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Open access

Marek Durlik and Katarzyna Gardian

Metalloproteinase 2 and 9 Activity in the Development of Pancreatic Cancer

Pancreatic adenocarcinoma is the fourth most common cancer occurring in both women and men. In Poland, within the past ten years the number of deaths from pancreatic cancer increased by 29%.

The aim of the study was to determine the correlation between the activity of metalloproteinase (MMP) 2 and 9 and progression and aggressiveness of pancreatic cancer.

Material and methods. Tissue samples were collected from 36 patients with diagnosed pancreatic adenocarcinoma who underwent Whipple resection. Tumor tissues were analyzed by gel zymography, zymography in situ and immunohistochemistry.

Results. The activity of MMPs was found mainly in cancer cells. Active form of MMP2 (62 kDa) was present in 88% of cases and MMP9 (83 kDa) in 38% of cases. By contrast, immunohistochemical staining revealed the presence of metalloproteinase 9 in all studied tissues. MMP activity was assessed against histological grade of the tumor. In the case of group G1 there was no activity of matrix metalloproteinase 9. By comparing the activity we concluded that the activity of MMPs in tumors with the highest degree of differentiation is significantly lower than in G2 and G3. Metalloproteinase 9 expression analysis revealed no significant differences between the groups of various degrees of histological maturity. The level of expression did not differ between the groups N0 and N1.

Conclusion. Lack of metalloproteinase 9 activity in group G1 may indicate that MMP9 is activated only in higher tumor grades. We have shown that an active form of MMP2 is found in all histological grades, which supports its involvement in the development of pancreatic cancer. Metalloproteinases are attractive target of anticancer therapy but not only the level of expression of metalloproteinases should be taken into account but also their level of activity and factors associated with their activation.

Open access

Bernadetta Kałuża, Ireneusz Ziobrowski and Marek Durlik

Surgical Procedures Not Connected with Transplantation in Patients After Kidney or Kidney and Pancreas Transplant with Stable Function of Graft

The aim of the study was to evaluate complication during and after surgical procedure without connection with transplantation among patients after kidney, kidney and pancreas transplantation with stable function of graft.

Material and methods. 54 patients underwent 62 surgical procedures without connection with transplantation procedure. Main characteristic: standard immunosuppressive treatment, main age 51.1±13.95 years, men 77.4%, hospitalization time 5.27±3.31 day, group 1 - 55 procedures among patients after kidney transplantation, group 2 - 7 procedure among patients after kidney and pancreas transplantation.

Results. Procedures from general surgery comprised 60% [cholecystectomy 19 (51%), left hemicolectomy 1 (3%), esophagus removal 1 (3%), hernia repair 8 (22%), nefrectomy 3 (8%), pancreas transplantation in patients with functional renal graft 1 (3%), laparotomy 4 (11%), vascular surgery 27% (correction of arteriovenosus fistula 13 (76%), by-pass surgery 1 (6%), embolectomy 1 (6%), implantation of aortal - iliac stentgraft 1 (6%), surgery of iliac artery 1 (6%)]. There has been no difference between parameters measured before and after procedure: creatinine (p=0.93), GFR (p=0.07), urea (p=0.25), glycaemia (p=0.322), glycated hemoglobin (p=0.3), C-peptide (p=0.3). In both groups were no differences in levels of creatinine (p=0.78) and urea (p=0.23), measured in the next years after surgical procedure. Mortality 0%, lost of graft 0%, in - hospital morbidity 10 (16.2%) (hematoma 1.6%, endocavitary electrode 1.6%, wound healing defect 16.2%). Morbidity in group 1 - 12.7%, group 2 - 48.8%, p=0.04.

Conclusions. Surgical procedures performed in a specialist center do not impaire prognosis of patients with stable function of graft, after kidney, kidney and pancreas transplantation.

Open access

Marek Durlik and Katarzyna Baumgart

Abstract

Chronic pancreatitis is an inflammatory disease that may require surgical intervention. In some patients a total pancreatectomy is necessary. Such patients develop diabetes, which in some cases may be difficult to control. When standard insulin treatment is unsuccessful and the patient has frequent blood glucose swings with life-threatening hiper- and hypoglycemic episodes, a pancreas transplant should be considered.

Open access

Joanna Wiśniewska-Goryń, Ewa Gorczyca-Wiśniewska, Tomasz Goryń, Piotr Andziak and Marek Durlik

Treatment of Vascular Complications After Kidney Transplantation

The aim of the study was to determine the frequency of occurrence and treatment methods of early vascular complications after kidney transplantation.

Material and methods. A retrospective analysis comprised of 245 patients subjected to kidney transplantation during the period between 1998 and 2006 in our department. Of these, 236 patients received organs from deceased donors, while nine patients received organs from living donors. The occurrence of vascular complications and the diagnostic and treatment methods used were determined for each patient. Patients operated on during the period between 1998 and 2001 were compared to those operated on between 2002 and 2006.

Results. Twenty-two patients presented with vascular complications after kidney transplantation. The following were observed: bleeding (6.1%), anastomotic stenosis (1.2%), renal vein thrombosis (0.81%), renal artery thrombosis (0.4%), and false aneurysm of the renal artery (0.4%). Nineteen patients underwent surgery, and two required intravascular procedures while one was subjected to conservative treatment. Good treatment results were obtained in 17 patients, while five patients had the transplanted kidney removed.

Seventy-eight transplantations were performed in the first four years (1998-2001). In that period, vascular complications occurred in 13 patients (17%). During the following four years (2002-2006) we transplanted 167 patients, and vascular complications were observed in nine patients (5%). Statistical analysis showed a significant reduction (p=0.004-test chi2) in the number of vascular complications during the latter period.

Conclusions. As surgeons gain experience treating transplant recipients, the number of vascular complications decreases. Diagnostics and treatment depends on the early visualization of complications by means of Doppler ultrasound and angio-MRI examinations. The use of intravascular techniques could be an effective and safe therapeutic method in the case of vascular complications.

Open access

Marek Durlik, Marta Matejak-Górska, Radosław Jaworowski, Zuzanna Kaszycka and Katarzyna Baumgart

Abstract

The improvement of laparoscopic techniques that we witnessed over the last decade, also applied to pancreatic surgery. Both worldwide and in Poland, increasingly more patients with lesions located within the body and tail of the pancreas are treated using laparoscopic distal pancreatectomy.

The aim of the study was to compare the outcomes of laparoscopic and open distal pancreatectomy.

Material and method. Between January 2009 and March 2013, 107 patients underwent distal pancreatectomy at a single institution: 39 using laparoscopic technique and 68 using open technique. This was a retrospective study.

Results. There were no significance differences with regard to duration of the surgical procedure, duration of hospitalization and complication rate between both groups. Statistically significant difference was found for the incidence of spleen preservation in patients undergoing laparoscopy, due to better visualization of the structures. In the group of patients with pancreatic cancer there was no significance difference in the incidence of malignancy found in the surgical margin. Our results are similar to that presented in the literature.

Conclusions. Laparoscopic distal pancreatectomy is a safe method, with a higher rate of spleen preservation among the patients with the lesion located in the body and tail of the pancreas.