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High-risk lesions in the remnant pancreas: fate of the remnant pancreas after pancreatic resection for pancreatic cancer and intraductal papillary mucinous neoplasms

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Abstract

Progress in diagnostic modalities, surgical procedures, and multidisciplinary treatment for pancreatic diseases has increased the number of long-term survivors after pancreatic resection. Several reports have focused on high-risk lesions (HRLs), including high-grade pancreatic intraepithelial neoplasia (PanIN), pancreatic ductal adenocarcinoma, high-grade intraductal papillary mucinous neoplasm (IPMN), and IPMN with an associated invasive carcinoma, in the remnant pancreas after partial pancreatic resection for pancreatic cancer or IPMN. The etiology of HRLs in the remnant pancreas is thought to be either isolated local recurrence of the initial lesion in the remnant pancreas or a newly developed primary lesion. Although it is difficult to distinguish between local recurrence and a new primary lesion, comparison of genetic alterations between two lesions may help with this distinction. Early detection of HRLs in the remnant pancreas may improve the prognosis of patients, and several investigators have proposed predictive factors for HRLs in the remnant pancreas after partial pancreatic resection for pancreatic cancer or IPMN. The reported short- and long-term outcomes of surgical resection of HRLs in the remnant pancreas are relatively favorable. Life-long surveillance of the remnant pancreas is recommended after partial pancreatic resection for pancreatic cancer or IPMN.

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References

  1. Schnelldorfer T, Adams DB, Warshaw AL, Lillemoe KD, Sarr MG. Forgotten pioneers of pancreatic surgery: beyond the favorite few. Ann Surg. 2008;247:191–202.

    PubMed  Google Scholar 

  2. Daniel F, Tamim H, Hosni M, Ibrahim F, Mailhac A, Jamali F. Validation of day 1 drain fluid amylase level for prediction of clinically relevant fistula after distal pancreatectomy using the NSQIP database. Surgery. 2019;165:315–22.

    PubMed  Google Scholar 

  3. Kimura W, Miyata H, Gotoh M, Hirai I, Kenjo A, Kitagawa Y, et al. A pancreaticoduodenectomy risk model derived from 8575 cases from a national single-race population (Japanese) using a web-based data entry system: the 30-day and in-hospital mortality rates for pancreaticoduodenectomy. Ann Surg. 2014;259:773–80.

    PubMed  Google Scholar 

  4. Egawa S, Toma H, Ohigashi H, Okusaka T, Nakao A, Hatori T, et al. Japan pancreatic cancer registry; 30th year anniversary: Japan Pancreas Society. Pancreas. 2012;41:985–92.

    PubMed  Google Scholar 

  5. Huang L, Jansen L, Balavarca Y, Babaei M, van der Geest L, Lemmens V, et al. Stratified survival of resected and overall pancreatic cancer patients in Europe and the USA in the early twenty-first century: a large, international population-based study. BMC Med. 2018;16:125.

    PubMed  PubMed Central  Google Scholar 

  6. Ohtsuka T, Kono H, Tanabe R, Nagayoshi Y, Mori Y, Sadakari Y, et al. Follow-up study after resection of intraductal papillary mucinous neoplasm of the pancreas; special references to the multifocal lesions and development of ductal carcinoma in the remnant pancreas. Am J Surg. 2012;204:44–8.

    PubMed  Google Scholar 

  7. Yamaguchi K, Kanemitsu S, Hatori T, Maguchi H, Shimizu Y, Tada M, et al. Pancreatic ductal adenocarcinoma derived from IPMN and pancreatic ductal adenocarcinoma concomitant with IPMN. Pancreas. 2011;40:571–80.

    PubMed  Google Scholar 

  8. Basturk O, Hong SM, Wood LD, Adsay NV, Albores-Saavedra J, Biankin AV, et al. A revised classification system and recommendations from the Baltimore consensus meeting for neoplastic precursor lesions in the pancreas. Am J Surg Pathol. 2015;39:1730–41.

    PubMed  PubMed Central  Google Scholar 

  9. Adsay V, Mino-Kenudson M, Furukawa T, Basturk O, Zamboni G, Marchegiani G, et al. 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. Ann Surg. 2016;263:162–77.

    PubMed  PubMed Central  Google Scholar 

  10. Gotoh Y, Ohtsuka T, Nakamura S, Shindo K, Ohuchida K, Miyasaka Y, et al. Genetic assessment of recurrent pancreatic high-risk lesions in the remnant pancreas: metachronous multifocal lesion or local recurrence? Surgery. 2019;165:767–74.

    PubMed  Google Scholar 

  11. Miyasaka Y, Ohtsuka T, Tamura K, Mori Y, Shindo K, Yamada D, et al. Predictive factors for the metachronous development of high-risk lesions in the remnant pancreas after partial pancreatectomy for intraductal papillary mucinous neoplasm. Ann Surg. 2016;263:1180–7.

    PubMed  Google Scholar 

  12. Pea A, Yu J, Rezaee N, Luchini C, He J, Dal Molin M, et al. Targeted DNA sequencing reveals patterns of local progression in the pancreatic remnant following resection of intraductal papillary mucinous neoplasm (IPMN) of the pancreas. Ann Surg. 2017;266:133–41.

    PubMed  PubMed Central  Google Scholar 

  13. Akabori H, Shiomi H, Naka S, Murakami K, Murata S, Ishida M, et al. Resectable carcinoma developing in the remnant pancreas 7 years and 10 months after distal pancreatectomy for invasive ductal carcinoma of the pancreas: report of a case. World J Surg Oncol. 2014;12:224.

    PubMed  PubMed Central  Google Scholar 

  14. Dalla Valle R, Mancini C, Crafa P, Passalacqua R. Pancreatic carcinoma recurrence in the remnant pancreas after a pancreaticoduodenectomy. JOP. 2006;7:473–7.

    PubMed  Google Scholar 

  15. Eriguchi N, Aoyagi S, Imayama H, Okuda K, Hara M, Fukuda S, et al. Resectable carcinoma of the pancreatic head developing 7 years and 4 months after distal pancreatectomy for carcinoma of the pancreatic tail. J Hepatobiliary Pancreat Surg. 2000;7:316–20.

    CAS  PubMed  Google Scholar 

  16. Frei L, Stieger R, Bayerl C, Breitenstein S, Staerkle RF. Resectable adenocarcinoma developing in the remnant pancreas 7 years after partial pancreatoduodenectomy for invasive ductal adenocarcinoma of the pancreas: a case report. J Med Case Rep. 2017;11:194.

    PubMed  PubMed Central  Google Scholar 

  17. Hamner JB, White M, Crowder C, Singh G. Resection of metachronous pancreatic cancer 4 years after pancreaticoduodenectomy for stage III pancreatic adenocarcinoma. World J Surg Oncol. 2015;13:290.

    PubMed  PubMed Central  Google Scholar 

  18. Ikematsu Y, Tamura H, Nakata Y, Hayashi T, Kanai T, Hirayama K, et al. Metachronous multiple adenocarcinomas of the pancreas. Int J Clin Oncol. 2011;16:726–31.

    PubMed  Google Scholar 

  19. Kinoshita H, Yamade N, Nakai H, Sasaya T, Matsumura S, Kimura A, et al. Successful resection of pancreatic carcinoma recurrence in the remnant pancreas after a pancreaticoduodenectomy. Hepatogastroenterology. 2011;58:1406–8.

    PubMed  Google Scholar 

  20. Koizumi M, Sata N, Kasahara N, Morishima K, Sasanuma H, Sakuma Y, et al. Remnant pancreatectomy for recurrent or metachronous pancreatic carcinoma detected by FDG-PET: two case reports. JOP. 2010;11:36–40.

    PubMed  Google Scholar 

  21. Ogino T, Ueda J, Sato N, Takahata S, Mizumoto K, Nakamura M, et al. Repeated pancreatectomy for recurrent pancreatic carcinoma after pylorus-preserving pancreatoduodenectomy: report of two patients. Case Rep Gastroenterol. 2010;4:429–34.

    PubMed  PubMed Central  Google Scholar 

  22. Shonaka T, Inagaki M, Akabane H, Yanagida N, Shomura H, Yanagawa N, et al. Total pancreatectomy for metachronous mixed acinar-ductal carcinoma in a remnant pancreas. World J Gastroenterol. 2014;20:11904–9.

    PubMed  PubMed Central  Google Scholar 

  23. Tajima Y, Kuroki T, Ohno T, Furui J, Tsuneoka N, Adachi T, et al. Resectable carcinoma developing in the remnant pancreas 3 years after pylorus-preserving pancreaticoduodenectomy for invasive ductal carcinoma of the pancreas. Pancreas. 2008;36:324–7.

    PubMed  Google Scholar 

  24. Takamatsu S, Ban D, Irie T, Noguchi N, Kudoh A, Nakamura N, et al. Resection of a cancer developing in the remnant pancreas after a pancreaticoduodenectomy for pancreas head cancer. J Gastrointest Surg. 2005;9:263–9.

    PubMed  Google Scholar 

  25. Wada K, Takada T, Yasuda H, Amano H, Yoshida M. A repeated pancreatectomy in the remnant pancreas 22 months after pylorus-preserving pancreatoduodenectomy for pancreatic adenocarcinoma. J Hepatobiliary Pancreat Surg. 2001;8:174–8.

    CAS  PubMed  Google Scholar 

  26. Hashimoto D, Chikamoto A, Ohmuraya M, Sakata K, Miyake K, Kuroki H, et al. Pancreatic cancer in the remnant pancreas following primary pancreatic resection. Surg Today. 2014;44:1313–20.

    PubMed  Google Scholar 

  27. Ikemoto J, Hanada K, Minami T, Okazaki A, Abe T, Amano H, et al. Prospective follow-up study of the recurrence of pancreatic cancer diagnosed at an early stage: the value of endoscopic ultrasonography for early diagnosis of recurrence in the remnant pancreas. Pancreas. 2018;47:482–8.

    PubMed  Google Scholar 

  28. Ishida J, Toyama H, Matsumoto I, Asari S, Goto T, Terai S, et al. Second primary pancreatic ductal carcinoma in the remnant pancreas after pancreatectomy for pancreatic ductal carcinoma: high cumulative incidence rates at 5 years after pancreatectomy. Pancreatology. 2016;16:615–20.

    PubMed  Google Scholar 

  29. Kanno A, Masamune A, Hanada K, Maguchi H, Shimizu Y, Ueki T, et al. Multicenter study of early pancreatic cancer in Japan. Pancreatology. 2018;18:61–7.

    PubMed  Google Scholar 

  30. Luchini C, Pea A, Yu J, He J, Salvia R, Riva G, et al. Pancreatic cancer arising in the remnant pancreas is not always a relapse of the preceding primary. Mod Pathol. 2018. https://doi.org/10.1038/s41379-018-0183-7(Epub ahead of print).

    Article  PubMed  PubMed Central  Google Scholar 

  31. Matsuda R, Miyasaka Y, Ohishi Y, Yamamoto T, Saeki K, Mochidome N, et al. Concomitant intraductal papillary mucinous neoplasm in pancreatic ductal adenocarcinoma is an independent predictive factor for the occurrence of new cancer in the remnant pancreas. Ann Surg. 2018. https://doi.org/10.1097/SLA.0000000000003060(Epub ahead of print).

    Article  Google Scholar 

  32. Miyazaki M, Yoshitomi H, Shimizu H, Ohtsuka M, Yoshidome H, Furukawa K, et al. Repeat pancreatectomy for pancreatic ductal cancer recurrence in the remnant pancreas after initial pancreatectomy: is it worthwhile? Surgery. 2014;155:58–66.

    PubMed  Google Scholar 

  33. Nakayama Y, Sugimoto M, Gotohda N, Konishi M, Takahashi S. Efficacy of completion pancreatectomy for recurrence of adenocarcinoma in the remnant pancreas. J Surg Res. 2018;221:15–23.

    PubMed  Google Scholar 

  34. Shima Y, Okabayashi T, Kozuki A, Sumiyoshi T, Tokumaru T, Saisaka Y, et al. Completion pancreatectomy for recurrent pancreatic cancer in the remnant pancreas: report of six cases and a review of the literature. Langenbecks Arch Surg. 2015;400:973–8.

    PubMed  Google Scholar 

  35. Suzuki S, Furukawa T, Oshima N, Izumo W, Shimizu K, Yamamoto M. Original scientific reports: clinicopathological findings of remnant pancreatic cancers in survivors following curative resections of pancreatic cancers. World J Surg. 2016;40:974–81.

    PubMed  Google Scholar 

  36. Thomas RM, Truty MJ, Nogueras-Gonzalez GM, Fleming JB, Vauthey JN, Pisters PW, et al. Selective reoperation for locally recurrent or metastatic pancreatic ductal adenocarcinoma following primary pancreatic resection. J Gastrointest Surg. 2012;16:1696–704.

    PubMed  Google Scholar 

  37. Yamada S, Kobayashi A, Nakamori S, Baba H, Yamamoto M, Yamaue H, et al. Resection for recurrent pancreatic cancer in the remnant pancreas after pancreatectomy is clinically promising: results of a project study for pancreatic surgery by the Japanese Society of Hepato-Biliary-Pancreatic Surgery. Surgery. 2018;164:1049–56.

    PubMed  Google Scholar 

  38. Groot VP, Gemenetzis G, Blair AB, Ding D, Javed AA, Burkhart RA, et al. Implications of the pattern of disease recurrence on survival following pancreatectomy for pancreatic ductal adenocarcinoma. Ann Surg Oncol. 2018;25:2475–83.

    PubMed  PubMed Central  Google Scholar 

  39. Sperti C, Pasquali C, Piccoli A, Pedrazzoli S. Recurrence after resection for ductal adenocarcinoma of the pancreas. World J Surg. 1997;21:195–200.

    CAS  PubMed  Google Scholar 

  40. Van den Broeck A, Sergeant G, Ectors N, Van Steenbergen W, Aerts R, Topal B. Patterns of recurrence after curative resection of pancreatic ductal adenocarcinoma. Eur J Surg Oncol. 2009;35:600–4.

    PubMed  Google Scholar 

  41. Groot VP, Rezaee N, Wu W, Cameron JL, Fishman EK, Hruban RH, et al. Patterns, timing, and predictors of recurrence following pancreatectomy for pancreatic ductal adenocarcinoma. Ann Surg. 2018;267:936–45.

    PubMed  Google Scholar 

  42. Launois B, Franci J, Bardaxoglou E, Ramee MP, Paul JL, Malledant Y, et al. Total pancreatectomy for ductal adenocarcinoma of the pancreas with special reference to resection of the portal vein and multicentric cancer. World J Surg. 1993;17:122–6 (discussion 126–7).

    CAS  PubMed  Google Scholar 

  43. Tryka AF, Brooks JR. Histopathology in the evaluation of total pancreatectomy for ductal carcinoma. Ann Surg. 1979;190:373–81.

    CAS  PubMed  PubMed Central  Google Scholar 

  44. Shi C, Klein AP, Goggins M, Maitra A, Canto M, Ali S, et al. Increased prevalence of precursor lesions in familial pancreatic cancer patients. Clin Cancer Res. 2009;15:7737–43.

    CAS  PubMed  PubMed Central  Google Scholar 

  45. Al Efishat M, Attiyeh MA, Eaton AA, Gonen M, Basturk O, Klimstra D, et al. Progression patterns in the remnant pancreas after resection of non-invasive or micro-invasive intraductal papillary mucinous neoplasms (IPMN). Ann Surg Oncol. 2018;25:1752–9.

    PubMed  Google Scholar 

  46. Blackham AU, Doepker MP, Centeno BA, Springett G, Pimiento JM, Malafa M, et al. Patterns of recurrence and long-term outcomes in patients who underwent pancreatectomy for intraductal papillary mucinous neoplasms with high grade dysplasia: implications for surveillance and future management guidelines. HPB (Oxford). 2017;19:603–10.

    PubMed  Google Scholar 

  47. Fujii T, Kato K, Kodera Y, Kanda M, Nagai S, Yamada S, et al. Prognostic impact of pancreatic margin status in the intraductal papillary mucinous neoplasms of the pancreas. Surgery. 2010;148:285–90.

    PubMed  Google Scholar 

  48. He J, Cameron JL, Ahuja N, Makary MA, Hirose K, Choti MA, et al. Is it necessary to follow patients after resection of a benign pancreatic intraductal papillary mucinous neoplasm? J Am Coll Surg. 2013;216:657–65 (discussion 665–7).

    PubMed  PubMed Central  Google Scholar 

  49. Hirono S, Kawai M, Okada K, Miyazawa M, Shimizu A, Kitahata Y, et al. Long-term surveillance is necessary after operative resection for intraductal papillary mucinous neoplasm of the pancreas. Surgery. 2016;160:306–17.

    PubMed  Google Scholar 

  50. Marchegiani G, Mino-Kenudson M, Sahora K, Morales-Oyarvide V, Thayer S, Ferrone C, et al. IPMN involving the main pancreatic duct: biology, epidemiology and long-term outcomes following resection. Ann Surg. 2015;261:976–83.

    PubMed  PubMed Central  Google Scholar 

  51. Miller JR, Meyer JE, Waters JA, Al-Haddad M, Dewitt J, Sherman S, et al. Outcome of the pancreatic remnant following segmental pancreatectomy for non-invasive intraductal papillary mucinous neoplasm. HPB (Oxford). 2011;13:759–66.

    PubMed  PubMed Central  Google Scholar 

  52. Moriya T, Traverso W. Fate of the pancreatic remnant after resection for an intraductal papillary mucinous neoplasm: a longitudinal level II cohort study. Arch Surg. 2012;147:528–34.

    PubMed  Google Scholar 

  53. Rezaee N, Barbon C, Zaki A, He J, Salman B, Hruban RH, et al. Intraductal papillary mucinous neoplasm (IPMN) with high-grade dysplasia is a risk factor for the subsequent development of pancreatic ductal adenocarcinoma. HPB (Oxford). 2016;18:236–46.

    PubMed  Google Scholar 

  54. Schnelldorfer T, Sarr MG, Nagorney DM, Zhang L, Smyrk TC, Qin R, et al. Experience with 208 resections for intraductal papillary mucinous neoplasm of the pancreas. Arch Surg. 2008;143:639–46 (discussion 646).

    PubMed  Google Scholar 

  55. White R, D'Angelica M, Katabi N, Tang L, Klimstra D, Fong Y, et al. Fate of the remnant pancreas after resection of noninvasive intraductal papillary mucinous neoplasm. J Am Coll Surg. 2007;204:987–93 (discussion 993–5).

    PubMed  Google Scholar 

  56. Yogi T, Hijioka S, Imaoka H, Mizuno N, Hara K, Tajika M, et al. Risk factors for postoperative recurrence of intraductal papillary mucinous neoplasms of the pancreas based on a long-term follow-up study: proposals for follow-up strategies. J Hepatobiliary Pancreat Sci. 2015;22:757–65.

    PubMed  Google Scholar 

  57. Kawakubo K, Tada M, Isayama H, Sasahira N, Nakai Y, Yamamoto K, et al. Incidence of extrapancreatic malignancies in patients with intraductal papillary mucinous neoplasms of the pancreas. Gut. 2011;60:1249–53.

    PubMed  Google Scholar 

  58. Malleo G, Marchegiani G, Borin A, Capelli P, Accordini F, Butturini G, et al. Observational study of the incidence of pancreatic and extrapancreatic malignancies during surveillance of patients with branch-duct intraductal papillary mucinous neoplasm. Ann Surg. 2015;261:984–90.

    PubMed  Google Scholar 

  59. Uehara H, Nakaizumi A, Ishikawa O, Iishi H, Tatsumi K, Takakura R, et al. Development of ductal carcinoma of the pancreas during follow-up of branch duct intraductal papillary mucinous neoplasm of the pancreas. Gut. 2008;57:1561–5.

    CAS  PubMed  Google Scholar 

  60. Frankel TL, LaFemina J, Bamboat ZM, D'Angelica MI, DeMatteo RP, Fong Y, et al. Dysplasia at the surgical margin is associated with recurrence after resection of non-invasive intraductal papillary mucinous neoplasms. HPB (Oxford). 2013;15:814–21.

    PubMed  PubMed Central  Google Scholar 

  61. Kang MJ, Jang JY, Lee KB, Chang YR, Kwon W, Kim SW. Long-term prospective cohort study of patients undergoing pancreatectomy for intraductal papillary mucinous neoplasm of the pancreas: implications for postoperative surveillance. Ann Surg. 2014;260:356–63.

    PubMed  Google Scholar 

  62. Date K, Ohtsuka T, Fujimoto T, Tamura K, Kimura H, Matsunaga T, et al. Molecular evidence for monoclonal skip progression in main duct intraductal papillary mucinous neoplasms of the pancreas. Ann Surg. 2017;265:969–77.

    PubMed  Google Scholar 

  63. Tanaka M, Fernandez-Del Castillo C, Kamisawa T, Jang JY, Levy P, Ohtsuka T, et al. Revisions of international consensus Fukuoka guidelines for the management of IPMN of the pancreas. Pancreatology. 2017;17:738–53.

    PubMed  Google Scholar 

  64. Matthaei H, Norris AL, Tsiatis AC, Olino K, Hong SM, dal Molin M, et al. Clinicopathological characteristics and molecular analyses of multifocal intraductal papillary mucinous neoplasms of the pancreas. Ann Surg. 2012;255:326–33.

    PubMed  PubMed Central  Google Scholar 

  65. European study group on cystic tumours of the pancreatic cystic neoplasms. European evidence-based guidelines on pancreatic cystic neoplasms. Gut. 2018;67:789–804.

    Google Scholar 

  66. Vege SS, Ziring B, Jain R, Moayyedi P. American Gastroenterological Association institute guideline on the diagnosis and management of asymptomatic neoplastic pancreatic cysts. Gastroenterology. 2015;148:819–22.

    PubMed  Google Scholar 

  67. Groot VP, van Santvoort HC, Rombouts SJ, Hagendoorn J, Borel Rinkes IH, van Vulpen M, et al. Systematic review on the treatment of isolated local recurrence of pancreatic cancer after surgery; re-resection, chemoradiotherapy and SBRT. HPB (Oxford). 2017;19:83–92.

    PubMed  Google Scholar 

  68. Hashimoto D, Chikamoto A, Masuda T, Nakagawa S, Imai K, Yamashita YI, et al. Pancreatic cancer arising from the remnant pancreas: is it a local recurrence or new primary lesion? Pancreas. 2017;46:1083–90.

    PubMed  Google Scholar 

  69. Hashimoto D, Chikamoto A, Taki K, Arima K, Yamashita Y, Ohmuraya M, et al. Residual total pancreatectomy: short- and long-term outcomes. Pancreatology. 2016;16:646–51.

    CAS  PubMed  Google Scholar 

  70. Shiroshita H, Inomata M, Bandoh T, Uchida H, Akira S, Hashizume M, et al. Endoscopic surgery in Japan: the 13th national survey (2014–2015) by the Japan Society for Endoscopic Surgery. Asian J Endosc Surg. 2019;12:7–18.

    PubMed  Google Scholar 

  71. Sahakyan MA, Yaqub S, Kazaryan AM, Villanger O, Berstad AE, Labori KJ, et al. Laparoscopic completion pancreatectomy for local recurrence in the pancreatic remnant after pancreaticoduodenectomy: case reports and review of the literature. J Gastrointest Cancer. 2016;47:509–13.

    PubMed  Google Scholar 

  72. Sunagawa H, Mayama Y, Orokawa T, Oshiro N. Laparoscopic total remnant pancreatectomy after laparoscopic pancreaticoduodenectomy. Asian J Endosc Surg. 2014;7:71–4.

    PubMed  Google Scholar 

  73. Zhou Y, Song A, Wu L, Si X, Li Y. Second pancreatectomy for recurrent pancreatic ductal adenocarcinoma in the remnant pancreas: a pooled analysis. Pancreatology. 2016;16:1124–8.

    PubMed  Google Scholar 

  74. Oettle H, Post S, Neuhaus P, Gellert K, Langrehr J, Ridwelski K, et al. Adjuvant chemotherapy with gemcitabine vs observation in patients undergoing curative-intent resection of pancreatic cancer: a randomized controlled trial. JAMA. 2007;297:267–77.

    CAS  PubMed  Google Scholar 

  75. Uesaka K, Boku N, Fukutomi A, Okamura Y, Konishi M, Matsumoto I, et al. Adjuvant chemotherapy of S-1 versus gemcitabine for resected pancreatic cancer: a phase 3, open-label, randomised, non-inferiority trial (JASPAC 01). Lancet. 2016;388:248–57.

    CAS  PubMed  Google Scholar 

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  1. Department of Surgery and Oncology, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan

    Yoshihiro Miyasaka, Takao Ohtsuka, Ryota Matsuda, Yasuhisa Mori, Kohei Nakata, Kenoki Ohuchida & Masafumi Nakamura

  2. Department of Surgery, Fukuoka University Chikushi Hospital, Chikushino, Japan

    Yoshihiro Miyasaka

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  1. Yoshihiro Miyasaka
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Miyasaka, Y., Ohtsuka, T., Matsuda, R. et al. High-risk lesions in the remnant pancreas: fate of the remnant pancreas after pancreatic resection for pancreatic cancer and intraductal papillary mucinous neoplasms. Surg Today 50, 832–840 (2020). https://doi.org/10.1007/s00595-019-01852-3

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