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 CA19.9showed 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.

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 4cm, 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.

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, 56inpatients 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.