Application of three-dimensional visualization technology for laparoscopic resection of cystic carcinoma in the pancreatic body and tail / 南方医科大学学报

<p><b>OBJECTIVE</b>To study the application of three-dimensional visualization technology for laparoscopic resection of cystic carcinoma in the pancreatic body and tail.</p><p><b>METHODS</b>Six cases of cystic carcinoma in the pancreatic body and tail treated between Nov, 2009 and Mar, 2011 were retrospectively analyzed. The original image data of 64-slice spiral CT were collected and using adaptive region growing algorithm, the serial CT images were segmented and automatically extracted to obtain the 3-dimensional reconstruction images with customized image manipulation software. The specific surgical approach (the trocar position) and surgical procedure were planned based on the reconstructed mode.</p><p><b>RESULTS</b>The reconstructed 3-dimensional model clearly displayed cystic carcinoma in the pancreatic body and tail and the adjacent organs, showing distinct relationship between the cystoma and the splenic artery and vein. All the patients successfully underwent laparoscopic resection of the pancreatic body and tail without perioperative death. The spleen was preserved in 5 cases and removed in 1 case due to mucinous cystadenocarcinoma. The overall rate of pancreatic fistulae was 33.3% without incidences of postoperative hemorrhage. The average hospital stay of the patients was 12 days.</p><p><b>CONCLUSION</b>Three-dimensional reconstruction based on pancreatic CT data provides valuable assistance for laparoscopic resection of cystic carcinoma in the pancreatic body and tail.</p>

Identification of microRNA-217 targeted gene ANLN in pancreatic cancer PANC1 cells / 中华胰腺病杂志

Objective To identify the miR-217 targeted gene ANLN by experiment.Methods Bioinformatic algorithms were used to predict the potential targets of miR-217.Then,ANLN binding with miR217 and mutant ANLN (mutANLN) sequence were designed and synthesized,and their amplified fragments were inserted into plasmid psiCHECK-2,and recombinant plasmid psiCHECK-2-ANLN and psiCHECK-2-mutANLN were reconstructed.The two recombinant plasmids were co-transfected into pancreatic cancer cell line PANC1 with miR-217,miR-217 inhibitor,NC,NC inhibitor by liposome,respectively.Dual luciferase reporter system was used to determine the luciferase activity,and Western blot was used to measure the expression of ANLN protein.Results The luciferase activities of psiCHECK-2-ANLN,psiCHECK-2-ANLN +miR-217,psiCHECK-2ANLN + miR-217 inhibitor,psiCHECK-2ANLN + NC,psiCHECK-2-ANLN + NC inhibitor were 2.221 ± 0.188,0.769 ± 0.061,3.764 ± 0.371,2.265 ± 0.201,2.242 ± 0.018,and the difference among these groups was statistically significant (F =77.405,P ＜0.001),but the difference among psiCHECK-2ANLN group,psiCHECK-2-ANLN + NC group and psiCHECK-2-ANLN + NC inhibitor group was not statistically significant.However,luciferase activities of psiCHECK-2-ANLN + miR-217 group were significantly decreased when compared with other 3 groups,and luciferase activity of psiCHECK-2-ANLN +miR-217 inhibitor group were significantly increased when compared with other 4 groups (all P ＜0.001).Luciferase activities of groups transfected with psiCHECK-2-mutANLN was not significantly different (P =0.053).The expression of ANLN protein in PANC1 with psiCHECK-2-ANLN + miR-217 co-transfection was significantly down-regulated when compared with that with psiCHECK-2-ANLN transfection alone.Conclusions ANLN is one of the direct target genes of miR-217 in PANC1 cells.

Expression of miR-216a in pancreatic cancer and its clinical significance / 南方医科大学学报

<p><b>OBJECTIVE</b>To explore the clinical significance of miRNA-216a expression in pancreatic cancer.</p><p><b>METHODS</b>Fourteen patients with pancreatic cancer undergoing pancreaticoduodenectomy and 6 patients with benign pancreas lesions were examined for miR-216a expressions in the tumor or lesion tissues using Agilent Human miRNA Microarray (V12.0). The relationship between miR-216a expressions and the clinicopathological features of the patients was analyzed.</p><p><b>RESULTS</b>The expression of miRNA-216a was significantly lower in pancreatic cancer than in benign pancreas lesions (P=0.000). The expression of miRNA-216a was significantly correlated with the T stage of the tumor (P=0.002), but not with the patients' age, gender, smoking status, tumor stage, lymph node metastases, distant metastasis, tumor differentiation, nerve invasion, vessel invasion or serum CA19-9 level (P>0.05).</p><p><b>CONCLUSIONS</b>The down-regulated expression of miR-216a in pancreatic cancer suggests the involvement of miR-216a in the tumorigenesis and development of pancreatic cancer. miR-216a may potentially serve as a novel tumor marker and also a prognostic factor for pancreatic cancer.</p>

The value of 18-fluorodeoxyglucose positron emission tomography in prognosis of patients with pancreatic cancer / 中华普通外科杂志

Objective To evaluate the value of 18F-FDG PET in predicting the prognosis of pancreatic cancer. Methods Fifty-four cases of pancreatic cancer were divided into two groups. Taking standard uptake value(SUV) at 4 as the cut off point, patients (22 cases) with that not more than four were classified into group A, and those (32 cases) with SUV greater than four were into group B. The prognosis of patients by SUV was analyzed statistically. Results There was a statistically significant difference in survival between the two groups ( P =0. 01 ). The 1-,3-year survival rate was 68. 18% 、34. 91% in group A in those the SUV≤4, and 33.61% 、11.95% in group B( SUV ＞4), respectively. Cox proportional hazard model showed that tumor staging and SUV were the significantly independent prognostic factors in patients with pancreatic cancer. Conclusions 18F-FDG PET is of value in predicting the prognosis of patients with pancreatic cancer.

Surgical treatment for huge pancreatic pseudocysts / 中华普通外科杂志

Objective To explore the clinical characteristics of huge pancreatic pseudocysts and to evaluate the effect of different surgical treatments. Method We retrospectively analyzed the clinical data of 27 patients with huge pancreatic pseudocyst managed from Feb 1991 to Feb 2008. Result Among a total of 129 patients with pancreatic pseudocyst treated during this period of time,27 (20.9% ) patients were diagnosed as with huge pancreatic pseudocyst (diameter > 10cm). As to the etiology, 51.9% of the psudoeyst was caused by acute pancreatitis, 33.3% by pancreatic trauma and previous surgery, 11.1% by chronic pancreatitis. Pseudoeysts in the majority of cases(21/27)had a history less than 6 weeks. Upper GI obstruction complicated 30% cases (8/27). Imaging showed that all huge pancreatic pseudocysts were single. ERCP showed communication with the main pancreatic duct in 9 out of 11 cases. Nine cases underwent catheter drainage, 10 cases underwent cystogastrostomy,2 cases underwent endoscopic drainage of pancreatic pseudocyst via ERCP, 17 cases underwent Roux-en-Y cystojejunostomy including 11 cases in which other previous procedures failed. All 27 cases were finally cured. Conclusions Huge pancreatic pseudocyst might have unique clinical characteristics. Anatomical changes of main pancreatic duct were found in most cases under ERCP. The proper time and indication for surgical intervention might be different from minor pancreatic pseudocyst.

The diagnosis and treatment of cystic pancreatic tumors / 中华普通外科杂志

Objective To explore the diagnosis and treatment of cystic pancreatic tumors. Methods The clinical data of 21 cases with cystic pancreatic tumors were retrospectively analyzed. Results This group enrolled 21 cases including serous cystic neoplasm of the pancreas (SCN, 11 cases), mucinous cystic neoplasm of the pancreas (MCN, 6 cases), intraductal papillary mucinous neoplasms (IPMN,2 cases), solid posudopapillary tumor of the pancreas (SPTP,2 cases). Seven cases had certain symptoms or typical signs, while others were asymptomatic and tumors were found by regular physical examinations. All of the cases were diagnosed by CT scans, and the value of serum tumor markers was within normal range. Twenty patients underwent pancreatic tumor resections and there was no perioperative death. Pancreaticoduodenectomy was performed in 8 cases, and distal pancreatectomy was performed in 6 cases including 1 patient undergoing laparoscopic distal pancreatectomy. Middle segment resection was performed in 4 cases, and tumor enucleation was performed in 2 cases. These 20 patients were followed up for 11 to 96 months, and there was no tumor recurrence or metastasis. One patient with mucinous cystic carcinoma underwent palliative operation and survived 4 months after surgery. Conclusions Preoperative imaging was not able to confirm the definite tumor pathological category. Laparotomy should be performed in a patient with cystic pancreatic tumor. The selection of surgical approach should be individualized, and the laparoscopic operation is an alternative.

Surgical management and prognostic factors of hilar cholangiocarcinoma: experience with 115 cases in China.

BACKGROUND: Hilar cholangiocarcinoma (or Klatskin tumor) is a rare condition, accounting for less than 1% of all cancers. This study was designed to assess the surgical and postsurgical management of affected patients, including the postoperative chemotherapy, and an analysis to determine prognostic factors for postoperative morbidity and mortality. METHODS: A retrospective review of 115 consecutive cases treated with resection between January 1990 and January 2004 at a single university medical center in southern China was carried out. Clinicopathological data were analyzed and univariate and multivariate analyses against outcome was employed to determine the prognostic significance of a variety of factors including excision margin characteristics, status of metastases, tumor type, histological differentiation, lymph node characteristics, and postoperative therapy. RESULTS: Median survival time of patients treated with resection and anastomosis with postoperative chemotherapy was 41 months compared with 36 months for patients who did not receive chemotherapy postoperatively. Factors correlating with shorter survival were positive excision margin, metastasis, adenoacanthoma-type tumor, poor or unknown histological differentiation, and positive lymph nodes. In addition, postoperative chemotherapy improved survival. Patients treated with chemotherapy postoperatively had a survival of 43.15 +/- 21.02 months, which was significantly longer than the survival of patients who received no postoperatively chemotherapy (36.97 +/- 15.99 months; P < 0.05). CONCLUSION: Resection with anastomosis and postoperative chemotherapy results in longer survival time compared with no chemotherapy postoperatively. Positive excision margins, metastases, adenoacanthoma-type tumor, poor or unknown histological differentiation, and positive lymph nodes correlate with shorter survival.

CLIP for the evaluation of liver cancer patients after hepatectomy / 中华普通外科杂志

Objective To evaluate the prognostic value of the Cancer of the Liver Italian Program (CLIP) score system in a study of hepatocellular carcinoma (HCC) patients who underwent radical resection. Methods Clinical pathological and follow-up data of 157 HCC patients, who underwent radical resection in our hospital from 1996 to 2004, were reveiwed retrospectively. Patients were divided into four groups according to CLIP scores. Disease-free survival rate was compared between groups, and within groups, the disease-free survival rate of patients receiving anatomic liver resection was compared with that of irregular liver resection. Results The overall 1,3,5-year disease-free survival rate was 63.6%、45.2%、35.7%,and there were significant differences among the four groups. For the zero score group, the recurrence rate of patients undergoing anatomic liver resection was lower than that of irregular liver resection (P = 0.003). Conclusions CLIP score system can be used to evaluate the recurrence rate of HCC patients receiving hepatectomy. CLIP score system can be used as a guidance for liver resection.

Chemotaxis on Umbilical Vein Endothelial Cells of SMMC7721 Hepatic Carcinoma Cells with Angiopoietin Gene Expression / 中国普外基础与临床杂志

Objective To observe the chemotactic role on umbilical vein endothelial cells of SMMC7721 hepatic(carcinoma) cells with angiopoietin gene expression in order to study the effects of angiopoietin on hepatocellular carcinoma angiogenesis.Methods Angiopoietin gene 1(Ang-1) fragment and Ang-2 fragment was transfected into SMMC7721 liver carcinoma cell line by Lipofectamine induced gene transfection technique.The chemotactic role of SMMC7721 liver carcinoma cell line on umbilical vein endothelial cells was observed through microchemotaxis analysis.Results The chemotactic response of the Umbilical vein endothelial cells was obviously improved with Ang-1 expression (P0.05).Conclusion Ang-1 is a chemotactic factor for vascular endothelial cell and a promoter for angiogenesis,whereas Ang2 does not show obvious chemotactic role.

The expression of angiopoietin mRNA in hepatocellular carcinoma tissue and its relation with tumor angiogenesis and metastasis / 中国普通外科杂志

ObjectiveTo study the expression of angiopoietin in hepatocellular carcinoma tissue, and its relation with tumor angiogenesis and clinical significance. Methods Using immunohistochemistry and in situ hybridization, we observed the expression of angiopoietin 1(Ang 1) and angiopoietin 2(Ang 2) mRNA in 21 HCC patients and 5 normal liver tissues. The correlation between angiopoietin expression and several pathological markers was analyzed with computer statistical tools. Results Ang 1 equally expressed in tumor tissue, the adjacent noncarcinomatous tissue and normal liver. Ang 2 was highly expressed in tumor tissue, especially in tumor margin. The difference was significant between the group with metastasis and that without ( P

Hepatic segmentectomy under ultrasound guided segmental staining and intraoperative chemotherapy for the treatment of liver cancer / 中国普通外科杂志

Objective[WT5”BZ] To evaluate the effect of hepatectomy under direction of ultrasound guided segmental dye staining combined with intraoperative chemotherapy following segmental portal vein branch occlusion by a balloon catheter.[WT5”HZ]Methods[WT5”BZ] 12 cases of hepatic carcinoma underwent this novel therapy(group A).Results were compared with that of 21 cases treated by hepatectomy (group B).AFP,CT and MRI were used regularly during the follow up period of 24 months to evaluate the outcome.[WT5”HZ]Results[WT5”BZ] The average disease free survival time is 21 months in group A, and 11 months in group B. Recurrent carcinoma was found in 2 cases during the fellow up period in group A, and in 13 cases in group B.[WT5”HZ]Conclusions[WT5”BZ] The preliminary result showes that our new approach to the treatment of hepatic carcinoma is more effective than traditional hepatectomy. [WT5”HZ]

Endovascular intervention for the treatment of Klippel-Trenaunay-Weber syndrome / 中国普通外科杂志

Objective To explore the feasibility of endovascular intervention for the treatment of Klippel-Trenaunay-Weber syndrome ( KTWS ). Methods Fourteen KTWS patients underwent arteriography followed by endovascular intervention with bleomycin( A5) + extraliquid lipiodol, PVA, NBCA, steel coil, respectively. Results Both haemangioma ( nevus) lesion and varicosities of the superficial vein in the involved limb improved in all 14 patients significantly. Main complications were pain, swelling of the embolized area. Severe swelling of the whole limb occurred in 3 cases, which subsided spontaneously within 7 - 9 days. At one month follow-up limb girth at the middle part of the thigh and at the point of 10 cm below the knee reduced by 2. 1 ?0. 3 cm and 2.0 ?0.2 cm respectively. Preoperative lymphatic edema of the limb in 3 cases (3/4) and the regurgitation of the superficial femoral vein in 3 cases also improved significantly. Conclusion Endovascular intervention of KTWS leads to symptomatic improvement of patients with KTWS.

Controlled study on different hepatic blood flow occlusion in hepatectomy / 中国普通外科杂志

Objective To evaluate the indications of different hepatic blood flow occlusion in hepatectomy of cancer patients. Methods One hundred and fifty-six patients admitted between 1991-2001 underwent hepatectomy with hepatic blood flow occlusion in different ways, among them 48 cases underwent hepatic segmentectomy with segmental portal vein occlusion by a balloon catheter, 71 cases underwent hepatectomy with porta hepatis occlusion by Pringle method, 37 cases treated by hemihepatectomy or partial hepatectomy with hemihepatic occlusion. Results Intraoperative blood loss in patients using balloon catheter was smaller and postoperative liver function recovered faster compared with other ways of blood flow occlusion. Conclusion The preliminary result shows that hepatic segmentectomy with segmental portal vein occlusion by a balloon catheter is safe and useful technique for hepatectomy.