Resection of the mesopancreas (RMP): a new surgical classification of a known anatomical space

BACKGROUND: Prognosis after surgical therapy for pancreatic cancer is poor and has been attributed to early lymph node involvement as well as to a strong tendency of cancer cells to infiltrate into the retropancreatic tissue and to spread along the peripancreatic neural plexuses. The objective of our study was to classify the anatomical-surgical layer of the mesopancreas and to describe the surgical principles relevant for resection of the mesopancreas (RMP). Immunohistochemical investigation of the mesopancreatic-perineural lymphogenic structures was carried out with the purpose of identifying possible routes of metastatic spread. METHODS: Resection of the mesopancreas (RMP) was performed in fresh corpses. Pancreas and mesopancreas were separated from each other and the mesopancreas was immunohistochemically investigated. RESULTS: The mesopancreas strains itself dorsally of the mesenteric vessels as a whitish-firm, fatty tissue-like layer. Macroscopically, in the dissected en-bloc specimens of pancreas and mesopancreas nerve plexuses were found running from the dorsal site of the pancreatic head to the mesopancreas to establish a perineural plane. Immunohistochemical examinations revealed the lymphatic vessels localized in direct vicinity of the neuronal plexuses between pancreas and mesopancreas. CONCLUSION: The mesopancreas as a perineural lymphatic layer located dorsally to the pancreas and reaching beyond the mesenteric vessels has not been classified in the anatomical or surgical literature before. The aim to ensure the greatest possible distance from the retropancreatic lymphatic tissue which drains the carcinomatous focus can be achieved in patients with pancreatic cancer only by complete resection of the mesopancreas (RMP)

The effect of interaction between hepatitis C virus and cigarette smoking on the risk of hepatocellular carcinoma

We evaluated the interaction between hepatitis C virus (HCV) and cigarette smoking on death from hepatocellular cancer in The Japan Collaborative Cohort Study. The odds ratio of death from HCC for smoking was 9.60 (1.50–61.35) and 1.71(0.58–5.08) among anti-HCV positive and negative individuals, respectively

Is adjuvant chemotherapy by continuous infusion 5-fluorouracil plus daily low dose cisplatin useful in advanced (stageIV) pancreatic cancer ?

Thirty-five patients were analyzed in this study to elucidate the usefulness of adjuvant chemotherapy by continuous infusion of 5-fluorouracil plus daily low-dose cisplatin after resection in advanced (stage IV) pancreatic cancer. The patients were divided into 3 groups : 8 patients were treated with the above therapy (group A), 16 patients with conventional chemotherapy (group B), and 11 patients received no chemotherapy whatsoever (group C). Mean survival time was longer in group A than in group B and C. These results were remarkable given that the patients had been diagnosed as stage IVb and curability C. Al-though the occurrence of adverse effects was higher in group A, none of them were severe. We conclude in this retrospective study that continuous infusion of 5-fluorouracil plus daily low-dose cisplatin is effective adjuvant chemotherapy in the treatment of advanced cancer of the pancreas. Therefore, the prospective trial will be necessary in near future

A case of giant hepatic hemangioma with spontaneous intratumoral bleeding

Cavernous hemangioma is the most common benign tumor of the liver, and most of them remain asymptomatic. However, a giant hemangioma may rupture spontaneously and present severe complications such as shock and anemia, and need emergency operation. We report a case that spontaneous intratumoral bleeding of a giant hemangiona of the liver that occurred in a 55-year-old woman. She presented with severe abdominal pain, anemia, and shock at 3 and a half years after a transcatheter arterial embolization (TAE) treatment. Although the bleeding was under control, a surgical procedure was considered to reduce the risk for rerupture. The general outcome of surgical treatment for giant hemangiomas is satisfactory. In contrast, especially in our case. TAE was unable to reduce the risk of rupture over the long term. Therefore, surgery for giant hemangioma of the liver should be considered as the first treatment to avoid the risk of rupture even in "healthy" case