Objective:To investigate the classification of main pancreatic duct and treatment strategy after linear stapler closure of pancreatic neck in laparoscopic pancreaticoduodenectomy (LPD).Methods:The records of 51 consecutive patients with LPD who were treated by linear staple closure technique of pancreatic neck from February to December 2022 from Binzhou Second People′s Hospital, Shijingshan Campus, Beijing Chaoyang Hospital, Capital Medical University, Rizhao Hepatobiliary-Pancreatic-Splenic Surgery Research Institute, Chaoyang Central Hospital, Shandong Juxian People′s Hospital, Weihai Municipal Hospital, Binzhou Central Hospital, and Affiliated Hospital of Chifeng University were retrospectively reviewed. According to the visibility, position and diameter of the main pancreatic duct at the stump of the pancreas, the type of main pancreatic duct was divided into type I, type Ⅱ, type Ⅲa and type Ⅲb. The number of cases in each main pancreatic duct classification and the corresponding treatment strategies were examined.Results:A total of 51 cases of LPD were successfully completed. Of these patients, the males comprised 56.9%(29/51), and females comprised 43.1%(22/51), with age ranging from 31 to 88 years old. The type of the main pancreatic duct at the stump of the pancreas included 7 cases (13.7%) of type Ⅰ, 39 cases (76.5%) of type Ⅱ, 2 cases (3.9%) of type Ⅲa, and 3 cases (5.9%) of type Ⅲb. Corresponding treatment strategies were adopted according to different main pancreatic duct types, the main pancreatic duct was successfully found, and a support drainage tube was inserted.Conclusion:After linear stapler closure of pancreatic neck, corresponding treatment strategies should be adopted according to the classification of the main pancreatic duct, which would help to improve the success rate of finding the main pancreatic duct and placing a support drainage tube.

Objective:To analyze the effects of the primary location of colorectal cancer on the surgical outcome of liver metastases.Methods:A cross-sectional study was conducted on 178 patients with liver metastases from colorectal cancer admitted to Binzhou Central Hospital from January 2012 to January 2022. According to whether the patients had recurrence after surgery, they were divided into a recurrence group ( n = 88) and a control group ( n = 90). The general and clinical data were compared between the two groups. Logistic multivariate analysis of the factors with statistical significance was further performed to identify the risk factors of postoperative recurrence of liver metastases from colorectal cancer after surgery. The correlation between the primary location of colorectal cancer and each risk factor was analyzed. The recurrence of colorectal cancer was compared anong patients with different primary locations of colorectal cancer at 12 months after surgery. Results:Primary location at the right colon [55.68% (49/88), lymph node metastasis [92.05% (81/88)], D-dimer ≥ 180 μ g/L, albumin < 29 g/L, ineffective/no neoadjuvant chemotherapy [43.18% (33/38)], and high-risk clinical risk score [53.41% (47/88)] were risk factors for postoperative recurrence of liver metastases from colorectal cancer after surgery ( P = 0.024, 0.019, 0.001, 0.028, < 0.001, 0.001). The primary location of colorectal cancer was positively correlated with lymph node metastasis, D-dimer, and clinical risk score ( P = 0.043, 0.046, 0.030), and negatively correlated with albumin and the efficacy of neoadjuvant chemotherapy ( P = 0.004, 0.033). In 178 patients, the recurrence rate of liver metastases from colorectal cancer at 3 months [53.57% (15/70)], 6 months [55.17% (32/70)], and 12 months [55.68% (49/70)] was significantly higher in the right colon compared with the left colon [32.14% (9/40), 24.14% (14/40), 26.14% (23/40) and the rectum [14.29% (4/68), 20.69% (12/68), 18.18% (16/68)] ( χ2= 4.73, 7.85, 6.27, all P < 0.05). Conclusion:Right colon, lymph node metastasis, D-dimer, albumin, neoadjuvant chemotherapy efficacy, and clinical risk score are the risk factors for postoperative recurrence of liver metastases from colorectal cancer. Patients with the primary location at the right colon have a higher postoperative recurrence rate.

Objective:To study the use of primary continuous single-layer pancreaticojejunostomy after linear stapler closure of pancreatic neck in pancreaticoduodenectomy (PD).Methods:The clinical data of 21 patients who were treated with primary continuous single-layer pancreaticojejunostomy after linear stapler closure of pancreatic neck in PD at Beijing Chaoyang Hospital Affiliated, West Campus, Capital Medical University, Rizhao Hepatobiliary-pancreatic-splenic Surgery Research Institute, Binzhou Second People’s Hospital, Chaoyang Central Hospital from February 2022 to May 2022 were retrospectively analyzed. There were 12 males and 9 females, with ages ranging from 31.0 to 82.0 years (median age 63.0 years). The success rates of linear stapling at pancreatic neck, time of pancreaticojejunostomy, postoperative complications, pancreatic fistula risk score, and length of hospital stay were studied.Results:Among the 21 patients, there were 3 patients who underwent open PD and 18 patients who underwent laparoscopic PD. Primary continuous single-layer pancreaticojejunostomy after linear stapler closure of pancreatic neck was successfully carried out in all these patients. The success rate was 100.0%. The success rate of finding pancreatic ducts at the pancreatic stumps and inserting an drainage tube was 100.0%(21/21). In the 3 patients who underwent open PD, the operation time were 230.0, 245.0 and 250.0 minutes respectively. The time for completing pancreaticojejunostomy were 12.0, 13.0 and 12.0 minutes respectively. The estimated blood loss were 300.0, 450.0 and 600.0 ml respectively. The length of hospital stay were 14.0, 15.0 and 21.0 days. In the 18 patients who underwent laparoscopic PD, the operation time was (295.9±14.5) min, the time for constructing pancreaticojejunostomy was (22.3±1.5) min, the blood loss was (180.0±40.0) ml, the length of hospital stay ranging from 8.0 to 16.0 days (median 10.5 days). Among all the 21 patients, the pancreatic fistula risk score was (4.7±1.5). Postoperative acute pancreatitis occurred in 3 patients (14.3%), delayed gastric emptying occurred in 4 patients (19.0%), and all of them recovered after conservative treatment. There was no postoperative bleeding, nosocomial infection, grade B and C postoperative pancreatic fistula or perioperative death.Conclusion:The continuous single-layer pancreaticojejunostomy after linear stapler closure of the pancreatic neck was safe, reliable, simple and technically easy. It has the potential to prevent clinical postoperative pancreatic fistula and pancreaticojejunostomy bleeding. It is worth to popularize this surgical procedure.

Objective:To investigate the significance of MLH1 protein expression and MLH1 gene methylation rate between metastatic solid pseudopapillary tumor of pancreas (SPT) and non-metastatic SPT, and to explore the correlation between MLH1 gene methylation and SPT metastasis.Methods:Twelve metastatic SPT patients admitted to Peking University People's Hospital, Rizhao Central Hospital and Chaoyang Central Hospital of Liaoning Province from January 2009 to May 2022 were studied retrospectively, including 3 males and 9 females, with a median age of 47 years old, ranging from 21 to 73 years old. Thirty non-metastatic SPT patients with clear diagnosis, clear medical history and complete follow-up data from pathological database of Peking University People's Hospital from January 2009 to May 2017 were selected as the control group, including 12 males and 18 females, with a median age of 42 years old, ranging from 34 to 69 years old. Clinical data such as gender, age and pathological data were collected. Immunohistochemical expression of MLH1 protein and methylation of MLH1 gene were detected by pathological paraffins.Results:There was no significant difference in general data between the two groups (all P>0.05). Among the 12 metastatic SPT patients, 4 cases metastasized to liver, 2 to spleen, 2 to lung, 2 to lymph nodes, 1 to mediastinum, and 1 to sacrum. Compared with the non-metastatic tissue, the MLH1 protein deletion in metastatic pancreatic lesions (metastatic SPT-P) and metastatic lesions (metastatic SPT-M) were increased [both 33.3%(4/12)], and the difference was statistically significant (both Chi square=5.00, both P=0.041). Compared with 0 (0/30) MLH1 gene methylation rate in non-metastatic SPT tissues, the methylation rate of MLH1 gene in metastatic SPT-M and metastatic SPT-P tissues [both 30% (3/10)] were higher, with statistical significance (both Chi square=0.96, both P=0.032). Conclusion:Compared with non-metastatic SPT, the loss rate of MLH1 protein expression and MLH1 gene methylation are increased in metastatic SPT. MLH1 methylation may occur before metastasis, which can be used as a predictor of SPT metastasis.

Objective:To study the impact of Roux-en-Y reconstruction with isolated pancreatic drainage (RYR) on delayed gastric emptying (DGE) after pancreaticoduodenectomy (PD).Methods:The data of 203 patients who underwent PD at 5 clinical centers from January 2014 to June 2020 were collected. According to the method of reconstruction of the digestive tract, the patients were divided into the RYR group ( n=88) and the conventional loop reconstruction (CLR) group ( n=115). The incidence and severity of DGE were compared between groups. The risk factors of clinically relevant DGE (CR-DGE) after PD were analysed by univariate and multivariate analyses. Results:Of 203 patients, there were 124 males and 79 females, aged (61.6±10.2) years. The overall incidence of DEG was 27.6% (56/203). The incidence of CR-DGE in the RYR group was significantly lower than that in the CLR group [13.6%(12/88) vs 26.1%(30/115), P=0.030]. Patient age of more than 65 years ( OR=2.966, 95% CI: 1.162-8.842, P=0.024), clinically relevant pancreatic fistula ( OR=3.041, 95% CI: 1.122-8.238, P=0.029), ascites and abdominal infection ( OR=10.000, 95% CI: 2.552-39.184, P=0.001), and CLR ( OR=3.206, 95% CI: 1.162-8.842, P=0.024) were identified as independent risk factors for CR-DGE. The duration of hospitalization and hospital expenditure of patients were significantly increased in the CR-DGE group ( P<0.05). Conclusions:Patients over 65 years with clinically relevant pancreatic fistula, with ascites or abdominal infection after operation, had a higher evidence of CR-DGE. Roux-en-Y reconstruction with isolated pancreatic could helped to decrease the incidence of CR-DGE after PD.

Objective:To explore the perivenous blocking management strategy for portal vein-superior mesenteric vein (PSMV) resection and reconstruction and its effect on postoperative complications in patients undergoing pancreaticoduodenectomy (PD).Methods:The data of 137 patients with pancreatic cancer treated with PD in Beijing Chaoyang Hospital Affiliated to Capital Medical University, Chaoyang Central Hospital, the Second Hospital of Chaoyang, Rizhao Central Hospital, the Second People's Hospital of Binzhou from January 2010 to December 2020 were collected. There were 83 males and 54 females with an average age of 61.8 years. There were 42 patients in the reconstruction group and 95 patients in the control group. The main intraoperative indexes and postoperative complications were compared between the two groups with the aim to review our experience in PSMV resection and reconstruction by using the perivenous blocking management strategy.Results:PD was successfully completed in 137 patients in the reconstruction group, the PSMV blocking time was 15-120 min, with a median of 30 min. The operation time 380 (330, 465) min, intraoperative blood loss 725 (500, 1000) ml, and postoperative hospital stay 21.0 (16.0, 28.0) d in the reconstruction group were significantly higher than those of control group [305 (280, 340) min, 400 (300, 500) ml and 18.0 (14.0, 24.5) d] (all P<0.05). The reoperation rate and perioperative mortality were 4.8% (2/42) and 2.4% (1/42) in the reconstruction group, while 2.1% (2/95) and 1.0% (1/95) in the control group, respectively. There was no significant difference between the two groups (both P>0.05). The incidence of pancreatic fistula, peritoneal effusion and infection, pulmonary infection of the reconstruction group was significantly higher than those of the control group ( P<0.05). There was no significant difference in the incidence of postoperative bleeding, delayed gastric emptying, biliary fistula, incision infection, reoperation between the two groups ( P>0.05). Conclusions:PSMV resection and reconstruction significantly increased the incidences of complication after PD, including pancreatic fistula, peritoneal effusion/infection and pulmonary infection. The perivenous blocking management strategy significantly promoted smooth postoperative recovery and effectively reduced morbidity rates of postoperative bleeding and mortality after PSMV resection and reconstruction in PD.

Objective To study the value of radiofrequency ablation of gallbladder beds in radical surgery for stage T1b gallbladder cancer.Methods A retrospective study was conducted on 21 patients with stage T1 b gallbladder cancer treated in the Department of Hepatobiliary Pancreas and Spleen Surgery,West Campus,Beijing Chaoyang Hospital,Capital Medical University,from April 1,2011 to March 31,2019.Patients who were diagnosed with frozen section during operation were included into the surgery group.Patients who were diagnosed postoperatively and underwent radical surgery for the gallbladder carcinoma were included in the secondary surgery group.The differences in surgical time,bleeding volume,survival rate,and survival time between the two groups after regular follow-up were compared,and the 5-year cumulative survival rates and overall survival time of the two groups were calculated.Results All patients underwent radical gallbladder cancer surgery.There were 14 males and 7 females,aged from 26 to 70 (49.0 ± 13.5)years.There were no perioperative deaths.There were 15 patients in the operation group,and 6 patients in the secondary surgery group.The bleeding volume of the surgery group was significantly less than the secondary surgery group [(101.3 ± 35.5) ml vs.(177.0 ± 44.6) ml,P ＜ 0.05].There were no significant differences in surgical time,survival rate,and survival time between the two groups (all P ＞ 0.05).The 5-year cumulative survival rate for the two groups of patients was 56.5％,and the overall survival time was (79.0 ± 9.3) months.Conclusions Radiofrequency ablation of the gallbladder bed was safe and effective in radical surgery of T1 b gallbladder cancer.For T1 b stage gallbladder cancer,which is difficult to diagnose during surgery,secondary radical surgery achieved the same results as primary radical surgery.

Objective:To explore the influencing factors of long-term survival for hepatocellular carcinoma (HCC) treated by radiofrequency ablation (RFA).Methods:A retrospective analysis of 255 patients who underwent RFA as the main treatment modality for HCC from May 1, 2004 to Feb 28, 2015 was performed. All patients were divided into two groups according to the postoperative survival time: the 5-year or more survival group and the less than 5-year survival group. Clinical indicators such as age, maximum tumor size and number, and frequency of radiofrequency ablation were compared between the two groups. Cox single factor and multiple factors were used to analyze the influencing factors of long-term survival.Results:The median overall survival of all the 255 patients was 4.3 years (range 0.5-15.5 years). There were 115 patients (45.1%) who survived for 5 years or more and 140 patients (54.9%) who survived for less than 5 years. The 1-, 3-, 5-, and 10-year survival rates of all the patients were 86.7%, 61.2%, 44.8% and 34.8%, respectively. There were no significant differences in gender, age, accompanying symptoms, aetiology of liver disease, level of alpha fetoprotein and treatment ( P>0.05), but there were significant differences in Child-Pugh class, liver cirrhosis, maximum diameter of tumor, tumor number, tumor stage, and frequency of RFA ( P<0.05) between the 2 groups of patients. Multivariate analysis showed that age ≥70 years old, Child-Pugh class B, maximum diameter of tumor >5.0 cm, multiple tumor were independent risk factors of long-term survival, but the number of sessions of RFA was a protective factor. Conclusions:For medium sized HCC and solitary large HCC, RFA combined with other therapeutic modalities could achieve satisfactory therapeutic results. Age, Child-Pugh class, maximum diameter of tumor, tumor number and RFA frequency were influencing factors for long-term survival of HCC patients.

Objective:To analyze the auxiliary application strategy and efficacy of radiofrequency ablation (RFA) in laparoscopic anatomical hemihepatectomy (LAH).Method:The clinical data of consecutive patients who underwent RFA-assisted LAH from 5 hospitals including Beijing Chaoyang Hospital, Capital Medical University between January 2016 and January 2020 were retrospectively reviewed.Results:Among the 32 patients, there were 21 males and 11 females. The age range is 32 to 77 years, with a median age of 52 years. There were 18 cases of hepatocellular carcinoma, including 16 cases of single lesion and 2 cases of two lesions, with the maximum tumor diameter of (5.6±1.2) cm. There were 12 cases of metastatic liver cancer, including 8 cases of single lesion, 3 cases of two lesions, 1 case of three lesions, and the maximum tumor diameter (4.7±1.6) cm. Primary hepatolithiasis: 2 cases. Right hemihepatectomy was performed in 23 cases and left hemihepatectomy in 9 cases. No conversion to laparotomy. The operation time of right hemihepatectomy was (310.0±22.0) min, and left hemihepatectomy was (285.0±25.0) min. Intraoperative hemorrhage (330.0±28.0) ml. No patients received intraoperative infusion of human red blood cell suspension. Postoperative reactive pleural effusion occurred in 6 cases, biliary fistula in 3 cases, wound infection in 1 case, and cross section effusion in 1 case, all of which recovered after conservative treatment. No postoperative abdominal bleeding and liver insufficiency. Postoperative hospital stay (9.5±3.2) d. The follow-up time was 1-42 months, and the median follow-up time was 20 months. During the follow-up period, 17 (56.7%) of the 30 patients with malignant tumor experienced tumor recurrence, no sectional tumor recurrence, and no death.Conclusions:RFA has a variety of auxiliary applications in LAH, including prevention and treatment of liver cancer rupture during mobilization of liver, treatment of small bleeding blood vessels during liver transection, and help in securing safe and adequate resection margins.

Objective:To evaluate the clinical prognostic significance of molecular markers with high predictive value for lymph node metastasis (LNM) before operation in gastric cancer (GC).Methods:From January 2013 to December 2015, at Peking University Third Hospital, 85 patients with GC confirmed by preoperative biopsy under gastroendoscopy and receiving radical gastrectomy were selected. Among 85 patients with GC, 34 patients had LNM and the other 51 patients were without LNM. The expression levels of macrophage capping protein G (CapG), tyrosine kinase receptor B (TrkB), prosperohomeobox protein l (Prox-1), matrix metalloproteinase-2 (MMP-2), vascular endothelial growth factor-C (VEGF-C) and vascular endothelial growth factor receptor 3 (VEGFR3) were detected by immunohistochemistry (IHC) in preoperative gastric biopsy tissues. Chi-square test was performed to analyze the correlation between the expression of different markers and various clinicopathological characteristics. Receiver operating characteristic (ROC) curve was drawn to compare the predictive value of different markers on LNM of GC. Kaplan-Meier curve was applied to evaluate the impact of different markers on the prognosis of GC patients.Results:The positive expression rates of CapG, TrkB, Prox-1, MMP-2, VEGF-C and VEGFR3 of the LNM-positive group were higher than those of the LNM-negative group (85.3%, 29/34 vs. 35.3%, 18/51; 76.5%, 26/34 vs. 29.4%, 15/51; 67.6%, 23/34 vs. 11.8%, 6/51; 64.7%, 22/34 vs. 33.3%, 17/51; 61.8%, 21/34 vs. 29.4%, 15/51; 52.9%, 18/34 vs. 23.5%, 12/51, respectively), and the differences were statistically significant ( χ2=20.631, 18.093, 28.342, 8.086, 8.746 and 7.727, all P<0.01). The area under the ROC curve (AUC) values and 95% confidence interval ( CI) of CapG, TrkB, Prox-1, MMP-2, VEGF-C and VEGFR3 in predicting LNM of GC before operation were 0.787 (0.687 to 0.880), 0.772 (0.656 to 0.860), 0.761 (0.661 to 0.883), 0.724 (0.618 to 0.830), 0.687 (0.571 to 0.803) and 0.583 (0.452 to 0.715), respectively. Among them, the AUC values of CapG, Prox-1 and TrkB were relatively high. The expression levels of CapG and Prox-1 were correlated with invasion depth and TNM stage of GC ( χ2=4.792, 13.664, 4.204 and 19.948, all P<0.05). And TrkB expression was correlated with TNM stage of GC ( χ2=12.036, P<0.05). Kaplan-Meier curves revealed that the overall survival rates of CapG, TrkB or Prox-1 positive groups were significantly lower than those of CapG, TrkB or Prox-1 negative groups (70.2%, 33/47 vs. 94.7%, 36/38; 70.7%, 29/41 vs. 90.9%, 40/44; 69.0%, 20/29 vs. 87.5%, 49/56, respectively), and the differences were statistically significant ( χ2=9.820, 4.909 and 4.683, all P<0.05). Conclusions:CapG, TrkB and Prox-1 are markers with relatively high predictive value for LNM of GC, and all of them are correlated with the progression and poor prognosis of GC.