Compliance with and effects of preoperative immunonutrition in patients undergoing pancreaticoduodenectomyJournal of Hepato-Biliary-Pancreatic Sciences - - 2012
Hirofumi Soejima, Taira Kinoshita, Naoto Gotohda, Shinichiro Takahashi, Toshio Nakagohri, Masaru Konishi
AbstractBackground/purposeThis study was conducted to ascertain the feasibility and effectiveness of preoperative enteral immunonutrition using an immune‐enhanced formula (Impact) in patients undergoing pancreaticoduodenectomy.
MethodsTwenty‐five patients undergoing an elective pancreaticoduodenectomy were asked to ingest Impact for 5 days (750 mL/day) prior to surgery in addition to their normal diets. We retrospectively compared the early postoperative outcomes of the Impact group (n = 18), which consisted of patients who fully complied with the study protocol, and a control group (n = 13), which consisted of patients who had not ingested Impact prior to surgery.
ResultsOverall, 82.6% of the patients complied with the preoperative oral ingestion of Impact; all but four patients tolerated a daily intake of 750 mL. While the clinical backgrounds of the Impact and control groups were not significantly different, the frequency of incisional wound infection was lower (0 vs. 30.8%,p = 0.012) and the change in systemic severity as evaluated using the acute physiology and chronic health evaluation (APACHE)‐II scoring system was milder (p = 0.033) in the Impact group than in the control group.
ConclusionThe preoperative oral ingestion of Impact was well tolerated and appeared to be effective for preventing incisional wound infection and reducing the response to surgical stress in patients undergoing a pancreaticoduodenectomy.
Basics and applications of stem cells in the pancreasJournal of Hepato-Biliary-Pancreatic Sciences - Tập 19 - Trang 594-599 - 2012
Keisuke Sekine, Hideki Taniguchi
Enormous efforts have been made to establish pancreatic stem/progenitor cells as a source for regenerative medicine for the treatment of diabetes mellitus. In recent years, it has been recognized that the self-renewal of beta cells is the dominant process involved in postnatal beta-cell regeneration and expansion. Nevertheless, several in-vitro studies have suggested that ductal or as yet unidentified cells are candidates for pancreatic stem/progenitor cells that can differentiate into multilineage cells, including insulin+ cells. The question remains as to whether beta cells are generated postnatally from stem/progenitor cells other than pre-existing beta cells. Furthermore, mutated pancreatic stem cells are considered to be prospective candidates for cancer stem cells or tumor-initiating cells. This review highlights recent progress in pancreatic stem/progenitor cell research.
Chụp CT đường mật 64 hàng đa detector qua tĩnh mạch ở gan heo: nghiên cứu khả thi với định nghĩa khoảng thời gian tối ưu cho việc xác định đường mật Dịch bởi AI Journal of Hepato-Biliary-Pancreatic Sciences - Tập 17 - Trang 666-672 - 2010
Christof M. Sommer, C. B. Schwarzwaelder, S. Ramsauer, U. Stampfl, W. Stiller, F. Nickel, W. Omri, H. G. Kenngott, T. Gehrig, H. P. Meinzer, H. U. Kauczor, B. A. Radeleff
Nghiên cứu khả thi về việc chụp CT đường mật 64 hàng đa detector qua tĩnh mạch ở gan heo, với việc xác định khoảng thời gian tối ưu để ghi rõ đường mật. Sáu con heo Landrace khỏe mạnh, mỗi con nặng 28.97 ± 2.99 kg, đã tiến hành chụp CT đường mật 64 hàng đa detector. Mỗi con heo được bơm liên tục 50 ml meglumine iotroxate trong khoảng thời gian 20 phút; bắt đầu từ khi khởi đầu bơm, đã thực hiện 18 lần chụp CT liên tiếp ở bụng với khoảng cách 2 phút giữa các lần chụp. Tất cả các chuỗi đều được đánh giá về điểm số hình ảnh đường mật và đường kính tối đa của đường mật như là mục tiêu chính của nghiên cứu, cùng với độ suy giảm của đường mật và sự tăng cường của gan như là mục tiêu phụ. Trong tổng số 16 đoạn của đường mật đã được phân tích, điểm số hình ảnh tối đa của đường mật nằm trong khoảng 4.00 ± 0.00 đến 2.83 ± 1.47. Thời gian đến điểm số hình ảnh tối đa của đường mật nằm trong khoảng 10 đến 34 phút. Điểm số hình ảnh trung bình của đường mật cho khoảng thời gian từ 10 đến 34 phút nằm trong khoảng 3.99 ± 0.05 đến 2.78 ± 0.10. Đường kính tối đa của đường mật nằm trong khoảng 6.47 ± 1.05 đến 2.65 ± 2.23 mm. Thời gian đến đường kính tối đa của đường mật nằm trong khoảng 24 đến 34 phút. Đường kính trung bình của đường mật cho khoảng thời gian từ 10 đến 34 phút nằm trong khoảng 6.00 ± 0.38 đến 2.40 ± 0.13 mm. Chụp CT đường mật 64 hàng đa detector qua tĩnh mạch ở gan heo không bị bệnh là khả thi, với việc xác định đường mật tốt nhất đạt được trong khoảng thời gian từ 10 đến 34 phút sau khi bắt đầu bơm phẩm tương phản.
“Liver-first” approach for synchronous colorectal liver metastases: is this a justifiable approach?Journal of Hepato-Biliary-Pancreatic Sciences - Tập 20 - Trang 263-270 - 2013
A. De Rosa, D. Gomez, A. Brooks, I. C. Cameron
To review the outcomes of patients with synchronous colorectal liver metastases (CRLM) treated by the “liver-first” approach. Relevant articles were reviewed from the published literature using the Medline database. The search was performed using the keywords “colorectal cancer”, “liver-first”, “reverse strategy”, “liver metastases”, “liver resection” and “hepatectomy”. There have been four retrospective studies that have reported the outcomes of patients with synchronous CRLM following the reverse strategy. The number of patients included ranged from 16 to 27. One study included patients with advanced rectal cancer and synchronous liver metastases only. None of the studies defined resectability for the CRLM. Overall, the morbidity and mortality rates were low. The recurrence rate ranged from 25 to 70 %. One study did not report survival data, and the overall 5 year survival ranged from 31 to 41 %. The “liver-first” approach may be beneficial to a selected group of patients with synchronous CRLM. Patient selection is likely to be determined by their response to down-staging chemotherapy with or without biological agents.
The distribution of atypical epithelium in main-duct type intraductal papillary mucinous neoplasms of the pancreasJournal of Hepato-Biliary-Pancreatic Sciences - Tập 18 - Trang 241-249 - 2010
Tatsuo Ito, Ryuichiro Doi, Akihiko Yoshizawa, Morito Sakikubo, Kazuyuki Nagai, Atsushi Kida, Masayuki Koizumi, Toshihiko Masui, Yoshiya Kawaguchi, Toshiaki Manabe, Shinji Uemoto
The purpose of this study was to obtain the fundamental data necessary to discuss the appropriate operative mode for the resection of main-duct type intraductal papillary mucinous neoplasms (mIPMNs) of the pancreas. In 23 patients who underwent total pancreatectomy with preoperative and postoperative diagnoses of mIPMN, the imaging studies and clinicopathological data were collected. The whole pancreatic specimen was histologically evaluated, and the distribution of atypical epithelium was mapped on a schema. Pathological examination of the specimens revealed that 18 patients had carcinoma in the pancreas; 8 patients had invasive lesions and one patient had lymph node metastasis. Specimens from 5 patients did not bear carcinoma lesions but had widespread borderline lesions in the pancreas. The mapping of lesions in the pancreatic specimens revealed that, at least, borderline or higher lesions were present both in the head and distal pancreas in all patients. In the majority of the specimens, lesions from adenoma to carcinoma co-existed on the same slide, and there were normal cell intervals between the malignant lesions. We conclude that total pancreatectomy should be performed for mIPMN when dilatation of the main duct suggests possible spread of the lesion to the whole pancreas.
Gene expression analysis for predicting gemcitabine resistance in human cholangiocarcinomaJournal of Hepato-Biliary-Pancreatic Sciences - Tập 18 - Trang 700-711 - 2011
Jun Sato, Takashi Kimura, Takuro Saito, Takayuki Anazawa, Akira Kenjo, Yoshihiro Sato, Takao Tsuchiya, Mitsukazu Gotoh
Gemcitabine is a promising drug for cholangiocarcinoma treatment. However, the kinetics and metabolism of this drug in cholangiocarcinoma treatment are not well defined. We aimed to investigate the potential clinical role of gemcitabine metabolism-related genes in the gemcitabine sensitivity of cholangiocarcinoma and identify and characterize novel gemcitabine resistance-related genes. Expressions of genes related to gemcitabine sensitivity and gemcitabine metabolism were measured in 10 cholangiocarcinoma cell lines, and the association between gene expression and gemcitabine sensitivity was evaluated. Furthermore, gemcitabine-resistant cell lines were established from YSCCC cells and subjected to genome-wide microarray analysis. The 2-fold upregulated and downregulated genes were then subjected to pathway analysis. p53R2 mRNA expression was significantly higher in gemcitabine-resistant cell lines (IC50 > 1000 nM), and all subunits of ribonucleotide reductase were upregulated in the established gemcitabine-resistant cell lines. Microarray analysis revealed that the upregulated genes in the resistant cells belonged to the glutathione and pyrimidine metabolism pathways, and that the downregulated genes belonged to the N-glycan biosynthesis pathway. Increased expression of p53R2 may predict gemcitabine resistance, and upregulated RNR activity may influence gemcitabine resistance in cholangiocarcinoma cells. Glutathione pathway-related genes were induced by continuous exposure to gemcitabine and may contribute to gemcitabine resistance.
Staging systems: Is there a surgical staging and a medical one? A surgeon’s perspectiveJournal of Hepato-Biliary-Pancreatic Sciences - - 2009
Carlo M. Contreras, Jean-Nicolas Vauthey
From a surgeon’s perspective, the AJCC 6th edition is the staging system of choice due to its simplified clinicopathologic schema, discriminatory accuracy, extensive external validation, widespread geographic reproducibility, and applicability to both the resection and transplantation patient population with hepatocellular carcinoma.
Robot-assisted laparoscopic pancreaticoduodenectomyJournal of Hepato-Biliary-Pancreatic Sciences - Tập 18 - Trang 287-291 - 2010
A. Horiguchi, I. Uyama, S. Miyakawa
Robotic surgery is the most advanced development in minimally invasive surgery. However, the number of reports on robot-assisted endoscopic gastrointestinal surgery is still very small. In this article, we describe total laparoscopic pancreaticoduodenectomy (PD) undertaken using the da Vinci Surgical System® (Intutive Surgical). Three patients underwent robotic PD between November 2009 and February 2010. Following resection of the pancreatic head, duodenum, and the distal stomach, intracorporeal anastomosis was accomplished by Child’s method of reconstruction, which includes a two-layered end-to-side pancreaticojejunostomy, an end-to-side choledochojejunostomy, and a side-to-side gastrojejunostomy. The time required for surgery was 703 ± 141 min, and blood loss was 118 ± 72 mL. The average hospital stay period was 26 ± 12 days. As a postoperative complication, pancreatic juice leak occurred in one case, but it was managed with conservative treatment. Of the three patients, one had cancer of the papilla of Vater, one had cancer of the pancreatic head, and one had a solid pseudopapillary neoplasm. In all cases, the surgical margin was negative for tumor. Robot-assisted PD required a long time, but organ removal with less bleeding was able to be safely performed owing to the high degree of freedom associated with the forceps manipulation and the magnified view. Similarly, pancreatojejunostomy could certainly be conducted. No major postoperative complications were found. Accumulation of da Vinci PD experience in the future will lead to safer and faster PD.
Intraductal oncocytic papillary neoplasms of the pancreas and bile ducts: a description of five new cases and review based on a systematic survey of the literatureJournal of Hepato-Biliary-Pancreatic Sciences - - 2010
Łukasz Liszka, Jacek Pająk, Ewa Zielińska-Pająk, Łukasz J. Krzych, Dariusz Gołka, Sławomir Mrowiec, Paweł Lampe
AbstractBackgroundIntraductal oncocytic papillary neoplasms (IOPN) are rare tumors of the pancreatic and biliary ductal system. It is not absolutely clear if the molecular and clinicopathologic characteristics of IOPN differ significantly from other related lesions, namely intraductal papillary mucinous neoplasms (IPMN). Therefore it is not clear if it is reasonable to consider IOPN as a separate diagnostic and clinical entity.
MethodsIn order to describe the clinicopathologic characteristics of IOPN and to compare them with the IPMN profile, we performed a systematic review of the literature and additionally studied five previously unreported IOPN cases.
ResultsIOPN differ from IPMN by lack of K‐ras gene mutations in all studied cases. Several differences in the clinical and biological profile between IOPN and IPMN exist, but they are of quantitative rather than of qualitative nature. Additionally, pancreaticobiliary or gastric‐foveolar IPMN components may coexist with IOPN component within a single lesion, which suggests at least a partial relation of the pathogenetic pathways of IPMN and IOPN. Importantly, the pathogenesis of accumulation of mitochondria and oxyphilic appearance of IOPN remains unknown.
ConclusionsAt present, there are no reliable criteria other than histopathological picture and K‐ras gene status to differentiate IOPN from IPMN. In particular, no clear differences in optimal treatment options and prognosis between these tumors are known. Further studies are needed to clarify the biology of IOPN and to establish their position in clinicopathologic classifications of pancreatic tumors.
Tumor-related factors do not influence the prognosis of solitary hepatocellular carcinoma after partial hepatectomyJournal of Hepato-Biliary-Pancreatic Sciences - Tập 18 - Trang 689-699 - 2011
Tsuyoshi Kobayashi, Toshiyuki Itamoto, Hirotaka Tashiro, Hironobu Amano, Akihiko Oshita, Yoshisato Tanimoto, Shintaro Kuroda, Hirofumi Tazawa, Hideki Ohdan
Although many factors related to the tumor or the hepatic functional reserve may affect the outcome of partial hepatectomy for hepatocellular carcinoma (HCC), these factors have not yet been intensively investigated in patients with solitary HCC. The purpose of this study is to determine the clinicopathological factors influencing the long-term outcomes of partial hepatectomy for solitary HCC. Data on 266 consecutive patients with a solitary HCC who underwent curative hepatectomy between 1997 and 2006 were analyzed with regard to prognosis. Overall survival rates at 3, 5, and 10 years were 89.5, 79.6, and 56.1%, respectively. The significant independent predictors for overall survival included hepatitis C virus infection, liver cirrhosis, and prolonged prothrombin activity. Disease-free survival rates at 3, 5, and 10 years were 51.7, 41.1, and 20.4%, respectively. The significant independent predictors for disease-free survival included elevated levels of aspartate amino transferase, decreased platelet counts, presence of liver cirrhosis, and prolonged prothrombin activity. Tumor-related factors such as tumor size and microscopic vascular invasion were not significant predictors of overall or disease-free survival. The long-term outcomes of patients with a solitary HCC who underwent partial hepatectomy mainly depended on the background liver status but not on tumor-related factors; this suggests that partial hepatectomy is a remarkably effective antitumor therapy. If the hepatic functional reserve is within the permissible range, partial hepatectomy should be considered as the treatment of choice for patients with a solitary HCC.
