Total mesopancreas excision for pancreatic head cancer: analysis of 120 cases

Objective： To evaluate the feasibility and safety of total mesopancreas excision （TMpE） in the treatment of pancreatic head cancer. Methods： The clinical and pathological data of 120 patients with pancreatic head cancer who had undergone TMpE in our center from May 2010 to January 2014 were retrospectively analyzed. Results： The mean operative time was （275.0±50.2） min and the average intra-operative blood loss was （390.0±160.5） mL. Post-operative complications were reported in 45 patients, while no peri-operative death was noted. The specimen margins were measured in three dimensions, and 86 patients （71.6%） achieved R0 resection. Conclusions： TMpE is safe and feasible for pancreatic head cancer and is particularly helpful to increase the R0 resection rate.

Hepatopancreatoduodenectomy for advanced biliary malignancies

Background:Hepatopancreatoduodenectomy(HPD)has been considered the only curative treatment for metastatic cholangiocarcinoma and some locally advanced gallbladder cancers(GBCs).However,HPD has not yet been included in treatment guidelines as a standard surgical procedure in consideration of its morbidity and mortality rates.The aim of this study was to evaluate the safety and effectiveness of HPD in treating biliary malignancies.Methods:The medical records of 57 patients with advanced biliary cancer undergoing HPD from January 2009 to December 2019 were retrospectively retrieved.A case-control analysis was conducted at our department.Patients with advanced GBC who underwent HPD(HPD-GBC group)were compared with a control group(None-HPD-GBC group).Baseline characteristics,preoperative treatments,tumor pathologic features,operative results,and prognosis were assessed.Results:Thirteen patients with cholangiocarcinoma and 44 patients with GBC underwent HPD at our department.Significant postoperative complications(grade III or greater)and postoperative pancreatic fistula were observed in 24(42.1%)and 15(26.3%)patients,respectively.One postoperative death occurred in the present study.Overall survival(OS)was longer in patients with advanced cholangiocarcinoma than in those with GBC(median survival time[MST],31 months vs.11 months;P<0.001).In the subgroup analysis of patients with advanced GBC,multivariate analysis demonstrated that T4 stage tumors(P=0.012),N2 tumors(P=0.001),and positive margin status(P=0.004)were independently associated with poorer OS.Patients with either one or more prognostic factors exhibited a shorter MST than patients without those prognostic factors(P<0.001).Conclusion:HPD could be performed with a relatively low mortality rate and an acceptable morbidity rate in an experienced highvolume center.For patients with advanced GBC without an N2 or T4 tumor,HPD can be a preferable treatment option.

Regulation of BMP2K in AP2M1-mediated EGFR internalization during the development of gallbladder cancer

Dear Editor,Gallbladder cancer(GBC),the most common malignant tumor of the biliary tract,is a highly invasive form of cancer.Surgical resection is currently the first line approach to effectively treat GBC;however,very few patients have the opportunity to receive radical surgical treatment due to lack of obvious symptoms.1 The median survival of patients with GBC is only 12 months and 5-year survival rate is<5%,indicating GBC is extremely poor prognosis.Therefore,it is urgent to identify novel key molecules that can potentially serve as early diagnostic biomarkers and/or therapeutic targets.The current study focused on the potential role of bone morphogenetic protein 2 inducible kinase(BMP2K),a serine/threonine kinase,which was recently identified as clathrin-coated vesicle-associated protein in the development of GBC;the outcome may hold diagnostic and therapeutic promising for clinical practice.

大豆异黄酮genistein的长期暴露通过下调MCM复合物抑制胆囊癌增殖的研究

大豆异黄酮是天然的酪氨酸激酶抑制剂,与多种肿瘤发病率和死亡率的降低密切相关.同时,酪氨酸激酶如ERBB2的激活是胆囊炎转化为胆囊癌的重要机制,因此,研究长期接触大豆异黄酮与胆囊癌的发生和发展之间的关系十分重要.这项85对的病例对照研究发现,高血浆大豆异黄酮genistein水平与较低的胆囊癌风险相关(≥326.0与≤19.3 ng/mL对比,OR=0.15,95%可信区间0.04~0.59;趋势检验P=0.016),并且genistein暴露水平与胆囊癌组织中Ki67表达负相关(85例).与这些结果一致,体外和体内的长期genistein暴露模型中,胆囊癌细胞的增殖受到抑制.长期暴露于genistein降低了ERBB2的酪氨酸激酶活性,并影响了PTK6-AKT-GSK3β轴的功能,导致胆囊癌细胞中MCM复合物的表达下调.总之,长期接触与大豆制品摄入相关的genistein可能在预防甚至抑制胆囊癌的增殖方面起到一定的作用.