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Objective:To compare safety and efficacy of one-stage laparoscopic common bile duct exploration plus laparoscopic cholecystectomy (LCBDE+ LC) with endoscopic retrodrade cholangiopancreatography plus laparoscopic cholecystectomy (ERCP+ LC) in elderly patients with concomitant gallbladder and common bile duct (CBD) stones.Methods:This is a two-center retrospective study with clinical data on 492 patients aged over 80 years diagnosed with concomitant gallbladder and CBD stones treated between January, 2014 and December, 2020 at The First Affiliated Hospital of Wenzhou Medical University and Quzhou Hospital Affiliated to Wenzhou Medical University. There were 254 males and 238 females, aged (83.9±3.0) years. These patients were divided into two groups based on their operative methods: the one-stage group (LCBDE+ LC, n=186) and the two-stage group (ERCP+ LC, n=306). Differences in surgery, stones and hospitalization costs were compared between the two groups. Results:When compared with the ERCP+ LC group, the LCBDE+ LC group had significantly higher incidences of previous gastrectomy [21.5%(40/186) vs 4.2%(13/306)], multiple stones [77.4%(144/186) vs 49.3%(151/306)], larger stone diameter [13.7(6.4, 18.6)mm vs 10.9(5.7, 16.1) mm], and increased hospitalization expenditure [(2.37±0.31) Wanyuan vs (3.26±0.44) Wanyuan] (all P<0.05). However, the rates of residual stone [2.7%(5/186) vs 1.3%(4/306)], stone recurrence [2.2%(4/186) vs 5.2%(16/306)], postoperatively overall complications [3.2%(6/186) vs 1.3%(4/306)], and total hospital stay [(10.7±6.2) d vs (11.3±5.4) d] were not significantly different between the two groups (all P>0.05). Conclusions:Allowing for the similar safety and effectiveness, and lower hospitalization expenditure, LCBDE+ LC was a preferred choice for patients aged over 80 year, especially in patients who had previous gastrectomy, multiple large CBD stones, or who could not accept endoscopic procedures for treatment of CBD stones.
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Objective To investigate the clinical characteristics, treatment and prognosis of the eighth edition of AJCC stage Ⅲ gallbladder cancer (GBC). Methods We collected the clinical data and follow-up results of 3485 patients with AJCC 8th stage Ⅲ gallbladder cancer. Kaplan Meier survival curves of ⅢA and ⅢB, T3N0M0 (ⅢA), T1-2N1M0 (ⅢB) and T3N1M0 (ⅢB) were drawn and compared. Single factor analysis and Cox multiple factor regression analysis were used to analyze the relation between clinical characteristics, treatment plan, stage Ⅲ subtype and prognosis. Results One-year survival rate of stage ⅢB gallbladder cancer patients was 49.70%, higher than those of stage ⅢA(36.41%); the 1-year survival rate of stage T1-2N1M0 (ⅢB) gallbladder cancer patients was 65.52%, higher than those of stage T3N0M0 (ⅢA) (36.41%) and stage T3N1M0 (ⅢB) (37.05%). According to Cox multivariate analysis, age, tumor grade, tumor size, operation mode, radiotherapy, chemotherapy, AJCC 8th TNM specific subtype and T stage were independent related factors affecting the prognosis of stage Ⅲ GBC patients (P < 0.01). Conclusion The overall survival of stage ⅢB GBC is better than that of stage ⅢA. The risk of stage Ⅲ GBC death was T1-2N1M0 (ⅢB) < T3N0M0 (ⅢA) < T3N1M0 (ⅢB). Radical cholecystectomy (number of dissected lymph node≥6), radiotherapy and chemotherapy are beneficial to the improvement of prognosis of stage Ⅲ GBC patients.
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Objective To evaluate the feasibility and efficacy of preoperative sequential transcatheter arterial chemoembolization (TACE) followed by selective portal venous embolization (PVE) in patients with marginally resectable hepatocellular carcinoma (HCC).The aim was to find out whether this combined procedure helped to increase the rate of extended radical liver resection.Methods From March 2009 to November 2016,29 patients with HCC which were marginally resectable underwent preoperative TACE combined with PVE were included into this study.All these patients were subsequently assessed to undergo radical hepatectomy.The complications,laboratory results,volume changes of each liver lobe and patient survival were analyzed.Results TACE combined with PVE was successful in all the 29 patients.There were no major complications.After the procedure,the volumes of the tumor and the part of the liver to be resected decreased to certain degree.The remnant liver volume (RLV) increased remarkably.The RLV were (395.4 ±58.7) cm3 and (599.2 ±75.2) cm3 before and after the procedure,respectively.The difference was significant (P ＜ 0.05).19 patients underwent radical hemihepatectomy or trisectionectomy,with a resection rate of 65.5％ (19/29).There were sufficient surgical margins in all the resected tumors.After operation,the 1-,3-,and 5-year survival rates were 58.8％,35.5％ and 17.6％,respectively.Conclusion For HCC patients who had marginally resectable HCC,preoperative TACE combined with PVE efficiently controlled the growth of the tumors,decreased the volume of the liver lobe with tumor,increased the RLV,and made it possible for a planned two-stage radical hepatectomy with sufficient surgical margin and better survival in a significant proportion of patients.