Value of adipokines in predicting the severity of acute pancreatitis:Comprehensive review

AIM:To analyze the prognostic value of adipokines in predicting the course,complications and fatal outcome of acute pancreatitis(AP).METHODS:We performed the search of PubMed database and the systemic analysis of the literature for both experimental and human studies on prognostic value of adipokines in AP for period 2002-2012.Only the papers that described the use of adipokines for prediction of severity and/or complications of AP were selected for further analysis.Each article had to contain information about the levels of measured adipokines,diagnosis and verification of AP,to specify presence of pancreatic necrosis,organ dysfunction and/or mortality rates.From the very beginning,study was carried out adhering to the PRISMA checklist and flowchart for systemic reviews.To assess quality of all included human studies,the Quality Assessment of Diagnostic Accuracy Studies tool was used.Because of the high heterogeneity between the studies,it was decided to refrain from the statistical processing or meta-analysis of the available data.RESULTS:Nine human and three experimental studies were included into review.In experimental studies significant differences between leptin concentrations at 24 and 48 h in control,acute edematous and acute necrotizing pancreatitis groups were found(P = 0.027 and P < 0.001).In human studies significant differences between leptin and resitin concentrations in control and acute pancreatitis groups were found.1-3 d serum adiponectin threshold of 4.5 μg/mL correctly classified the severity of 81% of patients with AP.This threshold yielded a sensitivity of 70%,specificity 85%,positive predictive value 64%,negative predictive value88%(area under curve 0.75).Resistin and visfatin concentrations differ significantly between mild and severe acute pancreatitis groups,they correlate with severity of disease,need for interventions and outcome.Both adipokines are good markers for parapancreatic necrosis and the cut-off values of 11.9 ng/mL and 1.8 ng/mL respectively predict the high ranges of radiological scores.However,the review revealed that all nine human studies with adipokines are very different in terms of methodology and objectives,so it is difficult to generalize their results.It seems that concentrations of the leptin and resistin increases significantly in patients with acute pancreatitis compared with controls.Serum levels of adiponectin,visfatin and especially resitin(positive correlation with Acute Physiology and Chronic Health Evaluation Ⅱ,Ranson and C-reactive protein) are significantly different in mild acute pancreatitis and severe acute pancreatitis patients,so,they can serve as a markers for the disease severity prediction.Resistin and visfatin can also be used for pancreatic and parapancreatic necrosis prediction,interventions needs and possible,outcome.CONCLUSION:High levels of adipokines could allow for prediction of a severe disease course and outcome even in small pancreatic lesions on computed tomography scans.

Stage Ⅱ Pancreatic Cancer: Radical, Palliative Surgery or Stenting?

Background: Pancreatic ductal adenocarcinoma is the fourth most common reason of death among oncological diseases with ever increasing mortality. At the time of diagnosis, patients are usually suitable for three ways of treatment: radical, palliative surgery or stenting. Deciding the best option depends on clinical situation, but is still a matter of debate. Methods: We performed a retrospective research of patients with stage II pancreatic head cancer treated in our clinic between years 2002-2014. Four groups were formed according to the used treatment method: group A: radical surgery with R0 (microscopic tumour clearance) margin;group B: radical surgery with R1 (presence of tumour cells within 1 mm of the resection margin) margin;group C: biliary tract stenting;group D: biliodigestive anastomosis. Clinical data and most importantly the survival of these patients were compared. Results: 200 patients were involved in the final analysis, 82 (41%) of them were IIA and 118 (59%) were IIB. Group A consisted of 113 patients;group B consisted of 28 patients;group C consisted of 33 patients;group D consisted of 26 patients. In patients with IIA stage, group A had the highest survival rate compared with other groups, mean survival was 3.242 versus 1.600;0.454;0.652 years. Patients with IIB stage of cancer similarly had longer survival in group A versus other groups, 1.720 versus 0.931;0.713;0.957 years. Conclusions: Patients with IIA and IIB stage of pancreatic cancer benefit the most from radical surgery with R0 margin. However, for patients with lymph node involvement (stage IIB) and when achieving R0 margin is hardly possible, neoadjuvant treatment seems promising, but we need further randomized controlled trials to fully confirm its effectiveness.