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Laparoscopic local resection of pancreatic tumor
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Abstracts / Pancreatology 13 (2013) e1–e94
differentiated tubular adenocarcinoma was detected in two patients, moderately differentiated tubular adenocarcinoma in 13 patients and poorly differentiated tubular adenocarcinoma in one. Two patients were classified into Stage IA, 2 patients IB, 7 patients IIA and 5 patients IIB. In the treatment for the remnant pancreatic cancer, 8 patients underwent total excision of the remnant pancreas, 4 patients received chemotherapy and 4 patients received best supportive care. The mean time to the treatment for the remnant pancreas was 83 months (range, 29-240). The pathological findings of the remnant pancreas in the 8 resected cases were PDAC with 6 patients and malignant IPMN with 2 patients. Five patients who underwent total excision of the remnant pancreas were alive, but remained 11 patients were dead. Conclusions: The long-term survivors after curative resection for the pancreatic cancer should be paid attention to the remnant pancreas and the aggressive resection of the remnant pancreas or total pancreatectomy at the first operation should be considered for more favorite prognosis of the PDAC.
pancreatic tumor is ultimate less invasive pancreatic surgery, though its indication is limited. We review our series of patients underwent laparoscopic local resection on pancreatic diseases. Patients and methods: Eleven patients underwent laparoscopic local resection between 2007 and 2011 were reviewed. Results: Laparoscopic resection was comleted in 10 patients (91%). Of the 11 patients, 7 had neuroendocrine tumors (NETs), 2 had solid and pseudo papillary tumor (SPT) and 1 had mucinous cystic neoplasm (MCN). Mean tumor size was 21.2 mm (8-45). In one patient preoperatively diagnosed as NET by EUS guided fine needle aspiration cytology, tumor could not be detected even converted to open laparotomy. In another patient diagnosed as NET (Insulinoma), resected tumor was non functioning NET and hypoglycemia last even after resection. All the resected NETs were diagnosed as G1 according to WHO classification. Grade B pancreatic fistula was occurred in one patients (9.0%) and cured by endoscopic naso-pancreatic drainage (ENPD). Conclusions: Laparoscopic enuleation is a good option for benign or borderline disease located on the surface of the pancreas. Especially with NETs, preoperative diagnosis and intraoperative detection of the tumor is important. ENPD is useful for management of postoperative pancreatic fistula.
P235. In vitro assessment of a superparamagnetic iron oxide nanoparticle for targeting pancreatic cancer cells P. Sykes 1, C. Olariu 2, E. Hasan 2, D. Lydon 2, C. Rubbi 1, J. Neoptolemos 1, E. Costello 1, M. Rosseinsky 2, C. Halloran 1. 1 Department of Molecular and Clinical Cancer Medicine, University of Liverpool, UK 2 Department of Chemistry, University of Liverpool, UK Introduction: Despite advances in the surgical management of pancreatic cancer, particularly adjuvant chemotherapy, pancreatic cancer continues carry a poor prognosis. Nanotechnology offers the possibility of patient targeted therapy while providing novel methods of drug delivery. Aim: To develop an iron oxide-based nanoparticle capable of targeting pancreatic cancer cells in vitro through the use of a targeting antibody and an external magnetic field. Methods: Nanoparticles (NPs) were manufactured by coating 6nm diameter iron oxide cores in a novel polyoxazoline (POZ) polymer and conjugated with a rhodamine fluorophore for tracking. BxPC-3 pancreatic cancer cells were cultured in the presence of an external magnetic field and the rate of uptake assessed using fluorescent microscopy. A targeting anti-CA19.9 (NP:CA19.9) or isotype control (NP:Iso) antibody was then conjugated to the particles and the rate of uptake measured in a similar fashion in BxPC-3 cells (CA19.9 expressing). Results: In the presence of a magnetic field, NP uptake was significantly increased after 2 hours compared to uptake in the absence of a magnetic field (mean intensity 49.8AU, 95%CI 19.4-77.8 vs 1.7AU, 95%CI 0-3.70; p<0.01). NP:CA19.9 particles demonstrated increased cellular uptake at 2 hours when compared to NP:Iso (mean intensity 9.83AU, 95%CI 6.21-13.52 vs 0.14AU, 95%CI 0.01-0.27; p<0.01). Conclusions: We have developed a novel iron oxide based nanoparticle capable of multi-modal targeting of pancreatic cancer cells through the conjugation of an antibody and the use of an external magnetic field. This provides a stable platform on which to build a drug delivery vehicle, capable to targeting specific tissues and delivering chemotherapy agents directly into the cells, therefore reducing the offtarget effects often associated with these drugs.
P237. Pancreatic duct decompression improves pancreatic blood perfusion Y. Takeyama 1, T. Yasuda 1, T. Nakai 1, T. Murakami 2. 1
Department of Surgery, Kinki University Faculty of Medicine, Osakasayama, Osaka, Japan 2 Radiology, Kinki University Faculty of Medicine, Osaka-sayama, Osaka, Japan Background & aim: Obstructive pancreatitis is defined as pancreatitis due to obstruction of the main pancreatic duct. It is characterized by evenness of changes in the lesion and reversibility after release of obstruction. After the obstruction, not only exocrine but endocrine function is impaired and insulin-dependent diabetes is complicated. Some investigators reported that pancreatic ischemia is associated with experimental obstructive pancreatitis, and is improved by pancreatic duct decompression. In this paper, we examined pancreatic perfusion clinically before and after the surgical pancreatic decompression. Methods: Two clinical cases were examined. Both of them were alcoholic chronic pancreatitis characterized by the incarcerated obstruction of main pancreatic duct by single stone. In both cases, decompression of the pancreatic duct was achieved by pancreaticojujunostomy. Pancreatic blood perfusion was evaluated by perfusion CT technique using GE Light Speed VCT VISION (64ch), and the data was analyzed by deconvolution method. Pancreatic blood perfusion was evaluated pre and postoperatively, and postoperative evaluation was performed 1 month after the operation. Results: Blood flow in the pancreatic gland affected by obstructive pancreatitis was increased 4.3 and 5.7 folds by pancreatic duct decompression in each case. Blood volume was also increased 12.3 and 15.6 folds, and mean transit time was also increased 2.1 and 2.1 folds in each case. Discussion: We have confirmed clinically using perfusion CT technique that decreased pancreatic blood perfusion can be improved by pancreatic duct drainage in obstructive pancreatitis. After pancreaticojejunostomy, pancreatic perfusion was strikingly increased. In both cases, endocrine function was also improved. Pancreatic damage due to the elevation of intraductal pressure is assumed to be partly derived from pancreatic ischemia.
P236. Laparoscopic local resection of pancreatic tumor S. Takahata, T. Otsuka, J. Ueda, K. Mizumoto, S. Shimizu, S. Aishima, M. Tanaka. Department of Surgery and Oncology Kyushu University, Department of Anatomic Pathology, Kyushu University, Japan Background: Laparoscopic surgery is now widely accepted even on pancreatic diseases. Laparoscopic tumor enucleation or local resection on
P238. Functional loss to anatomical loss of b cells in chronic pancreatitis: Is it a continuum? R. Talukdar, M. Sasikala, G. Radhika, P. Pavan Kumar, G.V. Rao, R. Pradeep, D.N. Reddy. Asian Institute of Gastroenterology, Hyderabad, India
Abstracts / Pancreatology 13 (2013) e1–e94
differentiated tubular adenocarcinoma was detected in two patients, moderately differentiated tubular adenocarcinoma in 13 patients and poorly differentiated tubular adenocarcinoma in one. Two patients were classified into Stage IA, 2 patients IB, 7 patients IIA and 5 patients IIB. In the treatment for the remnant pancreatic cancer, 8 patients underwent total excision of the remnant pancreas, 4 patients received chemotherapy and 4 patients received best supportive care. The mean time to the treatment for the remnant pancreas was 83 months (range, 29-240). The pathological findings of the remnant pancreas in the 8 resected cases were PDAC with 6 patients and malignant IPMN with 2 patients. Five patients who underwent total excision of the remnant pancreas were alive, but remained 11 patients were dead. Conclusions: The long-term survivors after curative resection for the pancreatic cancer should be paid attention to the remnant pancreas and the aggressive resection of the remnant pancreas or total pancreatectomy at the first operation should be considered for more favorite prognosis of the PDAC.
pancreatic tumor is ultimate less invasive pancreatic surgery, though its indication is limited. We review our series of patients underwent laparoscopic local resection on pancreatic diseases. Patients and methods: Eleven patients underwent laparoscopic local resection between 2007 and 2011 were reviewed. Results: Laparoscopic resection was comleted in 10 patients (91%). Of the 11 patients, 7 had neuroendocrine tumors (NETs), 2 had solid and pseudo papillary tumor (SPT) and 1 had mucinous cystic neoplasm (MCN). Mean tumor size was 21.2 mm (8-45). In one patient preoperatively diagnosed as NET by EUS guided fine needle aspiration cytology, tumor could not be detected even converted to open laparotomy. In another patient diagnosed as NET (Insulinoma), resected tumor was non functioning NET and hypoglycemia last even after resection. All the resected NETs were diagnosed as G1 according to WHO classification. Grade B pancreatic fistula was occurred in one patients (9.0%) and cured by endoscopic naso-pancreatic drainage (ENPD). Conclusions: Laparoscopic enuleation is a good option for benign or borderline disease located on the surface of the pancreas. Especially with NETs, preoperative diagnosis and intraoperative detection of the tumor is important. ENPD is useful for management of postoperative pancreatic fistula.
P235. In vitro assessment of a superparamagnetic iron oxide nanoparticle for targeting pancreatic cancer cells P. Sykes 1, C. Olariu 2, E. Hasan 2, D. Lydon 2, C. Rubbi 1, J. Neoptolemos 1, E. Costello 1, M. Rosseinsky 2, C. Halloran 1. 1 Department of Molecular and Clinical Cancer Medicine, University of Liverpool, UK 2 Department of Chemistry, University of Liverpool, UK Introduction: Despite advances in the surgical management of pancreatic cancer, particularly adjuvant chemotherapy, pancreatic cancer continues carry a poor prognosis. Nanotechnology offers the possibility of patient targeted therapy while providing novel methods of drug delivery. Aim: To develop an iron oxide-based nanoparticle capable of targeting pancreatic cancer cells in vitro through the use of a targeting antibody and an external magnetic field. Methods: Nanoparticles (NPs) were manufactured by coating 6nm diameter iron oxide cores in a novel polyoxazoline (POZ) polymer and conjugated with a rhodamine fluorophore for tracking. BxPC-3 pancreatic cancer cells were cultured in the presence of an external magnetic field and the rate of uptake assessed using fluorescent microscopy. A targeting anti-CA19.9 (NP:CA19.9) or isotype control (NP:Iso) antibody was then conjugated to the particles and the rate of uptake measured in a similar fashion in BxPC-3 cells (CA19.9 expressing). Results: In the presence of a magnetic field, NP uptake was significantly increased after 2 hours compared to uptake in the absence of a magnetic field (mean intensity 49.8AU, 95%CI 19.4-77.8 vs 1.7AU, 95%CI 0-3.70; p<0.01). NP:CA19.9 particles demonstrated increased cellular uptake at 2 hours when compared to NP:Iso (mean intensity 9.83AU, 95%CI 6.21-13.52 vs 0.14AU, 95%CI 0.01-0.27; p<0.01). Conclusions: We have developed a novel iron oxide based nanoparticle capable of multi-modal targeting of pancreatic cancer cells through the conjugation of an antibody and the use of an external magnetic field. This provides a stable platform on which to build a drug delivery vehicle, capable to targeting specific tissues and delivering chemotherapy agents directly into the cells, therefore reducing the offtarget effects often associated with these drugs.
P237. Pancreatic duct decompression improves pancreatic blood perfusion Y. Takeyama 1, T. Yasuda 1, T. Nakai 1, T. Murakami 2. 1
Department of Surgery, Kinki University Faculty of Medicine, Osakasayama, Osaka, Japan 2 Radiology, Kinki University Faculty of Medicine, Osaka-sayama, Osaka, Japan Background & aim: Obstructive pancreatitis is defined as pancreatitis due to obstruction of the main pancreatic duct. It is characterized by evenness of changes in the lesion and reversibility after release of obstruction. After the obstruction, not only exocrine but endocrine function is impaired and insulin-dependent diabetes is complicated. Some investigators reported that pancreatic ischemia is associated with experimental obstructive pancreatitis, and is improved by pancreatic duct decompression. In this paper, we examined pancreatic perfusion clinically before and after the surgical pancreatic decompression. Methods: Two clinical cases were examined. Both of them were alcoholic chronic pancreatitis characterized by the incarcerated obstruction of main pancreatic duct by single stone. In both cases, decompression of the pancreatic duct was achieved by pancreaticojujunostomy. Pancreatic blood perfusion was evaluated by perfusion CT technique using GE Light Speed VCT VISION (64ch), and the data was analyzed by deconvolution method. Pancreatic blood perfusion was evaluated pre and postoperatively, and postoperative evaluation was performed 1 month after the operation. Results: Blood flow in the pancreatic gland affected by obstructive pancreatitis was increased 4.3 and 5.7 folds by pancreatic duct decompression in each case. Blood volume was also increased 12.3 and 15.6 folds, and mean transit time was also increased 2.1 and 2.1 folds in each case. Discussion: We have confirmed clinically using perfusion CT technique that decreased pancreatic blood perfusion can be improved by pancreatic duct drainage in obstructive pancreatitis. After pancreaticojejunostomy, pancreatic perfusion was strikingly increased. In both cases, endocrine function was also improved. Pancreatic damage due to the elevation of intraductal pressure is assumed to be partly derived from pancreatic ischemia.
P236. Laparoscopic local resection of pancreatic tumor S. Takahata, T. Otsuka, J. Ueda, K. Mizumoto, S. Shimizu, S. Aishima, M. Tanaka. Department of Surgery and Oncology Kyushu University, Department of Anatomic Pathology, Kyushu University, Japan Background: Laparoscopic surgery is now widely accepted even on pancreatic diseases. Laparoscopic tumor enucleation or local resection on
P238. Functional loss to anatomical loss of b cells in chronic pancreatitis: Is it a continuum? R. Talukdar, M. Sasikala, G. Radhika, P. Pavan Kumar, G.V. Rao, R. Pradeep, D.N. Reddy. Asian Institute of Gastroenterology, Hyderabad, India