Sachio Terai

Application of the two-layer method on pancreas digestion results in improved islet yield and maintained viability of isolated islets

Background. Oxygenation of the pancreas during preservation by the two-layer method (TLM) has shown beneficial effects in islet transplantation. Here, we apply this concept (oxygenation) to the isolation process. Methods. Rat pancreases were digested using four different methods. Pancreases were digested with preoxygenated perfluorocarbon (PFC) in group 2 and without it in group 1. Additionally, adenosine was included in the collagenase solution in subgroups B but not in subgroups A. Islet yields and viability were compared between groups. Results. Tissue oxygen tension in group 1 was essentially zero during digestion, but rapidly reached around 300 mm Hg and was maintained in group 2. The tissue adenosine triphosphate (ATP) level in rat pancreas just after laparotomy (control) was 4.2±0.7 &mgr;mol/g dry weight; after digestion, it was 0.12±0.03 &mgr;mol/g, 0.70±0.10 &mgr;mol/g, 0.30±0.18 &mgr;mol/g, and 2.90±0.80 &mgr;mol/g in groups 1A, 1B, 2A, and 2B, respectively. No significant differences were observed between group 2B and control (P=0.19). Islet yields (IEQ/pancreas) were 1600±400, 1400±400, 1300±400, and 2400±100 in groups 1A, 1B, 2A, and 2B, respectively. The islet yield of group 2B was significantly higher than other groups (P<0.05). The cure rate after transplanting 200 islets into athymic nude mice did not differ (80% in all groups). The stimulation indices in the four groups were also the same. Conclusions. Tissue ATP levels after digestion were well maintained using TLM with adenosine digestion method. Consequently, greater numbers of islets could be retrieved. The new method was at least equivalent to islet function isolated by conventional method. Clinical study is therefore warranted.

Second primary pancreatic ductal carcinoma in the remnant pancreas after pancreatectomy for pancreatic ductal carcinoma: High cumulative incidence rates at 5 years after pancreatectomy

OBJECTIVES The aim of this study was to determine the incidence rate and clinical features of second primary pancreatic ductal carcinoma (SPPDC) in the remnant pancreas after pancreatectomy for pancreatic ductal carcinoma (PDC). METHODS Data of patients undergoing R0 resection for PDC at a single high-volume center were reviewed. SPPDC was defined as a tumor in the remnant pancreas after R0 resection for PDC, and SPPDC met at least one of the following conditions: 1) the time interval between initial pancreatectomy and development of a new tumor was 3 years or more; 2) the new tumor was not located in contact with the pancreatic stump. We investigated the clinical features and treatment outcomes of patients with SPPDC. RESULTS This study included 130 patients who underwent surgical resection for PDC between 2005 and 2014. Six (4.6%) patients developed SPPDC. The cumulative 3- and 5-year incidence rates were 3.1% and 17.7%, respectively. Four patients underwent remnant pancreatectomy for SPPDC. They were diagnosed with the disease in stage IIA or higher and developed recurrence within 6 months after remnant pancreatectomy. One patient received carbon ion radiotherapy and survived 45 months. One patient refused treatment and died 19 months after the diagnosis of SPPDC. CONCLUSIONS The incidence rate of SPPDC is not negligible, and the cumulative 5-year incidence rate of SPPDC is markedly high. Post-operative surveillance of the remnant pancreas is critical for the early detection of SPPDC, even in long-term survivors after PDC resection.

Effect of Oxygenated Perfluorocarbon on Isolated Islets During Transportation

BACKGROUND Previous studies demonstrated the efficacy of the two-layer method (TLM) using oxygenated perfluorochemicals (PFC) for pancreas preservation. The current study investigated the effect of oxygenated PFC on isolated islets during transportation. MATERIALS AND METHODS Purified rat islets were stored in an airtight conical tube for 24h in RPMI culture medium at 22 degrees C or University of Wisconsin solution (UW) at 4 degrees C, either with or without oxygenated PFC. After storage, the islets were assessed for in vitro viability by static incubation (SI), FDA/PI staining, and energy status (ATP, energy charge, and ADP/ATP ratio) and for in vivo viability by a transplantation study. RESULTS UW at 4 degrees C and RPMI medium at 22 degrees C maintained islet quality almost equally in both in vitro and in vivo assessments. The ATP levels and energy status in the groups with PFC were significantly lower than those without PFC. The groups with PFC showed a significantly higher ADP/ATP ratio than those without PFC. In the transplantation study, blood glucose levels and AUC in the UW+PFC group were significantly higher than those in UW group. CONCLUSIONS UW at 4 degrees C and RPMI medium at 22 degrees C maintained islet quality equally under the conditions for islet transportation. The addition of oxygenated PFC, while advantageous for pancreas preservation, is not useful for islet transportation.

Preoperative Oral Branched-Chain Amino Acid Supplementation Suppresses Intraoperative and Postoperative Blood Lactate Levels in Patients Undergoing Major Hepatectomy

BACKGROUND Lactate production is exacerbated by surgical stress. We sought to determine whether branched-chain amino acid (BCAA) supplementation could decrease blood lactate levels in patients undergoing hepatectomy. METHODS A total of 275 consecutive patients who underwent hepatectomy of ≥2 segments were retrospectively reviewed. Blood lactate levels in patients treated with BCAA supplementation before hepatectomy (December 2011 to December 2016) were compared with levels in patients who were not pretreated (January 2008 to November 2011). RESULTS Postoperative lactate levels were significantly lower in patients who received preoperative BCAA supplementation than in those who did not (2.6 vs 3.4 mmol/L; P < .001). Intraoperative blood lactate levels, which were evaluated after induction of general anesthesia, were also lower in those who received BCAA supplementation than in those who did not (1.1 vs 1.5 mmol/L, respectively; P < .001). A multiple regression analysis revealed that preoperative BCAA supplementation was independently associated with decreased postoperative and intraoperative lactate levels (P = .030 and P < .001, respectively). CONCLUSION Preoperative BCAA supplementation decreased intraoperative and postoperative blood lactate levels in patients undergoing major hepatectomy.

Effect of Oral Branched-Chain Amino Acid Supplementation on Postoperative Blood Lactate Levels in Patients Undergoing Pancreatoduodenectomy

BACKGROUND Elevations in blood lactate levels have been associated with poor postoperative outcome. The aim of the present study was to determine if preoperative supplementation with branched-chain amino acids (BCAA) decreases postoperative blood lactate levels in patients undergoing pancreatoduodenectomy. METHODS The cases of 223 consecutive patients who underwent pancreatoduodenectomy were retrospectively reviewed. Postoperative blood lactate levels in patients who were treated with BCAA supplementation before pancreatoduodenectomy (December 2011-December 2014) were compared with levels in patients who were not pretreated (January 2008-November 2011). RESULTS Postoperative lactate levels were significantly lower in patients who received preoperative BCAA supplementation than in patients who did not (2.6 vs 3.1 mmol/L, P = .005), although preoperative blood lactate levels were statistically equivalent between the groups. In the univariate analysis, preoperative BCAA supplementation, preoperative lactate levels, operation time, and postoperative glucose levels were associated with postoperative lactate levels. A multiple regression analysis was performed among the 4 factors, and the preoperative use of BCAA supplementation was independently correlated with postoperative lactate levels ( P = .046). CONCLUSIONS Preoperative BCAA supplementation decreased postoperative blood lactate levels. These results suggest that preoperative BCAA supplementation may help patients recover after surgery.

Surgical resection for liver metastases developing 10 and 21 years after primary surgery for mucinous colon adenocarcinoma: A Case Report

Abstract Introduction Optimal management for liver metastases from colorectal mucinous adenocarcinoma is still controversial. Here, we report such a case of liver metastases which developed twice with 10 year intervals after curative resection. Case presentation An 84-year-old man had undergone a radical left hemicolectomy for descending colon cancer at 63 years of age. The histopathological diagnosis was mucinous adenocarcinoma. Ten years later, he was found to have a cystic tumor in liver and underwent partial hepatectomy of segment 5. Moreover, eleven years later of hepatic resection, CT showed low density tumor with calcification in remnant liver and partial hepatectomy of segment 8 was performed. Histopathological and immunohistochemical findings of each liver tumor indicated metastasis from primary colon mucinous adenocarcinoma. It is rare that colorectal mucinous adenocarcinoma recurs twice after long intervals of 10 years. However, also in a patient with a history of colorectal mucinous adenocarci...

Internal hernia through a transverse mesocolon defect after laparoscopic distal pancreatectomy: Report of a case

We report a case of an internal hernia through a transverse mesocolon defect after laparoscopic distal pancreatectomy. The patient was a 58‐year‐old man with an intraductal papillary mucinous neoplasm of the pancreatic body who underwent laparoscopic distal pancreatectomy. During surgery, an approximately 5‐cm defect in the transverse mesocolon was inadvertently made. The defect was not closed as it was thought to be large enough to preclude incarceration. However, the patient developed a bowel obstruction 2 months postoperatively. Laparotomy revealed that a loop of the proximal jejunum herniated through the defect and was adherent to the stapled pancreatic stump. An additional loop of the jejunum was herniated through the narrowed mesenteric defect. To our knowledge, this is the first case of an internal hernia through a transverse mesocolon defect after laparoscopic distal pancreatectomy.