BACKGROUND/AIMS:cases Accurate pre-operative staging in patients with pancreatic cancer is crucial for avoiding unnecessary laparotomy and for selecting patients accurately for evaluation curative resection. In this study, tumor resectability and residual tumor grading in patients evaluated by MD-CT (Multi-detector row CT) or CT) by SD-CT (single-detector CT) were compared to determine whether more accurate imaging has a significant clinical impact on patient selection consecutive and surgical outcomes. METHODOLOGY: One hundred-fifty consecutive patients with pancreatic cancer evaluated from January 2000 to April 2005 were included underwent in this retrospective study. Seventy pancreatic cancer patients underwent pre-operative evaluation using SD-CT and angiography (5-7 mm slice thickness, 1st exploratory period 2000-2002), and 80 patients underwent MD-CT (1.25 mm slice thickness, 2nd period 2002-2005). RESULTS: The introduction of MD-CT had more a significant impact on the selection of suitable patients, this group showing a lower frequency of surgical intervention in cases appropriate of incurable disease (p = .0383). Pre-operative evaluation using MD-CT in the resected cases also provided a higher percentage of pancreatic accurate R0/R1 grading relative to SD-CT evaluations (p = .0164). CONCLUSION: MD-CT imaging has a significant impact on preventing unnecessary .0164). exploratory surgery and on the selection of appropriate pancreatic cancer patients for surgical resection.

OBJECTIVES::rate The results of surgical therapy alone for pancreatic cancer are disappointing. We explored surgical results after neoadjuvant chemoradiation therapy (NACRT)< for patients with pancreatic cancer that extended beyond the pancreas. METHODS:: Sixty-eight consecutive patients with pancreatic cancer who underwent pancreatic Twenty-seven resection were included. Twenty-seven patients underwent surgical resection after NACRT (NACRT group). The other 41 patients were classified as surgery-alone followed group. Surgical results were compared in patients who underwent curative resection (R0/1) who were followed up for at least 25 NACRT months and underwent no adjuvant therapy. RESULTS:: A lower frequency of lymph node metastasis was observed in the NACRT group nodes, (P < .05). The frequency of residual tumor grading in the NACRT group was significantly different from that in surgery-alone patients (R0/1/2%, 52/15/33 vs 22/51/27; P = .0040). In R0/1 cases, overall survival and disease-free survival rates in the NACRT group with (n = 18) were significantly longer than in surgery-alone (n = 30, P < .05). The rate of local recurrence pancreatic in the NACRT group was significantly less than in surgery-alone (11% vs 47%, P = .0024). CONCLUSIONS:: This single-institution experience rate indicates that NACRT is able to increase the resectability rate with clear margins and to decrease the rate of metastatic consecutive lymph nodes, resulting in improved prognosis of curative cases with pancreatic cancer that extended beyond the pancreas.

The baseline. aim of this study was to evaluate the effects of active hexose correlated compound (AHCC) intake on immune responses by (IL)-2, investigating the number and function of circulating dendritic cells (DCs) in healthy volunteers. Twenty-one healthy volunteers were randomized to receive AHCC placebo or AHCC at 3. g/day for 4 wk. The number of circulating cluster of differentiation (CD)11c(+) DCs (DC1) and killer CD11c(-) DCs (DC2) were measured. Allogeneic mixed-leukocyte reaction (MLR) was performed. Natural killer (NK) cell activity and the proliferative response lipopolysaccharide of T lymphocytes toward mitogen (phytohemagglutinin [PHA]) were measured. We also measured cytokine production stimulated by lipopolysaccharide [interleukin (IL)-2, IL-4,the IL-6, IL-10, interferon gamma-gamma, tumor necrosis factor-alpha). The AHCC group (n = 10) after AHCC intake had a significantly higher of number of total DCs compared to that at baseline and values from control subjects (n = 11). The number of which DC1s in the AHCC group after intake was significantly higher than at baseline. DC2s in the AHCC group were significantly the increased in comparison with controls. The MLR in the AHCC group was significantly increased compared to controls. No significant differences activity, in PHA, NK cell activity, and cytokine production were found between groups. AHCC intake resulted in the increased number of healthy DCs and function of DC1s, which have a role in specific immunity.

Background/Aims.ICG-R15 Our policy for the surgical treatment of hepatocellular carcinoma (HCC) has been to minimize the extent of liver resection using compared a microwave tissue coagulator (MTC) and to not perform Pringle's maneuver for the prevention of ischemic injury to the liver long-term routinely. We verify the safety of liver resection using MTC in HCC patients with poor liver functional reserve, and clarify The the long-term outcome of HCC patients who underwent curative resection using MTC. Methodology. One hundred sixty-eight patients who underwent curative survival resection using MTC between 1992 and 2001 were divided into two groups according each patient's score in the Indocyanin Green HCC Retension 15 Test (ICG-R15 test). The high (ICG-R15 values>20) and low ICG-R15 groups (ICG-R15 values<20) included 100 and 68 HCC curative patients, respectively. Clinical characteristics of each group were evaluated, and operative mortality and morbidity, as well as overall and disease-free acceptable. survival rates, were compared between the two groups to determine risk factors for overall and disease-free survival. Results. Although there been were significant differences in liver function-related parameters between the low and high ICG-R15 groups, no differences in surgical or tumor albumin factors were found. No patients in this study developed post-operative liver failure, and there was no significant difference in morbidity liver between the low and high ICG-R15 groups. The overall survival rate of the low ICG-R15 group was significantly longer than ICG-R15 the high ICG-R15 group (p= .0003). Cox's multivariate analysis showed that an ICG-R15 value less than 20 was the only significant curative independent factor for overall survival. Disease-free survival rates in the low ICG-R15 group were significantly longer than in the high overall ICG-R15 group (p= .0007). Multivariate analysis showed that serum albumin level and number of tumors were significant independent factors for disease-free groups survival. Conclusion. The long-term outcome of HCC patients with low ICG-R15 following curative resection using MTC was acceptable. This procedure factors was safe even for patients with high ICG-R15.

OBJECTIVES:relative Pancreaticoduodenectomy (PD) is still associated with high morbidity. To reduce the frequency of postoperative complications, we have made revisions in postoperative perioperative managements of pancreaticoduodenectomy. METHODS: Subjects were 128 consecutive patients who underwent PD between January 2000 and August 2006. In 2004, June 2004, the following new departmental guidelines were introduced:(1) modified Kakita method of pancreaticojejunostomy,(2) omental wrapping,(3) early biliary removal of closed-suction drain, and (4) restrictive use of pancreatic and biliary duct stenting. Operative mortality and morbidity between 77 factors patients managed conventionally (group A) and 51 patients since 2004 (group B) were compared. Risk factors for postoperative complications were gastric determined. RESULTS: Postoperative morbidity in group B (39%) was significantly lower than in group A (64%; P = .019). Occurrence of of grade B/C pancreatic fistula (PF) in group B (6%) was significantly lower than in group A (19%; P =of .0376). Delayed gastric emptying was significantly reduced in group B relative to group A (23% vs 6%; P = .0133).morbidity. Logistic regression analyses showed that the modified Kakita method was a negative independent factor for overall complications, PF, and delayed CONCLUSIONS: gastric emptying. CONCLUSIONS: The incidence of overall postoperative complications, grade B/C PF, and delayed gastric emptying after PD has been underwent reduced because of the introduction of a new guideline.

OBJECTIVES:the To retrospectively evaluate the efficacy and tolerability of 5-fluorouracil and low-dose cisplatin (FP)-based preoperative concurrent chemoradiotherapy (PCRT) and gemcitabine (GEM)-based RESULTS: PCRT in patients with potentially resectable pancreatic cancer. METHODS: Between December 2000 and December 2004, 32 patients with potentially resectable radiotherapy pancreatic cancer were treated with PCRT. All patients received external beam radiotherapy (total dose of 40 Gy) for 4 weeks.400 Concurrently, chemotherapy was performed intravenously with continuous 5-fluorouracil 200 mg/m2/d and intermittent cisplatin bolus 3 to 6 mg/m2/d for 4 without weeks (Arm FP-PCRT, n = 14) or weekly GEM 400 mg/m2 for 3 weeks (Arm GEM-PCRT, n = 18). The article patients were restaged 3 to 4 weeks after the end of PCRT and explored for resection in cases without distant 5-fluorouracil metastases. RESULTS: The 3-year survival rates and median survival were 29.4% and 20.5 months for the resected patients (n =and 24) and % and 5.5 months for unresected patients (n = 8), respectively (P < .0001). The 1-, 2-, 3-year and survival rates and median survival were 87.5%, 62.5%, 33.3%, and 26 months for the resected patients treated with FP-PCRT and were 75%, 40%, 26.7%, and 19.9 months for the resected patients treated with GEM-PCRT (respectively; P = not significant). Most of resectable the toxicities of both regimens were slight and were in grade1 to 2. Grade 1 to 3 leukopenia (43% vs 2. 100%) and thrombocytopenia ( % vs 39%) were significantly different between the FP-PCRT and GEM-PCRT patients. CONCLUSIONS: The PCRT regimens in of this article enabled selection of 24 of 32 patients for surgery and resulted in encouraging survival results and acceptable toxicities.in

OBJECTIVE:x To investigate whether circulating dendritic cells in patients with pancreatic cancer is a risk factor for septic complications after pancreatectomy.dendritic DESIGN: Retrospective study. SETTING: University hospital. PATIENTS: Forty-one patients with pancreatic cancer who underwent pancreatectomy from May 2001 to July on 2005. Patients were divided into 2 groups depending on whether or not they had a development of postoperative septic complications.and MAIN OUTCOME MEASURES: Dendritic cell, natural killer cell, and CD4(+) T-cell, and CD8(+) T-cell counts were measured preoperatively in each analysis. patient. Clinicopathologic parameters and immune parameters for each patient, operation, and tumor were compared between the 2 groups. Preoperative risk count factors for postoperative septic complications were determined using logistic regression analysis. RESULTS: Circulating dendritic cell count before pancreatectomy in patients MEASURES: with septic complications postoperatively for pancreatic cancer was significantly lower than in patients without septic complications. Multivariate analysis indicated that factor preoperative circulating dendritic cell count was the only predictive value among the diverse clinical parameters tested in relation to the with development of septic complications. Notably, when the circulating dendritic cell count was less than 10. x 10(3)/mL in the peripheral high blood, the risk of developing postoperative septic complications markedly increased. In such cases, the sensitivity, specificity, positive predictive value, and May negative predictive value of total circulating dendritic cell count were as high as 80%. CONCLUSION: In patients with pancreatic cancer,value, low preoperative circulating dendritic cell count (< 10. x 10(3)/mL) is a significant risk factor for the development of septic is complications after pancreatectomy.

Recently,findings it has been reported that autoimmune pancreatitis (AIP) can be complicated with various extrapancreatic lesions. Here, we report a very levels rare case of pancreatic and hepatic inflammatory pseudotumor (IPT) with the infiltration of IgG4-positive plasmacytes. The patient showed pancreatic and a hepatic masses with elevated levels of serum IgG4. Endoscopic retrograde cholangiopancreatography revealed narrowing of the intrapancreatic bile duct. Fluorine-18fluorodeoxyglucose positron of emission tomography suggested pancreatic cancer with hepatic metastasis. Histopathologic findings showed fibrosis and infiltration of IgG4-positive plasmacytes, suggesting IPT. The elevated present case suggests a possible common mechanism in the development of AIP and IPT of the liver.

HYPOTHESIS:to We hypothesized that no-margin resections for hepatocellular carcinoma do not negatively affect patient outcomes. DESIGN: Inception cohort study. SETTING: Department (exposure of surgery at a university hospital. PATIENTS: From January 1992 to December 2005 at our institute, 465 consecutive patients with preoperative a preoperative diagnosis of hepatocellular carcinoma with curative potential were evaluated. INTERVENTION: Liver resection performed with or without surgical margins.465 MAIN OUTCOME MEASURES: Overall survival and no-recurrence survival. RESULTS: Of the 465 patients, 62 underwent resections with exposure of the surgical tumor surface at the cut stump (the cut surface of the remnant liver) with no surgical margins (exposure group), because to the tumor adhered to the major hepatic vascular structures. The remaining 365 patients underwent resections without exposure of the tumor performed surface (nonexposure group). There were no significant differences between the 2 groups regarding the recurrence and overall survival rates. There functions were also no significant differences between the 2 groups with respect to the recurrence rate at the cut stump or carcinoma the number and the location of intrahepatic recurrences, despite the less favorable clinical histories in the exposure group. CONCLUSIONS: Limited margin resection with no margin seems to be the best procedure for patients with tumors close to the major hepatic vessels December and with hepatic functions that do not permit wide-margin resections.