ABSTRACT
BACKGROUND: An enhanced recovery after surgery (ERAS) programme aims to reduce the stress response to surgery and thereby accelerate recovery. The experience of implementing the ERAS programmes in pancreatoduodenectomy (PD) is relatively limited. The aim of this study was to evaluate the feasibility, safety and clinical outcomes of the ERAS programme after PD at a high-volume Chinese university referral centre. METHODS: Between September 2014 and July 2016, a retrospective analysis of 166 consecutive patients who underwent PD at a tertiary referral care center was carried out. Ninety-eight patients who received conventional perioperative management (the conventional group) were compared with 68 patients who received ERAS programme (the ERAS group). The incidences of postoperative complications, length of stay, expenses, postoperative readmissions, and reoperation rates were compared. RESULTS: A total of 166 patients who underwent PD were analysed (68 patients in the ERAS group, and 98 patients in the conventional group). There were no significant differences in mortality, reoperation, and readmission rates. The ERAS group had a lower morbidity rate than the conventional group (50% vs. 90.8%; P = 0.00), as well as a shorter length of hospital stay (7.5 vs 12 days; P = 0.00). Delayed gastric emptying was significantly reduced in the ERAS group (0 vs. 11.2%; P = 0.011). Pancreatic fistula (grade B,C) was significantly reduced in the ERAS group (14.7 vs 30.6%; P = 0.018). The median total hospital cost was also significantly reduced in the ERAS group (¥79790.40 vs ¥102982.81; P = 0.000). CONCLUSION: The ERAS programme is feasible and safe in patients who underwent PD, and it can reduce postoperative complications and improve clinical outcomes.
Subject(s)
Pancreaticoduodenectomy/adverse effects , Perioperative Care/methods , Adolescent , Adult , Aged , Aged, 80 and over , Anastomosis, Surgical , Feasibility Studies , Female , Gastroparesis/etiology , Gastroparesis/prevention & control , Humans , Intestines , Length of Stay/statistics & numerical data , Male , Middle Aged , Pancreaticoduodenectomy/mortality , Pancreaticoduodenectomy/rehabilitation , Patient Readmission/statistics & numerical data , Postoperative Complications/prevention & control , Program Evaluation , Recovery of Function , Reoperation/statistics & numerical data , Retrospective Studies , Tertiary Care Centers , Treatment Outcome , Young AdultABSTRACT
Immobilization of a ligand that selectively interacts with cancer cells to nanomaterials can enhance their diagnostic and therapeutic efficiency. In this study, we firstly demonstrate the high expression of receptor for cyclic nine-amino acid peptide LyP-1 (Cys-Gly-Asn-Lys-Arg-Thr-Arg-Gly-Cys) in both mouse and human pancreatic cancer. Based on these findings, sub-50 nm multifunctional superparamagnetic mesoporous nanospheres with surface modified with LyP-1 are rationally designed. Theses nanospheres have a core of silica-protected magnetite nanoparticle and a shell of FITC-labeled mesoporous silica, and they are able to specifically recognize and conjugate with the pancreatic cancer cell in vitro, as verified by the combined techniques of fluorescent imaging and T2 weight magnetic resonance imaging. After systematic administration, these LyP-1 immobilized nanospheres are found to actively target to mouse orthotopic xenograft of pancreatic cancer, which opens up the door for applications in early probing and diagnosis of pancreatic cancer by the multimodal imaging.
Subject(s)
Magnetite Nanoparticles/chemistry , Molecular Probe Techniques , Nanospheres/chemistry , Pancreatic Neoplasms/diagnostic imaging , Pancreatic Neoplasms/metabolism , Peptides, Cyclic/pharmacokinetics , Animals , Cell Line, Tumor , Contrast Media/chemistry , Female , Magnetite Nanoparticles/ultrastructure , Mice , Mice, Inbred BALB C , Molecular Probes/chemistry , Multimodal Imaging/methods , Nanocapsules/chemistry , Nanocapsules/ultrastructure , Nanoconjugates/chemistry , Nanoconjugates/ultrastructure , Nanospheres/ultrastructure , Pancreatic Neoplasms/pathology , Peptides, Cyclic/chemistry , Porosity , Reproducibility of Results , Sensitivity and SpecificityABSTRACT
OBJECTIVES: To investigate the expression and clinical significance of Sonic hedgehog (Shh) in pancreatic adenocarcinoma. METHODS: The expression of Shh protein was examined in 34 surgical specimens of primary pancreatic adenocarcinoma, 21 nonmalignant specimens of the pancreas by immunohistochemistry streptavidin-perosidase (SP) method. In addition, semiquantitative reverse transcriptase polymerase chain reaction was carried out to analyze Shh mRNA expression in 22 pairs of freshly resected pancreatic adenocarcinoma tissues and their adjacent nontumorous tissues. RESULTS: The positive expression rate of Shh protein was 64.7% (22/34) in 34 surgical specimens of primary pancreatic adenocarcinoma and 0% (0/21) in 21 nonmalignant specimens of the pancreas. The expression rate of Shh was higher in pancreatic adenocarcinoma tissues than that of nonmalignant pancreatic tissues (χ2 = 22.647, P = 0.000). Sonic hedgehog protein expression correlated with TNM stages and distant metastasis. Moreover, the expression levels of Shh mRNA were higher in pancreatic adenocarcinoma tissues than that of the matched adjacent nontumorous tissues. CONCLUSIONS: Sonic hedgehog might play a pivotal role during tumorigenesis of pancreatic adenocarcinoma, and high Shh expression might be associated with the malignant potential of pancreatic cancer.
