Notes

Child years vaccination insurance coverage nationwide: a good fairness standpoint.
ence was extremely rare; however, patients with any of these pathologic findings require careful follow-up.
Healthcare policies have focused on centralizing care to high-volume centers in an effort to optimize patient outcomes; however, little is known about patients' and caregivers' considerations and selection process when selecting hospitals for care. We aim to explore how patients and caregivers select hospitals for complex cancer care and to develop a taxonomy for their selection considerations.

This was a qualitative study in which data were gathered from in-depth interviews conducted from March to November 2019 among patients with hepatopancreatobiliary cancers who were scheduled to undergo a pancreatectomy (n = 20) at a metropolitan, urban regional, or suburban medical center and their caregivers (n = 10).

The interviews revealed six broad domains that characterized hospital selection considerations hospital factors, team characteristics, travel distance to hospital, referral or recommendation, continuity of care, and insurance considerations. The identified domains were similar between participants sicies to help increase patient access to high-quality cancer care that is consistent with their priorities and needs.
This study investigated the safety and feasibility of intraoperative portal vein blood (PVB) collection at the time of pancreatic ductal adenocarcinoma (PDAC) resection. Relationships of circulating tumor cells (CTCs) in PVB and peripheral blood (PB) with overall survival (OS) and recurrence-free survival were studied.

Patients undergoing PDAC resection were offered enrollment in a prospective liquid biopsy protocol. The patients had PB drawn before incision and PVB drawn before tumor mobilization, then again immediately after resection. Using standard CellSearch protocols, CTCs were identified and compared with OS.

Of the 34 patients enrolled in this study, 23 (68%) underwent pancreaticoduodenectomy, 8 (23%) underwent distal pancreatectomy, and 3 (9%) underwent total pancreatectomy. CUDC-101 Peripheral blood was available for 22 (65%) and PVB for 31 (91%) of the patients. No bleeding or thrombotic complications occurred with the PVB draws. The CTC counts per 7.5mL of PVB collected before and after resection werTCs at PDAC resection.
Upfront surgery is the current standard for resectable intrahepatic cholangiocarcinoma (ICC) despite high treatment failure with this approach. We sought to examine the use of neoadjuvant chemotherapy (NAC) as an alternative strategy for this population.

The National Cancer Database was used to identify patients with resectable ICC undergoing curative-intent surgery (2006-2014). Utilization trends were examined and survival estimates between NAC and upfront surgery were compared; propensity score-matched models were used to examine the association of NAC with overall survival (OS) for all patients and risk-stratified cohorts. Models accounted for clustering within hospitals, and results represent findings from a complete-case analysis.

Among 881 patients with ICC, 8.3% received NAC, with no changes over time (Cochran-Armitage p = 0.7). Median follow-up was 50.9months, with no difference in unadjusted survival with NAC versus upfront surgery (median OS 51.8 vs. 35.6months, and 5-year OS rates of 38.2% vs. 36.6%; log rank p = 0.51), and no survival benefit in the propensity score-matched analysis (hazard ratio [HR] 0.78, 95% CI 0.54-1.11; p = 0.16). However, for patients with stage II-III disease, NAC was associated with a trend towards improved survival (median OS of 47.6months vs. 25.9months, and 5-year OS rates of 34% vs. 25.7%; log-rank p = 0.10) and a statistically significant survival benefit in the propensity score-matched analysis. (HR 0.58, 95% CI 0.37-0.91; p = 0.02).

NAC is associated with improved OS over upfront surgery in patients with resectable ICC and high-risk of treatment failure. These data support the need for prospective studies to examine NAC as an alternative strategy to improve OS in this population.
NAC is associated with improved OS over upfront surgery in patients with resectable ICC and high-risk of treatment failure. These data support the need for prospective studies to examine NAC as an alternative strategy to improve OS in this population.
The Glissonean approach is a widely used anatomic liver resection technique, which can be divided into three types the extrahepatic, intrahepatic, and transfissural approaches. This report describes the technical details and surgical outcomes of these laparoscopic right anterior sectionectomy (lap-RAS) approaches.

Using the extrahepatic Glissonean approach, the posterior extremity of the cystic plate is dissected and divided. The hilar plate is detached from Laennec's capsule covering the liver parenchyma. The gap between the plate system and Laennec's capsule is entered. Without liver parenchymal transection, the right anterior Glissonean pedicle (RAGP) is dissected extrahepatically. Using the intrahepatic Glissonean approach, the posterior extremity of the cystic plate is divided, and the hilar plate is detached, which may decrease the visibility of the RAGP. The RAGP then is dissected intrahepatically through the minor parenchymal transection around the cystic plate. When the extra- or intrahepatic Glissonean approach fails, the transfissural Glissonean approach can be used, with the RAGP dissected through the major parenchymal transection along the main portal fissure.

Three patients underwent lap-RAS using the Glissonean approach. The median operation time was 330min (range, 300-380min), and the median estimated blood loss was 160mL (range, 80-180mL). No cases of postoperative morbidity or mortality were observed.

The feasibility of the Glissonean approach in lap-RAS could be increased by appropriate selection of the extrahepatic, intrahepatic, and transfissural Glissonean approaches.
The feasibility of the Glissonean approach in lap-RAS could be increased by appropriate selection of the extrahepatic, intrahepatic, and transfissural Glissonean approaches.
Borderline resectable pancreatic cancer (BRPC) is frequently encountered in high-volume centers. It has various definitions among different societies or institutions.

In this landmark series review, we summarize the critical randomized controlled studies that have defined the neoadjuvant and surgical management of BRPC.

Surgical resection after neoadjuvant treatment is the mainstay of treatment and should involve margin-negative resection with regional lymphadenectomy. Several recently completed randomized controlled clinical trials have defined the role of neoadjuvant chemotherapy for patients with BRPC. The utilization of chemoradiation remains controversial.

The definition of BRPC goes beyond the anatomic relationship between the tumor and vessels. We need to include biological and conditional dimensions. Neoadjuvant chemotherapy and surgery are associated with improved outcomes of BRPC. Understanding the molecular features of pancreatic cancer should lead to the discovery of novel biomarkers as well as a more personalized approach to guide individualized therapy.
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