Plasma exosomal miR-451a levels may be a useful minimally invasive biomarker for the prediction of recurrence and prognosis in PDAC patients.

Background Pancreatic ductal adenocarcinoma (PDAC) is a lethal malignancy with poor prognosis. This is due to late diagnosis and lack of reliable prognostic biomarkers. In this study, we focused on exosomal microRNA (miRNA) in portal vein blood (PVB) as a potential biomarker to identify patients at high‐risk for recurrence and poor postoperative outcome. Methods Exosomal miR‐4525, miR‐451a and miR‐21 expressions were assessed using PVB and peripheral blood (PB) collected from 55 PDAC patients during curative pancreatectomy. Correlation between the miRNA expressions and clinical outcomes, and target genes expressions was investigated. Results Exosomal miR‐4525, miR‐451a and miR‐21 levels were upregulated in PVB, which were higher than those in the PB. High expression of miR‐4525, miR‐451a and miR‐21 in PVB was associated with recurrence with a higher sensitivity, specificity, and accuracy than that in PB. Cox regression analysis showed miR‐4525, miR‐451a and miR‐21 levels in PVB were independent prognostic factors for overall survival and disease‐free survival. There was a negative correlation between the expressions of miR‐4525 and MEN1 mRNA, miR‐451a and CAB39 mRNA, and t miR‐21 and PDCD4 mRNA. Conclusions miR‐4525, miR‐451a and miR‐21 in PVB are potential biomarkers identifying patients at high‐risk for recurrence and poor survival in resected PDAC patients.

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Objective We investigated the validity of our intraperitoneal onlay mesh (IPOM) Plus technique with barbed sutures. Background Laparoscopic intraperitoneal onlay mesh repair has become a proven method for treating abdominal incisional hernias in recent years. There have been a few reports on the utility of IPOM Plus, which is IPOM + celiorrhaphy, although this method has not been widely discussed. We adopted the IPOM Plus technique with barbed sutures at our hospital and investigated the validity of this technique. Methods We included 7 patients who underwent IPOM Plus repair from 2015 to 2017 at our hospital. We excluded patients with a hernia hilum <2 cm or ≥10 cm, age < 20 years old, PS3 or more, and uncontrolled comorbidity. The hernial orifice was closed laparoscopically using barbed sutures and subsequently secured by tacking on an onlay mesh. Results The median hernial orifice size of the 7 patients was 45 mm (25 to 55 mm). Hernia onset occurred after laparotomy in all cases. In one case, an abdominal incisional hernia recurred after IPOM used to treat the condition 15 years earlier. The mean duration of surgery was 80.5 minutes (53 to 126 minutes), and the median pain scale score was 3 points (0 to 3 points), indicating little pain. None of the patients reported persistent postoperative pain. The mean duration of the postoperative hospital stay was a median of 3.5 days (2 to 5 days). Both short- and long-term outcomes indicated that no recurrence or complications, such as bulging or seroma, occurred. Conclusions IPOM Plus with intracavitary abdominal suturing using barbed suture for abdominal scar hernia repair may be a valid surgical procedure.