<正>Pancreatic cancer is the fourth leading cause of cancer death worldwide and leads to an estimated 220 000 deaths per year1.The malignancy is difficult to detect and diagnose,as there are no ...noticeable signs or symptoms in the early stages of the disease,and the pancreas is located deep in the abdomen.Surgical resection is widely accepted as the only potentially curative therapy for
Pancreaticoduodenectomy and distal pancreatectomy are the traditional surgical treatments of tumors in the neck or body of the pancreas. Although resecting the lesions successfully, these procedures ...can also, however, lead the substantial loss of normal pancreatic parenchyma, causing endocrine and exocrine function disorder. The combination of distal pancreatectomy with splenectomy increased the risk of thrombosis sometimes. So the surgical trauma is too great, especially for benign and lower malignant tumors located in the neck or body of the pancreas. While, middle pancreatectomy may decrease operative trauma with the excision of these lesions, and can maximize the retention of pancreatic parenchyma, and maintain pancreatic endocrine and exocrine function integrity. The procedure is interesting but rarely performed. With the application and development of minimally invasive surgical techniques, laparoscopic and robotic middle pancreatectomy are available now. Researches about laparoscopic and robotic middle pancreatectomy are presented, with decreased morbidity, reduced operation time and hospital stay. There is only a few reports on the two procedures, but the security and effectiveness of them are suggested.
Recent studies suggest that the ability to form and grow tumors specifically resides in a small cell population called cancer stem cells (CSCs). These studies were conducted mainly on various human ...cancers; however, isolation and characterization of stem cells from cholangiocarcinoma have not been attempted. The molecular markers CD24, CD44, CD34, and epithelial cell adhesion molecule (EpCAM) are widely used, individually or in combination, to characterize some types of CSCs. In this study, we used these markers to identify a subpopulation of cells in extrahepatic cholangiocarcinoma (ECC) with cancer stem/progenitor cell‐like properties. We found that CD24+CD44+EpCAMhigh cells (0.39–2.27%) were present in human ECC tissues. The expression of a CD24+CD44+EpCAMhigh subpopulation was consistent with primary cancers and could be duplicated during serial in vivo passaging in NOD/SCID mice. CD24+CD44+EpCAMhigh cells isolated from 3 cholangiocarcinoma xenografts showed high tumorigenic potential compared with CD24−CD44−EpCAMlow/− cells. These tumorigenic ECC cells exhibited the stem cell properties of self‐renewal and ability to produce heterogeneous progeny. We report the identification of a CSC population in ECC characterized by CD24, CD44 and EpCAM phenotypes. Our findings could provide new insight into the tumorigenesis of cholangiocarcinoma and offer a potential target for anti‐cancer therapy.
Cancer stem cells (CSCs)/tumor-initiating cells have been defined as a subset of tumor cells responsible for initiating and sustaining tumor development. Emerging evidence strongly supports the ...existence of CSCs in various solid tumors, but they have not yet been identified in human gallbladder carcinomas (GBC). In this study, we identified CSCs in primary GBC and in the cell line GBC-SD using the cell surface markers CD44 and CD133. The percentages of CD44+CD133+ cells were 1.76-3.05% in primary tumors and 40.29% in GBC-SD cells. These cells showed stem cell properties, including self-renewal, differentiation potential, and high tumorigenicity. In vitro culture experiments revealed that CD44+CD133+ GBC cells possessed a higher spheroid-colony forming ability in serum-free media than other subpopulations. When injected into nonobese diabetic/severe combined immunodeficient mice, these cells formed new tumors and generated CD44+CD133+, CD44-, and CD133- progeny. CD44+CD133+ cells also showed a high degree of chemoresistance, possibly due to upregulation of the breast cancer resistance protein (ABCG2) and the transcription factor Gli1 in these highly tumorigenic cells. These results suggest that the CD44+CD133+ population exhibited CSC-like characteristics and may thus provide a novel approach to the diagnosis and treatment of GBC.
Abstract
Pancreatic surgery is one of the most complex and challenging fields in abdominal surgery associated with extensive surgical trauma, damage to adjacent organs, a long operation time and a ...high incidence of postoperative complications. Since the early 1990s, laparoscopic techniques have been applied to a growing number of pancreas surgeries, and great progress has been achieved in laparoscopic pancreaticoduodenectomy. As surgeons become proficient in laparoscopic pancreaticoduodenectomy techniques, laparoscopic techniques are gradually used in other pancreatic surgeries, such as laparoscopic distal pancreatectomies and laparoscopic duodenum-preserving pancreatic head resection (LDPPHR), which may benefit patients by reducing postoperative pain and hospital stays and providing a quick recovery to normal activity. Recently, a great number of literature have introduced LDPPHR. It is a good surgical method for benign and low-grade malignant tumors of the pancreatic head. Although LDPPHR is technically feasible, it is not yet generally practicable and limited to highly skilled endoscopic surgeons, and the long-term results after LDPPHR are still not well defined. This article aims to provide a literature review of LDPPHR to assess its feasibility, safety, postoperative recovery, and future outlook according to early experiences of this technique.
Background
The extent of pancreatoduodenectomy for pancreatic head cancer remains controversial, and more high‐level clinical evidence is needed. This study aimed to evaluate the outcome of extended ...pancreatoduodenectomy (EPD) with retroperitoneal nerve resection in pancreatic head cancer.
Methods
This multicenter randomized trial was performed at 6 Chinese high‐volume hospitals that enrolled patients between October 3, 2012, and September 21, 2017. Four hundred patients with stage I or II pancreatic head cancer and without specific pancreatic cancer treatments (preoperative chemotherapy or chemoradiation) within three months were randomly assigned to undergo standard pancreatoduodenectomy (SPD) or EPD, with the latter followed by dissection of additional lymph nodes (LNs), nerves and soft tissues 270° on the right side surrounding the superior mesenteric artery and celiac axis. The primary endpoint was overall survival (OS) by intention‐to‐treat (ITT). The secondary endpoints were disease‐free survival (DFS), mortality, morbidity, and postoperative pain intensity.
Results
The R1 rate was slightly lower with EPD (8.46%) than with SPD (12.56%). The morbidity and mortality rates were similar between the two groups. The median OS was similar in the EPD and SPD groups by ITT in the whole study cohort (23.0 vs. 20.2 months, P = 0.100), while the median DFS was superior in the EPD group (16.1 vs. 13.2 months, P = 0.031). Patients with preoperative CA19–9 < 200.0 U/mL had significantly improved OS and DFS with EPD (EPD vs. SPD, 30.8 vs. 20.9 months, P = 0.009; 23.4 vs. 13.5 months, P < 0.001). The EPD group exhibited significantly lower locoregional (16.48% vs. 35.20%, P < 0.001) and mesenteric LN recurrence rates (3.98% vs. 10.06%, P = 0.022). The EPD group exhibited less back pain 6 months postoperation than the SPD group.
Conclusions
EPD for pancreatic head cancer did not significantly improve OS, but patients with EPD treatment had significantly improved DFS. In the subgroup analysis, improvements in both OS and DFS in the EPD arm were observed in patients with preoperative CA19–9 < 200.0 U/mL. EPD could be used as an effective surgical procedure for patients with pancreatic head cancer, especially those with preoperative CA19–9 < 200.0 U/mL.
Crohn’s disease of the duodenum is an uncommon condition. Our case was an extremely rare manifestation of Crohn’s disease, who presented with obstruction of the pylorus and the first and the second ...parts of the duodenum. Because of the severity of the obstruction, he underwent laparoscopic pancreaticoduodenectomy. Postoperative pancreatic leakage and bowel fistula were not observed, and there was no morbidity during the follow-up period. There was also no disturbance in digestive function, postoperatively. This is the first case employing laparoscopic pancreaticoduodenectomy to cure benign lesions leading to duodenal obstruction. Minimally invasive laparoscopic pancreaticoduodenectomy technology shows a very big advantage in treating this rare benign Crohn’s disease.
In clinical practice, pancreatic neuroendocrine neoplasms (pNENs) with a diameter smaller than 2 cm are commonly referred to as small pNENs. Due to their generally favorable biological ...characteristics, the diagnosis and treatment of small pNENs differ from other pNENs and are somewhat controversial. In response to this, the Chinese Pancreatic Surgery Association, Chinese Society of Surgery, Chinese Medical Association have developed a consensus on the diagnosis and treatment of small pNENs, which is based on evidence-based medicine and expert opinions. This consensus covers various topics, including concepts, disease assessment, treatment selection, follow-up, and other relevant aspects.
PDF
