title: Radical distal gastrectomy in laparoscopic and open surgery: is it necessary for pancreatic capsule resection?
abstract: OBJECTIVE
  To explore the involvement of the pancreatic capsule during radical gastrectomy in gastric cancer.
  
  
  METHODS
  Pancreatic capsule samples were collected from the 83 cases (56 men and 27 women) during open radical gastrectomy and laparoscopic resection between January 2007 and July 2008. RT-PCR and immunohistochemistry were applied for tumor detection. There was a 2-year follow-up; the relationship of the pancreatic capsule involvement, tumor stage and survival rate were evaluated. Results from radical distal gastrectomy were combined with those of gastric cancer pancreatic capsule cleaning; clinical data, pathology, immunohistochemistry and RT-PCR were used to confirm the necessity of pancreatic capsule resection in laparoscopic radical gastrectomy.
  
  
  RESULTS
  H&E staining of the pancreatic capsule showed no tumor existence in any of the 83 patients but immunohistochemistry showed CK20 positive cells in 20 patients (33.7%), while RT-PCR detected CK20 mRNA positive cells in 42 patients (50.6%). Cases with stage T1 and T2 were negative for CK20 in both RT-PCR and immunohistochemistry and the few cases with T3 and T4 were also negative in both RT-PCR and immunohistochemistry. The metastasis in the pancreatic capsule correlated mainly with the invasive serous membrane, lymph node metastasis and tumor stage (p<0.05) but not with gender and age (p>0.05).
  
  
  CONCLUSIONS
  For T1 and T2 stage, there was no evidence of pancreatic capsule metastasis, which may facilitate the decision making of the pancreatic capsule resection during radical distal gastrectomy.
authors.affiliation: General Surgery Department, Harbin Medical University, Harbin City, China.
authors.forename: Lei
authors.initials: L
authors.lastname: Zhao
authors.forename: Zhifei
authors.initials: Z
authors.lastname: Wang
authors.forename: Jun
authors.initials: J
authors.lastname: Xu
authors.forename: Mingfeng
authors.initials: M
authors.lastname: Ding
mesh_terms: D000328:Adult; D000368:Aged; D014408:Biomarkers, Tumor / Q000032:analysis / Q000235:genetics; D002277:Carcinoma / Q000737:chemistry / Q000235:genetics / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D016009:Chi-Square Distribution; D005260:Female; D005743:Gastrectomy / Q000009:adverse effects / Q000379:methods* / Q000401:mortality; D006801:Humans; D007150:Immunohistochemistry; D053554:Keratin-20 / Q000032:analysis / Q000235:genetics; D010535:Laparoscopy / Q000009:adverse effects / Q000401:mortality; D008297:Male; D008875:Middle Aged; D061206:Neoplasm Micrometastasis; D009367:Neoplasm Staging; D010180:Pancreatectomy / Q000009:adverse effects / Q000401:mortality; D010190:Pancreatic Neoplasms / Q000737:chemistry / Q000235:genetics / Q000556:secondary / Q000601:surgery*; D020133:Reverse Transcriptase Polymerase Chain Reaction; D013274:Stomach Neoplasms / Q000737:chemistry / Q000235:genetics / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D014408:Biomarkers, Tumor; C507499:KRT20 protein, human; D053554:Keratin-20