ObjectiveThe authors evaluated the rationale for and feasibility of gastroduodenal artery preservation in pylorus-preserving pancreatoduodenectomy (PPPD) for periampullary cancer in which the pancreatic remnant maintains a normal function and morphologic characteristics. Summary Background DataPylorus-preserving pancreatoduodenectomy has become one of the standard treatments used for benign and malignant diseases of the pancreatoduodenal region, surpassing ordinary pancreatoduodenectomy in terms of technical ease, mortality rate, and postoperative nutrition. Pylorus-preserving pancreatoduodenectomy is usually associated with gastroduodenal artery division, which presents potential risks of insufficient duodenal vascularity and lethal postoperative bleeding from the gastroduodenal artery stump. The latter complication particularly occurs after resection of bile duct or ampullary cancer in a patient whose pancreas remains functionally and morphologically normal to have much more pancreatic secretion than the fibrotic pancreas seen in pancreatic cancer. According to the authors' data on the volume of secretion from the residual pancreas via a stent tube after pancreatoduodenectomy, the sclerotic pancreas, as seen in cancer of the pancreatic head, secretes only 20 to 50 mL/day, whereas the secretion from the soft pancreas, as seen in bile duct cancer, amounts to 300 to 600 mL/day, even during the period of nothing by mouth. MethodsRetrospectively, we made a histopathologic study of eight specimens of distal bile duct and ampullary cancer resected by pancreatoduodenectomy or PPPD with gastroduodenal artery division. Prospectively, we performed gastroduodenal artery-preserving PPPD for 10 patients with distal bile duct, ampullary, and islet cell cancers. ResultsThe histopathologic study revealed no invasion or metastasis around the gastroduodenal artery. Clinical application of gastroduodenal artery-preserving PPPD showed no technical difficulty, and neither severe complications nor recurrence around the gastroduodenal artery were observed for up to 22 months after surgery. ConclusionsGastroduodenal artery-preserving PPPD might be recommended as a safe procedure for patients who have a functionally and morphologically normal pancreas. 194

ObjectiveTo evaluate the role of human macrophage metalloelastase (HME) in pancreatic cancer. Summary Background DataHME, a member of the human matrix metalloproteinase family, possesses elastolytic activity and is critical for the degradation of extracellular matrix proteins. Inasmuch as tumor invasion and metastasis formation require lysis of extracellular matrix, HME plays a critical role in both processes. MethodsHME expression was analyzed by Northern blot analysis, reverse transcriptase-polymerase chain reaction, Western blot analysis, and immunohistochemistry in 39 pancreatic cancer tissues and 13 normal controls. The molecular data were related to clinicopathologic parameters and patient survival. ResultsIn human pancreatic cancer, overexpression of HME mRNA was present in 25 of 39 pancreatic cancer tissues (64%) and in five pancreatic cancer cell lines. In contrast, low levels of HME mRNA expression were present in 13 normal pancreatic tissues samples. By Western blot analysis, high levels of HME were found in pancreatic cancer tissues and in the pancreatic cancer cell lines compared with the normal controls. Fifty-six percent of the cancer samples exhibited HME immunoreactivity in the cancer cells, and 63% in the stromal cells. Analysis of the survival data revealed that patients whose tumors exhibited HME mRNA overexpression lived significantly shorter compared with patients whose tumors did not overexpress HME. No relationship between HME expression and tumor stage, tumor grading, or presence of lymph node metastases was found. ConclusionsThese findings indicate that HME participates in pancreatic cancer progression and that its presence worsens the prognosis. These data suggest a benefit of its inhibition in the treatment of pancreatic cancer.

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KONDO1)Recently work rolls for cold rolling mill have been required for higher toughness because of

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