Objective:To explore the learning curve of central pancreatectomy (CP) and provide an excellent reference for surgeons to get the point of this operation.Methods:Clinical data of 73 patients who underwent CP in the same operation team from January 2006 to January 2018 were collected and retrospectively analyzed by the moving average method (MAM) and the cumulative sum method (CUSUM). Data was analyzed by statistical package for social science (SPSS) software.Results:According to the MAM and CUSUM curves, the learning process of CP could be divided into two stages. At the first stage ( n=1-11), the median operation time was 340 minutes and the median intraoperative hemorrhage was 400 ml. In the second stage ( n=12-73), the median operation time was 213 minutes and the median intraoperative hemorrhage was 100 ml. The difference was statistically significant ( P<0.001). There were no significant differences between the two stages of patients in terms of other aspects ( P>0.05). Conclusions:CP can be mastered after 11 cases of exercises. In the first 11 operations, surgeons should get familiar with the operation process, respond actively to emergencies and accumulate experience to gain this surgical technique fast.

Objective:To explore the learning curve of central pancreatectomy (CP) and provide an excellent reference for surgeons to get the point of this operation.Methods:Clinical data of 73 patients who underwent CP in the same operation team from January 2006 to January 2018 were collected and retrospectively analyzed by the moving average method (MAM) and the cumulative sum method (CUSUM). Data was analyzed by statistical package for social science (SPSS) software.Results:According to the MAM and CUSUM curves, the learning process of CP could be divided into two stages. At the first stage ( n=1-11), the median operation time was 340 minutes and the median intraoperative hemorrhage was 400 ml. In the second stage ( n=12-73), the median operation time was 213 minutes and the median intraoperative hemorrhage was 100 ml. The difference was statistically significant ( P<0.001). There were no significant differences between the two stages of patients in terms of other aspects ( P>0.05). Conclusions:CP can be mastered after 11 cases of exercises. In the first 11 operations, surgeons should get familiar with the operation process, respond actively to emergencies and accumulate experience to gain this surgical technique fast.

Objective:To analyze the sleep quality before treatment and related risk factors of sleep disorder in patients with nasopharyngeal carcinoma (NPC). Methods: Totally 143 patients first diagnosed as nasopharyngeal carcinoma were selected [ average age (43 ± 10) years, 100 males and 43 females] in a NPC ward of one hospital, the Chinese version of Pittsburgh Sleep Quality Index (PSQI, total score ＞ 5 diagnosed as sleep disorder) was used to investigate the sleep quality before treatment, and the logistic regression analysis was used to analyze related factors of the sleep disorder before treatment Results: The rate of sleep disorder was 50.3％. The logistic regression analysis showed that age was a risk factor of sleep disorder before treatment in patients with NPC (OR = 1.04, 95％ CI: 1.01-1.08), while gender, culture degree, clinical stage, body mass index were not correlated with sleep disorder (Ps＞0.05). Conclusion: It suggests that patients with NPC may have a higher incidence of sleep disorder before treatment, and older patients may be more prone to pre-treatment sleep disorder.

Objective To investigate the inhibitory effect of carbon-coated iron nanoparticles carrying cisplatin on the growth of NCI-H446 lung cancer cells and expressions of Caspase 3 and Survivin mRNA.Methods NCI-H446 lung cancer cells were treated with iron-carbon nanoparticles and/or cisplatin.The cell viability was detected by MTT method,and the mRNA expressions of Caspase 3 and Survivin were measured with RT-PCR.Results Cisplatin could inhibit the growth of NCI-H446 lung cancer cells,and the inhibitory effect was stronger when it was combined with the iron-carbon nanoparticles.The cells had apoptosis.The mRNA expression of Caspase 3 of NCI-H446 lung cancer cells was remarkably enhanced after treatment with iron-carbon nanoparticles combined with cisplatin,while the mRNA expression of Survivin was notably weakened (P＜0.05).Conclusion Carbon-coated iron nanoparticles carrying cisplatin could significantly increase the chemotherapy sensitivity of cisplatin on NCI-H446 lung cancer cells and enhance the therapeutic efficacy of chemotherapy drugs.

Objective Pancreatic neuroendocrine carcinoma ( pNEC) is a highly malignant tumor. This study aimed to evaluate the role of surgery and the prognosis for patients with pancreatic neuroendocrine carcinoma ( pNEC ) . Methods We collected and reviewed all clinical data of patients who underwent radical surgery for pNEC from Jan 2000 through Jan 2016 in our hospital. Cox?regression analysis wasused to evaluate the factors potentially influencing survival. Results Twenty patients including 11 males and 9 females ( median age, 62.5 years) were included in this study. All patients underwent radical surgery and 17 cases received postoperative platinum?based chemotherapy. The median follow?up time was 41 months (range, 1 to 127 months).The 1?,3?, and 5?year survival rates of the patients were 66.7%, 51.5% and 28.1%, with a median survival time of 75.3 months.The multivariate analysis indicated that tumor size and Ki?67 index were of prognostic significance. Conclusions Pancreatic neuroendocrine carcinomas are rare but increasing in incidence. Patients with localized nonmetastatic primary tumors seem to benefit from surgery. Early diagnosis and multimodality therapy are key points of an improved survival.

Objective Pancreatic neuroendocrine carcinoma ( pNEC) is a highly malignant tumor. This study aimed to evaluate the role of surgery and the prognosis for patients with pancreatic neuroendocrine carcinoma ( pNEC ) . Methods We collected and reviewed all clinical data of patients who underwent radical surgery for pNEC from Jan 2000 through Jan 2016 in our hospital. Cox?regression analysis wasused to evaluate the factors potentially influencing survival. Results Twenty patients including 11 males and 9 females ( median age, 62.5 years) were included in this study. All patients underwent radical surgery and 17 cases received postoperative platinum?based chemotherapy. The median follow?up time was 41 months (range, 1 to 127 months).The 1?,3?, and 5?year survival rates of the patients were 66.7%, 51.5% and 28.1%, with a median survival time of 75.3 months.The multivariate analysis indicated that tumor size and Ki?67 index were of prognostic significance. Conclusions Pancreatic neuroendocrine carcinomas are rare but increasing in incidence. Patients with localized nonmetastatic primary tumors seem to benefit from surgery. Early diagnosis and multimodality therapy are key points of an improved survival.

OBJECTIVETo explore the learning curve for middle pancreatectomy by comparing the outcomes of middle pancreatectomy operated by a single treatment group at different stages.

METHODSA total of 48 patients received middle pancreatectomy by single treatment group between January 2006 and April 2014 at our hospital. These 48 cases were divided into 10 stages (5 cases in each) according to the operation sequence. The operation time, blood loss, surgical complications, rate of negative margin and postoperative hospital stay were analyzed retrospectively.

RESULTSThere was no significant difference among the 10 stages in respect to surgical complications, rate of negative margin and postoperative hospital stay (P>0.05). The median operation time and blood loss in the first stage was 375 min and 530 ml, respectively. The median operation time and blood loss in the second stage was 280 min and 330 ml, respectively. There were significant differences between these two stages and the other later stages in median operation time and blood loss (P<0.01). However, there was no significant difference among the stages 3 to 10 in the median operation time and blood loss (P>0.05 for all).

CONCLUSIONAfter 10-15 cases of middle pancreatectomy, a surgeon can be skilled and experienced in this surgical procedure with few surgical complications.

Humans ; Learning Curve ; Length of Stay ; Operative Time ; Pancreatectomy ; methods ; Retrospective Studies

OBJECTIVETo investigate the value of Physiological and Operative Severity Score for the enUmeration of Mortality and morbidity (POSSUM) and a modification of the POSSUM system (P-P0SSUM) scoring system in predicting the surgical operative risk of pancreaticoduodenectomy for periampullary tumors.

METHODSPOSSUM and P-POSSUM scoring systems were used to retrospectively evaluate the clinical data of 432 patients with periampullar tumors who underwent pancreaticoduodenectomy in the Department of Abdominal Surgery, Cancer Hospital, Chinese Academy of Medical Sciences from January 1985 to December 2010. The predictive occurrence of postoperative complications and mortality rate were calculated according to the formula. ROC curve analysis and different group of risk factors were used to determine the discrimination ability of the two score systems, and to determine their predictive efficacy by comparing the actual and predictive complications and mortality rates, using Hosmer-Lemeshow test to determine the goodness of fit of the two scoring systems.

RESULTSThe average physiological score of the 432 patients was 16.1 ± 3.5, and the average surgical severity score was 19.6 ± 2.7. ROC curve analysis showed that the area under ROC curve for mortality predicted by POSSUM and P-POSSUM were 0.893 and 0.888, showing a non-significant difference (P > 0.05) between them. The area under ROC curve for operative complications predicted by POSSUM scoring system was 0.575. The POSSUM score system was most accurate for the prediction of complication rates of 20%-40%, showing the O/E value of 0.81. Compared with the POSSUM score system, P-POSSUM had better ability in the prediction of postoperative mortality, when the predicted value of mortality was greater than 15%, the predictive result was more accurate, and the O/E value was 1.00.

CONCLUSIONSPOSSUM and P-POSSUM scoring system have good value in predicting the mortality of patients with periampullary tumors undergoing pancreaticoduodenectomy, but a poorer value of POSSUM score system in prediction of complications. We can establish a more suitable scoring system for pancreaticoduodenectomy by modifying the score constant and weight, to better predict surgical risk and reduce the operative complications and mortality.

Ampulla of Vater ; Common Bile Duct Neoplasms ; mortality ; surgery ; Humans ; Morbidity ; Pancreaticoduodenectomy ; adverse effects ; mortality ; Postoperative Complications ; diagnosis ; mortality ; Postoperative Period ; Predictive Value of Tests ; ROC Curve ; Retrospective Studies ; Risk Assessment ; Risk Factors

Objective To investigate the value of Physiological and Operative Severity Score for the enUmeration of Mortality and morbidity(POSSUM)and a modification of the POSSUM system(P?P0SSUM) scoring system in predicting the surgical operative risk of pancreaticoduodenectomy for periampullary tumors. Methods POSSUM and P?POSSUM scoring systems were used to retrospectively evaluate the clinical data of 432 patients with periampullar tumors who underwent pancreaticoduodenectomy in the Department of Abdominal Surgery, Cancer Hospital,ChineseAcademy of Medical Sciences from January 1985 to December 2010. The predictive occurrence of postoperative complications and mortality rate were calculated according to the formula. ROC curve analysis and different group of risk factors were used to determine the discrimination ability of the two score systems, and to determine their predictive efficacy by comparing the actual and predictive complications and mortality rates, using Hosmer?Lemeshow test to determine the goodness of fit of the two scoring systems. Results The average physiological score of the 432 patients was 16.1±3.5, and the average surgical severity scorewas 19.6±2.7. ROC curve analysis showed that the area under ROC curve for mortality predicted by POSSUM and P?POSSUM were 0.893 and 0.888, showing a non?significant difference ( P>0. 05 ) between them. The area under ROC curve for operative complications predicted by POSSUM scoring system was 0. 575. The POSSUM score system was most accurate for the prediction of complication rates of 20%?40%, showing the O/E value of 0.81. Compared with the POSSUM score system, P?POSSUM had better ability in the prediction of postoperative mortality, when the predicted value of mortality was greater than 15%, the predictive result was more accurate, and the O/E value was 1.00. Conclusions POSSUM and P?POSSUM scoring system have good value in predicting the mortality of patients with periampullary tumors undergoing pancreaticoduodenectomy, but a poorer value of POSSUM score system in prediction of complications. We can establish a more suitable scoring system for pancreaticoduodenectomy by modifying the score constant and weight, to better predict surgical risk and reduce the operative complications and mortality.

Objective To explore the learning curve for middle pancreatectomy by comparing the outcomes of middle pancreatectomy operated by a single treatment group at different stages. Methods A total of 48 patients received middle pancreatectomy by single treatment group between January 2006 and April 2014 at our hospital. These 48 cases were divided into 10 stages ( 5 cases in each) according to the operation sequence. The operation time, blood loss, surgical complications, rate of negative margin and postoperative hospital stay were analyzed retrospectively. Results There was no significant difference among the 10 stages in respect to surgical complications, rate of negative margin and postoperative hospital stay ( P>0.05) . The median operation time and blood loss in the first stage was 375 min and 530 ml, respectively. The median operation time and blood loss in the second stage was 280 min and 330 ml, respectively. There were significant differences between these two stages and the other later stages in median operation time and blood loss ( P<0.01) . However, there was no significant difference among the stages 3 to 10 in the median operation time and blood loss ( P>0.05 for all) . Conclusion After 10?15 cases of middle pancreatectomy, a surgeon can be skilled and experienced in this surgical procedure with few surgical complications.