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.
目的探讨增强miR-146b-3p表达对胰腺癌细胞增殖和凋亡的影响。方法 Real time PCR检测miR-146b-3p在6种人胰腺癌细胞系(MIA PaCa-2、BxPC-3、AsPC-1、PANC-1、SW1990、PC-3)和手术切除的12对胰腺癌/癌旁组织中的表达。将Pre-miR-hsa-miR-146b-3p Precursor转染MIA PaCa-2细胞,Real time PCR检测转染后miR-146b-3p的表达变化,四甲基偶氮唑蓝(MTT)法检测细胞增殖能力,流式细胞仪检测细胞凋亡率,免疫印迹法(Western blot)检测凋亡相关蛋白Bcl-2、Bax、Caspase-3、Caspase-8的表达变化。结果与正常胰腺组织相比,miR-146b-3p在6种胰腺癌细胞系中均呈低表达,以MIA PaCa-2细胞最为明显;12对胰腺组织中,癌组织miR-146b-3p表达水平均低于癌旁组织。同阴性对照组比较,转染前体组的MIA PaCa-2细胞,miR-146b-3p表达增强383.25倍,细胞增殖能力下降,细胞凋亡率增加,蛋白Bcl-2表达降低(50.0%),Bax表达升高(4.29倍)。结论 miR-146b-3p在胰腺癌细胞系和癌组织中低表达;上调胰腺癌细胞MIA PaCa-2中miR-146b-3p的表达,能够抑制增殖和诱导细胞凋亡,其机制可能与下调Bcl-2表达,上调Bax的表达有关。
BACKGROUND: Myeloid-derived suppressor cells(MDSCs) are heterogeneous cell types that suppress T-cell responses in cancer patients and animal models, some MDSC subpopulations are increased in patients with pancreatic cancer. The present study was to investigate a specific subset of MDSCs in patients with pancreatic cancer and the mechanism of MDSCs increase in these patients.METHODS: Myeloid cells from whole blood were collected from 37 patients with pancreatic cancer, 17 with cholangiocarcinoma, and 47 healthy controls. Four pancreatic cancer cell lines were cocultured with normal peripheral blood mononuclear cells(PBMCs) to test the effect of tumor cells on the conversion of PBMCs to MDSCs. Levels of granulocyte-macrophage colony-stimulating factor(GM-CSF) and arginase activity in the plasma of cancer patients were analyzed by enzyme-linked immunosorbent assay. RESULTS: CD14+/CD11b+/HLA-DR- MDSCs were increased in patients with pancreatic or bile duct cancer compared with those in healthy controls, and this increase was correlated with clinical cancer stage. Pancreatic cancer cell lines induced PBMCs to MDSCs in a dose-dependent manner. GM-CSF and arginase activity levels were significantly increased in the serum of patients with pancreatic cancer. CONCLUSIONS: MDSCs were tumor related: tumor cells induced PBMCs to MDSCs in a dose-dependent manner and circulating CD14+/CD11b+/HLA-DR- MDSCs in pancreatic cancer patients were positively correlated with tumor burden. MDSCs might be useful markers for pancreatic cancer detection and progression.
BACKGROUND: The treatment of borderline resectable pancreatic head cancer(BRPHC) is still controversial and challenging. The artery-first approaches are described to be the important options for the early determination. Whether these approaches can achieve an increase R0 rate, better bleeding control and increasing long-term survival for BRPHC are still controversial. We compared a previously reported technique, a modified artery-first approach(MAFA), with conventional techniques for the surgical treatment of BRPHC.METHODS: A total of 117 patients with BRPHC undergone pancreaticoduodenectomy(PD) from January 2013 to June 2015 were included. They were divided into an MAFA group(n=78) and a conventional-technique group(n=39). Background characteristics, operative data and complications were compared between the two groups.RESULTS: Mean operation time was significantly shorter in the MAFA group than that in the conventional-technique group(313 vs 384 min; P=0.014); mean volume of intraoperative blood loss was significantly lower in the MAFA group than that in the conventional-technique group(534 vs 756 m L; P=0.043); and mean rate of venous resection was significantly higher in the conventional-technique group than that in the MAFA group(61.5% vs 35.9%; P=0.014). Pathologic data, early mortality and morbidity were not different significantly between the two groups.CONCLUSIONS: MAFA is safe, simple, less time-consuming, less intraoperative blood loss and less venous resection, and therefore, may become a standard surgical approach to PD for BRPHC with the superior mesenteric vein-portal vein involvement but without superior mesenteric artery invasion.
Min WangHang ZhangFeng ZhuFeng PengXin WangMing ShenRen-Yi Qin
