Pancreatic carcinoma is one of the malignancies of the gastrointestinal tract with the most dismal prognosis.As a consequence of its anatomic and biological behavior,the 5-year survival is only 10％- 20％ even after curative resection.There are many problems which need to be solved in the diagnosis and treatment of pancreatic cancer.This paper aims to discuss the preoperative assessment of resectability,histological diagnosis,radical surgery,multidisciplinary and multimodality treatment to help to raise the standard of diagnosis and treatment of pancreatic cancer in China.

Objective To study the clinical feature, diagnosis and surgical treatment of mixed hepatocellular and cholangiocellular carcinoma(MHC).Methods The clinical materials of 14 surgically treated patients with MHC were retrospectively analyzed.Results There were nine males and five females, with age ranging from 33 to 62 years (mean 50 years). Some patients had a history of hepatitis B(71%), and cirrhosis(64%). Elevation of serum alpha-fetaprotein(AFP) was observed in nine patients(64%). The resection rate was 86%(12/14), and postoperative overall 1-, 3-, 5-year survival rates were 71%(10/14)?43%(6/14)?and 29%(4/14), respectively. In the tumor-resected patients, the 1-, 3-, 5-year survival rates were 83%(10/12)?50%(6/12)?and 33%(4/12),respectively. Conclusions MHC patients lack typical clinical manifestations. Radical surgery is an effective treatment for this disease. The cholangiocellular carcinoma component appears to determine the prognosis.

Objective To study the clinical feature,diagnosis,treatment and prognosis of hepatocellular adenoma(HA).Methods The clinical data of 10 patients confirmed pathologically with HA,were retrospectively analyzed.Results There were four females and six males,aging from 25 to 71 years(mean:42.6 years).Among these 10 patients,6 cases were discovered to have no clinical symptom.Tumors were located in the right lobe of the liver in 4 cases,and in the left lobe in 6 cases.Uhrasonography was performed in all cases.Six cases underwent CT examination and three cases experienced MRI as well as angiography was conducted in one case.All cases were confirmed by complete excision and pathology.All of them were followed up for 5 months to 9 years without tumor recurrence.Conclusion The combination of imaging data is helpful in the diagnosis of HA.Surgery is the best treatment with satisfactory results,and its prognosis is fairly good.

Objective To study the diagnosis and treatment of pancreatic cystadenoma and cystadenocarcinoma.Methods The clinical data of 21 surgically treated patients of the cystic neoplasms of pancreas(CNP),confirmed by pathology,in recent 8 years were retrospectively analyzed.Results CNP was more frequently seen in young to middle-aged women.Upper abdominal mass and abdominal distention and pain were the main clinical presentations.The CNP resection rate was 95%(100%and 80%in benign and malignant CNP respectively).Of the 21cases,pancreaticoduodenectomy and distal pancreatectomy were performed in 2 and 16 respectively;and middle segment pancreatectomy in 2 patients.Postoperative pancreatic fistula was the leading complication.Conclusion CNP have no clinical characteristics.Ultrasonography and CT could be helpful to the diagnosis of CNP.The resection of the whole tumor with part paratumor pancreas tissue is advocated.

Objective To investigate the effectiveness of surgical resection for metastatic liver cancer in patients of gastric carcinoma, and evaluate the prognosis. Methods Clinical data of 24 gastric cancer cases undergoing hepatectomy for hepatic metastatic tumor were collected retrospectively. There were 18 cases of synchronous resection and 6 cases of heterochronous resection. The prognostic values of clinicopathological factors were assessed by univariate and multivariate analyses. Results Postoperatively all cases were followed up until the death of the patietns. Counting from the time of liver resection the 1-,3- and 5-year survival rate was 67%, 21% and 13% respectively. Univariate analysis showed lymph node involved, tumor size of hepatic metastases, vascular invasion and R0 margin as significant prognostic factors;Multivariate analysis indicated that tumor size of hepatic metastases and vascular invasion were independent prognostic factors influencing the survival. Conclusion These results suggest that for patients with liver metastasia from gastric cancer, better prognosis can be obtained by surgical treatment.

Objective To explore the clinicopathological characteristics as prognostic factors in patients with colorectal signet-ring cell carcinoma. Methods Clinical data of 62 patients of colorectal signet-ring cell carcinoma and 281 patients of colorectal low-differentiated adenocarcinoma were retrospectively analyzed. COX Proportional Hazards Model was used in multivariate analysis. Results Colorectal signet-ring cell carcinoma occurred more frequently in young patients and most of them located in the rectum. Gender, preoperative CEA, pathological type and liver metastasis were not statistically different from low-differentiated adenocarcinoma (X2=0.07,0.04,0.06,1.79,P>0.05).Bowel obstruction, operative modalities, tumor embolism, infiltration depth, lymph node metastasis were statistically different from low-differentiated adenocarcinoma (X2=8.96,75.1,18.5,72.0,7.44,P<0.05). Median survival time was 28 months in patients of colorectal signet-ring cell carcinoma and 49 months in patients of colorectal low-differentiated adenocarcinoma. The difference was statistically significant (X2=12.51,P<0.05). Infiltration depth, lymph node metastasis, operative modalities and postoperative adjunctive therapy were independent prognostic factors based on a multivariate analysis of the COX Proportional Hazards Model. Conclusions The biological malignancy of colorectal signet-ring cell carcinoma is higher than that of low-differentiated adenocarcinoma in colorectal carcinoma. Radical resection and postoperative adjunctive therapy were effective treatment methods.

Objective To evaluate the clinical presentation,pathologic features,diagnosis and treatment of hepatic angiomyohponm(HAML).Methods Retrospective analysis was made on 22 HAML cases in terms of clinical finding,images,pathologic examination and surgical treatment.Results Of the 22 patients,6 were male and 16 were female.The average age was 48.2 years.Seventeen patients had no clinical symptoms.None had the history of hepatitis virus infection.None of them was complicated with renal AML.None had tlle history of taking oral contraceptives in the sixteen female patients.Serum AFP、CEA、CA19-9、CA242 levels were all within normal limits.The correct diagnostic rate of BUS.CT and MRI was 2l%(4/19)、23.5%(4/17)and 25%(2/8),respectively.All tumorts were single nodule with a diameter of 4～17 cm,without complete capsula.All these 22 patients underwent tumor resection,including partial liver resection in 17 patients,left hemihepatectomy in 5.One patient died of postoperative complication,one patient suffered from temporary bile leak.The HMB45 positive rate by immunohistochemical method was 100%.Extramedullary hemopoiesis was found in 4 patients.Follow up of 6 months to 17 years in 91%(20/22)patients found no tumor recurrence. Conclusions HAML had no specifiC symptoms.The preoperative imaging diagnosis is difficult.Surgical resection is the therapy of choice for HAML.

Objective To investigate the surgical treatment for patients with isolated recurrence and metastasis of colon cancer after primary curative-intent resection. Methods In this stuay,58 cases suffering from postoperative recurrence of colon cancer between the year of 1996-2005 were analyzed retrospectively.Data were analyzed using statistical package for the social sciences(Release 11.5,SPSS,Inc).x2 analysis was used to determine the related factors,survival analysis was estimated using the Kaplan-Meier method and compared using tlle log-rank test. Results In this reoperative group radical resection was achieved in 81%(47/58)cases,and palliative operation in 11 cases,with median survival time of 48 months and 12 months respectively(x2=12.30,P=0.0005). Conclusion Postoperative isolated recurrence and metastasis of colon cancer usually allows radical resection in most cases with favorable long-time survival.

Objective To explore clinieopathologieal features and prognosis in a high grade malignancy group of colorectal mueinous carcinoma, signet-ring cell carcinoma and low-differentiated carcinoma. Methods Retrospective analysis and follow-up were made on 148 patients with colorectal mucinous carcinoma, 55 patients with signet-ring cell carcinoma and 281 low- differentiated carcinoma treated in our hospital from 1988 to 2006. Obtained data were analyzed by SPSS13.0. Related factors underwent x2 analysis, survival analysis were estimated using Kaplan-Meier method and compared using the Log-rank test. Results Coloreetal signet-ring cell carcinoma were significantly different from mucinous carcinoma and low- differentiated carcinoma in gender, age, tumor location, bowel obstruction, operative modus, tumor embolism, tumor infiltration and lymph node metastasis(x2 = 7, 67,38.4,86.0,14.5,93.7,17.3,62. 1,24. 4,56.17 ,P <0.05). Median survival time was 24 months in signet-ring cell carcinoma, 47 months in mueinous carcinoma and 49 months in low- differentiated carcinoma. The difference is of significance(x2 = 21.3, P < 0.05). Conclusions Clinicopathological characteristics and prognosis of colorectal signet-ring cell carcinoma, mueinous carcinoma and low- differentiated carcinoma is of significant difference(P < 0.05). Malignancy of signet-ring cell carcinoma is higher with worse prognosis.

Objective To investigate the surgical treatment and indications for primary lesion in patients with stage Ⅳ rectal cancer.nethods Clinical data of 118 patients with stage Ⅳ rectal cancer undergoing surgical treatment from January 1988 to December 2005 in Cancer Hospital of Chinese Academy of Medical Sciences were analyzed retrospectively using Statistical Package for the Social Sciences(Release 13.0,SPSS,Inc).Survival was estimated using the Kaplan-Meier method and compared using the log-rank test.Cox regression was used in multivariate analysis.Results One hundred and five of 118 patients received rectal primary lesion resection,including 16 cases with simultaneously metastatic tumor resection.13 of 118 patients received ostomy.The overall 5-year survival rate of the primary lesion resection group was 8.57%,the 5-year survival rate of the metastatic tumor resection group was 31.2%.The median survival in the primary lesion resection group and the ostomy group was 15 months and 13 months respectively(X2=0.736.P=0.778).Multivariate analysis showed that degree of differentiation of primary tumor,maximal diameter of liver metastasis and chemotherapy were the most important prognostic factor of the primary tumor resection group.Conclusion Simultaneous resection of primary and metastatic tumor can prolong suivival time of patients with resectable stage Ⅳ rectal cancer.