Objective To evaluate surgical treatment for different types of tumor of the suprarenal infrahepatic segment of the inferior vena cava (IVC).Methods A retrospective analysis was made on 8cases of IVC leiomyosarcoma at the suprarenal infrahepatic IVC segment.According to the extent of tumor invasion and collateral circulations,operations included tumor resection plus inferior vena cava reconstruction or tumor resection plus right nephrectomy.Results Tumors were completly resected in all patients.Renal function recovered after operation.During a follow up of 24 mons,7 cases had no recurrence.One case with recurrence after 12 months underwent successful resection and is doing well after a follow-up of 12 months.Conclusion CT and inferior vena cavography can determine the extent of tumor invasion and collateral circulations helping select appropriate surgical aproach before the operation resulting in less renal injury.

Objective To investigate the clinical features,imaging and pathologic findings of fibrolamellar hepatocellular carcinoma (FL-HCC).Methods Clinical data from 2 patients with FL-HCC confirmed by operation were analyzed retrospectively.Results There were 1 man and 1 woman,both of them were younger than 40 years.The man had hepatitis B,the woman did not have underlying hepatitis.The 2 patients had a normal hepatic function and α-fetoprotein level.Under dynamic contrast material-enhanced computed tomography,hepatic arterial phase CT images demonstrated heterogeneous enhancement of the tumor.Calcification was depicted in the CT images of 1 patients.Both of them underwent a successful operation.After 8 months of follow-up,1 patient had recurrence.And the other patient had no evidence of recurrence during 16 months follow-up time.Conclusion FL-HCC is a rare liver tumor that has distinct clinicopathologic features comparing with hepatocellular carcinoma.Most of FL-HCC occurs in young patients with normal level of α-fetoprotein and no history of hepatitis.Tumors may have calcification and become predominantly on hepatic arterial phase CT images.The most effective treatment for FL-HCC is surgical resection and prognosis is good.

Objective To investigate the suitable treatment of post operative anastomotic recurrence after anterior resection of rectal cancer and analyze the relationship between different kinds of therapy with prognosis. Methods The clinical data of 41 cases of local recurrent rectal cancer after anterior resection admitted in our hospital from 1999 to 2009 were analyzed retrospectively. The median survival time and survival rate were calculated by Life Tables method. The influence of different kinds of treatment to prognosis was evaluated by Kaplan-Meier method and the variability was analyzed by Log-rank method. P <0.01 means statistical significance. Results Thirty-three (80.5 %) of 41 patients were recurrent in the first 3 years and the median survival time was 23 months. Seventeen (41.5 %) of 41 patients underwent radical R0 resection. The median survival time of radical resection patients and non-radical resection ones were 49 months and 18 months, respectively, and the difference was significant (χ2=12.245, P=0.000). Thirty-one patients with radiotherapy and/or chemotherapy showed a statistically longer median survival time than the other 10 patients without these adjuvant treatment (39 months and 9 months, respectively) (χ2=17.533, P =0.000). Conclusion Most post operative anastomotic recurrent of rectal cancer cases occurs in the first 3 years after primary surgery. Radical resection, radiotherapy and chemotherapy can improve the prognosis.

Objective To investigate the clinical characteristics and analyze prognostic risk factors of combined hepatocellular-cholangiocarcinoma. Methods The clinical data of 19 cases of combined hepatocellular-cholangiocarcinoma admitted in our hospital from January 1999 to December 2009 were analyzed retrospectively. The survival function was analyzed by Kaplan-Meier. The possible prognostic risk factors were tested by χ2-test. Results Hepatocellular-cholangiocarcinoma was diagnosed by pathology in the 19 patients, among which hepatic tunic was infiltrated in 13 cases, peritoneum involved in 1 case, intravascular cancer embolus in 1 case. At that time lymphocyte nodes metastasis in 2 cases were found by regional lymphadenectomy in 7cases. The 1-year and 3-year survival rates were 61% and 42%,respectively. Prognosis of patients with tumor size ＞ 5 cm ( χ2 = 4. 392, P = 0. 036 ), history of heavy drinking ( χ2 = 11.010, P = 0.001 ) or intraoperative blood transfusion ( χ2 = 4. 645,P = 0. 031 ) were worse than others. Conclusion It was difficult to get correct preoperative diagnosis of combined hepatocellularcholangiocarcinoma. Tumor size, history of heavy drinking and blood transfusion were all prognostic related risk factors.

Objective To review the clinical features,therapeutic approach and prognosis of hepatocellular adenoma(HCA)and liver adenomatosis(LA).Methods The clinical data from patients with histopathological diagnosis confirmed on operative specimens were analyzed retrospectively.Results There were 10 patients with HCA and 1 with LA.The disease was found mainly in females (n=7,63.6％),and only one female patient with LA had a history of use of oral contraceptive.The median age at presentation was 33 years(range,25-70 years).Most patients(n=8,72.7％)had no significant symptom.Tumor markers including CA19-9 and alpha fetoprotein(AFP)were normal.On dynamic ultrasonography,CT and MRI,most lesions showed contrast enhancement in the arterial phase and washout in the portal venous phase and delayed phase.For the 10 patients with HCA,the lesion was solitary.On histopathology,atypia and dysplasia were present in 1 patient,dysplasia in 1 patient,and active tumor cell growth in 1 patient.The patients with liver adenomatosis had multiple lesions and atypia.All patients underwent liver resection.There was no recurrence on follow-up which ranged from 21 to 125 months.Conclusions Most patients had no clinical symptoms.Hepatic steato sis may be a potential cause for HCA and LA.Oral contraceptive plays an important role in the patho genesis of LA.Dynamic imaging examinations were helpful for diagnosis.In view of the associated risks of hemorrhage and malignant transformation,surgical resection is the optimal treatment.The prognosis is good.

Objective:To evaluate the clinicopathological features of primary retroperitoneal paragangliomas.Methods:Data of 24 patients with retroperitoneal paragangliomas who underwent surgical treatment in our hospital from Jan 2015 to Dec 2018 was collected and analyzed.Results:Hypertension, abdominal pain/discomfort and headache were the most common complaints while 10 patients were asymptomatic and were diagnosed accidently in routine body examination. Tumor size ranged from 3.4-13.0 cm (6.9±2.5) cm, and all the tumors were located in the vicinity of abdominal aorta and inferior vena cava. All the patients received surgical treatment. Intraoperative blood pressure fluctuations were significantly correlated with prolonged operation time, more blood loss, more blood transfusion and prolonged length of stay (all P<0.05). The median follow-up time was 29 months and 1 patient died from tumor recurrence and progression. The other patients have had a tumor free survival. Conclusions:Surgical resection was the principal treatment of primary paraganglioma. Preoperative assessment was very important for perioperative safety.

Objective:To investigate the pathogeny, diagnosis and treatment of solitary fibrous tumors of the abdomen and pelvis.Methods:Retrospective analysis was made on the clinical data of 12 SFT patients undergoing surgical resection in Peking University International Hospital from Jul 2015 to Jul 2019.Results:All patients underwent radical resection. After operation, complications in clued pelvic hemorrhage in 1 case and ureteral fistula in 1 case, all improved after conservative treatment.According to pathological and immunohistochemical results, 7 cases were MSFT and 5 cases were SFT. All patients were followed up for 2-53 months. 5 cases were recurrent, among which 1 case died of intestinal obstruction caused by tumor compression.Conclusion:The clinical manifestations of solitary fibrous tumors are mostly nonspecific.Imaging examination and puncture pathology are of great significance for preoperative diagnosis. Radical resection is an important means to improve the prognosis of patients.

Objective:To summarize the experience of surgical treatment of pelvic retroperitoneal neoplasms.Methods:A total of 107 patients with pelvic retroperitoneal neoplasms underwent surgical treatment from Apr 2015 to Sep 2020. According to the neoplasm location, size, and the relationship with the surrounding tissues, individualize the surgical plan, analyze the patient's basic condition, bleeding volume, tumor size, whether it is the first operation,or combined organ resection, etc.to find out the relevant factors affecting the surgical complications.Results:The surgical route included anterior approach in 67 cases , sacrococcygeal approach in 21 cases, combined abdominal-sacral approach in 13 cases, and laparoscopy in 5 cases. Twenty-nine patients underwent combined organ resection, postoperative complications occurred in 27 patients including colorectal anastomotic leakage in 6 cases, urinary fistula in 6 cases, delayed pelvic floor healing in 6 cases, rectovaginal fistula in 3 cases, and postoperative bleeding in 2 cases. The statistical analysis show whether or not first operation is related to the occurrence of complications ( χ2=4.79, P<0.05) Conclusion:Pelvic retroperitoneal neoplasms need to be fully prepared before surgery and individualized design. Intraoperative combined bleeding control measures and combined organ resection can effectively increase the resection rate and ensure the safety of surgery.

Objective:To analyze the operative outcomes and postoperative pathological features of retroperitoneal leiomyosarcoma(RPLMS) undergoing surgeries.Methods:Medical records of RPLMS patients admitted to Peking University International Hospital from Jan 2015 through Dec 2020 were retrospectively reviewed.Results:Ninety-seven patients undergoing resectional surgeries were included in the study. Of whom, 49 cases were primary RPLMS. Others were recurrent sarcomas or sarcomas with incomplete resection in the first surgical intentions. The most frequent symptoms were abdominal pain and distention (30 cases) as well as lower back pain (23 cases). All patients underwent resectional surgeries with a R 0/R 1 rate of 84.5%. Sixty-four cases received extended surgeries with combined organs resection. External iliac artery resection with reconstruction were performed on 2 cases. And 19 patients underwent partial IVC resection in combination of sarcoma resection. The general postoperative morbidity was 26.8%, including 4 intestinal fistulas, 1 pancreatic fistula, 1 vesicovaginal fistula, 1 urinary fistula, 1 biliary fistula, 2 abdominal major bleeding, 7 IVC thrombosis, 3 gastroplegiaetc. One patient deceased within post-operative 30 d due to massive bleeding.Pathology found that spindle and pleomorphic cell types were most common subtypes of RPLMS. Conclusions:Surgery remains the mainstay in the treatment of RPLMS which often presents with atypical symptoms. Extended surgeries combining with multiple organ and major vascular resections could be only suggested in experienced sarcoma centers due to high risk of severe postoperative complications.

Objective:To investigate the perioperative alterations and management of coagulation function in patients of massive blood transfusion during retroperitoneal tumor (RT)resection.Methods:Fourty-seven RT patients at Peking University International Hospital from Jan 2016 to Dec 2021 undergoing resection with massive blood transfusion more than 20 U within 24 h were reviewed for coagulation function before and after surgery.Results:Intraoperative bleeding was 3 000-25 800 ml, 10 patients had blood loss ≥10 000 ml. During the operation, (25.3±9.9) U of red blood cells were transfused, (2 720±1 369) ml plasma transfused, and (2.4±3.3) U platelets were transfused in 6 patients. Fourty-five patients received intraoperative albumin of (79.5±46.5) g; All 47 patients received fibrinogen of (2.3±1.3) g; Prothrombin complex was given in 45 patients (1 205±807) U. Preoperative hemoglobin was statistically different compared to postoperatively and days 1, 3 and 5 ( W=1 790, P<0.001; W=1 672, P<0.001; W=1 704, P<0.001; W=1 486, P=0.004);As with platelets, the difference was also statistically significant compared to postoperative days 1, 3, and 5 ( W=2 153, P<0.001; W=2 092, P<0.001; W=1 732, P<0.001); Preoperative albumin was different compared to postoperative days 1 and 3 ( W=1 568, P<0.001; W=1 578, P<0.001,); Preoperative fibrinogen was different compared to postoperative day 1 ( W=1 964, P<0.001). PT and APTT were prolonged on postoperative days 1 and 3 ( W=628, P<0.001, W=804, P=0.023) ( W=661, P<0.001, W=796, P=0.02). Patient's preoperative fibrin degradation products and D-dimer were above the normal value and were higher on postoperative days 3 and 5 ( W=498, P<0.001, W=345, P<0.001). Conclusions:Coagulation disorders occur perioperatively in patients with massive transfusion while undergoing surgery for RT.The implementation of ratiional transfusion strategy and close postoperative survey and management of coagulation dysfunction help avoid the coagulation related morbidities.