Minimally Invasive Treatment for Severe Acute Pancreatitis With Superior Mesenteric Vein and Common Bile Duct Stenosis

Abstract

showing a wide range in the CEA values (from 0.2 to 4400). Cytokines were quantified, and those demonstrating statistical significance between the groups are presented in Figure 1. The cytokines for NM samples were IL-1α and IL-5, and M samples were IL-10 and GM-CSF. Interleukin-1α has been reported to have antitumor activity where IL-1αexpressing tumor cells fail to initiate tumor development or block progression in mice. Interleukin-1α directly activates the antitumor activity of CD8+ T cells. Consistent with these observations, our results showed the significantly higher secretion of IL-1α in NM cysts when compared with the M group. The accumulation of inflammatory stimuli, including IL-1α, can be correlated with the benign formation of a cyst but also with stalled cancer progression. This cytokine facilitates interactions between malignant and immune effector cells that bear IL-1Rs promoting apoptosis of malignant cells. Furthermore, our results showed a significantly higher concentration of IL-5 in the NM group that also could be correlated to antitumor activity. Eosinophils, the main cells involved in IL-5 production, can serve as accessory cells for the attraction of tumor-specific CD8+ T cells and macrophages. Interleukin-5 promotes an immunosuppressive environment by inducing apoptosis and tumor hypoxia. In addition, we also detected 2 cytokines that were secreted in significantly higher levels in the M group. Our results suggest that IL-10 and GM-CSF could assist in diagnosing or monitoring malignant transformation of mucinous cysts because their concentration was significantly higher than in the NM group. These results align with previous studies on IL-10 in several types of cancers because it polarizes T-cell responses toward the Th2 phenotype while suppressing antigen-presentation and Th1 response. Furthermore, GM-CSF is produced by T cells and has been used to predict survival in patients with resectable pancreatic adenocarcinoma, as high plasma levels of this cytokine were significantly associated with shorter patients survival after surgery. In conclusion, this study demonstrated that selective cytokines measured in pancreatic cyst fluid appear to be able to differentiate mucinous from nonmucinous cysts and may possibly be predictive of the malignant potential in mucinous pancreatic cysts. The measurement of these cytokines could represent a significant advantage over current protocols for assessment of pancreatic cysts, thus preventing unnecessary resections. Our pilot study shows a significant correlation between the cytokines identified for each cyst group, but a larger prospective trial will be needed to determine sensitivity/