Expression of human epidermal growth factor receptor 2 in pancreatic ductal adenocarcinoma and its clinical significance / 中华胰腺病杂志

Objective:To investigate the expression of human epidermal growth factor receptor 2 (HER2) in pancreatic ductal adenocarcinoma(PDAC) and its relationship with the prognosis of patients with PDAC.Methods:From January 2001 to December 2012, 109 paraffin embedded PDAC tissue samples and 27 normal pancreatic tissue samples were collected from the Department of Pathology, Huadong Hospital Affiliated to Fudan University. The expression of HER2 protein in pancreatic tissue was detected by immunohistochemical Envision two-step method. HER2 expression was evaluated according to Hercept test, and its relationship with clinicopathological features and survival time was analyzed.Results:The expression of HER2 protein was negative (-) in 29.4% of PDAC tissues, weakly positive (+ ) in 35.8%, positive (+ + ) in 25.7% and strongly positive (+ + + ) in 9.2%, respectively, and the overexpression rate (+ + , + + + ) was 34.9%; the negative (-) and weakly positive (+ ) expression of HER2 protein in normal pancreatic tissues accounted for 88.9% and 11.1% respectively. There was no expression with positive (+ + ) or strongly positive (+ + + ), therefore, the overexpression rate was 0. The overexpression rate of HER2 protein in PDAC and normal pancreatic tissues was significantly different ( P=0.000). The expression of HER2 protein was significantly correlated with age, and the expression of HER2 protein in patients with PDAC over 65 years old was significantly higher than that in patients with PDAC under 65 years old ( P=0.043), but not with gender, tumor location, tumor grade, T stage, N stage and nerve invasion (all P>0.05). Univariate Cox proportional hazards analysis showed that HER2 expression was associated with postoperative survival time of patients with PDAC ( P=0.032). Multivariate Cox proportional hazards analysis showed that HER2 expression was an independent prognostic factor for survival of patients with PDAC ( P=0.040). The median survival period of patients with HER2 expression + + + was significantly longer than that of patients with HER2 expression -~+ + (128.4 months vs 21.5 months), and the difference was statistically significant ( P=0.038). Conclusions:The overexpression of HER2 in PDAC tissue was related to the age of patients. The survival time of patients with HER2 strongly positive PDAC was significantly longer. HER2 can be considered as an index to evaluate the biological behavior and prognosis of PDAC.

Progress in the relationship between postoperative pancreatic fistula and abdominal infection / 中华肝胆外科杂志

Postoperative pancreatic fistula (POPF) is one of the main life-threatening complications after pancreatectomy, with an incidence of 3% to 45%. Despite there were significant advances in pancreatic surgery in recent decades and continued decreasing mortality, the incidence of postoperative pancreatic fistula still remains high. Clinically relevant postoperative pancreatic fistula after pancreatic surgery is often accompanied by abdominal infection. Studies have shown that abdominal infection is not only related to postoperative pancreatic fistula, but also it’s an important factor which may induce and aggravate the development of postoperative pancreatic fistula. The exact correlation between POPF and abdominal infection is not clear. The goal of this review is to discuss the current research progress on the relationship between postoperative pancreatic fistula and abdominal infection.

Expression of adipocytokine resistin and inflammatory cytokines, and their associations with the clinicopathological features of pancreatic carcinoma / 中华肝胆外科杂志

Objective To investigate the expression of resistin and inflammatory cytokines in pancreatic cancer and explore the association with clinicopathological features.Methods The enzyme-linked immunosorbent assay (ELISA) technique was used to examine the serum resistin level in 38 patients with pancreatic cancer and 32 healthy controls.The real-time PCR technique was used to detect the mRNA expression level of resistin and inflammatory cytokines TNF-α,IL-2 and IL-8 in surgically resected specimens of pancreatic cancer patients.Results The serum resistin level in patients with pancreatic cancer was significantly higher than that in healthy controls (P ＜ 0.05).The serum resistin level was positively associated with TNM stage and lymph node metastasis,respectively (P ＜ 0.05).There was no significant correlation between serum resistin level and age,gender,BMI,preoperative blood glucose levels,tumor location,tumor size,nerve invasion and differentiation grade (P ＞ 0.05).The expression level of resistin mRNA in pancreatic cancer tissues was 3.8 times more than that in normal pancreatic tissues (P ＜ 0.05).The mRNA expressiou level of proinflammatory cytokines as TNF-α and IL-8 in pancreatic cancer tissues were 2.1 and 1.9 times higher than those in normal pancreatic tissues (P ＜ 0.05).The mRNA expression level of anti-inflammatory cytokines IL-2 accounted for 20％ of that in normal pancreatic tissues (P ＜ 0.05).Conlusions The serum resistin level in patients with pancreatic cancer was significantly higher than that of healthy controls,and positively associated with TNM stage and lymph node metastasis.The expression level of resistin and proinflammatory cytokines IL-8 and TNF-α of pancreatic cancer tissues were significantly higher than those of normal pancreatic tissues.The expression level of anti-inflammatory cytokine IL-2 was less than that in normal pancreatic tissues.It's suggested that resistin may take part in the development and progression of pancreatic cancer by mediating inflammatory reaction.

A comparative study between minimally invasive and traditional open surgery in treating patients with pancreatic body or tail lesions / 中华肝胆外科杂志

Objective To study the feasibility,safety,indications and possible advantages of minimally invasive surgery over traditional open surgery in treating pancreatic body or tail lesions.Methods From December 2009 to December 2014,the clinical data of 71 patients with lesions in pancreatic body or tail who underwent minimally invasive distal pancreatectomy (MIDP) or open distal pancreatectomy (ODP) at the General Surgery of Huadong Hospital were retrospectively analyzed.There were 22 patients in the MIDP group and 49 patients in the ODP group.The operations in 15 patients in the MIDP group were performed by the Da Vinci robot-assisted surgical system and 7 patients by laparoscopic distal pancreatectomy.Results The MIDP group had a shorter time to pass first flatus [(MIDP (2.5 ± 1.0) d vs ODP (3.5 ±1.0)d,P ＜ 0.05],and shorter postoperative hospital stay [(MIDP (15.2 ± 7.9) d vs ODP (23.4 ±21.2) d,P ＜ 0.05] than the ODP group.There were no significant differences on total pancreatic fistula rate [MIDP 45.5％ (10/22) vs ODP 55.1％ (27/49),P ＞ 0.05] and symptomatic postoperative pancreatic fistula rate [MIDP 18.2％ (4/22) vs ODP 18.4％ (9/49),P ＞ 0.05] between the two groups.The MIDP group had a significant longer operative time [MIDP (246.3 ±75.3)min vs ODP (168.1 ±33.7)min,P＜0.05] than the ODP group.Conclusions Minimally invasive surgery is safe and feasible in treatment of lesions in pancreatic body or tail with less trauma and faster recovery.The application of robotic surgery has expanded the treatment options for lesions in pancreatic body or tail.