Colorectal cancer liver metastasis can be categorized as initially resectable and initially unresectable liver metastasis. Patients with initially resectable colorectal cancer liver metastases may benefit from hepatic surgery significantly,while those with initially unresectable metastases also have an opportunity to be treated radically by liver surgery after conversion therapy,so as to have a prolonged survival time. It is crucial to choose the right time and right way of surgical intervention. The timing depends on determination of tumor resectability,controlling of pre-operative systemic therapy and evaluation of liver function after systemic treatment. The selection of right way contains the election between synchronous operation and staged operation, resection margin and using of technologies such as laparoscope and associating liver partition and portal vein ligation for staged hepatectomy. This paper aims to explore the optimal timing for operation and the approaches of surgical method based on the research progress worldwide for prolonging the survival time of patients with colorectal cancer multiple liver metastases.

Colorectal cancer liver metastasis can be categorized as initially resectable and initially unresectable liver metastasis. Patients with initially resectable colorectal cancer liver metastases may benefit from hepatic surgery significantly,while those with initially unresectable metastases also have an opportunity to be treated radically by liver surgery after conversion therapy,so as to have a prolonged survival time. It is crucial to choose the right time and right way of surgical intervention. The timing depends on determination of tumor resectability,controlling of pre-operative systemic therapy and evaluation of liver function after systemic treatment. The selection of right way contains the election between synchronous operation and staged operation, resection margin and using of technologies such as laparoscope and associating liver partition and portal vein ligation for staged hepatectomy. This paper aims to explore the optimal timing for operation and the approaches of surgical method based on the research progress worldwide for prolonging the survival time of patients with colorectal cancer multiple liver metastases.

Objective To investigate the classiifcation, and reasonable choice and curative effect of the surgical procedures for pancreatic duct stone. Methods Clinical data of 18 patients with pancreatic duct stone undergoing surgery in Sun Yat-sen Memorial Hospital, Sun Yat-sen University from January 2010 to December 2012 were retrospectively analyzed. There were 13 males and 5 females with the average age of (53±12) years. Fourteen cases suffered from abdominal pain, 5 complicated with pancreatic cancer, 6 with bile duct stone and 8 with mellitus diabetes. The informed consents of all patients were obtained and the local ethical committee approval was received. Classiifcation, surgical procedures and postoperative complications of the pancreatic duct stone patients during perioperative period and the curative effect during follow-up were observed. Results All patients received surgical treatment. Two cases with typeⅠ pancreatic duct stone underwent pancreaticoduodenectomy (Whipple operation), 8 with type Ⅱand 1 with typeⅢunderwent pancreatolithotomy+pancreato-jejunal Roux-en-Y anastomosis (Partington operation). Two with typeⅢunderwent distal pancreatectomy+splenectomy. Among 5 cases with typeⅣ,2 underwent Whipple operation and 3 underwent Partington operation. No patients died during perioperative period. Postoperative complications were observed in 5 cases, including 3 with pancreatic ifstula and 2 with ascites, and the patients were cured after symptomatic treatments. Abdominal pain disappeared after surgery in 12 cases and was signiifcantly alleviated in 2 cases. One case complicated with pancreatic cancer died 1 year after surgery. No recurrence of stones was observed in the remaining cases. Conclusions Based on the priciple of individualized treatment, reasonable surgical procedure should be choosed according to the classiifcation of pancreatic duct stone. Pancreatolithotomy and pancreatojejunostomy are the main surgical procedures.