Background: The aim of this study was to evaluate whether our standardized procedure with mesh-reinforced stapler (Endo-GIA TM with Tri-Staple TM technology; black reload; 60-m long; Covidien) can reduce the incidence of postoperative pancreatic fistula (POPF) after distal pancreatectomy. Methods: A total of 60 patients underwent mesh-reinforced stapled distal pancreatectomy at our institute from July 2016 to November 2019. Laparoscopic distal pancreatectomy was performed in 43 (71.7%) patients. The incidence of clinically relevant POPF (grade B or C based on the International Study Group on Pancreatic Fistula criteria) was retrospectively analyzed. Surgical procedures: The pancreatic parenchyma was transected by stapler on the transection line with safety margin from the lesion. The closure jaw was carefully clamped over a 1-min period at a fixed speed. The stapler was slowly fired over a 6-min period and then released. Careful, gentle handling of the stapler was required during transection of the pancreatic parenchyma. A closed-suction drain was always placed near the stump of the remnant pancreas. Results: The median operative time was 274min (133-585), and median operative blood loss was 170g (1-2519). The incidence of clinically relevant POPF occurred in 4 patients (6.7%). We have never experienced POPF grade C. The major morbidity rate (Clavien-Dindo classification grade !III) occurred in 7 patients (15%). Complications other than POPF grade B occurred in 3 patients (ileus, n=2; delayed gastric emptying, n=1). No surgical mortality or inhospital death occurred in this study. Conclusions: Our standardized technique with mesh-reinforced stapler can reduce clinically relevant POPF after distal pancreatectomy.
Objectives: Cancer-derived immunoglobulin G (CIgG) is a novel molecule plays important roles in carcinogenesis. Previous studies showed that the expression of CIgG was closely related to tumor differentiation of pancreatic cancer. This study aimed to evaluate the expression and potential significance of CIgG in intraductal papillary mucinous neoplasms (IPMNs) of the pancreas. Methods: Eighty-eight pathological tissues diagnosed with different grades of IPMN were enrolled in the study. The expression of CIgG was assessed by immunohistochemistry. ROC analysis was used to test CIgG's significance in the differential diagnosis between LG-IPMN patients and HG/inv-IPMN patients Results: CIgG was expressed in both IPMN and pancreatic ductal adenocarcinoma, but not expressed in normal pancreas tissue. The expression of CIgG was significantly elevated during the malignant progression of IPMN (LG-IPMN vs. HG-IPMN, P=0.001; HG-IPMN vs. inv-IPMN, P=0.004; LG-IPMN vs. inv-IPMN, P< 0.001). The AUC for CIgG expression was 0.765 (95% confidence interval (CI), 0.663-0.849; P< 0.001). The sensitivity and specificity of CIgG in discriminating LG-IPMN from HG/inv-IPMN was 61.4% (95% CI 0.455 to 0.756) and 90.9% (95% CI 0.783 to 0.975), respectively. Conclusions: This study demonstrates that CIgG participates in the malignant progression of IPMN and could serve as a potential diagnostic biomarker for IPMN.
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