Usefulness of endoscopic ultrasound-guided fine needle aspiration in the diagnosis of hepatic,gallbladder and biliary tract Lesions

Endoscopic ultrasound(EUS)-guided fine needle aspira-tion(FNA) of the liver is a safe procedure in the diag-nosis and staging of hepatobiliary malignancies with a minimal major complication rate. EUS-FNA is useful for liver lesions poorly accessible to other imaging modali-ties of the liver. EUS-guided FNA of biliary neoplasia and malignant biliary stricture is superior to the con-ventional endoscopic brushing and biopsy.     

胰腺癌:经腹腔镜肿瘤分期

Objective： Accurate staging of patients with pancreatic cancer is crucial to clarify whether meaningful resection is indeed possible. Staging laparoscopy has been suggested as a tool for staging which may spare up to two-fifth of these patients from undergoing nontherapeutic laparotomy. A controversy exists, however, as to whether the procedure should be used routinely or selectively in these patients with no evidence of metastasis on noninvasive staging. This review aims to evaluate the available literature critically, identify its limitations and address the existing controversies. Methods： The current available English literature was reviewed on this topic. Results： A direct and conclusive comparison of the controversial literature is difficult because of inconsistent use of high-quality CT scans, different study designs and dissimilarity of judgment for non-resectability among patients staged by laparoscopy. However, recent studies reveal that not more than 14% of the patients benefit from diagnostic laparoscopy when a dual-contrast thin cut and 3-D digital reformatting CT scan has been performed previously. Conclusion： We conclude that routine use of diagnostic laparoscopy does not appear warranted in all patients with pancreatic cancer, especially for patients with early-staged pancreatic cancer or non-pancreatic periampullary cancers, because diagnostic laparoscopy is costly and ultrasonography is largely operator-dependent. Rather, selective use is appropriate, especially in patients with a large primary tumor, a tumor in the body or tail of the pancreas, equivocal findings of metastasis on CT, the presence of ascites, severe weight loss, hypoalbuminemia, and a markedly elevated CA 19-9.     

Pancreatic cancer–Staging laparoscopy

Objective: Accurate staging of patients with pancreatic cancer is crucial to clarify whether meaningful resection is indeed possible. Staging laparoscopy has been suggested as a tool for staging which may spare up to two-fifth of these patients from undergoing nontherapeutic laparotomy. A controversy exists, however, as to whether the procedure should be used routinely or selectively in these patients with no evidence of metastasis on noninvasive staging. This review aims to evaluate the available literature critically, identify its limitations and address the existing controversies. Methods: The current available English literature was reviewed on this topic. Results: A direct and conclusive comparison of the controversial literature is difficult because of inconsistent use of high-quality CT scans, different study designs and dissimilarity of judgment for non-resectability among patients staged by laparoscopy. However, recent studies reveal that not more than 14% of the patients benefit from diagnostic laparoscopy when a dual-contrast thin cut and 3-D digital reformatting CT scan has been performed previously. Conclusion: We conclude that routine use of diagnostic laparoscopy does not appear warranted in all patients with pancreatic cancer, especially for patients with early-staged pancreatic cancer or non-pancreatic periampullary cancers, because diagnostic laparoscopy is costly and ultrasonography is largely operator-dependent. Rather, selective use is appropriate, especially in patients with a large primary tumor, a tumor in the body or tail of the pancreas, equivocal findings of metastasis on CT, the presence of ascites, severe weight loss, hypoalbuminemia, and a markedly elevated CA 19–9.     

Assessment of Resectability of Pancreatic Carcinoma by Endoscopic Ultrasonography

OBJECTIVE To study the value of endoscopic ultrasonography (EUS) in the preoperative assessment of resectability of pancreatic carcinoma. METHODS Thirty-eight non-selected consecutive patients were prospectively investigated using EUS to determine tumor resectability. The EUS findings in each of the patients were evaluated prospectively by 2 EUS specialists. All patients were explored and resectability determinded.RESULTS Ten out of 38 cases with pancreatic carcinoma were considered to be resectable by EUS with a positive predictive value of 80% compared to findings with surgery. EUS also had a high correlation with surgical results in assessing unresectability of pancreatic carcinoma, the negative predictive. value was 96.4%. There were 2 false-positive and 1 false-negative assessments (sensitivity, 88.9% and specificity, 93.1%). The accuracy of EUS was the highest. The diagnostic accuracy of EUS, CT, MRI and sonography were 97.4%, 94.6%, 89.5%, and 73.6% respectively. CONCLUSION Endoscopic ultrasonography is an effective method to assess resectability of pancreatic carcinoma.     

Prognostic value of metabolic tumor burden in lung cancer

Accurate prognosis in patients with lung cancer is important for clinical decision making and treatment selection. The TNM staging system is currently the main method for establishing prognosis. Using this system, patients are grouped into one of four stages based on primary tumor extent, nodal disease, and distant metastases. However, each stage represents a range of disease extent and may not on its own be the best reflection of individual patient prognosis. 18F-fluorodeoxyglucose_positron emission tomography （18F-FDG-PET） can be used to evaluate the metabolic tumor burden affecting the whole body with measures such as metabolic rumor volume （MTV） and total lesion glycolysis （TLG）. MTV and TLG have been shown to be significant prognostic factors in patients with lung cancer, independent of TNM stage. These metabolic tumor burden measures have the potential to make lung cancer staging and prognostication more accurate and quantitative, with the goal of optimizing treatment choices and outcome predictions.     

Radiological diagnosis and staging of hilar cholangiocarcinoma

Hilar cholangiocarcinoma is a rare malignant tumor arising from the epithelium of the bile ducts.Surgery is still the only chance of potentially curative treatment in patients with perihilar cholangiocarcinoma.However,radical resection requires aggressive surgical strategies that should be tailored optimally according to the location,size and vascular invasion of the tumors.Accurate diagnosis and staging of these tumors is therefore critical for optimal treatment planning and for determining a prognosis.Multidetector computed tomography(MDCT),magnetic resonance imaging(MRI) and MR cholangiography are useful tools,both to diagnose and stage hilar cholangiocarcinoma.Modern imaging techniques allow accurate detection of the level of obstruction and the longitudinal and radial spread of the tumor.In addition,high-resolution MDCT and MR provide specific radiographic features to determine vascular involvement of anatomic structures,such as the hepatic artery or the portal vein,which are critical to decide the surgical strategy.Finally,radiological staging allows detection of patients with distant metastasis in the liver or peritoneum who will not benefit from a surgical approach.     

Targeting inflammation in pancreatic cancer: Clinical translation

Preclinical modelling studies are beginning to aid development of therapies targeted against key regulators of pancreatic cancer progression. Pancreatic cancer is an aggressive, stromally-rich tumor, from which few people survive. Within the tumor microenvironment cellular and extracellular components exist, shielding tumor cells from immune cell clearance, and chemotherapy, enhancing progression of the disease. The cellular component of this microenvironment consists mainly of stellate cells and inflammatory cells. New findings suggest that manipulation of the cellular component of the tumor microenvironment is possible to promote immune cell killing of tumor cells. Here we explore possible immunogenic therapeutic strategies. Additionally extracellular stromal elements play a key role in protecting tumor cells from chemotherapies targeted at the pancreas. We describe the experimental findings and the pitfalls associated with translation of stromally targeted therapies to clinical trial. Finally, we discuss the key inflammatory signal transducers activated subsequent to driver mutations in oncogenic Kras in pancreatic cancer. We present the preclinical findings that have led to successful early trials of STAT3 inhibitors in pancreatic adenocarcinoma.     

Solid Pseudopapilllary Tumor of the Pancreas： a Case Report

Solid pseudopapillary tumors （SPT） to be a rare low-grade malignancy of the pancreas are considered that mainly appears in young women. It accounts for less than 1% of all pancreatic neoplasms and is pathologically distinctive from other types of pancreatic cancers. Curative resection is the optimal choice for SPT and the 5-year survival rate of SPT is about 95%. Here we report a case of a young girl who presented with this rare pancreatic tumor.     

Relationship between the pattern of methylation of calcitonin gene and activity of methyltransferase in 8 tumor cell lines

Hypermethylation of Calcitonin (CT) gene on chromosome 11p was found to be associated with tumor progression[1-4], therefore study on the modification pattern of methylation of CT gene in tumor cells and its mechanism is a valuable project for tumor therapy and prevention. In order to investigate the relationship between the pattern of methylation of CT gene and activity of Methyltransferase (MTase) the MTase activity in 6 solid tumor and 2 leukemia cell lines was detected by a radiologica…     

The Efficacy of High-Intensity Focused Ultrasound （HIFU） in Advanced Pancreatic Cancer

OBJECTIVE To observe the efficacy of high-intensity focused ultrasound (HIFU) in the treatment of late-stage pancreatic cancer. METHODS Sixteen patients with advanced pancreatic cancer received HIFU therapy.Evaluation of efficacy was made on the basis of changes in clinical symptoms and variations in the tumor echo and size. RESULTS Clinical symptoms such as pain were significantly alleviated,echo of the tumor was enhanced with B-US and the quality of life such as eating,sleeping and mental status was markedly improved;no serious complications were observed. CONCLUSION The use of HIFU in the treatment of advanced pancreatic cancer is feasible and safe.It is effective in killing the carcinoma cells and alleviating pain.This technique may offer non-invasive therapy for the treatment of patients with late-stage pancreatic cancer.     

Solid Pseudopapillary Tumor of the Pancreas:a Case Report

Case Report Solid pseudopapillary tumors(SPT)of the pancreas are considered to be a rare low-grade malignancy that mainly appears in young women.It accounts for less than 1%of all pancreatic neoplasms and is pathologically distinctive from other types of pancreatic cancers.Curative resection is the optimal choice for SPT and the 5-year survival rate of SPT is about 95%.Here we report a case of a young girl who presented with this rare pancreatic tumor.     

Multiple solid pancreatic hamartomas:A case report and review of the literature

Non-neoplastic tumor-like lesions in the pancreas are uncommon.Here,we present a case of multiple solid pancreatic hamartomas in a 78-year-old Japanese woman.Her computed tomography revealed a pancreatic mass,measuring 1.8 cm in maximum diameter.However,no symptoms were found.She was not an alcoholic and had no history of pancreatitis.The patient underwent a pancreatoduodenectomy,and three well-demarcated solid nodules measuring 1.7 cm,0.4 cm,and 0.3 cm in diameter were found in the pancreatic head.Microscopically,the lesions were composed of non-neoplastic,disarranged acinar cells and ducts embedded in a sclerotic stroma with elongated spindle cells that lacked discrete islets.The stromal spindle cells were immunoreactive for CD34 and CD117.The histological diagnosis was multiple solid hamartomas of the pancreas.There has been no recurrence 30 mo after surgery.So far,18 cases of pancreatic hamartoma have been reported in the English literature,including our case.Six out of these 18 cases seemed to fit the criteria of solid pancreatic hamartoma.Although the number of cases was limited,solid pancreatic hamartomas seem to be benign tumor-like lesions,which are found incidentally in healthy middle-aged adults,but occasionally involve the whole pancreas,resulting in a poor prognosis.Solid pancreatic hamartoma was sometimes associated with minor pancreatic abnormality,and multiple small lesions other than the main tumors were detected in a small number of cases.From these findings,one may speculate that solid pancreatic hamartoma could be the result of a malformation during the development of the pancreas.     

Pancreatic cancer–Laparoscopic resection

Objective: To assess current role of laparoscopic resection for pancreatic cancer, so as to improve the surgical management of pancreatic cancer. Methods: A comprehensive review of articles from PubMed was carried out. Results: Cur- rently, the advantages of a complete laparoscopic pancreatoduodenectomy (LPD) are still outweighed by the morbidity associ- ated with the procedure. However, laparoscopic distal pancreatectomy (LDP) offers patients benefits in terms of postoperative recovery and the length of hospital stay with similar morbidity and mortality to open surgery. Hand-assisted laparoscopic sur- gery can help to overcome the limitation of a complete laparoscopic surgery while maintaining a minimally invasive approach. Conclusion: Current literature suggests that laparoscopic resection of pancreatic cancer is feasible and safe in experienced hands. The hand-assisted laparoscopic surgery shows a promising future in pancreatic cancer surgery.     

胰腺癌:腹腔镜切除术

Objective： To assess current role of laparoscopic resection for pancreatic cancer, so as to improve the surgical management of pancreatic cancer. Methods： A comprehensive review of articles from PubMed was carried out. Results： Currently, the advantages of a complete laparoscopic pancreatoduodenectomy （LPD） are still outweighed by the morbidity associated with the procedure. However, laparoscopic distal pancreatectomy （LDP） offers patients benefits in terms of postoperative recovery and the length of hospital stay with similar morbidity and mortality to open surgery. Hand-assisted laparoscopic surgery can help to overcome the limitation of a complete laparoscopic surgery while maintaining a minimally invasive approach. Conclusion： Current literature suggests that laparoscopic resection of pancreatic cancer is feasible and safe in experienced hands. The hand-assisted laparoscopic surgery shows a promising future in pancreatic cancer surgery.     

Excision of head and neck tumors combined with carotid artery resection without arterial blood vessel reconstruction

OBJECTIVE To summarize our clinical experience in treating 31 patients with neck masses undergoing carotid artery resection without arterial anastomosis （vascular reconstruction） in Tianjin Cancer Hospital during a period from 1979 to 2002. METHODS Preoperatively, patients were instructed to apply pressure to the carotid artery. Tumor excision combined with carotid artery resection （TECCAR） was conducted after an accurate testing of valid cerebral blood supply and compensation. RESULTS Among the study patients, 17 were male and 14 female, with the age ranging from 14 to 58 years. Of the 31 cases, 23 were carotid body tumors （8 malignant）, 2 vagal body tumors （1 malignant）, 4 carotid aneurysms, and 2 were metastatic tumors from the cervix involving carotid artery. Of the patients, a subtotal resection of the head and neck masses was conducted in 22 cases. Intraoperative death did not cerebrovascular complications occur, and postoperative CNS or （CVC） were not found. CONCLUSION TECCAR without arterial anastomosis is a safe and feasible procedure. In addition, this method of surgery has more advantages in comparison to an arterial anastomosis： i） Tumor resection was more complete, ii） Complications such as thrombus, infection, and lethal hemorrhage etc., were rare after surgery; iii） Postoperative radiotherapy, if needed, would be safe and acceptable; iv） It was a more simplified operational procedure.     

胰腺癌:复发疾病的外科手术

Recurrence of pancreatic ductal adenocarcinoma （PDAC） after a resection with curative intent is inevitable in the majority of cases. Approximately three-quarters of patients ultimately die from metastatic, local, or combined tumor recurrence . This may be due to the insufficient control over the disease after resecting the tumor and/or the existence of micrometastases at the time of the initial diagnosis. Even multimodality approaches including surgery, neoadjuvant radio-chemotherapy, adjuvant therapy, and novel targeted therapies offer only limited benefit and are not able to prevent recurrence in most of the patients.     

Folate-chitosan-gemcitabine core-shell nanoparticles targeted to pancreatic cancer

Objective：Human pancreatic cancer is one of the most common clinical malignancies.The effect of comprehensive treatment based on surgery is general.The effects of chemotherapy were not obvious mainly because of lack of targeting and chemoresistance in pancreatic cancer.This study aimed to investigate the effects of folate receptor （FR）-mediated gemcitabine FA-Chi-Gem nanoparticles with a core-shell structure by electrostatic spray on pancreatic cancer.Methods：In this study,the levels of expression of FR in six human pancreatic cancer cell lines were studied by immunohistochemical analysis.The uptake rate of isothiocyanate-labeled FA-Chi nanoparticles in FR high expression cell line COLO357 was assessed by fluorescence microscope and the inhibition rate of FA-Chi-Gem nanoparticles on COLO357 cells was evaluated by MTT assay.Moreover,the biodistribution of PEG-FA-ICGDER02-Chi in the orthotopic pancreatic tumor model was observed using near-infrared imaging and the human pancreatic cancer orthotopic xenografts were treated with different nanoparticles and normal saline control.Results：The expression of FR in COLO357 was the highest among the six pancreatic cancer cell lines.The FR mainly distributed on cell membrane and fewer in the cytoplasm in pancreatic cancer.Moreover,the absorption rate of the FA-Chi-Gem nanoparticles was more than the Chi nanoparticles without FA modified.The proliferation of COLO357 was significantly inhibited by FA-Chi-Gem nanoparticles.The PEG-FA-ICGDER02-Chi nanoparticles were enriched in tumor tissue in human pancreatic cancer xenografts,while non-targeted nanoparticles were mainly in normal liver tissue.PEG-FA-Gem-Chi significantly inhibited the growth of human pancreatic cancer xenografts （PEG-FA-Gem-Chi vs.Gem,t=22.950,P=0.000）.Conclusions：PEG-FA-FITC-Chi nanoparticles might be an effective targeted drug for treating human FR-positive pancreatic cancer.     

Significance of inspecting serum VEGF during therapy of tumor

Neovascularization has been shown to be essential for the growth of solid tumor. Several angiogenic factors have been identified, such as transforming growth factors, fibroblast growth factor, platelet-derived endothelial cell factor and vascular endothelial growth factor (VEGF). Because of its ability to increase the permeability of microvasculature to circulating macromolecules and to stimulate tumor angiogenesis. VEGF is considered to play important role in neovascularization and distant…     

Peng‘s Pancreaticojejunal Anastomosis（Binding Pancreaticojejunostomy） for the Pancreatoduodenectomy

Obuective To evaluate the safety and feasibility of a new operative procedure called binding pancreaticojejunostomy (BPJ) for the preven-tion of pancreatic leakage after pancreatoduodenectomy(PD). Methods Binding pancreaticojejunostomy was perfomed in 100 patients from 1996 to 2000.During the operation,the cut end of the je-junum(3 cm) was everted,the everted mucosa of the jejunum was destroyed with carbolic acid .Meanwhile 3 cm long remnant of pancreas was isolated and sutured to 3 cm away form the jejunum cut end, care being taken not to penetrate the sero-muscular layer.Then,the everted jejunum was restituted to its nomal position and the remnant of the pancreas was naturally pushed into the jejunal lumen for 3 cm.Finally,the surface of pancreatic remnant was closely in contact with destroyed jejunal mucosa surface,and a piece of absorbable thread was used to bind circumferentially this jejunum and the pancreatic remnant together,so no gap existed between the jejunal mucosa and pancreatic remnant. Results No pancreatic leakage occurred in the 100 patients with BPJ. Conclusion Binding pancreaticojejunostomy procedure can effectively prevent the occurrence of anastomatic leakage and can be applied broadly.