The expression levels of hypoxia-inducible factor 1alpha(HIF-1α) and HIF-2α in pancreatic cancer(PC) and their association with clinicopathologic characteristics were investigated in order to elucidate their roles in the development of PC. HIF-1α and HIF-2α m RNA levels in 20 patients with PC were detected by quantitative real-time polymerase chain reaction. The expression of HIF-1α and HIF-2α protein in samples from other 90 patients with PC was measured by immunohistochemistry. Correlations between the expression of HIF-1α or HIF-2α and clinicopathologica features and prognosis were analyzed. The expression of both HIF-1α and HIF-2α m RNA was up-regulated in most cancer tissues(P<0.05). HIF-1α staining was weakly positive in most cancer tissues and strongly positive in adjacent pancreas tissues(P<0.05). Clinicopathologic analysis revealed that relatively strong HIF-1α expression in cancer tissues was related to greater invasion(P<0.05), higher tumor pathologic stage(P<0.05), higher American Joint Committee on Cancer(AJCC) stage(P<0.05) and shorter overall survival time(P<0.05). Conversely, HIF-2α staining was strongly positive in most cancer tissues and weakly positive in adjacent pancreas tissues. Clinicopathologic analysis revealed that relatively strong HIF-2α expression in cancer tissues was related to less invasion(P<0.05), lower tumor pathologic stage(P<0.05), lower AJCC stage(P<0.05) and longer overall survival time(P<0.05). Moreover, the HIF-1αhigh/HIF-2αlow group showed a shorter survival time than the HIF-1αlow/HIF-2αhigh group. In conclusion, although HIF-1α and HIF-2α m RNA expression patterns are the same, their protein expression patterns are significantly different and they play different roles in PC. Combined analysis of HIF-1α and HIF-2α expression might be useful to predict the prognosis of patients with PC.
Integrated resection of the pancreatic head is the most difficult step in radical pancreaticoduodenectomy(RPD) in patients with the portal vein(PV) and superior mesenteric vein(SMV) invasion or oppression by the tumor. This study introduced a new idea and skill named the "total arterial devascularization first"(TADF) technique and its applications in RPD. Three arterial blood supplies of pancreatic head were obstructed before dissection of veins. The critical steps included exposure of the anterior surface of the abdominal aorta(AA) by completely transecting neural and connective tissue between superior mesenteric artery(SMA) and pancreatic mesounsinate, and transection of the mesounsinate from the origin of SMA to the root of the celiac trunk. From January 2012 through May 2013, a total of 58 patients with PV/SMV invasion or oppression underwent RPD using this technique.The median operative time was 5.1 h(ranging 4.5–8.1 h). The median intraoperative blood loss was 450mL(ranging 200–900 mL). No intraoperative and postoperative bleeding of pancreatic head region occurred. Among the 58 patients, 21 were subjected to vessel lateral wall angiectomy or angiorrhaphy, and 10 to angiectomy and end-to-end anastomosis. The incidence of postoperative bleeding, postoperative pancreatic fistula and biliary fistula was 5.2%, 6.8%, and 1.7%, respectively. No patients died 3 months after operation. The TADF technique is a new method for intricate RPD and could improve the security of surgery and reduce intraoperative bleeding, which is expected to become standardized surgical approach for RPD.
