Resection margin involvement of pancreaticoduodenectomy is an key prognostic factor for pancreatic head cancer.However,there is a wide variation of reported microscopic margin involvement (R1) rate in the literature,and there is discrepancy between the R1 rate and clinical outcome.Recent studies indicate that the variation and the discrepancy are caused by confusing nomenclature,controversy regarding the difinition of R1,lack of standardization of pathological examination,and inaccurate diagnosis for the pancreatic head mass.This review summarizes the composition and nomenclature of the circumferential resection margin,the difinition of R1,the method of pathological examination,the relationship between R1 rate and prognosis,and the relationship between resection margin involvement and tumor origin.

Colorectal cancer (CRC) is one of the most common malignancies,and liver metastases become the leading cause of high mortality of CRC patients.Difference in the anatomy between the colon and rectum resulting in different metastatic pattern and treatment methods between the colonic cancer and the rectal cancer.Recently,molecular-based subtyping is becoming the basis of prediction of tumor response and outcomes,replacing clinical and pathological stagings.In this review,clinical characteristics,advances of molecular detection,surgery and adjuvant therapy of rectal liver metastases are summarized.

Objective To investigate curative effects of interventional therapy,palliative operation,and palliative operation combined with ~(125)I seed implantation for the treatment of advanced pancreatic carcinoma.Methods A total of 103 patients with unresectable pancreatic cancer were treated with percutaneous transhepatic cholangiography and drainage(Interventional Group,15 patients),or cholangiojejunostomy and gastroenterostomy(Palliative Group,60 patients),or palliative operation combined with ultrasound-guided ~(125)I seed interstitial implantation(Combination Group, 28 patients),respectively.Results Of 21 patients with preoperative pain in the Combination Group,the rate of partial pain relief and complete pain relief were 14.3%(3/21) and 76.2%(16/21),respectively,which were significantly higher than those in the other two groups(?~2=6.305,P=0.012;?~2=4.525,P=0.033).The median survival time was significantly longer in the Combination Group(8 months) than in the Palliative Group(7 months) and the Interventional Group(2 months)(P=0.0005).Conclusions Percutaneous transhepatic cholangiography and drainage can be applied to patients who cannot tolerate open surgery.Conventional palliative operations combined with ~(125)I seed implantation benefits the patients both in survival time and in pain relief.

Objective To investigate the feasibility and efficacy of ultrasound-guided interstitial implantation of radioactive ~(125)I seed for the treatment of unresectable pancreatic carcinoma.Methods Twenty-one patients with unresectable primary pancreatic carcinoma were treated with interstitial ~(125)I seed implantation under laparotomy.The radioactive activity and the number of implanted seed were determined according to preoperative CT scanning outcomes by using the Treatment Planning System(TPS).The matched peripheral dose(MPD) was 65~110 Gy.The radioactive activity ranged 0.4~0.5 mCi per seed.A total of 10~75 ~(125)I seed were implanted with an 18-gauge seed needle and the Mick applicator under direct visualization or ultrasound guidance.Gastroenterostomy or cholangiojejunostomy were performed in 8 patients before or after the implantation.Postoperative external radiation therapy combined with chemotherapy with gemcitabine was carried out in 2 patients. Stent placement was conducted in 2 patients preoperatively and postoperatively, respectively.Results Out of 15 patients with abdominal pain,complete and partial pain relief were obtained in 7 patients and 7 patients,respectively,at 1~3 postoperative days,the response rate being 93.3%(14/15). Except for 2 cases of loss of follow-up,there were 5 cases of complete response(CR),7 cases of partial response(PR),5 cases of progressive disease(PD),and 2 cases of no change(NC).Of 19 patients,the median survival time was 5 months and the 1-year survival rate was 26.3%.Chylous leakage occurred in 1 patient and seed dislodgement to the liver occurred in 3 patients.No pancreatic fistula or pancreatitis were encountered. Conclusions Radioactive ~(125)I seed implantation for the treatment of pancreatic carcinoma is safe,effective,and micro-invasive,being a good option of remedy.

Objective To explore the feasibility and safety of endoscopic thyroidectomy via axillo-breast approach and the cervical strap muscles. Methods From January to June 2007, endoscopic thyroidectomy was performed on 21 cases in our department via axillo-breast approach and the cervical strap muscles. The operation was carried out under general anesthesia, the anterior cervical muscles was preserved and dragged ahead if necessary. The pressure of CO2 at surgical space was set at 6-8 mm Hg.Results Endoscopic unilateral partial or subtotal thyroidectomy was completed in all the patients without converting to open surgery. No complication occurred in this series. The mean operation time was 70-120 min [mean,(88.3?19.5) min], and the mean blood loss was 2-100 ml [mean, (11.5?21.8) ml]. The drainage tube was removed at 36-48 hours after the operation. And the mean postoperative hospital stay was 2 days. A 3-month follow-up showed good outcomes in terms of sensation at the surgical region and cosmetic effect. Conclusion Endoscopic thyroidectomy via axillo-breast approach and the cervical strap muscles is feasible and safe for unilateral benign thyroid lesions.

Objective To evaluate the safety and feasibility of laparoscopic distal pancreatectomy.Methods From September 2005 to June 2008,26 patients with masses located at pancreatic body/tail were treated in our hospital.Before the operation,25 of the cases were diagnosed with benign tumor and one was suspected as having malignant neoplasm.The median size of the tumors was 5 cm in diameter(range,1.2 to 10 cm).Results All of the operations were completed by laparoscopy.Distal pancreatectomy was performed on 15 patients with the spleen being preserved with(10 cases)or without(5)splenic vessels preservation;and laparoscopic distal splenopancreatectomy was carried out in 10 cases.In one patient who had received open distal splenopancreatectomy before admission,resection of the pancreatic body was made.The median operation time was 268.5 minutes in this series(range,129 to 400 minutes),and the median intraoperative blood loss was 100 ml(range,50 to 800 ml).The patients were discharged in 6 to 21 days postoperation(median,9 days).None of them developed pancreatic fistula or splenic infarction.Two of the patients developed encapsulated fluid and were cured by conservative treatments,one patient showed incisional infection.Follow-up was available in all the patients for 1 to 35 months(median,15.5 months).During the period,no recurrence was detected.Conclusions Laparoscopic distal pancreatectomy is feasible and safe for benign tumors located at the body or tail of the pancreas.

Objective To investigate the relationship between dose and trough blood concentration of tacrolimus after orthotopic liver transplantation and the changes of time-dependent concentration. Methods The doses and trough blood concentrations of tacrolimus from 20 patients who survived longer than 1 year were summarized retrospectively.Results The initial oral doses of 0.15 mg?kg -1?d -1 as suggested by most surgeons led to 53.4 % of the measured whole blood concentrations in the first postoperative week were higher than 15 ?g/L, 23.3 % of them within 10 ?g/L to 15 ?g/L and 23.3 % of them lower than 10 ?g/L. The ratio of trough concentration/dose was increased gradually after transplantation and reached its peak at the second postoperative month, which was higher than those in the following month 3, 4, 5, 6, 7, 8 and 11 significantly (all P

0 05) and incidence rate of postoperative complications (0 vs.0). Postoperative hospital stay in group experiment was longer than that in group control ((2 2?0 4)d vs. (2?0)d, t =2 958, P

Objective To summarize our experiences in the diagnosis and treatment of giant colonic lipoma,and enhance awareness of the disease and avoid misdiagnosis.Methods We retrospectively analyzed the clinical data of 5 cases of giant colonic lipoma that were mistaken for colon cancer,and evaluate the possible reasons of misdiagnosis.Results Colonic lipoma is an uncommon benign tumor.Most cases with larger tumor size were misdiagnosed as colon cancer when they suffered from the symptoms of abdominal pain,bloody stool,abdominal mass,even bowel obstruction and intussusception.Barium enema and colonoscopy are important diagnostic means.Contrast enhanced CT scan can provide definitive topographical information identifying a colonic lipoma.Surgical resection was performed in all the 5 cases.Conclusion Giant colonic lipoma with intussusception can mimic a colonic carcinoma leading to misdiagnosis.

Objective To study the topoanatomy of anterior perineal plane and adjoining tissue structure in the preparation of ultra-low anterior resection of the rectum. Methods Dissection was performed on 16 male cadavers of semi-pelvis sectioned in the saggital plane. Eight indexes were measured and recorded. Results Anterior perineal plane was clearly found in all 16 cadavers. The median distance of rectum-urethra (R-U) was 14 mm (ranging 10 -17 mm). The contour of perineal body was trapezoid,which was narrow cranially and broad caudally. The median width of cranial perineal body was 8 mm (ranging 6 -9 mm), while the median width of caudal perineal body was 21 mm (ranging 18 -23 mm).The median numerus of thickness of perineal body (TPB), thickness of puborectalis (TPR), arrterior wall of rectum (aPR) -D, pPR-D and width of pelvic diaphragm (WPD) were 20. 5 mm ( ranging 17 - 23 mm),12 mm(ranging 10 -16 mm), 25 mm(ranging 21 -27 mm), 20 mm(ranging 16 -23 mm) and 8 mm (ranging 6 - 10 mm) respectively. Conclusions Anterior perineal plane clearly exists, through which about 20 mm more length of the distal rectum is available which could increase the sphincter-saving rate in cases of low rectal carcinoma.