【Abstract】Objective To explore the clinical significance of β-catenin expression in pancreatic carcinoma.Methods The immunohistochemical staining was performed to detect the expression of β-catenin in the specimens of 46 patients with pancreatic carcinoma and the results were statistically analyzed.Results The abnormal expression rate on the membrane was 54.3%, the poorer the differentiation, the higher the abnormal expression rate. The levels of the cases in whom metastasis occurred were much higher than those without metastasis. The abnormal cytoplasm expression rate was 21.7%,which had not significant correlation with the clinical indexes, such as staging, tumor size, grading and metastasis. In 23 patients who accepted intervention chemotherapy before operation, the cytoplasm expression rate in those with tumor mass smaller was 0, which was evidently lower than that of those without tumor mass change (33.3%). Moreover, the abnormal membrane and cytoplasm expression rates had remarkable concordance (63.0%).Conclusion The abnormal membrane expression of β-catenin may accelerate metastasis, and the abnormal expression of β-catenin in cytoplasm may result in cell proliferation.
Compared with open surgery, laparoscopic radical resection of the body and tail pancreatic cancer is gradually being accepted due to its shorter hospital stay, reduced intraoperative blood loss, and comparable perioperative and oncological prognosis. The proposal of radical antegrade modular pancreatosplenectomy (RAMPS) has established a standardized approach for resection scope and lymph node dissection in pancreatic body and tail cancers. Studies have confirmed that RAMPS surgery can achieve a higher N1 station lymph node dissection, R0 margin ratio, and satisfactory patient survival rates. Furthermore, RAMPS has demonstrated oncological advantages in terms of postoperative local control. Laparoscopic RAMPS (LRAMPS) has been shown to be technically feasible and to yield long-term oncologic outcomes comparable to open RAMPS. An increasing number of studies have evaluated LRAMPS as the standard surgical modality for resectable body and tail pancreatic cancers. This article discusses the main points and challenges of LRAMPS surgery, and presents some personal experiences.
Objective To investigate the cause, treatment, and prognosis of the postpancreaticoduodenectomy hemorrhage (PPH) . Method A total of 779 patients who underwent pancreaticoduodenectomy at Fudan University Shanghai Cancer Center between January 2015 and December 2016 were enrolled, and the data of them were retrospectively analyzed. Results Sixteen patients (PPH group) suffered from PPH and 763 patients didn’t suffered from PPH (non-PPH group) of 779 patients. There was no significant difference in the age, gender, type of disease, operative time, blood loss, and ratio of blood transfusion between the 2 groups (P>0.05), but the incidences of pancreatic fistula and delayed gastric emptying, postoperative drainage time, hospital stay, and mortality were all higher or longer in PPH group compared with non-PPH group (P<0.001). Of the 16 PPH patients, early haemorrhage occurred in 3 patients (including 2 patients with gastrointestinal haemorrhage and 1 patient with intra-abdominal haemorrhage) and delayed haemorrhage occurred in 13 patients (including 6 patients with gastrointestinal haemorrhage and 7 patients with intra-abdominal haemorrhage). All the 3 patients with early haemorrhage were cured by surgery. Of the 13 patients with delayed haemorrhage, 5 patients were cured by radiological intervention, 2 patients were cured by endoscopic hemostasis, and 3 patients were cured by conservative treatment, but 3 patients with sentinel bleeding died after interventional embolization+surgery. Conclusions The mortality of PPH is high. Surgery is optimal to early haemorrhage and radiological intervention is optimal to delayed haemorrhage, including embolization or covered stent implantation. The sentinel bleeding should be given great attention.
The detection rate of benign and borderline/low-grade malignant tumors of pancreas has increased year by year. Most of the patients are middle-aged and young people, who have thirst for high quality of life in long-term. Pancreatic-duct-preserving partial pancreatectomy can meet the needs of reducing surgical trauma, preserving normal pancreatic function and improving patients’ quality of life. However, pancreatic-duct-preserving partial pancreatectomy often needs to face the problem of pancreatic duct defect. Repair of pancreatic duct needs to be applied according to different types of pancreatic duct defect. At the same time, the prevention and treatment of pancreatic fistula also require more patience, courage and creativity of pancreatic surgeons. Pancreatic-duct-preserving partial pancreatectomy can solve the current clinical problems. It is safe and feasible with carefully evaluate indications, characters of patients and the personal ability of surgeons.