Caveolin-1-ROS feedforward in PSC induces stroma-tumor metabolic coupling in pancreatic cancer

Objective: To investigate the clinical application of binding pancreaticogastrostomy (BPG) anastomosis in medial pancreatectomy(MP). Methods: The clinical data of 62 patients with benign and low-grade malignant lesions in neck and body of pancreas who received medial pancreatectomy combined with binding pancreaticogastrostomy anastomosis from January 2010 to October 2014 were retrospectively analyzed. MP: Several surgical approaches were combined used to finish the pass-through of the neck of pancreas as the common hepatic artery, portal vein, superior mesenteric vein and splenic vein for the anatomic axis. The pancreas was transected apart from the tumor 1 cm. The proximal stump was closed by interrupted sutures after the main pancreatic duct was ligated. Dissecting the tumor-burdened pancreas and ligating the branch vessels between the splenic vessels and pancreas exactly. After identification of the distal main pancreatic duct, a stent was implanted and fixed. BPG: The reconstruction began with a mobilization of distal pancreatic stump for 3-4cm. After evaluating the size and position of pancreatic stump, a purse-string suture was preset around the sero-muscular layer of the posterior gastric wall. A small gastrostomy was performed in this area with a size equivalent to accommodate the pancreatic stump. An incision was made at the anterior gastric wall. The pancreas remnant was pulled into the gastric cavity. The purse-string, as the outer binding, was tied just enough for anastomosis and the endogastric mucosa and pancreatic capsule were interrupted sutured. The incision on the anterior gastric wall was closed with a closure device. Results: Operation was successfully performed on all patients. The mean operation time was 155 min, the mean blood loss was 300 ml and the mean postoperative length of hospital stay was 10.5 days. 6 patients had postoperative pancreatic fistula (2 were Grade B and 4 were Grade A). The follow-up range time was 3 ~ 36 months. None of the 62 patients were found to have pancreatic endocrine or exocrine insufficiency or formation of pseudo pancreatic cyst. Conclusion: Medial pancreatectomy showed trauma little, quick recovery and maximum protection the pancreatic exocrine and endocrine function which should be realized as a preferred treatment for pancreas injury and the benign or low-grade malignant tumor in neck and body of pancreas. Binding pancreaticogastrostomy anastomosis could effectively reduce the incidence of pancreatic fistula which should be a ideal reconstruction mode in medial pancreatectomy.