Objective:To analyze the application value of three-dimensional visualization combined with indocyanine green fluorescence staining in laparoscopic resection of patients with complex liver cancer.Methods:The data of patients with complex liver cancer (liver cancer located in liver segments Ⅶ, Ⅷ, Ⅳa, Ⅴ and caudate lobe) who underwent laparoscopic anatomical liver resection in Zhengzhou University People's Hospital from August 2018 to August 2023 were retrospectively analyzed. A total of 334 patients were enrolled, including 249 males and 85 females, with the age of (57.0±10.6) years. Among the 334 patients, patients who underwent laparoscopic liver resection using three-dimensional visualization combined with indocyanine green fluorescence staining were included in the combined group ( n=128), and the other patients who underwent traditional laparoscopic liver resection were included in the traditional group ( n=206). Propensity score was used to match the preoperative indicators and postoperative pathology between the two groups. The two groups were compared in terms of gender, age, maximum diameter of tumor, alpha-fetoprotein, number of tumors, tumor location, American Society of Anesthesiologists (ASA) grade, operation time, portal occlusion time, intraoperative blood loss, surgical margin and postoperative aspartate transaminase (ALT), alanine transaminase (AST), albumin, total bilirubin, and severe postoperative complications (Clavien-Dindo grade≥grade Ⅲ). The Kaplan-Meier method was used to analyze the prognosis, and the log-rank test was used to compare the survival rate. Results:After propensity score matching, 120 cases were included in the combined group and the traditional group, respectively. There were no significant differences in gender, age, maximum diameter of tumor, alpha-fetoprotein, number of tumors, tumor location, and ASA grade between the two groups (all P>0.05). The intraoperative blood loss in the combined group was 200.0 (150.0, 300.0) ml, and the positive surgical margin rate was 6.7% (8/120), which were lower than 300.0 (150.0, 500.0) ml and 15.8% (19/120) in the traditional group, with statistically significant differences ( Z=-2.43, P=0.015, χ2=5.05, P=0.025). There were no statistically significant differences in the operation time, portal occlusion time, and postoperative ALT, AST, albumin, and total bilirubin between the two groups (all P>0.05). Eight cases (6.7%) in the combined group and 11 cases (9.2%) in the traditional group had severe complications after surgery, and all were discharged after treatment. The 1-, 3-, and 5-year recurrence-free survival rates of the combined group were 83.3%, 61.7%, and 58.3% respectively, while that of the traditional group were 71.7%, 52.5%, and 49.2%, respectively, with significant difference ( χ2=4.57, P=0.031). There was no significant difference in the cumulative survival rate between the combined group and the traditional group ( χ2=0.66, P=0.417). Conclusion:Compared with laparoscopic liver resection, laparoscopic liver resection for patients with complex liver cancer using three-dimensional visualization technology combined with indocyanine green fluorescence staining technology can reduce intraoperative blood loss, positive margin rate, and postoperative recurrence.

Objective:To analyze the application value of three-dimensional visualization combined with indocyanine green fluorescence staining in laparoscopic resection of patients with complex liver cancer.Methods:The data of patients with complex liver cancer (liver cancer located in liver segments Ⅶ, Ⅷ, Ⅳa, Ⅴ and caudate lobe) who underwent laparoscopic anatomical liver resection in Zhengzhou University People's Hospital from August 2018 to August 2023 were retrospectively analyzed. A total of 334 patients were enrolled, including 249 males and 85 females, with the age of (57.0±10.6) years. Among the 334 patients, patients who underwent laparoscopic liver resection using three-dimensional visualization combined with indocyanine green fluorescence staining were included in the combined group ( n=128), and the other patients who underwent traditional laparoscopic liver resection were included in the traditional group ( n=206). Propensity score was used to match the preoperative indicators and postoperative pathology between the two groups. The two groups were compared in terms of gender, age, maximum diameter of tumor, alpha-fetoprotein, number of tumors, tumor location, American Society of Anesthesiologists (ASA) grade, operation time, portal occlusion time, intraoperative blood loss, surgical margin and postoperative aspartate transaminase (ALT), alanine transaminase (AST), albumin, total bilirubin, and severe postoperative complications (Clavien-Dindo grade≥grade Ⅲ). The Kaplan-Meier method was used to analyze the prognosis, and the log-rank test was used to compare the survival rate. Results:After propensity score matching, 120 cases were included in the combined group and the traditional group, respectively. There were no significant differences in gender, age, maximum diameter of tumor, alpha-fetoprotein, number of tumors, tumor location, and ASA grade between the two groups (all P>0.05). The intraoperative blood loss in the combined group was 200.0 (150.0, 300.0) ml, and the positive surgical margin rate was 6.7% (8/120), which were lower than 300.0 (150.0, 500.0) ml and 15.8% (19/120) in the traditional group, with statistically significant differences ( Z=-2.43, P=0.015, χ2=5.05, P=0.025). There were no statistically significant differences in the operation time, portal occlusion time, and postoperative ALT, AST, albumin, and total bilirubin between the two groups (all P>0.05). Eight cases (6.7%) in the combined group and 11 cases (9.2%) in the traditional group had severe complications after surgery, and all were discharged after treatment. The 1-, 3-, and 5-year recurrence-free survival rates of the combined group were 83.3%, 61.7%, and 58.3% respectively, while that of the traditional group were 71.7%, 52.5%, and 49.2%, respectively, with significant difference ( χ2=4.57, P=0.031). There was no significant difference in the cumulative survival rate between the combined group and the traditional group ( χ2=0.66, P=0.417). Conclusion:Compared with laparoscopic liver resection, laparoscopic liver resection for patients with complex liver cancer using three-dimensional visualization technology combined with indocyanine green fluorescence staining technology can reduce intraoperative blood loss, positive margin rate, and postoperative recurrence.

Objective:To analyze the influencing factors of not achieving textbook outcome (TO) after laparoscopic radical surgery in patients with malignant pancreatic body and tail tumor, and to establish and evaluate a nomogram for predicting the failure to achieve TO.Methods:The clinical data of 111 patients with malignant pancreatic body and tail tumors undergoing laparoscopic radical surgery in the Department of Hepatobiliary and Pancreatic Surgery in Henan Provincial People's Hospital from January 2020 to December 2022 were retrospectively analyzed, including 44 males and 67 females, aged (53.8±14.7) years. All patients were staged TNM I to II, including pancreatic ductal adenocarcinoma ( n=102, 91.9%), pancreatic neuroendocrine tumor ( n=5, 4.5%), and pancreatic intraductal papillary mucinous tumors ( n=4, 3.6%). The patients were randomly divided into a training set ( n=78) and a test set ( n=33) at a ratio of 7∶3. The 78 patients in the training set were further divided into TO group ( n=28) and control group ( n=50, not achieving TO). Based on the univariate and multivariate logistic regression analysis of training set, the influencing factors of failure to achieve TO after laparoscopic radical surgery in patients with pancreatic body and tail tumor were analyzed. A nomogram based on the multi-factors were established to predict the failure to achieve TO. Receiver operating characteristic (ROC) curve, calibration curve, decision curve analysis (DCA) were utilized to evaluate the nomogram. Results:There were significant differences in tumor diameter, positive lymph nodes, operation time and CT value of pancreas between the TO and control groups (all P<0.05). Multivariate logistic regression analysis showed that tumor diameter >4 cm ( OR=9.673, 95% CI: 2.198-42.579), positive lymph node ( OR=5.385, 95% CI: 1.514-19.154), pancreatic CT value ( OR=0.594, 95% CI: 0.392-0.902) were the influencing factors for patients who did not achieve TO (all P<0.05). Based on the results of multiple factors, a nomogram was established to predict the failure to achieve TO after laparoscopic radical surgery. The area under the ROC curve of the nomogram was 0.849 (95% CI: 0.757-0.940) and 0.873 (95% CI: 0.730-1.000) in the training and test sets, respectively. The calibration curve was close to the ideal curve and the predicted results of the nomogram matched well with the actual results. The DCA showed that the nomogram has obvious positive net benefit. Conclusion:The nomogram constructed with tumor diameter > 4 cm, positive lymph nodes and CT value of pancreas for prediction of the patients with pancreatic body and tail malignant tumor after laparoscopic radical surgery did not achieve TO has good performance.

Objective:To compare the short-term clinical outcomes of patients undergoing laparoscopic versus open radical resection of hilar cholangiocarcinoma.Methods:The clinical data of 91 patients who underwent radical resection for hilar cholangiocarcinoma at our hospital from January 2018 to June 2021 were analyzed retrospectively. There were 48 males and 43 females, with aged of (61.51±7.18) years old. The patients were divided into the laparotomy group ( n=59) and the laparoscopic group ( n=32) based on the operations they received. The general data, perioperative data and complications of the two groups were compared. Results:There was no perioperative death in the laparoscopic group, but one patient died of abdominal bleeding in the laparotomy group. All other patients recovered from postoperative complications with treatment. When compared with patients in the laparotomy group, the operation time [(381.28±102.37) vs. (296.81±84.74) min] and biliary intestinal anastomosis time [(17.81±2.81) vs. (15.19±2.27) min] were significantly longer in the laparoscopic group. However, the postoperative hospital stay [(12.34±3.46) vs. (15.10 ± 4.48) d], bed rest time [(3.38±0.66) vs. (5.24±0.88) d], analgesic time [(4.31±0.90) vs. (6.22±1.26) d] and postoperative time to first feeding [(3.91±0.89) vs. (5.32±0.86) d] were significantly lower ( P<0.05). There were no significant differences in amounts of intraoperative bleeding, numbers of lymph node harvested and incidences of postoperative complications between groups ( P>0.05). Conclusion:Under the premise of strictly indications, laparoscopic radical resection of hilar cholangiocarcinoma was safe and feasible, and had certain advantages in promoting the rapid recovery of patients.

Objective:This study aimed to compare the clinical outcomes of laparoscopic pancreaticoduodenectomy (LPD) versus open pancreaticoduodenectomy (OPD).Methods:The clinical data of 386 patients who successfully underwent pancreaticoduodenectomy at the People's Hospital of Zhengzhou University from June 2017 to December 2019 were retrospectively analyzed. According to the different surgical methods, patients were divided into the LPD group ( n=122) and the OPD group ( n=264). The differences in operation time, intraoperative blood loss, postoperative hospital stay, postoperative complications, postoperative oncology survival outcomes and prognosis between groups were compared. Results:Of 386 patients in this study, there were 232 males and 154 females, aged (57.8±11.0) years. The operation time of the LPD group was (330.69±80.55) min which was significantly longer than that of the OPD group (241.13±77.24) min. The intraoperative blood loss 300.00(200.00, 400.00) ml was also significantly less than the OPD group 400.00(262.50, 500.00) ml, and the length of postoperative stay in the LPD group (12.21±5.24) d was significantly less than the OPD group (16.61±6.63) d, (all P<0.05). There were 36 patients (29.51%) in the LPD group and 81 patients (30.68%) in the OPD group who developed postoperative complications, with no significant difference between groups ( P>0.05). Postoperative oncology outcomes showed that the number of lymph nodes dissected in the LPD group was significantly more than that in the OPD group [(12.65±5.03) vs (10.07±5.09)], ( P<0.05). There were no significant differences between the two groups in tumor pathology type, size, degree of differentiation and R 0 resection rates (all P>0.05). All patients were followed up for 6-36 months, with a median follow-up of 20 months. The survival rates of patients with malignant tumors after following-up for more than 1 year in the LPD group was 84.72%(61/72), that in the OPD group was 85.81%(133/155), with no significant difference between groups ( P>0.05). Conclusion:LPD was safe and feasible with its advantages of minimally invasiveness.

Objective:To investigate the value of tumor budding in the clinicopathology and prognosis of pancreatic neuroendocrine tumors.Methods:The Cliniccal data of 105 pancreatic neuroendocrine tumor patients underwent resection in Henan Provincial People's Hospital from Jan 2010 to Dec 2016 were retrospectively analyzed. Tumor budding was calculated through hematoxylin-eosin (HE) and immunohistochemical stained slides. Based on the receiver operating characteristic curve (ROC), the number of tumor budding ≥10 was defined as the high-grade budding group, and <10 as the low-grade budding group. Multiple analysis was performed to determine the relationship between tumor budding and clinicopathology as well as prognosis.Results:High-grade budding group was observed in 35 cases and low-grade group in 70. High-grade budding were more common in tumors with advanced T stage, high risk of lymphatic metastasis, preoperative liver metastasis, vascular invasion and postoperative recurrence (respectively χ 2=9.043, 4.286, 10.130, 12.090, 9.260, all P<0.05). Multivariate COX regression analysis showed that tumor budding ( P=0.018), tumor grade ( P=0.026), preoperative liver metastasis ( P=0.042), vascular invasion( P=0.048) was independent risk factors predicting poor prognosis. Conclusion:Tumor budding is highly correlated with clinicopathological parameters which reflect the aggressiveness of pancreatic neuroendocrine tumor, it is also an important prognostic factor.

Objective To explore the technical knowhow and experience of mesohepatectomy for central region liver disease.Methods The clinical data of 86 patients with liver disease in central region undergoing mesohepatectomy were retrospectively analysed in Henan Provincial People's Hospital,including 49 males and 37 females.There were 47 cases of central liver cancer,15 cases of hilar cholangiocarcinoma,4 cases of hepatic hemangioma,13 cases of gallbladder cancer,and 7 cases of intrahepatic cholangiolithiasis in central liver.25 cases received accurate hepatectomy (group A) and 61 cases did irregular hepatectomy (group B).Results In group A,15 cases did Ⅳ,Ⅴ and Ⅷ lobectomy,10 cases underwent Ⅳ and Ⅴpartial lobectomy.Among the irregular hepatectomy group (group B),35 were treated with hepatic middle lobe resection,26 with local middle liver resection.There were significant differences in operation time,degree of postoperative liver function damage between the two groups (P ＜ 0.05),while there was no difference in postoperative complications (P ＜ 0.05).Conclusions The accurate mesohepatectomy can reduce the incidence of postoperative liver function damage and surgical complications.

Objective:To compare the short-term outcomes of patients undergoing laparoscopic pancreaticoduodenectomy (LPD) and those with open pancreaticoduodenectomy (open pancreatiloduodenectomy, OPD).Methods:The clinical data of 85 patients with LPD and 103 patients with OPD at our hospital from Jun 2017 to Jun 2019 were analyzed retrospectively.Results:There was no significant difference in clinical data and between the two groups ( P>0.05). Compared with OPD group, the operation time in LPD group was longer [(407.6±117.4) min vs. (220.8±23.9) min]( P<0.05), but the intraoperative blood loss was less [(285.1±21.9) ml vs. (550.5±65.5) ml]( P<0.05). There was more lymph node dissection (13.5±1.4 vs. 8.8±0.6) ( P<0.05), earlier feeding per month ( P<0.05), shorter time for the use of analgesia and hospital stay ( P<0.05). There was no significant difference in the incidence of postoperative complications such as pancreatic fistula, biliary fistula, gastroparesis and intra abdominal bleeding ( P>0.05). Conclusions:LPD is as safe and reliable as OPD, LPD has the advantages of more precise display during operation, while less traumatic and quicker recovery after operation.

Objective: To study the use of different techniques of pancreaticojejunostomy in laparoscopic pancreaticoduodenectomy (LPD) for patients with slim pancreatic ducts. Methods: The clinical data of 45 patients with slim pancreatic ducts (<3 mm) who underwent LPD in People's Hospital of Zhengzhou University from May 2017 to March 2019 were studied. These patients were divided into 2 groups: Chen's suturing technique (group A, n=31), and the imbedding pancreaticojejunostomy (group B, n=14). The postoperative pancreatic fistula (PF) rates, complication rate, pancreaticojejunostomy time, and length of postoperative hospital stay were compared between the 2 groups. Results: There was no significant difference in the general data between the two groups (P>0.05). The incidence of postoperative pancreatic fistula in group A (4 cases) was significantly lower than that in group B (6 cases) (12.9% vs. 42.9%, P<0.05). The operation time of pancreaticojejunostomy in group A was significantly shorter than that in group B [(26.5±0.8) min vs. (28.0±2.4) min, P<0.05]. There was no significant difference in the length of postoperative hospital stay between the 2 groups (P>0.05). Conclusion Chen's suturing technique was a safe and effective pancreaticojejunostomy technique in LPD carried out in patients with slim pancreatic duct patients.

Objective To evaluate fusion indocyanine green fluorescence imaging in laparoscopic anatomical hepatectomy.Methods The clinical data of 75 liver cancer patients undergoing laparoscopic anatomic hepatectomy (LAH) at the Department of Hepatobiliary and Pancreatic Surgery,Henan Provincial People's Hospital from Apr 2017 to Sep 2018 were retrospectively analyzed.Patients were divided into the indocyanine green fluorescence fusion imaging technique (FIGFI-LAH) group (35 cases) and laparoscopic anatomical hepatectomy (LAH) group (40 cases).Results Pathologically positive margin was found in 1 case in FIGFI-LAH group and 9 cases in LAH group (x2 =4.649,P =0.031).There were no significant differences in the mean operative time,intraoperative blood loss,blood transfusion rate,and rate of conversion to open surgery (P ＞ 0.05).Conclusion The use of FIGFI technique in laparoscopic anatomical hepatectomy for liver cancer effectively reduces the positive rate of surgical margin.