Is arterial infiltration still a criterion for unresectability in pancreatic adenocarcinoma?

As surgical resection remains the only hope for cure in pancreatic cancer (PC), more aggressive surgical approaches have been advocated to increase resection rates. Venous resection demonstrated to be a feasible technique in experienced centers, increasing survival. In contrast, arterial resection is still an issue of debate, continuing to be considered a general contraindication to resection. In the last years there have been significant advances in surgical techniques and postoperative management which have dramatically reduced mortality and morbidity of major pancreatic resections. Furthermore, advances in multimodal neo-adjuvant and adjuvant treatments, as well as the better understanding of tumor biology and new diagnostic options have increased overall survival. In this article we highlight some of the important points that a modern pancreatic surgeon should take into account in the management of PC with arterial involvement in light of the recent advances.

Hen lysozyme fibrillogenesis, molten globule intermediate and effect of copper salts.

The amyloid fibres have been related to many diseases. The molten globule intermediate has been proposed to form part of the folding pathway of many proteins. In the present study, we investigated the mechanism of amyloid-fibres formation of hen egg-white lysozyme (HEWL) incubated in a potassium phosphate buffer, pH 11.8, 100 mM, at 37 °C for 30 h, and evaluated the influence of Cu(II) present in two salts (CuSO4 and CuCl2) during fibrillogenesis. Co-incubation and post-incubation of lysozyme with copper salts reduced the fluorescence signal of thioflavin T with an increment in the intrinsic fluorescence of the protein. The ANS fluorescence test showed that incubation of HEWL for 6 h generated a molten globule intermediate state that formed amyloid fibres when incubation was carried out for a 30-h timespan. Dynamic light scattering showed a heterogeneous population of states in samples incubated in the absence or the presence of salts during the fibrillation process. The existence of a reducing potential was verified during the formation of HEWL amyloid fibres with the bathocuproine disulphonate test. Transmission electron microscopy confirmed the presence and absence of fibres in solutions incubated with and without Cu(II). This work demonstrated that lysozyme formed amyloid fibres at 37 °C and copper inhibited its formation.Communicated by Ramaswamy H. Sarma.

Robotic versus laparoscopic rectal resection: is there any real difference? A comparative single center study.

INTRODUCTION: Robotic surgery has gained worldwide acceptance in the past decade, and several studies have shown that this technique is safe and feasible. The aim of this study is to compare main outcomes of laparoscopic and robotic rectal resection. METHODS: In total, 143 consecutive patients treated for rectal cancer in our department with laparoscopic or robotic-assisted surgery from October 2010 to July 2013 were retrospectively analyzed. RESULTS: A total of 87 patients underwent laparoscopic rectal resection, and 56 patients were treated using a robotic approach. The conversion rate was 11.5% in the laparoscopic group and 3.5% in the robotics group (P = 0.09). The low rectal cancer conversion rate was significantly lower in the robotic group (1.8%) than in the laparoscopy group (9.2%) (P = 0.04). Mean operation time was 252 min in the laparoscopic group and 309 min in the robotic group (P = 0.023). CONCLUSIONS: The robotic approach shows a lower conversion rate in low rectal cancer but with a longer operative time compared with the laparoscopic technique.

¿Sigue representando la infiltración arterial un criterio de irresecabilidad en el carcinoma de páncreas? / Is arterial infiltration still a criterion for unresectability in pancreatic adenocarcinoma?

La resección quirúrgica representa en la actualidad la única posibilidad terapéutica para pacientes afectos de carcinoma de páncreas (CP). Procedimientos quirúrgicos agresivos han sido descritos en un intento de incrementar la resecabilidad. La resección venosa representa en la actualidad una técnica quirúrgica aceptada en centros con importante experiencia en cirugía pancreática. Por el contrario, la resección arterial en enfermos afectos de CP sigue siendo una técnica muy controvertida. La infiltración arterial en estos pacientes suele ser considerada un criterio de irresecabilidad. En los últimos años, importantes avances en la técnica quirúrgica y en el tratamiento postoperatorio de estos pacientes han permitido reducir la morbimortalidad de las resecciones pancreáticas. Por otra parte, notables mejoras en el tratamiento neoadyuvante y adyuvante así como un mayor conocimiento en la biología del tumor además de nuevas opciones diagnósticas han permitido mejorar la supervivencia. En el presente artículo, destacamos importantes puntos que un cirujano moderno debe de considerar para tratar a afectados de CP con infiltración arterial

As surgical resection remains the only hope for cure in pancreatic cancer (PC), more aggressive surgical approaches have been advocated to increase resection rates. Venous resection demonstrated to be a feasible technique in experienced centres, increasing survival. In contrast, arterial resection is still an issue of debate, continuing to be considered a general contraindication to resection. In the past few years there have been significant advances in surgical techniques and postoperative management which have dramatically reduced mortality and morbidity of major pancreatic resections. Furthermore, advances in multimodal neo-adjuvant and adjuvant treatments, as well as the better understanding of tumour biology and new diagnostic options have increased overall survival. In this article we highlight some of the important points that a modern pancreatic surgeon should take into account in the management of PC with arterial involvement in light of the recent advances