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 evaluate the diagnosis and treatment of duodenal neuroendocrine tumors.Method We retrospectively analyzed data of 15 patients with duodenal neuroendocrine tumors admitted between August 1999 and July 2012.Result In all the 15 cases accurate and definitive diagnosis were achieved via pathological examination and immunohistochemistry.Clinical diagnostic methods included ultrasound,endoscopy,upper gastrointestinal imaging,abdominal CT,MRI,etc.7 cases underwent pancreaticoduodenectomy,2 cases were treated by local excision,4 cases by endoscopic excision,and total gastrectomy and distal gastrectomy was performed in one each case.Conclusions The diagnosis of duodenal neuroendocrine tumors is established mainly by endoscopy and diagnostic imaging.Surgical resection is the treatment of choice.Pancreatoduodenectomy and local excision is applicable for G2 and G3 patients while endoscopic excision can be used for G1 patients.

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 the diagnosis and treatment of intrahepatic biliary cystadenoma and cystadenocarcinoma. Methods Eight patients with intrahepatic biliary cystadenoma and cystadenocarcinoma treated in our hospital were studied retrospectively. The clinical and pathological data were reviewed. Results Most of the patients had nonspecific symptoms and serum AFP level was normal. Uhrasonography and CT diagnosed correctly in 75% and 87.5% of all patients, respectively. All the 8 patients underwent resection and had no recurrence after operation except that 1 case of cystadenocarcinoma died of recurrence 3 years later. Conclusion The diagnosis of intrahepatic biliary cystadenoma and cystadenocarcinoma depends on radiography and pathological examination. Surgery is recommended to get satisfactory results.

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.