Postoperative pancreatic fistula (POPF) is the most common complication after pancreaticoduodenectomy (PD) and remains a challenge to pancreatic surgeons.In pancreaticojejunostomy,the methods of reconstruction,experience and operational techniques of surgeons are closely related to POPF.Based on a literature review and on personal experience,the author presented the basic requirements and principle in reconstructing a safe pancreaticojejunostomy (PJ).The traditional methods of pancreaticojejunostomy and their recent developments were evaluated,with their advantages and disadvantages compared.The indications of various types of PJ and the special skills required were summarized.According to his own experience,the author described in detail his recommended method of anastomosis.

Pancreatic cancer is one of the worst digestive malignancies characterized by non-specific symptoms, rapid progression and high mortality. Despite great efforts that have been made in basic and clinical research, the prognosis remains poor with an overall 5-year survival rate of less than 5%. Complete surgical resection is the only curative treatment option, but the curative resectabillty is still about 15% in China. Pancreatic surgery is considered one of the most techni-cally demanding and challenging procedures. The development of pancreatic surgery in China depends not only on the progress in surgical techniques, but also the specialization on pancreatic surgery. There has been advancement in combined therapy with a modern interdisciplinary approach including chemotherapy,radiotherapy, biotherapy and thermotherapy. The research pro-gress of gene therapy on pancreatic cancer showed us some hopes for the future. The outcome of pancreatic cancer treated by Chinese medicine with herbal drugs is encouraging, but still needs the support of more solid evidences from randomized con-trolled trials. It is suggested that the combined therapy should play an important role in the treatment of pancreatic cancer, and the fallow-up should be paid more attention.

Objectives To investigate the r el ationship between pancreatic ischemia and cytokines released in rats with acute pancreatitis(AP). Methods 20 acute edematous pancreatitis(AEP) and 20 acute necrotizing pancreatits(ANP) rat models wer e induced by injection of sodium taurocholate into the pancreatic duct, another 10 normal rats were used as control. At 12 hours after the induction of AP, 10 r ats in each group were sacrificed, blood and pacreatic tissue samples were taken for measurement of TNF-? and IL-10 levels. The pathological study of pancre as was performed, and pancreatic blood flow(PBF) was measured by Doppler ultraso und instrument.Results The TNF -? and IL-10 levels in serum and pancreatic tissue increased after the induction of AP, IL-10 levels elevated more significantly in AEP rats, TNF-? levels e levated more significantly in ANP rats. PBF reduced in AP rats, and the amplitud e of PBF measured by Doppler ultrasound was closely correlated with serum and ti ssue TNF-?, IL-10 levels, inflammation, hemorrhage and necrosis scores.Conclusion The reduction of PBF and the i ncreasement of cytokines developed simultaneously in rats with AP, hence both of them are important pathogenic factors of AP.

Lymphatic metastasis is an important prognostic factor for pancreatic cancer.However,lymphatic metastatic status (N0 or N1) can not reflect the degree of lymphatic metastasis.Lymph node ratio,which is defined as the number of positive lymph nodes divided by total examined lymph nodes,can reflect the degree of lymph metastatic metastasis and give consideration to examined lymph nodes.Lymph node ratio is superior to lymph metastatic status in staging,guiding treatment,and predicting prognosis.However,currently,lymph node ratio cannot replace lymph metastatic status for the undetermined minimum number of examined lymph nodes and cut-off value.Further evidence is needed to prove its clinical value.

10.3969/j.issn.1007-3969.2013.05.011

Objective To investigate the role of Stathmin in pancreatic cancer invasion and metastasis and its relationship with DNA methylation. Methods Immunohistochemical detection of MBDI and Stathmin protein expression in 40 cases of pancreatic cancer and 15 cases ot normal pancreatic tissue were performed,followed by analysis of their clinical and pathological relationship with pancreatic cancer; Human pancreatic cancer cell line BxPC-3 was treated with 5-Aza-2-dC (AZA).Both qRT-PCR and Western blot analysis of Stathmin expression were used before and after AZA treatment; Stathmin-siRNA transfected BxPC-3 cells were divided into the Stathmi-siRNA group and the empty vector control group.Transwell chamber invasion assay and animal experiment were performed to measure the changes in cell invasion and metastatic capability. Results lmmunohistochemistry showed positive MBDI and Stathmin expressions in 28 (70％) and 24 (60％) out of 40 cases of pancreatic cancer,respectively,which were significantly higher than that in the normal pancreatic tissue (P＜ 0.05); MBDI and Stathmin protein expressions were positively correlated (r =0.356,P =0.037),so were MBDI expression and lymph node metastasis (P=0.023).Stathmin expression was significantly correlated with clinical staging and lymph node metastasis (P =0.002,and P =0.001,respectively).After AZA treatment,both Stathmin mRNA and protein expression in BxPC-3 were significantly decreased.Transwell chamber invasion assay showed that compared with the control group,the cell invasion capability of the Stathmin-siRNA group was significantly decreased (P＜0.05).Animal experiment showed that the incidence of liver metastasis was significantly lower in the Stathmin-siRNA transfected group than the empty vector control group (P＜0.05).Conclusion Demethylation may contribute to the reduction of Stathmin expression in pancreatic cancer and further improve the prognosis of pancreatic cancer patients.

Objective To study the effect of intra-tumor injection of slow-release 5-FU on pancreatic carcinoma cells in nude mice,and on changes in serum tumor markers and cellular immunity of patients with pancreatic carcinoma.Methods (1) In vitro experiments, the releasing action and anti-tumor effect of slow-release 5-FU were studied. Measurement of the concentration of effused fluid,calculation of amount of drug released,and observation of the inhibitory effects of effused fluid on PC3 strains of pancreatic cancer cellswere perfomed.(2) Human pancreatic carcinoma strain PC-3 cells were cultured and inoculated into 60 nude mice,and were randomly divided into 5 groups according to various treatments received: NS injection as control group(A group), 5-FU (10 mg/kg)IV injection group(B group), stroma implant group(C group), intra-tumor injection of high dose slow-release 5-FU (4mg/kg) group(D group) and intra-tumor injection of low dose slow-release 5-FU (1mg/kg) group(E group). Tumor size were measured before and 14 days after treatment. On week 2, histological changes of the tumors were examined. The apoptotic index (AI) of the tumor cells was detected by terminal-deoxynucleotide transferase mediated d-UTP nick end labeling(TUNEL) and expression of bcl-2 and Bax by immunohistochemistry.(3) 69 cases of unresectable pancreatic carcinoma were divided into 3 groups randomly:intra-tumor injection of slow-release 5-FU treated group(treatment group), intra-venous injection of 5-FU group( chemotherapy group), and control group. The serum values of CD3+, CD4+, CD8+, CD4+/ CD8+, NK cells, CEA, CA50, CA19-9, CA125 and CA242 were measured in all patients 1 day before and 14 days after operation. Results (1) There was 0.85 mg 5-FU released in the 1st day and 0.45 mg 5-FU released in the 3rd day. The release remained constant at 0.25 mg and continued for about 14 days. (2) The tumor growth suppression rate on the 1st day by effusion fluid of slow-release 5-FU was 60.27% and on the 3rd day was 34.25%. Later, it remained at about 25.00%. The tumor growth rate was slower in D and E group than in other groups (P

Objective To evaluate the efficacy of preoperative regional intra-arterial chemotherapy (RIAC) in the treatment of resectable pancreatic head carcinoma. Methods The clinical data of 50 patients with resectable pancreatic head carcinoma who had been admitted to the Research Institute of Pancreatic Diseases of Fudan University from December 2006 to July 2007 were retrospectively analyzed. Patients were randomly divided into2 groups (n =25 in each group): patients in group A were treated with preoperative RIAC followed by regional pancreaticoduodenectomy, and patients in group B were treated with surgical procedure routinely. The lymphatic metastases in the 50 specimens of pancreatic head carcinoma were detected by histological examination with hematoxylin and eosin (HE) staining, and lymphatic micrometastases were detected by immunohistochemical method with staining of cytokeratin AE1/AE3 in 10 specimens with negative HE staining of the lymph nodes in each group. Results There was no significant difference in the incidence of complications, the length of hospital stay and the 1-, 2-year survival rates between the 2 groups (χ2 = 0.12, 2.88, P > 0.05). The incidence of positive lymph node metastasis in group A was 7.1% (52/734), which was significantly higher than 22.1% (118/532) in group B (χ2 = 60.01, P < 0.05). The incidence of lymphatic micrometastasis was 9.4% (30/319) in group A, and 9.1% (23/252) in group B, with no statistical difference between the 2 groups (χ2= 0.01, P > 0.05). Conclusions Preoperative RIAC is helpful in improving the prognosis of patients with resectable pancreatic head carcinoma by reducing the incidence of lymphatic metastasis and decreasing tumor stage.

Pancreatic neuroendocrine tumor is a common pancreatic tumor with high heterogeneity and multiple management modalities. A standard and practical staging system for pancreatic neuroendocrine tumors will be beneficial to clinical management and research. At present, there are two staging systems (ENETS and AJCC). Both of them have shortcomings which limit their clinical application. In addition, the coexistence of two staging systems is confusing to clinicians. We proposed a modified ENETS staging system by keeping the ENETS TNM definition and adopting the AJCC staging definition. The modified staging system can successfully distinguish patients with different prognosis and is helpful in establishing clinical standard. This study has been published in Journal of Clinical Oncology (JCO) and was selected as 2017 Best of JCO: Gastrointestinal edition. This paper was aimed to interpret the modified staging system in clinical practice.

Objective To investigate the clinical characteristics, diagnosis, treatment and prognosis of pancreatic gastrointestinal stromal tumor (GIST). Methods We reported a case and reviewed the medical literature on pancreatic malignant GIST. We searched the Pubmed and main domestic database. The clinical data of the reported cases were studied, and their predictive factors for postoperative recurrence and metastasis were analyzed. Results Between January 1980 and July 2010, 16 cases of pancreatic GIST were reported. There were 7 males and 9 females, with a median age pf 56.5 (31-72)years. The clinical symptoms were nonspecific. The main presentation was upper abdominal pain or discomfort. A preoperative diagnosis was suspected on radiological examination. The tumor mainly appeared as a well-defined solid-cystic mass. Irregular enhancement appeared in the circumferential and solid portion of the tumor on enhanced CT scan sequences. The pancreatic and biliary ducts were rarely dilated. Endoscopic ultrasound guided fine needle aspiration cytology (EUS-FNA) was helpful in preoperative diagnosis. Of the 15 surgical patients, 14 underwent complete resection, while the remaining received cyst-jejunostomy. A correct diagnosis was made on histopathology and immunohisto-chemistry. On a mean follow up of 21 months (range, 1-60) in 14 patients, all patients were alive.Recurrence or metastasis occurred in 4 patients with tumors of high malignant potential. On univariate analysis, the only significant predictor for adverse outcome was mitoses≥10/50 HPF. Conclusions Pancreatic GIST is a rare tumor of relatively low malignant potential. It has a better prognosis than ductal adenocarcinoma. It is important to arrive at a correct diagnosis and treat the tumor with radical resection. Aggressive surgical resection is potentially curative. Imatinib is recommended in the treatment of patients with tumors with high malignant potential.