Comparison of clinical outcomes according to the history of previous gastrectomy in patients undergoing pancreatoduodenectomy: a propensity score matching analysis

Purpose@#Although pancreatoduodenectomy (PD) in patients who have previously undergone gastrectomy is challenging, little is known about the clinical outcomes and the differences compared to those with conventional PD. We collected cases and conducted studies in retrospective review. @*Methods@#Of the 1,722 patients who underwent PD at Seoul National University Hospital between 2000 and 2014, 49 (2.8%) underwent previous gastrectomy. Clinical outcomes including operation-related factors and postoperative morbidities were analyzed. @*Results@#Among the 49 patients with curative surgery, 25 patients were male (51.0%) and the mean age was 64.7 years. Gastric cancer was the most frequent cause of previous gastrectomy (93.8%). With one-to-one propensity score matching analysis, lower preoperative body mass index (22.6 kg/m2 vs. 20.8 kg/m2, P = 0.002), higher EBL (390.0 mL vs. 729.5 mL, P = 0.027), and higher transfusion rates (10.2% vs. 36.7%, P = 0.002) were shown in the gastrectomy group. Operation time, postoperative hospital stay, and rate of clinically relevant pancreatic fistula were comparable. @*Conclusion@#Secondary PD after prior gastrectomy remains challenging, with higher EBL and rate of transfusion. However, when performed by experienced surgeons, the patients with or without previous gastrectomy show comparable postoperative clinical outcomes, such as similar duration of postoperative hospital stay and rate of postoperative pancreatic fistula.

Effects of Surgical Methods and Tumor Location on Survival and Recurrence Patterns after Curative Resection in Patients with T2 Gallbladder Cancer

BACKGROUND/AIMS: Extended cholecystectomy is generally recommended for patients with T2 gallbladder cancer. However, few studies have assessed the extent of resection relative to T2 gallbladder tumor location. This study analyzed the effects of surgical methods and tumor location on survival outcomes and tumor recurrence in patients with T2 gallbladder cancer. METHODS: Clinicopathological characteristics, extent of resection, survival rates, and recurrence patterns were retrospectively analyzed in 88 patients with pathologically confirmed T2 gallbladder cancer. RESULTS: The 5-year disease-free survival rate was 65.0%. Multivariate analysis showed that lymph node metastasis was the only independent risk factor for poor 5-year disease-free survival rate. Survival outcomes were not associated with tumor location. Survival tended to be better in patients who underwent extended cholecystectomy than in those who underwent simple cholecystectomy. Recurrence rate was not affected by surgical method or tumor location. Systemic recurrence was more frequent than local recurrence without distant recurrence. Gallbladder bed recurrence and liver recurrence were relatively rare, occurring only in patients with liver side tumors. CONCLUSIONS: Extended cholecystectomy is the most appropriate treatment for T2 gallbladder cancer. However, simple cholecystectomy with regional lymph node dissection may be appropriate for patients with serosal side tumors.

Co-stimulation of TLR4 and Dectin-1 Induces the Production of Inflammatory Cytokines but not TGF-beta for Th17 Cell Differentiation

Collaboration of TLR and non-TLR pathways in innate immune cells, which acts in concert for the induction of inflammatory cytokines, can mount a specific adaptive immune response tailored to a pathogen. Here, we show that murine DC produced increased IL-23 and IL-6 when they were treated with LPS together with curdlan that activates TLR4 and dectin-1, respectively. We also found that the induction of the inflammatory cytokine production by LPS and curdlan requires activation of IKK. However, the same treatment did not induce DC to produce a sufficient amount of TGF-beta. As a result, the conditioned media from DC treated with LPS and curdlan was not able to direct CD4+ T cells to Th17 cells. Addition of TGF-beta but not IL-6 or IL-1beta was able to promote IL-17 production from CD4+ T cells. Our results showed that although signaling mediated by LPS together with curdlan is a potent stimulator of DC to secrete many pro-inflammatory cytokines, TGF-beta production is a limiting factor for promoting Th17 immunity.

Risk Factors for Malignancy of Pheochromocytoma and Abdominal Paraganglioma in Children: Clinicopathologic Perspectives

No abstract available.

The Modified Static Spacers Using Antibiotic-Impregnated Cement Rod in Two-Stage Revision for Infected Total Knee Arthroplasty

The two-stage exchange arthroplasty (one- or two-stage) is believed to be the gold standard for the management of infections following total knee arthroplasty. We herein report a novel two-stage exchange arthroplasty technique using an antibiotic-impregnated cement intramedullary nail, which can be easily prepared during surgery using a straight thoracic tube and a Steinmann pin, and may provide additional stability to the knee to maintain normal mechanical axis. In addition, there is less pain between the period of prosthesis removal and subsequent reimplantation. Less soft tissue contracture, less scar adhesion, easy removal of the cement intramedullary nail, and successful infection control are the advantages of this technique.