 and March 2024. Post-hepatectomy-related DIC was defined as a revised Japanese Association for Acute Medicine DIC score of 3 or higher on postoperative day 3. Prognostic factors for overall and disease-free survival were analyzed using Cox proportional hazards regression models.

Post-hepatectomy-related DIC occurred in 29 patients (33%). Patients with post-hepatectomy-related DIC were more likely to undergo simultaneous colorectal and liver resection and anatomical hepatectomy, and had larger tumors, longer operative time, greater blood loss, and longer postoperative hospital stay. In multivariable analysis, carcinoembryonic antigen ≥20 ng/ml and post-hepatectomy-related DIC were independently associated with poorer overall survival, whereas lymph node metastasis and extrahepatic disease were independently associated with poorer disease-free survival.

Post-hepatectomy-related DIC was an independent predictor of poorer overall survival after hepatic resection for CRLM and may be useful for postoperative risk stratification.

The lack of direct comparative trials makes selection of immune checkpoint inhibitor (ICI)-based combination regimens for advanced unresectable hepatocellular carcinoma (uHCC) challenging. Consequently, this study aimed to identify the clinical factors influencing the choice between atezolizumab plus bevacizumab (ATEZO-BEV) and tremelimumab plus durvalumab (STRIDE) in real-world clinical setting in Japan.

This retrospective observational study analyzed 2,637 patients with uHCC who received first-line ICI-based therapy (ATEZO-BEV or STRIDE) at hospitals affiliated with the National Hospital Organization (NHO) of Japan between April 2023 and September 2024. Patient demographics, comorbidities, concomitant medications, and laboratory values were retrieved from the nationwide NHO clinical data archives. Multivariable logistic regression was performed to identify factors associated with regimen selection.

Out of the 2,637 patients, 2,027 (76.9%) received ATEZO-BEV and 610 (23.1%) received STRIDE. Multivariable analysis revealed that male sex [adjusted odds ratio (aOR)=2.73; p<0.001], total activities of daily living (ADL) score ≧20 (aOR=1.59; p<0.01), use of antihypertensive agents (aOR=1.23; p=0.04), and use of antiplatelet agents or anticoagulants (aOR=1.47; p<0.001) were significantly associated with STRIDE selection, whereas liver cirrhosis (aOR=0.57; p<0.01) was highly associated with a lower likelihood of receiving STRIDE.

Total ADL score of ≥20, liver cirrhosis, and concomitant medication patterns significantly influenced the choice between STRIDE and ATEZO-BEV. These findings highlight the importance of individualized, context-dependent decision-making in uHCC treatment, supporting further prospective comparisons to guide optimal therapy.

With the aging population, thoracic surgeons increasingly encounter patients with primary lung cancer who have a history of prior extrapulmonary malignancy (PEM). We investigated whether PEM independently compromises survival after curative-intent lung cancer resection and whether any difference is explained by impaired cancer control or competing mortality.

We retrospectively analyzed 1,857 consecutive lung cancer resections performed in 2017-2018 at 12 Yokohama City University-affiliated institutions. After exclusion of 74 patients with prior lung cancer only, 1,783 patients remained: 505 in the PEM group and 1,278 in the no prior extrapulmonary malignancy (NPEM) group. Overall survival (OS), recurrence-free survival (RFS), inverse probability of treatment weighting (IPTW)-adjusted outcomes, and Fine-Gray competing-risk analyses were evaluated.

Compared with the NPEM group, the PEM group was older and included higher proportions of men, ever-smokers, patients diagnosed during surveillance for other diseases, and patients treated with limited resection. Unadjusted 5-year OS was 80.43% in the PEM group and 81.42% in the NPEM group (p=0.092), whereas 5-year RFS was 68.76% and 68.52%, respectively (p=0.983). PEM was not independently associated with OS [hazard ratio (HR)=1.046, 95% confidence interval (CI)=0.825-1.326, p=0.712] or RFS (HR=0.970, 95%CI=0.798-1.178, p=0.756). IPTW-adjusted analyses were concordant. Fine-Gray models showed no significant association between PEM and lung cancer-related death or non-lung-cancer death.

PEM did not independently worsen postoperative cancer control or survival after lung cancer resection. Curative-intent surgery should therefore be considered according to the biology and operability of the current lung cancer rather than prior cancer history alone.

Symptomatic adverse events during enfortumab vedotin plus pembrolizumab (EV+P) therapy may be incompletely documented in routine practice. This study evaluated whether structured symptom monitoring (SSM) using treatment-specific questionnaires was associated with more comprehensive documentation of symptomatic adverse events in patients with advanced or metastatic urothelial carcinoma.

This multicenter retrospective study included 34 consecutive patients with advanced or metastatic urothelial carcinoma who initiated EV+P between October 2024 and August 2025. Fourteen patients treated at Wakayama Medical University Hospital underwent SSM via two locally developed questionnaires, whereas 20 patients treated at affiliated hospitals received usual care without structured questionnaires. The primary endpoint was the number of documented symptomatic adverse event types per patient.

The median number of documented symptomatic adverse event types per patient was higher in the SSM group than in the non-SSM group (3 vs. 2; median difference: 2; 95% confidence interval: 1-3; p<0.01). In contrast, the rates of any documented symptomatic adverse events (100.0% vs. 90.0%, p=0.50), grade ≥3 symptomatic adverse events (21.4% vs. 20.0%, p=1.00), and symptomatic adverse events leading to EV dose reduction (57.1% vs. 35.0%, p=0.29) were similar between groups. Subjective or lower-grade symptoms, including alopecia, dysgeusia, decreased appetite, and pruritus, were more commonly documented in the SSM group.

SSM implemented at a single institution was associated with more comprehensive documentation of symptomatic adverse events during EV+P therapy compared with external institutional usual care, particularly subjective or lower-grade symptoms. Clinical benefit was not established, but treatment-specific symptom monitoring may provide a practical framework for more systematic toxicity assessment in routine EV+P care.

Neoadjuvant chemotherapy with gemcitabine plus S-1 (NAC-GS) is used for resectable pancreatic cancer, but adverse events prevent some patients from completing planned therapy. This study examined associations of pretreatment absolute neutrophil count (ANC) and prognostic nutritional index (PNI) with NAC-GS completion and the perioperative treatment course.

This single-center retrospective observational study included 93 patients with resectable pancreatic cancer who received NAC-GS from November 2019 to February 2025. NAC completion was defined as completing the two planned NAC-GS cycles, with or without dose reduction. Baseline hematologic, inflammatory, and nutritional parameters were assessed at NAC initiation. Multivariable logistic regression was used to examine factors associated with NAC discontinuation; receiver operating characteristic curve analysis determined ANC and PNI cutoff values.

Of 93 patients, 39 completed NAC-GS and 54 discontinued before completion, with all discontinuations attributed to adverse events. ANC and PNI were independently associated with NAC discontinuation in multivariable analysis. Their cutoff values were 2.6×10³/μl and 43, respectively. NAC completion rates were significantly higher with ANC ≥2.6×10³/μl than with ANC <2.6×10³/μl (52.0% vs. 30.2%, p=0.03) and with PNI ≥43 than with PNI <43 (52.6% vs. 25.0%, p<0.01). Combined ANC/PNI stratification showed stepwise decreases in NAC completion, overall R0 resection rate, and R0 resection rate among patients who underwent pancreatectomy.

Pretreatment ANC and PNI were independently associated with NAC-GS completion. Combined ANC/PNI stratification may offer a simple pretreatment method for estimating NAC-GS completion and the perioperative treatment course.