Pancreatic cancer was considered to be one of the contraindications of laparoscopic pancreaticoduodenectomy, but a large number of studies have shown that laparoscopic pancreaticoduodenectomy is safe and feasible for surgeons who have passed the learning curve in high-volume hospitals.Laparoscopic pancreaticoduodenectomy can provide high-resolution intraoperative exploration and unique operative perspective,which can help to reduce intraoperative and postoperative complications,dissect lymph nodes more thoroughly and reduce intraoperative metastasis of tumors,so as to promote the development of postoperative adjuvant therapy and improve patients' quality of life.However,due to the long learning curve and unclear survival outcome, the application of laparoscopic pancreaticoduodenectomy in patients with pancreatic cancer is still controversial.This article summarizes the existing literature and the experience of the author's team,exploring the value and controversy of laparoscopic pancreaticoduodenectomy in the treatment of pancreatic cancer.Further,suggestions are put forward on how to improve the laparoscopic pancreaticoduodenectomy in China.
Humans ; Laparoscopy/adverse effects* ; Operative Time ; Pancreatic Neoplasms/pathology* ; Pancreaticoduodenectomy/adverse effects* ; Postoperative Complications/etiology* ; Quality of Life ; Retrospective Studies

BACKGROUND/AIMS: Concurrent chemoradiotherapy (CCRT) is considered the treatment option for locally advanced pancreatic cancer, but accompanying gastrointestinal toxicities are the most common complication. With the introduction of three-dimensional conformal radiotherapy (3-D CRT) and intensity-modulated radiotherapy (IMRT), CCRT-related adverse events are expected to diminish. Here, we evaluated the benefits of radiation modalities by comparing gastrointestinal toxicities between 3-D CRT and IMRT. METHODS: Patients who received CCRT between July 2010 and June 2012 in Severance Hospital, Yonsei University College of Medicine, were enrolled prospectively. The patients underwent upper endoscopy before and 1 month after CCRT. RESULTS: A total of 84 patients were enrolled during the study period. The radiotherapy modalities delivered included 3D-CRT (n=40) and IMRT (n=44). The median follow-up period from the start of CCRT was 10.6 months (range, 3.8 to 29.9 months). The symptoms of dyspepsia, nausea/vomiting, and diarrhea did not differ between the groups. Upper endoscopy revealed significantly more gastroduodenal ulcers in the 3-D CRT group (p=0.003). The modality of radiotherapy (3D-CRT; odds ratio [OR], 11.67; p=0.011) and tumor location (body of pancreas; OR, 11.06; p=0.009) were risk factors for gastrointestinal toxicities. CONCLUSIONS: IMRT is associated with significantly fewer gastroduodenal injuries among patients treated with CCRT for pancreatic cancer.
Aged ; Female ; Follow-Up Studies ; Gastrointestinal Diseases/*etiology ; Humans ; Male ; Middle Aged ; Pancreatic Neoplasms/*radiotherapy ; Prospective Studies ; Radiation Injuries/*complications ; Radiotherapy, Conformal/*adverse effects ; Radiotherapy, Intensity-Modulated/*adverse effects ; Risk Factors

The prevalence of diabetes mellitus (DM) and associated diseases such as cancers are substantially increasing worldwide. About 80% of the patients with pancreatic cancer have glucose metabolism alterations. This suggests an association between type 2 DM and pancreatic cancer risk and progression. There are hypotheses that show metabolic links between the diseases, due to insulin resistance, hyperglycemia, hyperinsulinemia, low grade chronic inflammation, and alteration in the insulin-insulin-like growth factor axis. The use of diabetes medications can influence the extent of carcinogenesis of the pancreas. This study briefly reviews recent literature on investigation of metabolic link of type 2 DM, risk of carcinogenesis of the pancreas and their association, as well as the current understanding of metabolic pathways implicated in metabolism and cellular growth. The main finding of this review, although there are discrepancies, is that according to most research long-term DM does not raise the risk of pancreatic cancer. The longest duration of DM may reflect hypoinsulinemia due to treatment for hyperglycemia, but recent onset diabetes was associated with increased risk for pancreatic cancer due to hyperinsulinemia and hyperglycemia. In conclusion, the review demonstrates that type 2 DM and the duration of diabetes pose a risk for pancreatic carcinogenesis, and that there is biological link between the diseases.
Diabetes Mellitus, Type 2/complications/epidemiology/metabolism/*pathology ; Humans ; Hyperglycemia/pathology ; Insulin/metabolism ; Insulin Resistance ; Insulin-Like Growth Factor I/metabolism ; Pancreatic Neoplasms/epidemiology/*etiology ; Risk Factors

Chronic inflammation has been known to be a risk for many kinds of cancers, including pancreatic and biliary tract cancer. Recently, inflammatory process has emerged as a key mediator of cancer development and progression. Many efforts with experimental results have been given to identify the underlying mechanisms that contribute to inflammation-induced tumorigenesis. Diverse inflammatory pathways have been investigated and inhibitors for inflammation-related signaling pathways have been developed for cancer treatment. This review will summarize recent outcomes about this distinctive process in pancreatic and biliary tract cancer. Taking this evidence into consideration, modulation of inflammatory process will provide useful options for pancreatic and biliary tract cancer treatment.
Biliary Tract Neoplasms/*etiology/metabolism ; Cell Transformation, Neoplastic ; Cyclooxygenase 2/metabolism ; Cytokines/metabolism ; Humans ; *Inflammation ; Matrix Metalloproteinases/metabolism ; NF-kappa B/metabolism ; Pancreatic Neoplasms/*etiology/metabolism ; Receptor, Epidermal Growth Factor/metabolism

BACKGROUND/AIMS: There are several methods for obtaining tissue samples to diagnose malignant biliary strictures during endoscopic retrograde cholangiopancreatography (ERCP). However, each method has only limited sensitivity. This study aimed to evaluate the diagnostic accuracy of a combined triple-tissue sampling (TTS) method (on-site bile aspiration cytology, brush cytology, and forceps biopsy). METHODS: We retrospectively reviewed 168 patients with suspicious malignant biliary strictures who underwent double-tissue sampling (DTS; n=121) or TTS (n=47) via ERCP at our institution from 2004 to 2011. RESULTS: Among the 168 patients reviewed, 117 patients (69.6%) were eventually diagnosed with malignancies. The diagnostic sensitivity for cancer was significantly higher in the TTS group than the DTS group (85.0% vs 64.9%, respectively; p=0.022). Furthermore, the combination of brush cytology and forceps biopsy was superior to the other method combinations in the DTS group. With respect to cancer type (cholangiocarcinoma vs noncholangiocarcinoma), interestingly, the diagnostic sensitivity was higher for cholangiocarcinoma in the TTS group than the DTS group (100% vs 69.4%, respectively; p<0.001) but not for the non-cholangiocarcinoma patients (57.1% vs 57.1%, respectively). CONCLUSIONS: TTS can provide an improved diagnostic accuracy in suspicious malignant biliary strictures, particularly for cholangiocarcinoma.
Aged ; Ampulla of Vater/*pathology ; Bile Duct Neoplasms/complications/diagnosis/pathology ; Bile Ducts, Intrahepatic/*pathology ; Biopsy/*methods ; Biopsy, Needle ; Carcinoma/complications/diagnosis/pathology ; Cholangiocarcinoma/complications/*diagnosis/pathology ; Cholangiopancreatography, Endoscopic Retrograde/*methods ; Cholestasis/etiology ; Common Bile Duct Neoplasms/complications/*diagnosis/pathology ; Female ; Humans ; Male ; Middle Aged ; Pancreatic Neoplasms/complications/*diagnosis/pathology ; Retrospective Studies ; Sensitivity and Specificity

BACKGROUND/AIMS: Endoscopic ultrasound-guided fine needle aspiration (EUS-FNA) is useful for the pathological diagnosis of pancreatic masses, but patients are susceptible to severe bleeding and perforation. Because the incidence and severity of these complications have not been fully evaluated. METHODS: We aimed to evaluate severe bleeding and perforation after EUS-FNA for pancreatic masses using large-scale data derived from a Japanese nationwide administrative database. RESULTS: In total, 3,090 consecutive patients from 212 low- to high-volume hospitals were analyzed. Severe bleeding requiring transfusion or endoscopic treatment occurred in seven patients (0.23%), and no perforation was observed. No patient mortality was recorded within 30 days of EUS-FNA. The rate of severe bleeding in low-volume hospitals was significantly higher than that in medium- and high-volume hospitals (0.48% vs 0.10%, p=0.045). CONCLUSIONS: Severe bleeding and perforation following EUS-FNA for pancreatic masses are rare, and the procedure is safe.
Blood Transfusion/statistics & numerical data ; Endoscopic Ultrasound-Guided Fine Needle Aspiration/*adverse effects ; Female ; Fibrinolytic Agents/adverse effects ; Gastrointestinal Hemorrhage/*etiology ; Humans ; Intestinal Perforation/*etiology ; Male ; Middle Aged ; Pancreatic Neoplasms/*pathology

No abstract available.
Abscess/complications/*diagnosis ; Adenocarcinoma/complications/*diagnosis ; Adult ; Diabetes Mellitus, Type 2/complications ; Diabetic Ketoacidosis/*etiology ; Fatal Outcome ; Female ; Humans ; Pancreatic Neoplasms/complications/*diagnosis

BACKGROUNDEpidemiologic studies have reported inconsistent results regarding tea consumption and the risk of pancreatic cancer. This study aimed to investigate whether tea consumption is related to the risk of pancreatic cancer.

METHODSWe searched Medline, EMBASE, ISI Web of Science, and the Cochrane library for studies published up to November 2013. We used a meta-analytic approach to estimate overall odds ratio (OR) and 95% confidence interval (CI) for the highest versus the lowest tea consumption categories.

RESULTSThe summary OR for high versus no/almost never tea drinkers was 1.04 (95% CI: 0.91-1.20), with no significant heterogeneity across studies (P = 0.751; I(2) = 0.0%). The OR was 0.99 (95% CI: 0.77-1.28) in males and 1.01 (95% CI: 0.79-1.29) in females. The OR was 1.07 (95% CI: 0.85-1.34) in Asian studies, 1.05 (95% CI: 0.84-1.31) in European studies, and 0.98 (95% CI: 0.72-1.34) in the US studies. The OR was 0.87 (95% CI: 0.69-1.10) without adjustment for a history of diabetes and 1.16 (95% CI: 0.97-0.39) after adjustment for a history of diabetes. The OR was 0.90 (95% CI: 0.72-1.12) without adjustment for alcohol drinking and 1.16 (95% CI: 0.96-1.39) after adjustment for alcohol drinking. The OR was 0.97 (95% CI: 0.76-1.25) without adjustment for BMI and 1.07 (95% CI: 0.87-1.31) after adjustment for BMI.

CONCLUSIONThis systematic meta-analysis of cohort studies dose not provide quantitative evidence that tea consumption is appreciably related to the risk of pancreatic cancer, even at high doses.

Asia ; Humans ; Pancreatic Neoplasms ; epidemiology ; etiology ; Tea ; adverse effects

Several studies have reported that ABO blood group, hepatitis B virus (HBV) and hepatitis C virus (HCV) infection contribute to the development of pancreatic cancer. The aim of this study was to evaluate the association between these factors and pancreatic cancer in the Korean population. We retrospectively recruited 753 patients with pancreatic cancer and 3,012 healthy controls, matched 4 to 1 with cancer patients for age and sex, between 2001 and 2011, at the National Cancer Center, Korea. A multivariate logistic regression analysis was employed to estimate adjusted odds ratios (AORs). The AOR for pancreatic cancer in subjects with non-O blood types (A, AB, and B), compared to blood type O, was 1.29 (95% CI, 1.05-1.58; P = 0.01). Seropositivity for hepatitis B virus surface antigen was not significantly related to pancreatic cancer, either in univariate (odds ratio 1.03; 95% CI, 0.69-1.53; P = 0.91) or multivariate analysis (AOR, 1.02; 95% CI, 0.67-1.56; P = 0.93). The AOR for pancreatic cancer in subjects displaying seropositivity for anti-HCV was 2.30 (95% CI, 1.30-4.08; P < 0.01). Our results suggest that the non-O blood types and anti-HCV seropositivity, but not HBV infection, may increase the risk of developing pancreatic cancer in Korea, where HBV is endemic.
ABO Blood-Group System ; Aged ; Case-Control Studies ; Female ; Hepatitis B/complications/diagnosis ; Hepatitis B Surface Antigens/blood ; Hepatitis C/*complications/diagnosis ; Hepatitis C Antibodies/blood ; Humans ; Logistic Models ; Male ; Middle Aged ; Multivariate Analysis ; Odds Ratio ; Pancreatic Neoplasms/diagnosis/*etiology ; Republic of Korea ; Retrospective Studies ; Risk Factors

OBJECTIVETo investigate the diagnosis and treatment of pancreatic islet cell tumors.

METHODSFifty-one patients with islet cell tumors treated in our department from January 1991 to April 2011 were included in this study. The data of clinical features, diagnosis and treatment were retrospectively analyzed.

RESULTSAmong the 51 cases, 38 cases showed typical Whipple's triad, and the other 13 cases were non-functional islet cell tumors. In these 13 cases, 5 patients had no specific clinical symptoms, and 8 patients had abdominal distending pain. The positive rates of imaging were: B-ultrasound 43.1%, multi-slice spiral CT 69.8%; MRI 62.5%, endoscopic ultrasonography (EUS) 64.7% (11/17), and intraoperative ultrasound (IOUS) 96.3%, the differences among them were statistically significant (P<0.05). All patients underwent surgical treatment. Postoperative pancreatic leakage happened in 6 cases. Finally all the patients recovered after effective external drainage, anti-infection treatment and nutritional support.

CONCLUSIONSIntraoperative ultrasonography (IOUS) has a higher accuracy in the diagnosis of pancreatic islet cell tumors, compared with preoperative B-ultrasonography, CT, MRI, and endoscopic ultrasound (EUS). The most effective treatment of this disease is surgery.

Adenoma, Islet Cell ; diagnosis ; diagnostic imaging ; surgery ; Adult ; Anastomotic Leak ; etiology ; Endosonography ; Female ; Humans ; Insulinoma ; diagnosis ; diagnostic imaging ; surgery ; Magnetic Resonance Imaging ; Male ; Middle Aged ; Multidetector Computed Tomography ; Pancreatectomy ; adverse effects ; Pancreatic Neoplasms ; diagnosis ; diagnostic imaging ; surgery ; Retrospective Studies