First results from the Swedish National Pancreatic and Periampullary Cancer Registry.

BACKGROUND: Despite improvements in therapy regimens over the past decades, overall survival rates for pancreatic and periampullary cancer are poor. Specific cancer registries are set up in various nations to regional differences and to enable larger prospective trials. The aim of this study was to describe the Swedish register, including possibilities to improve diagnostic work-ups, treatment, and follow-up by means of the register. METHODS: Since 2010, all patients with pancreatic and periampullary cancer (including also patients who have undergone pancreatic surgery due to premalignant or benign lesions) have been registered in the Swedish National Periampullary and Pancreatic Cancer registry. RESULTS: In total 9887 patients are listed in the registry; 8207 of those have malignant periampullary cancer. Approximately one-third (3282 patients) have had resections performed, including benign/premalignant resections. 30-day and 90-day mortality after pancreatoduodenectomy is 1.5% and 3.5%, respectively. The overall 3-year survival for resected pancreatic ductal adenocarcinoma is 35%. Regional variations decreased over the studied period, but still exist. CONCLUSION: Results from the Swedish National Registry are satisfactory and comparable to international standards. Trends over time show increasing resection rates and some improved results. Better collaboration and openness within pancreatic surgeons is an important side effect.

Soft-tissue-anchored transcutaneous port for long-term percutaneous transhepatic biliary drainage.

PURPOSE: A transcutaneous port (T-port) has been developed allowing easy exchange of a catheter, which was fixed inside the device, using the Seldinger technique. The objective of the study was to test the T-port in patients who had percutaneous transhepatic biliary drainage (PTBD). METHODS: The T-port, made of titanium, was implanted using local anesthesia in 11 patients (mean age 65 years, range 52-85 years) with biliary duct obstruction (7 malignant and 4 benign strictures). The subcutaneous part of the T-port consisted of a flange with several perforations allowing ingrowth of connective tissue. The T-port allowed catheter sizes of 10 and 12 Fr. RESULTS: All wounds healed uneventfully and were followed by a stable period without signs of pronounced inflammation or infection. It was easy to open the port and to exchange the drainage tube. The patient's quality of life was considerably improved even though several patients had problems with repeated bile leakage due to frequent recurrent obstructions of the tubes. The ports were implanted for a mean time of 9 months (range 2-21 months). Histologic examination in four cases showed that the port was well integrated into the soft tissue. Tilting of the T-port in two cases led to perforation of the skin by the subcutaneous part of the ports, which were removed after 7 and 8 months. CONCLUSION: The T-port served as an excellent external access to the biliary ducts. The drainage tubes were well fixed within the ports. The quality of life of the patients was considerably improved. Together with improved aesthetic appearance they found it easier to conduct normal daily activities and personal care. However, the problem of recurrent catheter obstruction remained unsolved.

RFX-B, a MHC class II transcription factor, suppressed in human colorectal adenocarcinomas.

Regulatory factor X (RFX) is an essential MHC class II transcription factor and contains three distinct subunits of which RFX-B is one. Aberrant expression of MHC class II genes is associated with autoimmunity, tumour growth and failure to mount an immune response. RFX-B protein expression in human colorectal adenocarcinomas and in normal adjacent tissue was analysed in this study. Western blot analysis showed a suppression of nuclear RFX-B protein in the tumour tissue. Immunohistochemistry revealed that the RFX-B protein levels in macrophages were generally lower in colorectal cancerous tissue compared to adjacent non-cancerous tissue and that focally and not frequently tumour and normal epithelial cells were stained weakly for RFX-B. As the expression of MHC class II correlates with the intensity of the immune response system these results may support the idea that cancer is associated with immunodeficiency and that low levels of RFX-B in interstitial macrophages could partly explain this thesis.