Aim To determine the plasma protein binding rate of five components of Eucommia ulmoides extract. Methods The equilibrium dialysis method was used to study the plasma protein binding rate. The plasma samples were extracted by protein precipitation with methanol. With the use of puerarin as the internal standard, UPLC-MS/MS was carried out to determine the concentration of the five compounds in and out of the dialysis membrane. Results The average plasma protein binding rates of five compounds on the area of the concentration which was determinate were as fol-lows, respectively: geniposidic acid was ( 25. 77 ± 2. 68 )%, protocatechuic acid was ( 57. 54 ± 3. 79)%, chlorogenic acid was (53. 91 ± 3. 00)%, pinoresinol diglucoside was (24. 15 ± 4. 92)%, and pinoresinol singleglucoside was (49. 78 ± 3. 61)%. Conclusions The results show that the binding percentage of geniposidic acid and pinoresinol diglucoside is relatively low, but the binding rate of the others with rat plasma protein is moderate.

Objective To detect the changes of the NJ001 specific antigen expression before and after surgery, and evaluate whether the NJ001 specific antigen could be used as a serum biomarker for the diagnosis of pancreatic cancer.Methods With the method of sandwich ELISA, the serum samples from 85 pancreatic cancer patients, 22 pancreatic benign tumor and 40 healthy controls were detected respectively. The results of the NJ001 specific antigen in the serum samples from 85 pancreatic cancer patients were compared with CA19-9 detected by ECLIA.Results The positive rate of NJ001 for the pancreatic cancer group was obviously higher than that for the benign pancreatic tumor and health control groups[50.6%(43/85) vs 18.2%(4/22), χ2 =7.451, P<0.05; 50.6%(43/85) vs 10.0%(4/40), χ2 =19.098, P<0.05].The difference between benign pancreatic tumor group and health control group had no statistical significance[18.2%(4/22) vs 10.0%(4/40),χ2 =0.845, P>0.05].The positive rate in the group of pancreatic cancer before surgery was higher than that after surgery[50.6%(43/85) vs 23.5%(20/85),χ2=13.341, P<0.05].In addition, the results from 85 pancreatic cancer patients showed the specificity of NJ001 specific antigen was up to 87.1%.Although the positive rate of NJ001 specific antigen for pancreatic cancer was lower than that of CA19-9[50.6%(43/85) vs 75.3%(64/85), χ2 =11.121, P<0.05], it was higher when they combined [ 85.9%( 73/85 ) ] .Conclusions It shows high positive rate of NJ001 specific antigen in the patients of pancreatic cancer in this study, which suggests that NJ001 specific antigen might be a potential valuable biomarker for the diagnosis of pancreatic cancer.

Objective To compare the short-term clinical effects of Da Vinci robotic surgical systemassisted and laparoscopy-assisted operations for gastrointestinal stromal tumor (GIST).Methods The retrospective cohort study was conducted.The clinical data of 98 patients with GIST who were admitted to the Lanzhou General Hospital of Chinese People's Liberation Army from June 2016 to May 2018 were collected.Of 98 patients,45 undergoing Da Vinci robotic surgical system-assisted surgery for GIST and 53 undergoing laparoscopy-assisted surgery for GIST were respectively allocated into the robotic group and laparoscopic group.The associate senior and above doctors performed the surgery.The wedge resection was applied to patients with diameter of gastric stromal tumor ＜ 5 cm,and subtotal gastrectomy + digestive tract reconstruction (gastrojejunostomy and Brauns anastomosis) were applied to patients with diameter of gastric stromal tumor ＞ 5 cm or tumor located in the cardia and pylorus.Patients with intestinal stromal tumor underwent intestinal resection + end-to-side anastomosis.Observation indicators:(1) surgical and postoperative situations;(2) follow-up.Follow-up using outpatient examination and telephone interview was performed to detect tumor recurrence or metastasis up to July 2018.Measurement data with normal distribution were represented as x-±s,and comparison between groups was done using the independent-sample t test.Measurement data with skewed distribution were represented as M (range),and comparison between groups was done using nonparametric test.Comparisons of count data were analyzed using chi-square test.Results (1) Surgical and postoperative situations:98 patients underwent successful surgery.The operation time,volume of intraoperative blood loss,recovery time of gastrointestinal function,time of gastrointestinal decompression tube removal,time of abdominal drainage tube removal and duration of postoperative hospital stay were respectively (152± 49) minutes,100 mL (range,10-300 mL),(2.6 ± 0.6) days,(1.1 ± 0.3)days,(5.7±1.2)days,(8.3±1.3)days in the robotic group and (201±62)minutes,100 mL (range,5-600 mL),(3.1±0.7) days,(2.1 ± 1.5) days,(6.9 ± 3.4) days,(11.6 ± 7.0) days in the laparoscopic group,with statistically significant difference between groups (t =-3.983,Z =2.104,t =-3.776,-3.637,-2.018,-2.817,P＜0.05).(2) Follow-up:98 patients were followed up for 2-24 months,with a median time of 13 months.During the follow-up,there was no tumor recurrence or metastasis between groups.Conclusion Compared with laparoscopy-assisted surgery,Da Vinci robotic surgical system-assisted surgery for GIST is safe and feasible,with advantages of shorter operation time,faster postoperative recovery and shorter duration of hospital stay.

Objective:To evaluate the value of 18F-FDG PET/CT in the diagnosis and treatment of primary breast lymphoma (PBL). Methods:Clinical data and 18F-FDG PET/CT imaging data of 6 patients (all females, age 46-79 years) with pathologically diagnosed primary breast diffuse large B cell lymphoma (PB-DLBCL) in Xishan People′s Hospital of Wuxi City and Affiliated Hospital of Jiangnan University from July 2015 to October 2021 were analyzed retrospectively. A total of 10 18F-FDG PET/CT scans were done for primary staging (6 scans of 6 patients), evaluation of treatment response (3 scans of 2 patients), and recurrence detection (1 scan of 1 patient). 18F-FDG PET/CT image analysis was performed qualitatively (visually) and semi-quantitatively (SUV max). Treatment response was evaluated by Deauville scores. Results:All 6 patients were diagnosed pathologically as PB-DLBCL (3 patients by core needle biopsy, 3 patients by biopsy after lumpectomy). All 6 patients were staged using baseline 18F-FDG PET/CT before chemotherapy. For 3 patients diagnosed by core needle biopsy, baseline 18F-FDG PET/CT showed unilateral breast lesion with high FDG uptake (SUV max: 23.0, 52.9, and 33.6). For 3 postoperative patients, baseline 18F-FDG PET/CT showed flocculent soft tissue density in the operative area with low FDG uptake (SUV max: 3.4, 2.2 and 2.0). Patient No.2 showed a large left breast mass with left axillary lymph node involvement by baseline PET/CT, and multiple nodular uptakes in bilateral breast (Deauville score of 4) after 4 courses of chemotherapy and negative result (Deauville score of 1) after 3 courses of new chemotherapy regimens by PET/CT. Patient No.4 showed right breast lesion and right axillary lymph nodes by routine preoperative imaging examination, but left breast lesion by postoperative PET/CT. According to the results of 18F-FDG PET/CT, patient No.4 was with complete response (Deauville score of 1) after treatment, but recurrence (Deauville score of 5) occurred after 7 months follow-up. Conclusion:18F-FDG PET/CT can play an important role in every step of management (diagnosis and staging, treatment response evaluation and detection of recurrence) in patients with PB-DLBCL.

Objective: To evaluate risk factors for delayed gastric emptying(DGE)following pancreaticoduodenectomy(PD). Methods: There were 492 consecutive patients who underwent PD in Pancreas Center, the First Affiliated Hospital with Nanjing Medical University between January 2012 and December 2014 were identified from a prospective database.There were 315 male and 177 female patients with a median age of 60.5 years.Univariate and multivariate analyses were performed to investigate the independent risk factors for clinically relevant DGE(CR-DGE). Results: The overall incidence of DGE was 29.5%, with Grade B and C occurring at 4.3% and 5.9%, respectively.In multivariate analysis, pancreatic duct diameter less than 3 mm(OR=1.888, P=0.042), pylorus-preserving pancreaticoduodenectomy(OR=2.627, P=0.005) and clinically relevant postoperative pancreatic fistula(OR=2.740, P=0.007) were independently associated with CR-DGE.Other main complications such as postoperative pancreatic fistula, pyoperitoneum, intraabdominal infection were also associated with the severity of DGE(χ²=21.360, 14.422, 14.378; P=0.011, 0.002, 0.002). DGE patients had a significantly prolonged postoperative length of stay(31(24-41)d vs. 13(11-17)d) and increased medical cost((122 367.5±66 068.3)yuan vs. (78 200.7±27 043.9)yuan)(both P<0.01). Conclusions Small pancreatic duct, underwent pylorus-preserving pancreaticoduodenectomy and suffered postoperative pancreatic fistula might indicate a high risk of CR-DGE.

Objective:To investigate the predictive value of postoperative C-reactive protein for serious complications after Da Vinci robotic surgical system radical gastrectomy of gastric cancer.Methods:The retrospective case-control study was conducted. The clinicopathological data of 298 patients with advanced gastric cancer who underwent Da Vinci robotic surgical system radical gastrectomy in the 940th Hospital of Joint Logistics Support Force of Chinese People's Liberation Army from January 2017 to June 2019 were collected. There were 253 males and 45 females, aged from 24 to 86 years, with a median age of 60 years. Of the 298 patients, 275 cases underwent no serious postoperative complications and 23 cases underwent serious postoperative complications. Observation indicators: (1) serious postoperative complications; (2) analysis of risk factors for serious postoperative complications after Da Vinci robotic surgical system radical gastrectomy of gastric cancer; (3) performance evaluation of the predictive indicators. Measurement data with skewed distribution were represented as M(range). Count data were described as absolute numbers and comparison between groups was conducted using the chi-square test or Fisher exact probability. Comparison of ordinal data was conducted using the rank sum test. Univariate analysis was conducted using the chi-square test. Multivariate analysis was conducted using Logistic regression model. The receiver operating characteristic curve was drawn and the area under curve (AUC) was used to compare and estimate the efficiency of diagnostic criteria. The value of Youden index was used to determine the optimal cut-off point. Results:(1) Serious postoperative complications: of the 298 patients, 23 cases underwent complications classified ≥grade Ⅲa of Clavien-Dindo classifica-tion, including 10 cases with grade Ⅲa complications, 7 cases with grade Ⅲb complications, 4 cases with grade Ⅳa complications, 1 case with grade Ⅳb complications and 1 case with grade Ⅴ complications. (2) Analysis of risk factors for serious postoperative complications after Da Vinci robotic surgical system radical gastrectomy of gastric cancer. Results of univariate analysis showed that operation time, indicators of C-reactive protein concentration and neutrophil count at post-operative day 1, and indicators of C-reactive protein concentration, white blood cells count, neutrophil count and platelet count at postoperative day 3 and pathological stage were related factors affecting serious complications for advanced gastric cancer after Da Vinci robotic surgical system radical gastrectomy ( χ2=7.671, 4.504, 5.045, 48.293, 9.575, 15.436, 13.731, 9.537, P<0.05). Results of multivariate analysis showed that the operation time ≥250 minutes, the concentration of C-reactive protein at postoperative day 3 ≥16.65 mg/dL, the neutrophil count at postoperative day 3 ≥8.167×10 9/L, the platelet count at postoperative day 3 ≥218×10 9/L and the pathological stage of tumor as stage Ⅱ and stage Ⅲ were independent risk factors affecting serious complications for advanced gastric cancer after Da Vinci robotic surgical system radical gastrectomy ( odds ratio=3.721, 16.084, 6.056, 6.893, 12.455, 95% confidence interval: 1.032-13.421, 4.657-55.547, 1.073-34.163, 1.798-26.423, 1.338-115.930, P<0.05). (3) Performance evaluation of the predictive indicators: the C-reactive protein concentration at postoperative day 3 was a high-performance predictor with the AUC as 0.851 (95% c onfidence interval: 0.780-0.921, P<0.05) and neutrophil count and platelet count at postoperative day 3 were low-performance predictors with the AUC as 0.659 and 0.666 (95% confidence interval: 0.570-0.748 and 0.581-0.750, P<0.05). Conclusion:The C-reactive protein concentration ≥16.65 mg/dL at postoperative day 3 is a high performance predictive indicator for serious complications after Da Vinci robotic surgical system radical gastrectomy of gastric cancer.

Objective:To analyze the clinical characteristics and diagnosis and treatment experiences of Langerhans cell histocytosis (LCH) in skull.Methods:Sixteen patients with cranial LCH admitted to our hospital from January 2015 to December 2019 were chosen in our study. Their clinical data, diagnosis and treatment procedures and prognoses were retrospectively analyzed.Results:Among the 16 patients, there were 13 males and 3 females, aged from 1 to 31 years. The clinical manifestations included space-occupying lesions of the skull; and imaging showed bone destruction of the skull, with or without involvement of other bones or organs. All patients were pathologically confirmed to have LCH after surgical total resection of the lesions. Routine whole-body bone scanning was performed after surgery: one was found to have local abnormal metabolic activity and received local radiotherapy; 8 were combined with other bone or organ involvement, and received chemotherapy. All the patients were followed up for 1-5 years, and no recurrence was found, and no one died.Conclusion:Good prognosis can be achieved in cranial LCH patients accepted resection by giving additional treatment according to the results of postoperative reexamination and combination use of standardized radiotherapy and chemotherapy.

Objective To explore the clinical efficacy of Da Vinci robot-assisted radical gastrectomy for gastric cancer.Methods The retrospective cohort study was conducted.The clinicopathological data of 472 patients who underwent radical gastrectomy for gastric cancer in the 940 Hospital of the People's Liberation Joint Service from June 2016 to June 2018 were collected.There were 372 males and 100 females,aged (57± 11) years,with a range from 17 to 85 years.Patients underwent gastrointestinal angiography,magnetic resonance imaging,computed tomography or gastrointestinal endoscopy before surgery,and were diagnosed with gastric cancer by biopsy.Of the 472 patients,241 underwent Da Vinci robot-assisted radical gastrectomy for gastric cancer were allocated into robotic group and 231 underwent laparoscopy-assisted radical gastrectomy were allocated into laparoscopic group.Observation indicators:(1) surgical situations;(2) postoperative situations;(3) follow-up and survival.Follow-up using outpatient examination and telephone interview was performed to detect the tumor recurrence and metastasis and survival of patients up to January 30,2019.Measurement data with normal distribution were expressed as Mean±SD,and comparison between groups was done using the t test.Measurement data with skewed distribution were described as M (range).Count data were described as absolute number or percentage,and the chi-square test was used for comparison between groups.Comparison of ordinal data was done using the rank-sum test.The accumulative survival rate,tumor-bearing survival rate and mortality of tumor recurrence were calculated by the Kaplan-Meier method,and Log-rank test was used for survival analysis.Results (1) Surgical situations:472 patients underwent successful operation,with R0 margin.Cases with total gastrectomy + D2 lymph node dissection + Roux-en-Y anastomosis,cases with distal subtotal gastrectomy + D2 lymph node dissection + Billroth Ⅱ anastomosis,operation time,upper margin distance,lower margin distance,tumor diameter,cases with shallow muscular invasion,deep muscular invasion,subserosal invasion and serosal invasion (depth of tumor invasion)were 107,134,(234±44)minutes,(4±3)cm,(6±4)cm,(5 ±3)cm,8,17,32,184 in the robotic group,and 94,137,(239±46)minutes,(4±3)cm,(6±4) cm,(5±3)cm,7,19,30,175 in the laparoscopic group,respectively;there was no significant difference in above indicators between the two groups (x2 =0.200,2.459,t =-1.212,-1.074,-0.420,-1.236,Z =0.171,P＞ 0.05).The volume of i ntraoperative blood loss,number of lymph nodes dissected in total gastrectomy,number of lymph nodes dissected in distal subtotal gastrectomy were (126±113)mL,45±14,and 36±18 in the robotic group,and (149±132) mL,39±14,30± 16 in the laparoscopic group,showing statistically significant differences between the two groups (t=-2.093,3.275,2.195,P＜0.05).(2) Postoperative situations:the time to recovery of gastrointestinal function,time of postoperative abdominal drainage tube removal,and hospitalization cost in the robotic group were (2.6 ± 0.6)days,(5.7± 1.2) days,and (100 157±44 888) yuan,respectively.The above indices of the laparoscopic group were (3.1±0.7)days,(7.0±3.0)days,and (82 220± 18 941)yuan,respectively.There were statistically significant differences between the two groups (t =-5.371,-3.212,5.603,P ＜ 0.05).The duration of postoperative hospital stay was (12±6)days in the robotic group and (12±6)days in the laparoscopic group,with no significant difference between the two groups (t =0.755,P＞ 0.05).Eighteen out of 472 patients had complications.There were 3 cases of anastomotic leakage in the robotic group,2 cases of gastroplegia,1 case of duodenal stump,and 1 case of pulmonary infection,with a incidence of postoperative complication as 2.90％ (7/241).There were 4 cases of anastomotic leakage in the laparoscopic group,1 case of gastroplegia,1 case of duodenal stump,and 3 cases of pulmonary infection,with a incidence of postoperative complication as 3.90％ (9/231).There was no statistically significant difference in the incidence of postoperative complication between the two groups (x2 =1.503,P ＞ 0.05).Patients with digestive tract fistula were re-explored and performed continuous flushing-negative pressure aspiration and nutritional support treatment,and then discharged after improvement.Patients with gastroplegia and lung infection were discharged after corresponding conservative treatment.(3) Follow-up and survival:404 out of 472 patients were followed up for 7-31 months,with a median follow-up time of 19 months,including 212 in the robotic group and 192 in the laparoscopic group.The 3-year survival rates were 96.70％ and 91.67％ in the robotic group and laparoscopic group,with no statistically significant difference between the two groups (x2=1.037,P＞0.05).During the follow-up,the tumor-beating survival rate and mortality of tumor recurrence of the robotic group were 0.47％ and 2.36％,respectively,versus 1.04％ and 6.77％ of the laparoscopic group,with statistically significant differences between the two groups (x2 =3.198,4.208,P＜0.05).Conclusion The Da Vinci robot-assisted radical gastrectomy for gastric cancer is safe and effective,which can reduce volume of intraoperative blood loss,shorten the postoperative recovery time,increase the number of lymph node dissection,however,it will increase the treatment expense.

Objective:To investigate the clinical efficacy of pancreaticoduodenectomy (PD) for periampullary diseases.Methods:The retrospective cohort study was conducted. The clinico-pathological data of 2 019 patients with periampullary diseases who underwent PD in the First Affiliated Hospital of Nanjing Medical University from January 2016 to December 2020 were collected. There were 1 193 males and 826 females, aged 63(15) years. Observation indicators: (1) surgical situations; (2) postoperative conditions; (3) postoperative pathological examinations; (4) prognosis of patients with periampullary carcinoma. Regular follow-up was conducted by telephone interview and outpatient examination once every 3 months within the postoperative first year and once every 6 months thereafter to detect the survival of patients with periampullary carcinoma. The follow-up was up to December 2021. Measurement data with skewed distribution were represented as M(IQR) or M(range), and comparison between groups was analyzed using the rank sum test. Count data were described as absolute numbers and (or) percentages, and comparison between groups was analyzed by the chi-square test or Fisher exact probability. Kaplan-Meier method was used to draw survival curves and calculate survival rates, and Log-Rank test was used to conduct survival analysis. Results:(1) Surgical situations: of 2 019 patients, 1 116 cases were admitted from 2016-2018 and 903 cases were admitted from 2019-2020. There were 1 866 cases undergoing open PD and 153 cases undergoing laparoscopic or robot-assisted PD. There were 1 049 cases under-going standard PD and 970 cases undergoing pylorus-preserved PD. There were 215 cases combined with portal mesenteric vein resection, 3 cases combined with arterial resection. The operation time of 2 019 patients was 255(104)minutes and the volume of intraoperative blood loss was 250(200)mL. The intraoperative blood transfusion rate was 31.401%(623/1 984), with the blood transfusion data of 35 cases missing. The proportions of pylorus-preservation, combination with portal mesenteric vein resection, intraoperative blood transfusion were 585 cases(52.419%), 97cases(8.692%), 384 cases(34.941%) for patients admitted in 2016-2018, versus 385 cases(42.636%), 118 cases(13.068%), 239 cases(27.006%) for patients admitted in 2019-2020, showing significant differences between them ( χ2=19.14,10.05,14.33, P<0.05). (2) Postoperative conditions: the duration of postoperative hospital stay of 2 019 patients was 13 (10) days. One of 2 019 patients lacked the data of postopera-tive complications. The overall postoperative complication rate was 45.292%(914/2 018), of which the incidence rate of grade B or C pancreatic fistula was 23.439%(473/2 018), the rate of grade B or C hemorrhage was 8.127%(164/2 018), the rate of grade B or C delayed gastric emptying was 15.312%(309/2 018), the rate of biliary fistula was 2.428%(49/2 018) and the rate of abdominal infection was 12.884%(260/2 018). The reoperation rate of 2 019 patients was 1.932%(39/2 019), the in-hospital mortality was 0.644%(13/2 019), the postoperative 30-day mortality was 1.238%(25/2 019), and the postoperative 90-day mortality was 2.675%(54/2 019). There were 541 cases(48.477%) with overall postoperative complications, 109 cases(9.767%) with grade B or C hemorr-hage, 208 cases(18.638%) with grade B or C delayed gastric emptying , 172 cases(15.412%) with abdominal infection, 39 cases(3.495%) with postoperative 90-day mortality of 1 116 patients admitted in 2016-2018. The above indicators were 373 cases(41.353%), 55 cases(6.098%), 101 cases(11.197%), 88 cases(9.756%), 15 cases(1.661%) of 902 patients admitted in 2019-2020, respectively. There were significant differences in the above indicators between them( χ2=10.22, 9.00, 21.30, 14.22, 6.45 , P<0.05). The in-hospital mortality occurred to 11 patients(0.986%) of 1 116 patients admitted in 2016-2018 and to 2 cases(0.221%) of 903 patients admitted in 2019-2020, showing a significant difference between them ( P<0.05). (3) Postoperative pathological examinations. Disease area of 2 019 patients reported in postoperative pathological examinations: there were 1 346 cases(66.667%) with lesions in pancreas, including 1 023 cases of carcinoma (76.003%) and 323 cases(23.997%) of benign diseases or low potential malignancy. There were 250 cases(12.382%) with lesions in duodenal papilla, including 225 cases of carcinoma (90.000%) and 25 cases(10.000%) of benign diseases or low potential malignancy. There were 174 cases(8.618%) with lesions in bile duct, including 156 cases of carcinoma (89.655%) and 18 cases(10.345%) of benign diseases or low potential malignancy. There were 140 cases(6.934%) with lesions in ampulla, including 134 cases of carcinoma (95.714%) and 6 cases(4.286%) of benign diseases or low potential malignancy. There were 91 cases(4.507%) with lesions in duodenum, including 52 cases of carcinoma (57.143%) and 39 cases(42.857%) of benign diseases or low potential malignancy. There were 18 cases(0.892%) with carcinoma in other sites. Postoperative pathological examination showed carcinoma in 1 608 cases(79.643%), benign diseases or low potential malignancy in 411 cases(20.357%). The histological types of 1 608 patients with carcinoma included adenocarcinoma in 1 447 cases (89.988%), intra-ductal papillary mucinous carcinoma in 37 cases(2.301%), adenosquamous carcinoma in 35 cases(2.177%), adenocarcinoma with other cancerous components in 29 cases(1.803%), neuroendocrine carcinoma in 18 cases(1.119%), squamous carcinoma in 1 case (0.062%), and other histological malignancies in 41 cases(2.550%). The histological types of 411 patients with benign or low poten-tial malignancy included intraductal papillary mucinous neoplasm in 107 cases (26.034%), chronic or autoimmune inflammatory disease in 62 cases(15.085%), neuroendocrine tumor in 58 cases(14.112%), pancreatic serous cystadenoma in 52 cases(12.652%), pancreatic solid pseudopapillary tumor in 36 cases(8.759%), gastrointestinal stromal tumor in 29 cases(7.056%), villous ductal adenoma in 20 cases(4.866%), pancreatic mucinous cystadenoma in 2 cases(0.487%), pancreatic or duodenal trauma in 2 cases(0.487%) and other histological types in 43 cases(10.462%). (4) Prognosis of patients with periampullary carcinoma. Results of survival analysis of 1 590 patients with main locations of periampullary carcinoma showed that of 1 023 patients with pancreatic cancer, 969 cases were followed up for 3.0-69.6 months, with a median follow-up time of 30.9 months. The median overall survival time, 1-year, 3-year and 5-year survival rates of pancreatic cancer patients were 19.5 months [95% confidence interval ( CI) as 18.0-21.2 months], 74.28%, 29.22% and 17.92%. Of 225 patients with duodenal papillary cancer, 185 cases were followed up for 3.0-68.9 months, with a median follow-up time of 36.7 months. The median overall survival time, 1-year, 3-year and 5-year survival rates were unreached, 94.92%, 78.87% and 66.94%. Of 156 patients with distal bile duct cancer, 110 cases were followed up for 3.0-69.5 months, with a median follow-up time of 25.9 months. The median overall survival time, 1-year, 3-year and 5-year survival rates were 50.6 months (95% CI as 31.4 to not reached), 90.37%, 56.11% and 48.84%. Of 134 patients with ampullary cancer, 100 cases were followed up for 3.0-67.8 months, with a median follow-up time of 28.1 months. The median overall survival time, 1-year, 3-year and 5-year survival rates were 62.4 months (95% CI as 37.8 months to not reached), 90.57%, 64.98% and 62.22%. Of 52 patients with duodenal cancer, 38 cases were followed up for 3.0-69.5 months, with a median follow-up time of 26.2 months. The median overall survival time, 1-year, 3-year and 5-year survival rates were 52.0 months (95% CI as 30.6 months to not reached), 93.75%, 62.24% and 40.01%.There was a significant difference in overall survival after PD between patients with different locations of periampullary malignancies ( χ2=163.76, P<0.05). Conclusions:PD is safe and feasible in a high-volume pancreas center, but the incidence of overall postoperative complications remains high. With the increase of PD volume, the incidence of overall postoperative complications has significantly decreased. There is a significant difference in overall survival time after PD among patients with different locations of periampullary malignancies. The 5-year survival rate after PD for duodenal papillary cancer, ampullary cancer, duodenal cancer and distal bile duct cancer is relatively high, whereas for pancreatic cancer is low.