https://jamanetwork.com en-us Fri, 28 Jun 2024 00:00:00 GMT Fri, 28 Jun 2024 11:07:52 GMT Silverchair [email protected] [email protected] https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2820557 Fri, 28 Jun 2024 00:00:00 GMT This diagnostic study evaluates the performance of a prediction model of acute pancreatitis in a prospective cohort of patients presenting to the emergency department with serum lipase levels elevated to 3 times the upper limit of the reference range. 7 6 e2419014 10.1001/jamanetworkopen.2024.19014 2820557 https://jamanetwork.com/journals/jamaoncology/fullarticle/2820218 Thu, 20 Jun 2024 00:00:00 GMT Despite years of surgical and therapeutic advances, pancreatic ductal adenocarcinoma (PDAC) remains a deadly disease with dismal long-term outcomes. Multimodality treatment with systemic chemotherapy in localized PDAC has shown incremental improvements in survival; however, many questions linger, with the most pressing being what is the correct sequencing in perioperative therapy? Neoadjuvant therapy is preferred in borderline resectable disease given improved R0 resection rates and overall survival (OS). However, in upfront resectable disease, there are conflicting schools of thought and varying institutional practices. Adjuvant chemotherapy with modified fluorouracil, leucovorin, irinotecan, and oxaliplatin (FOLFIRINOX) has shown superiority over single-agent gemcitabine and is the recommended treatment per National Comprehensive Cancer Network guidelines after upfront pancreatectomy. However, given the aggressive nature of PDAC, upfront chemotherapy first could potentially eradicate micrometastases early and also help ascertain the biology of the cancer, sparing a futile surgical procedure if there is development of metastasis during initial systemic therapy. 10.1001/jamaoncol.2024.0870 2820218