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.

This study was to evaluate the feasibility of hepatectomy for primary liver cancer (PLC) without hepatic blood flow occlusion. Methods 194 PLC patients admitted between 1988～1998 underwent hepatectomy without hepatic blood flow occlusion including nonanatomical hepatectomy (100 cases),hepatolobectomy (41 cases), combined adjacent organ resection (30 cases), hepatic segmentectomy (22 cases) and left hemihepatectomy (3 cases). Results Operative time was 2 4 hr, intraoperative blood transfusion averaged at 649 ml. Operative complication rate was 18 0%, and there was no mortality. Conclusion Hepatectomy without hepatic blood flow occlusion for PLC patients can be performed safely, so it is a useful technique for hepatectomy.

ObjectiveTo improve the diagnosis and treatment of duodenal carcinoma (DC).Methods A retrospective study was made on the diagnosis, treatment and prognosis of 45 duodenal carcinoma patients. Results The detection rate of DC by duodenoscopy was 95% (20/21), 96% (22/23) by hypotonic duodenography, 29% (13/45) by B ultrasound, 73% (19/26) by CT, and 80% (4/5) by MR. Forty four cases underwent surgery with resection rate of 53% (24/45), radical resection rate of 42% (19/45). The postoperative (radical resection) 1, 3, 5 year survival rate was 91%, 39%, and 26%, while the median survival time was 5 months in cases with unresectable tumor. Conclusions Duodenoscopy and hypotonic duodenography are ideal tools for the diagnosis of DC. For DC cases with obstructive jaundice, B ultrasound, CT and MR could show the obstructive portion and the metastasis.Radical resection is the mainstay for a long term survival.

ObjectiveTo study the clinical feature, diagnosis, treatment and prognosis of hepatic angiomyolipoma.Methods The clinical materials of eight surgically treated patients with hepatic AML were retrospectively analyzed.ResultsThere were five females and three males, with age ranging from 25 to 59 years (mean 39 6 years). Tumors were located in the right lobe of the liver in 5 cases, and in the left lobe in 3 cases. Ultrasonography and computed tomography were performed in all cases. Magnetic resonance imaging and angiography were done in two each cases. The myoid cells in all tumors showed over expression of HMB 45. One patient died of postoperative heart failure, seven were followed up for 9 mos to 12 years without tumor recurrence. Conclusions Comprehensive imaging features can reveal the characteristic components of hepatic angiomyolipoma. HMB 45 immunostaining can be used to confirm the diagnosis. Surgical resection is an effective treatment of hepatic AML.

ObjectiveTo study the clinical features, treatment and prognosis of hepatic hemangioma. MethodsClinical treatment of 160 cases of hemangioma was analyzed retrospectively, including partial hepatectomy in 66 cases, suture ligation in 30 cases, hepatic embolization performed in 37 cases, radiotherapy in 27 cases. Follow up was made from six months to 3 years. ResultsPartial hepatectomy has a recurernce rate of 4% in 3 years . Suture ligation was found with recurernce rate of 40% for 3 years. Hepatic artery embolization failed to hamper the growth of hemangiomas in 67% of the 37 cases. ConclusionPartial hepatectomy is the treatment of choice for patients suffering from a single huge hemangioma.

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 evaluate the preoperative diagnosis and treatment of primary duodenal adenocarcinoma ( PDA). Methods Clinical data of 89 PDA cases undergoing laparotomy from 1985 to 2009 in three hospital in Beijing and Zhengzhou were analyzed retrospectively. Results The prevalence rate of PDA is comparatively low and its clinical manifestations are not specific. The correct diagnostic rate of auxiliary examination were 93% by endoscopy,90% by gastrointestinal X-ray air barium double radiography,82% by MRCP,42% by BUS,70% by CT/MRI. The most common location of the adenocarcinoma(65% ) was at the second portion of the duodenum. Among 67 PDA cases 48 cases underwent pancreatoduodenectomy, 19 cases received segmental deodenectomy. The 5 year's survival rate was 47% and 50% respectively. Conclusions Endoscope and X-ray radiography are mainstays for the diagnosis of PDA. Early diagnosis and radical operation are the key to improve the resection rate and the long term survival.

Objective To investigate the effects of different surgical modalities on primary anorectal malignant melanoma. Methods Clinical data of 60 primary anorectal malignant melanoma cases who were admitted between 1965 and 2007 were collected, summarized and analyzed. Multivariate analysis was performed using the COX proportional hazards regression method. Results Tumors located in the rectum in 50 cases, in the anal canal in 10 cases. The overall survival rates were not significantly different between the 23 cases who received tumor resection only and those 30 cases receiving postoperative adjuvant therapy (X2=0. 078, P>0.05). Among these 53 surgical cases of anorectal malignant melanoma, 37underwent abdominoperineal resection, 16 underwent wide local excisions, There was no significant difference of the survival rates between the two groups (X2=1.464,P>0.05). Risk factors analysis revealed that the depth of tumor invasion is a risk factor (P<0.05), the modality of treatment is a protective factor (P<0.05). Conclusions Surgical operation is the principal effective management for anorectal malignant melanoma, Wide local excision is the principal therapeutic choice for localized well-circumferential anorectal malignant melanomas.

Objective To explore the value and criteria for primary tumor resection in patients with stage Ⅳ rectal cancer. Methods The clinical data were retrospectively analyzed for 53 patients with stage Ⅳ rectal cancer undergoing primary tumor resection. Results All patients were graded according to Eastern Cooperative Oncology Group (ECOG) performance as status 1. Seventeen of 53 patients (32%) received palliative resection. Thirty-six patients received adjuvant radiotherapy and/or chemotherapy. The median follow-up was 14 months. Forty-seven patients had complete resolution of their symptoms related to the primary rectal cancer for a year. The median survival was 16 months and 2-year overall survival of 24.5%. On multivariate analysis, chemotherapy was a determinant of prolonged survival (P=0.046). Conclusions Resection of primary tumor in patients with stage Ⅳ rectal cancer can improve the quality of life. Patients who have a good performance status, minimal metastatic disease and normal preoperative liver function tests should undergo resective surgery and aggresive systemic chemotherapy.

0.05). Intraoperative blood transfusion in drainage group (1 300ml) was significantly increased than that in non-drainage group( 939ml)(P0.05). The hospital stay in drainage group[ average 71(43-101)days] was significantly longer than that in non- drainage group [ average 47(29-81)days](P=0.05). Conclusions If a sufficient preoperative preparation is performed,one stage PD operation is a benificial method for peri-ampullar carcinoma patients complicated with severe obstructive jaundice.