[Significance of the mitochondrial D-loop alterations in hyperplastic pancreatic ductal cells in the vicinity of pancreatic cancer coexisting with chronic pancreatitis].

OBJECTIVE: To explore the significance of mitochondrial D-loop alterations in hyperplastic pancreatic ductal cells in vicinity of pancreatic cancer coexisting with chronic pancreatitis. METHODS: Malignant lesions and foci of pancreatic ductal intraepithelial neoplasia of the pancreas and paired normal gastric mucosal epithelial cells from the same patients, respectively, were assessed by polymerase chain reaction. Somatic point mutations and sequence variants of D-loop were searched by direct sequencing of the mitochondrial genome. D-loops were sequenced by BLAST to identify their mutations. RESULTS: Eleven of 12 pancreatic cancers displayed at least one D-loop variants and one tumor presented heteroplasmy. There was an apparent increase in incidence of D-loop mutational rate from PanIN1 (33.3%) to PanIN3 (75%, P < 0.01). CONCLUSION: Mitochondrial D-loop alterations in the pancreas occur in the earliest premalignant lesions and exhibite an increasing occurence that parallels histological severity. These alterations may serve as a valuable marker to follow the histopathological progression of the lesions. Large number of further studies are required to clarify clinical implications of the mitochondrial DNA alterations.

[To inquiry into clinical-pathological factors influencing cytological accuracy of pancreatic head lesions].

OBJECTIVE: To inquiry into clinical-pathological factors influencing cytological accuracy of pancreatic head lesions. METHODS: Cytology was retrospectively evaluated in 94 inpatients with a mass in head of pancreas existing with chronic pancreatitis in the past decade, the results of cytology were compared with clinical pathology or clinical follow-up to estimate the value and accuracy of cytology in detecting pancreatic cancer. Pancreatic clinical-pathology includes size of mass and component of mass which was composed of cancerous mode of development including shape of conglomeration, nest and pervasion, and pancreatic ductal epithelium inside the vicinity of 1 cm around the mass. Pancreatic ductal epithelium were divided into PanIN1, PanIN2 and PanIN3 three types according to classified criterion of pancreatic intraepithelial neoplasia (PanIN). RESULT: Forty-six patients were pathologically diagnosed as pancreatic cancer and five patients as chronic pancreatitis, accordingly, 29 malignant, 5 suspicious, 10 atypical hyperplasia among of them 5 malignant, 3 hyperplastic ductal epithelium, 1 nondiagnostic results due to interfered by blood and 3 insufficient specimens. 43 patients were clinically diagnosed as chronic pancreatitis. Cytologic evaluation of pancreatic cancer has an 84.2% accuracy less than or equal to 2.5 cm and 71.9% larger than 2.5 cm. Shape of conglomeration, and nest have more accurate than pervasion in cytological diagnosis. CONCLUSIONS: Cancerous mode of development is a vital factor influencing accuracy of cytology, cytological estimation of atypical hyperplasia and is still waiting for further investigation.

Extended radical operation of pancreatic head cancer: appraisal of its clinical significance.

AIM: To evaluate the significance of extended radical operation and its indications. METHODS: Between January 1995 and December 1998, 56 inpatients with pancreatic head cancer received operation. Among them 35 patients (group 1) experienced the Whipple operation, and 21 patients (group 2) received the extended radical operation. The 1-, 2-, 3-year cumulative survival rates were used to evaluate the efficacy of the two operative procedures. Clinical stage (CS) was assessed retrospectively with the help of CT. The indications for extended radical operation were discussed. RESULTS: There was no difference in hospital mortality and morbidity rates. Whereas the 1-, 2-, 3-year cumulative survival rates were 84.8%, 62.8%, 39.9% in the extended radical operation group, and were 70.8%, 47.6%, 17.2% in the Whipple operation group, there was a significant difference between the two groups (P<0.001, P<0.001, P<0.001, respectively). Most of the deaths within 3 years after operation were due to recurrence in the two groups. However, the 1-, 2-, 3-year cumulative rates of death due to local recurrence were decreased from 37.4% in patients that received the Whipple procedure to 23.8% in those who received by extended radical operation. Patients who survived for more than 3 years were only noted in those with CS1 in the Whipple procedure group and were founded in cases with CS1, CS2 and part of CS3 in the extended radical operation group. CONCLUSION: The extended radical operation appears to benefit patients with pancreatic head carcinoma which was indicated in CS1, CS2 and part of CS3 without severe invasion.

Values of mutations of K-ras oncogene at codon 12 in detection of pancreatic cancer: 15-year experience.

AIM: To summarize progress in the study of K-ras gene studies in pancreatic cancer and its potential clinical significance in screening test for early detection of pancreatic cancer, and to differentiate pancreatic cancer from chronic pancreatitis in recent decade. METHODS: Literature search (MEDLINE 1986-2003) was performed using the key words K-ras gene, pancreatic cancer, chronic pancreatitis, and diagnosis. Two kind of opposite points of view on the significance of K-ras gene in detection early pancreatic cancer and differentiation pancreatic cancer from chronic pancreatitis were investigated. The presence of a K-ras gene mutation at codon 12 has been seen in 75-100% of pancreatic cancers, and is not rare in patients with chronic pancreatitis, and represents an increased risk of developing pancreatic cancer. However, the significance of the detection of this mutation in specimens obtained by needle aspiration from pure pancreatic juice and from stools for its utilization for the detection of early pancreatic cancer, and differentiation pancreatic cancer from chronic pancreatitis remains controversial. CONCLUSION: The value of K-ras gene mutation for the detection of early pancreatic cancer and differentiation pancreatic cancer from chronic pancreatitis remains uncertain in clinical practice. Nevertheless, K-ras mutation screening may increase the sensitivity of FNA and ERP cytology and may be useful in identifying pancreatitis patients at high risk for developing cancer, and as a adjunct with cytology to differentiate pancreatic cancer from chronic pancreatitis.

Risk factors influencing recurrence following resection of pancreatic head cancer.

AIM: Whether operative procedure is a risk factor influencing recurrence following resection of carcinoma in the head of pancreas or not remains controversies. In this text we compared the recurrence rate of two operative procedure: the Whipple procedure and extended radical operation, and inquired into the factors influencing recurrence after radical resection. METHODS: From January 1995 to December 1998, 35 cases of carcinoma of pancreas underwent the Whipple operadure, 21 patients received the Extended radical operation. All patients were followed up for more than 3 years. Prognostic factors included operative procedure, size of tumor, lymph node, interstitial invasion. RESULTS: Deaths duo to recurrence within 3 years after operation were studied. The death rate was 51.4% in the Whipple procedure and 42.9% in the Extended radical operative procedure. There was a significant difference between the two groups. Recurrence occurred in 75% patients with tumor large than 4 cm, in 87.5% patients with lymph node involvement, and in 50% patients with the presence of interstitial invasion. CONCLUSION: Tumor exceeding 4 cm, lymph node involvement, and presence of interstitial invasion are high risk factors of recurrence after Whipple's procedure and extended radical operation.

p53 protein expression and CA19.9 values in differential cytological diagnosis of pancreatic cancer complicated with chronic pancreatitis and chronic pancreatitis.

AIM: To evaluate p53 protein overexpression and to measure serum CA19.9 concentrations in cytological diagnosis of patients with suspected pancreatic cancer. METHODS: 24 patients with suspected pancreatic cancer due to chronic pancreatitis, had a pancreatic mass determined by imaging methods. The serum CA19.9 concentration was measured by solid phase radioimmunoassay. On laparotomy, puncture biopsy was performed, and specimens were divided into two parts for cytological diagnosis and detection of p53 protein. RESULTS: Cytology offered a sensitivity of 0.63, a specificity of 1.00, and an accuracy of 0.63. p53 protein analysis offered a sensitivity of 0.44, a specificity of 1.00, and an accuracy of 0.73. CA19.9 offered a sensitivity of 0.44, a specificity of 0.80, and an accuracy of 0.67. The combined cytology and p53 protein analysis showed a sensitivity of 0.78, a specificity of 1.00, and an accuracy of 0.92. Cytology and CA19.9 showed a sensitivity of 0.67, a specificity of 0.80, an accuracy of 0.67. combined cytology and p53 protein analysis and CA19.9 showed a sensitivity of 0.78, a specificity of 0.80,and an accuracy of 0.79. CONCLUSION: Superior to any single test, the combined approach is helpful for the differential diagnosis of pancreatic cancer complicated with chronic pancreatitis. The combined cytology and p53 protein analysis offers the best diagnostic efficacy.

Significance of perigastric lymph node involvement in periampullary malignant tumor.

AIM: To determine the perigastric lymph node involvement in periampullar tumors, in an attempt to optimize the surgical treatment of pylorus- preserving pancreatoduodenectomy. METHODS: We retrospectively investigated the frequence of lymph nodes involvement in perigastric regions. Distribution and number of involved lymph nodes were examined from 112 patients with carcinoma of pancreas, 59 patients with distal bile duct carcinoma, and 41 patients with carcinoma of the papilla of Vater. RESULTS: The frequency of lymphatic spread of carcinoma in pancreas; distal bile duct and papilla of Vater was 18.7%, 1.9%, 2.5% respectively. With regard to the mode of lymphatic spread in perigastric region, Infrapyloric nodes of carcinoma of the head of pancreas predominated over others,in carcinomas of the distal bile duct and the papilla of Vater, the left gastric artery, and the greater curvature lymph nodes was the only sole sites, respectively. CONCLUSION: Understanding perigastric lymphatic involvement in periampullary tumors may be helpful for choosing the appropriate surgical approaches to pancreatoduodenectomy with preservation of pylorus.

[Significance of extended radical resection for cancer of pancreatic head].

OBJECTIVE: To evaluate the significance of extended radical resection in the treatment of pancreatic head cancer and its indication. METHODS: Between Jan. 1995 and Dec. 1998, 56 patients with pancreatic head cancer were retrospectively reviewed, among whom 35 were treated by the Whipple operation and 21 received the extended radical resection during the same interval. RESULTS: There was no significant difference between the mortality and morbidity rate of complication, though with more patients having higher clinical stages in the extended radical resection group. The 1-, 2- and 3-year survival rates were 84.8%, 62.8%, 39.9% in the extended radical resection group and 70.8%, 47.6%, 17.2% in the Whipple operation group with significant difference between the two groups. The total mortality rate was 51.4% in Whipple group and 42.9% in extended radical resection group with significant difference between the two. The 3-year cumulative rate of death from local recurrence decreased from 37.4% in the Whipple group to 23.8% in the extended radical operation group. Patients who survived for more than 3 years were only those in clinical stage (SC)1 in the Whipple group whereas they were found both in patients who had had CS1, CS2 lesions and also in some who had CS3 lesions in the extended radical resection group. CONCLUSION: The extended radical operation does benefit patients with pancreatic head carcinoma in CS1, CS2 and in a part of CS3 without too extensive exrtra-pancreatic invasion.

Surgical management of transected injury to the pancreatic neck.

OBJECTIVE: To present a batch of data of transected pancreatic neck injuries and to sum up the experience in surgical interventions for the injuries. METHODS: We analysed 13 patients with a transected injury to the pancreatic neck from Jan. 1995 to Dec. 2000. External drainage was performed in all patients. Pancreatoduodenectomy was conducted in 2 patients with a transected injury to the pancreatic neck associated with duodenal ruptures, and TPN was administered immediately after operation. Proximal closure of the transected margin and distal pancreaticojejunostomy was performed in 4 patients. Proximal closure of the transected margin and distal pancreaticojejunostomy plus splenectomy was performed in 7 patients associated with contusion of pancreatic body or tail plus spleen rupture. RESULTS: 12 patients healed and one patient died of anesthetic accident during the course of restoration of the dislocation of his right hip joint. Complications occurred in 7 patients. CONCLUSIONS: The operation should be performed according to the degree of the injuries and associated duodenal injuries. Routine drainage and nutrient support should be recommended.

[Inquire into factors influencing recurrence following resection of carcinoma of the head of pancreas].

OBJECTIVE: Inquire into factors influencing recurrence following resection of carcinoma of the head of pancreas to raise survival rate of pancreatic cancer. METHODS: We performed a retrospective review of 56 pancreatic resections with carcinoma of the head of pancreas operated from January 1995 to December 1998. 35 patients tolerated the Whipple operadure in comparison with 21 patients received the extended radical operation contemporaneously. All patients were followed up more than 3 years to find out factors influencing recurrence following resection of carcinoma of the head of pancreas. RESULTS: Deaths within 3-years after operation were due to recurrence, the cumulative rate of death from recurrence 51.4% in the Whipple procedure and 42.9% in the Extended radical operative procedure, significant difference in two groups. CONCLUSION: Tumour size exceed 4 cm with severe retropancreatic invasion, lymph node involvement surpass the second group are at high risk for recurrence.