Routine modified D2 lymphadenectomy performance in pT1-T2N0 gastric cancer

AIM:To evaluate routine modified D2 lymphadenectomy in gastric cancer,based on immunohistochemically detected skip micrometastases in levelⅡlymph nodes. METHODS:Among 95 gastric cancer patients who were routinely submitted to curative modified D2 lymphadenectomy,from January 2004 to December 2008,32 were classified as pN0.All levelⅠlymph nodes of these 32 patients were submitted to immunohistochemistry for micrometastases detection. Patients in whom micrometastases were detected in the levelⅠlymph node stations(n=4)were excluded from further analysis.The levelⅡlymph nodes of the remaining 28 patients were studied immunohistochemically for micrometastases detection and constitute the material of the present study. RESULTS:Skip micrometastases in the levelⅡlymph nodes were detected in 14%(4 out of 28)of the patients. The incidence was further increased to 17%(4 out of24)in the subgroup of T1-2 gastric cancer patients.All micrometastases were detected in the No.7 lymph node station.Thus,the disease was upstaged from stageⅠA toⅠB in one patient and from stageⅠB toⅡin three patients. CONCLUSION:In gastric cancer,true R0 resection may not be achieved without modified D2 lymphadenectomy. Until D2+/D3 lymphadenectomy becomes standard, modified D2 lymphadenectomy should be performed routinely.

Improvement of gastric emptying by enhanced recovery after pancreaticoduodenectomy

BACKGROUND： Enhanced recovery after surgery（ERAS） has improved postoperative outcomes particularly in colorectal surgery. This study aimed to assess compliance with an ERAS protocol and evaluate its effect on postoperative outcomes in patients undergoing pancreaticoduodenectomy. METHODS： Fifty patients who had received conventional peri operative management from 2005 to 2009（conventional group）were compared with 75 patients who had received perioperative care with an ERAS protocol（fast-track group） from 2010 to2014. Mortality, complications, readmissions and length of hospital stay were evaluated and compared in the groups.RESULTS： Compliance with each element of the ERAS pro tocol ranged from 74.7% to 100%. Uneventful patients had a significant higher adherence to the ERAS protocol（87.5% vs40.7%; P〈0.001）. There were no significant differences in de mographics and perioperative characteristics between the two groups. Patients in the fast-track group had a shorter time to remove the nasogastric tube, start liquid diet and solid food pass flatus and stools, and remove drains. No difference was found in mortality, relaparotomy, readmission rates and over all morbidity. However, delayed gastric emptying and length of hospital stay were significantly reduced in the fast-track group. The independent effect of the ERAS protocol in reduc ing delayed gastric emptying and length of hospital stay was confirmed by multivariate analysis.CONCLUSION： ERAS pathway was feasible and safe in improving gastric emptying, yielding an earlier postoperative recovery, and reducing the length of hospital stay.

Genetic polymorphisms of interleukin 1β gene and sporadic pancreatic neuroendocrine tumors susceptibility

AIM.:To evaluate the association between the interleukin 1β(IL-1β) polymorphisms and the pancreatic neuroendocrine tumor(pN ET) development.METHODS.:A case-control study was conducted analyzing IL-1β polymorphisms using germline DNA collected in a population-based case-control study of pancreatic cancer(51 pN ET cases,85 pancreatic ductal adenocarcinoma cases,19 intraductal papillary mucinous neoplasm and 98 healthy controls).RESULTS.:The distribution of genotypes for the-511C/T polymorphism in the pN ET patient groups showed significant difference compared to the control group.It is known that the carriers of the IL-1β-511 T allele have increased concentrations of IL-1β.The-511 CT and TT high-expression genotypes were over-represented in pN ET patients.CONCLUSION.:The findings of this study suggested a possible role of IL-1β-511 C/T genotypes in the pathogenesis of pN ETs since the presence of the IL-1β-511 CT and TT genotypes and the T allele was associated with an increased risk of pN ET only.