Background Obstructive jaundice is a common presenting symptom among patients with pancreatic cancer. While benefits of preoperative biliary drainage have been suggested by previous studies, recent ...evidence has shown no significant improvements of preoperative biliary drainage on the postoperative outcome but rather an increase of complications. There is no clear consensus on whether to treat malignant obstructive jaundice with preoperative biliary drainage prior to operative intervention or to proceed directly to resection. Thus, our aim was to elucidate the impact of preoperative biliary drainage of obstructive jaundice due to malignant pancreatic head tumors on postoperative morbidity and mortality. Methods We conducted a meta-analysis in accordance with the PRISMA guidelines and carried out a systematic search of medical databases. The results were analyzed according to predefined criteria. We pooled the incidence of overall complications, wound infection, pancreatic fistula, intra-abdominal abscess, and death within the perioperative time period. Results We initially identified 1,816 studies, and 25 of these (22 retrospective studies, 3 randomized controlled trials) were finally included in the analysis with a total number of 6,214 patients. Analysis revealed an increased incidence of overall complications (odds ratio: 1.40; 95% confidence interval: 1.14–1.72; P = .002) and wound infections (odds ratio: 1.94; 95% confidence interval: 1.48–2.53; P < .00001) in patients receiving preoperative biliary drainage compared to operative intervention first. Mortality, incidence of pancreatic fistula, or intra-abdominal abscess formation were not affected by preoperative biliary drainage. Conclusion Preoperative biliary drainage does not have a beneficial effect on postoperative outcome. The increase of postoperative overall complications and wound infections urges for precise indications for preoperative biliary drainage and against routine preoperative biliary decompression.
Abstract Backround The Translational Genome Research Network in Pancreatic Cancer performed a meta-analysis of publicly available various high-throughput gene analysis panels to identify drugable ...targets. There, the most differentially expressed gene between normal and cancerous pancreas was Kif20a. The aim of the study was to verify this expression pattern and further characterize Kif20a in pancreatic cancer. Materials and methods Detailed expression analyses were carried out in pancreatic tissues and in a wide panel of pancreatic cells including ductal adenocarcinoma (PDAC) and neuroendocrine-cancer cell lines as well as immortalized human pancreatic ductal epithelial and primary stellate cells using quantitative real-time polymerase chain reaction, immunohistochemistry, immunofluorescence, and immunoblot analyses. Effects on proliferation, apoptosis, and cell cycle were assessed by MTT assays, caspase-cleavage assays, and fluorescence-activated cell sorting analysis after Kif20a silencing. Cell motility was assessed by migration and invasion assays as well as time-lapse microscopy. Results Mean Kif20a messenger RNA expression was 18.4-fold upregulated in PDAC tissues compared with that in the normal pancreas. In line, neuroendocrine-cancer cell lines display a 1.6-fold increase and ductal adenocarcinoma cell lines a 11-fold increase of Kif20a messenger RNA ( P = 0.009) in comparison with primary stellate cells. A 7.3-fold overexpression was also found in immortalized pancreatic ductal epithelial cells. Kif20a silencing with small interfering RNA molecules resulted in an inhibition of proliferation, motility, and invasion of pancreatic cancer cell lines. Conclusions Targeting Kif20a reduces proliferation, migration, and invasion of pancreatic cancer cells. Together with its significant overexpression in PDAC, this makes it a potential target for diagnostic and interventional purposes.
Background Serum C-reactive protein (CRP) is an established discriminating factor for necrotizing pancreatitis. In this study, the CRP response with respect to inflammatory postoperative ...complications was examined in a large, homogeneous series of pancreatic resections in order to define a relevant clinical parameter for early detection of inflammatory postoperative complications. Methods 688 consecutive pancreatic resections with jejunal anastomosis were screened for inflammatory postoperative complications based on a prospective database. Ninety-one patients had at least one inflammatory postoperative complication and were compared to a subgroup of 60 consecutive patients with uneventful postoperative courses. Results In the postoperative setting after pancreatic resection, CRP peaked on postoperative day (POD) 3 with a median serum CRP of 132 mg/L, and gradually decreased thereafter in patients with an uncomplicated postoperative course. In complicated cases (with the exception of cholangitis), increase in CRP was significantly greater, peaked on POD 3 (median CRP 173 mg/L), and persisted thereafter, whereas white blood cell count and body temperature did not differ significantly from uneventful courses until POD 6. The median day of diagnosis of inflammatory postoperative complications was POD 9. A cutoff CRP value of 140 mg/dL on POD 4 yielded a positive predictive value of 89.1% (adjusted to the prevalence of inflammatory postoperative complications: 48.7%) with a specificity of 87.1% and a sensitivity of 69.5% for inflammatory postoperative complications. Conclusion Persistence of CRP elevation above 140 mg/dL on POD 4 is predictive of inflammatory postoperative complications and should prompt an intense clinical search for major septic processes (e.g. pancreatic fistula or abscess) if pneumonia and wound infection are unlikely or excluded.
The costimulatory molecule B7-H1 (programmed death-1 ligand-1, PD-L1) has been implicated as a potential regulator of antitumor immunity in various human cancers. To date, no data are available on ...the role of B7-H1 in Barrett carcinoma. Therefore, we investigated the expression pattern and clinical significance of B7-H1 in a large cohort of patients with Barrett carcinoma.
Expression of B7-H1 was evaluated by immunohistochemistry in 101 patients with Barrett carcinoma. Expression data were correlated with clinicopathologic features, including TNM stage, UICC (Union Internationale Contre le Cancer) tumor stage, tumor grade, resection status, and survival, and with the number of tumor-infiltrating CD3(+), CD8(+), and CD45RO(+) T lymphocytes.
Aberrant B7-H1 expression was found in Barrett carcinoma cells. High tumor B7-H1 expression was significantly associated with advanced T stage (p = 0.002), advanced UICC tumor stage (p = 0.022), and incomplete resection status (p = 0.009). The median survival of patients with high tumor B7-H1 expression was 38 months compared with 136 months for patients with no or low tumor B7-H1 expression. In the multivariable analysis, high tumor B7-H1 expression was significantly associated with an increased risk of death from Barrett carcinoma (hazard ratio, 3.50; 95% confidence interval, 1.66 to 7.38; p < 0.001).
Our data suggest that B7-H1 may represent a new prognostic marker for patients with Barrett carcinoma. Furthermore, given its immune-inhibitory function, B7-H1 may represent a potential target in the treatment of Barrett carcinoma.
Objective A prospective, randomized study was performed to evaluate two variations of the duodenum-preserving pancreatic head resection (DPPHR), either with (Beger procedure) or without (Berne ...modification) the division of the pancreas anterior to the portal vein, in patients with chronic pancreatitis. Methods Randomized, controlled, patient-blinded trial of patients with inflammatory pancreatic head tumors. The primary endpoint was the duration of surgery. Other a priori-ordered endpoints were length of ICU stay, postoperative complication, length of hospital stay, and quality of life after 24 months. Results Sixty-five patients were randomized to the Berne or Beger procedures. The Berne modification could be performed faster (46 minutes difference, P < .05). The median length of stay on the ICU was one day in both groups ( P = .97) but the median hospital stay was shorter in the Berne group (11 (8–39) versus 15 (8–47); P = .015). The quality of life two years after surgery did not differ significantly between the two groups (EORTC-QLQ-C30, Beger 65.6% vs. Berne 71.3%, P = .371). Three patients who had received the Berne procedure were reoperated on during the follow-up period due to ongoing pancreatitis and bile duct obstruction ( P = .22). Conclusion The Berne technique is technically simpler compared with the original Beger procedure, reflected in its significantly shorter operation times and hospital stays. The quality of life is similar after both procedures. The Berne modification of DPPHR adds to our panel of surgical procedures that can be applied with effective early and late outcomes.
Benign and premalignant neoplasms of the pancreas are increasingly detected and recommended for surgical treatment. For tumors of the pancreatic head, the challenging decision is: multiorgan ...resection or local tumor extirpation? Compared with pancreaticoduodenectomy, duodenum-preserving pancreatic head resection is associated with significantly fewer surgery-related serious and severe complications and lower in-hospital mortality. The decisive advantage of duodenum-preserving pancreatic head resection is the maintenance of endocrine and exocrine pancreatic and upper gastrointestinal tract functions.
Pancreatic pain Ceyhan, Güralp O., MD; Michalski, Christoph W., MD; Demir, Ihsan E ...
Baillière's best practice & research. Clinical gastroenterology,
01/2008, Letnik:
22, Številka:
1
Journal Article
Recenzirano
Abdominal pain is an important clinical symptom in pancreatic diseases. There is increasing evidence that pain in chronic pancreatitis and pancreatic cancer is triggered by pancreatic neuropathy. ...Damage to intrapancreatic nerves seems to support the maintenance and exacerbation of neuropathic pain. In chronic pancreatitis, intrapancreatic nerves are invaded by immune cells. This observation led to the hypothesis that neuro-immune interactions play a role in the pathogenesis of chronic pancreatitis and the accompanying abdominal pain syndrome. Similarly, pancreatic cancer cells infiltrate the perineurium of local nerves, which may in part explain the severe pain experienced by the patients. Furthermore, perineural invasion extending into extrapancreatic nerves may preclude curative resection and thus often leads to local recurrence. In recent years, the involvement of a variety of neurotrophins and neuropeptides in the pathogenesis of pancreatic pain was discovered. This review summarises recent data on the mechanisms of neuropathy and pain generation in pancreatic disorders.
Surgical Treatment of Pancreatic Cancer Büchler, Markus W., MD; Kleeff, Jörg, MD; Friess, Helmut, MD
Journal of the American College of Surgeons,
10/2007, Letnik:
205, Številka:
4
Journal Article
