Value of PUSSOM and P-POSSUM for the prediction of surgical operative risk in patients undergoing pancreaticoduodenectomy for periampullary tumors / 中华肿瘤杂志

<p><b>OBJECTIVE</b>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.</p><p><b>METHODS</b>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, 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.</p><p><b>RESULTS</b>The 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.</p><p><b>CONCLUSIONS</b>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.</p>

Learning curve for middle pancreatectomy / 中华肿瘤杂志

<p><b>OBJECTIVE</b>To explore the learning curve for middle pancreatectomy by comparing the outcomes of middle pancreatectomy operated by a single treatment group at different stages.</p><p><b>METHODS</b>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.</p><p><b>RESULTS</b>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).</p><p><b>CONCLUSION</b>After 10-15 cases of middle pancreatectomy, a surgeon can be skilled and experienced in this surgical procedure with few surgical complications.</p>

Early complications of intra-operative radiotherapy in locally advanced pancreatic cancer / 中华肿瘤杂志

<p><b>OBJECTIVE</b>To investigate the complications in intra-operative radiotherapy (IORT) for patients with local advanced pancreatic cancer.</p><p><b>METHODS</b>The clinical data, operation material, overall dose of IORT, postoperative therapy, complications, treatment and prognosis were retrospectively analyzed in all the in-hospital pancreatic cancer patients from Nov 2008 to Jan 2012.</p><p><b>RESULTS</b>There were 115 patients with local advanced pancreatic cancer treated with IORT in this study. 81 cases had a tumor in the head of pancreas and 34 cases in the pancreatic body and tail. The operation method was IORT combined with internal drainage surgery. The intra-operative radiotherapy was performed using Mobetron mobile electron accelerator, with a total dose of 12-20 Gy. Bilioenteric anastomosis and/or gastrointestinal anastomosis were included in the internal drainage surgery. Gastroparesis syndrome (10.4%), hemorrhage (3.5%), abdominal infection (2.6%), pancreatic fistula (0.9%) and renal failure (1.7%) were the common postoperative complication of IORT. All patients were cured except one who died of digestive tract hemorrhage.</p><p><b>CONCLUSIONS</b>Major complications of IORT are gastroparesis syndrome, abdominal infection and hemorrhage. The incidence of gastroparesis syndrome is at the top of the list. However, early complications have a relatively better prognosis, indicating that IORT is a safe and reliable therapy for patients with locally advanced pancreatic cancer.</p>

Correlation between clinicopathological features and CA19-9/CEA in patients with extrahepatic cholangiocarcinoma / 中华肿瘤杂志

<p><b>OBJECTIVE</b>To study the correlation between clinicopathological features and serum carbohydrate antigen 19-9 (CA19-9)/carcinoembryonic antigen (CEA) in patients with extrahepatic cholangiocarcinoma (ECC).</p><p><b>METHODS</b>The clinicopathological data of 126 cases of extrahepatic cholangiocarcinoma treated in our department from Jan. 1999 to Dec. 2012 were collected and analyzed in this study. The correlation between clinicopathological features and sensitivity of CA19-9/CEA was analyzed by chi-square test. The correlation of clinicopathological features and value of serum CA19-9/CEA was analyzed by t test and F test.</p><p><b>RESULTS</b>The average value of CA19-9 before surgery in the 126 patients was 595.3 U/ml. The values of CA19-9 in 91 patients were abnormal and the sensitivity of CA19-9 was 72.2%. The average value of CEA before surgery was 12.6 U/ml. The value of CEA in 26 patients were abnormal and the sensitivity of CEA was 20.6%. The values of combined detection of serum CA19-9 and CEA before surgery were abnormal in a total of 97 cases with a sensitivity of 77.0%. There was no significant correlation between clinicopathological features and sensitivity of CA19-9 (P > 0.05). The location of tumor was significantly correlated to the diagnostic sensitivity of CEA. The sensitivity of CEA to distal ECC was only 15.4%. The value of CA19-9 was relatively high in patients >60-year old or with neural invasion, while CEA was higher when tumor was located in the middle of bile duct (P < 0.05). There was no significant difference of serum CA19-9 before and after jaundice reduction (P > 0.05).</p><p><b>CONCLUSIONS</b>The diagnostic sensitivity of CA19-9 is not affected by gender, age, blood type, tumor location, degree of differentiation, tumor size, T stage, vascular tumor thrombus, lymph node metastasis, perineural invasion, and preoperative jaundice. However, the diagnostic sensitivity of CEA is affected by tumor location. The value of CA19-9 is correlated with tumor invasion and is relatively high in patients above 60 years old.</p>