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Objective:To evaluate the impact of neoadjuvant chemotherapy on long-term prognosis of patients with borderline resectable pancreatic cancer (BRPC) treated with combined allograft revascularization.Methods:The data of patients with BRCP who were treated at Beijing Chaoyang Hospital, Capital Medical University from March 2016 to March 2021 were retrospectively analysed. Of 52 patients who underwent radical surgery combined with allograft revascularization in this study, there were 24 males and 28 females, aged (60.3±10.6) years old. These patients were divided into two groups based on whether they received neoadjuvant chemotherapy before surgery. There were 19 patients in the neoadjuvant chemotherapy group and 33 patients in the vascular replacement group. Outpatient clinic and telephone follow-up were used. The clinical data and prognostic differences between the two groups were then analysed.Results:Of 52 patients who underwent surgery successfully, 14 patients (26.9%) developed postoperative complications. The incidence of postoperative pancreatic fistula was significantly lower in the neoadjuvant chemotherapy group than the vascular replacement group (0 vs. 21.2%, P<0.05). The median survivals were 15 and 13 months in the neoadjuvant chemotherapy and the vascular replacement groups, respectively, with a significant difference in cumulative postoperative survival between the two groups ( P=0.039). For patients with BRPC, CA19-9>400 U/ml ( RR=4.540, 95% CI: 2.332-8.836, P<0.001) was an independent risk factor for long-term survival after surgery. Conclusions:Neoadjuvant chemotherapy reduced the incidence of postoperative pancreatic fistula and improved survival prognosis in patients with BRPC. A high preoperative serum CA19-9 level was an independent risk factor for long-term survival in patients with BRPC.
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Objective:To evaluate the effect of allogenic vein replacement in treatment of borderline resectable pancreatic cancer, and to analyze risk factors of long-term stenosis.Methods:The clinical data of 77 patients with borderline resectable pancreatic cancer who underwent surgery from January 2013 to December 2021 at the Beijing Chaoyang Hospital, Capital Medical University were retrospectively analyzed. There were 34 males and 43 females, aged (61.4±10.8) years old. The peri-operative data, long-term prognosis and stenosis of allogenic vein were analysed. Risk factors of stenosis were analyzed by the Cox proportional hazards model. Patients were followed up by outpatient visits or by telephone.Results:Pancreatic cancer had invaded the junction of portal vein/superior mesenteric vein (SMV) in 41 patients, SMV in 22 patients and portal vein in 14 patients. The length of venous resection was (3.7±1.0) cm, the tumor longest diameter was (3.8±1.6) cm, lymph node metastasis was present in 57 patients, R 0 resection was carried out in 70 patients, and the postoperative complication rate was 29.9% (23/77). The survival rates in 6 months, 1-year and 2-year were 84.1%, 52.3% and 32.9% respectively. Mild venous stenosis occurred in 4 patients (5.2%), moderate stenosis in 9 patients (11.7%) and severe stenosis in 11 patients (14.3%). A vascular resection length of more than 3 cm ( RR=4.602, 95% CI: 1.657-12.781, P=0.003) and tumor recurrence ( RR=8.529, 95% CI: 1.129-64.448, P=0.038) were independent risk factors for long-term moderate and severe stenosis of allogeneic vein. Conclusion:It was safe and feasible for allogenic vein to be used to reconstruct the portal venous system in resection of borderline resectable pancreatic cancer. Long-term stenosis of the allogenic vein was related to a length of vascular resection of more than 3 cm and recurrence of tumor.
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Pancreatic cancer is one of the most common malignant digestive tumors with high malignancy and poor five-year survival. Due to the biological behavior of tumor and local adjacency, pancreatic cancer is frequently invaded to adjacent portal vein, superior mesenteric vein, and splenic vein, making surgical resection difficult. For pancreatic cancer with invasion of spleno-mesenterico-portal confluence, the difficulty of surgical R 0 resection is further increased, so it is important to reasonably resect the invaded vessels and complete vascular reconstruction. In this research, we summarized the different revascularization approaches in our center, aiming to analyze the surgical treatment strategy for pancreatic cancer with invasion of spleno-mesenterico-portal confluence.
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Objective:To evaluate the perioperative safety and long-term prognosis of allogeneic vein replacement in abdominal surgery.Methods:Clinical data of 115 patients receiving allogeneic vein replacement from Jan 2013 to Dec 2020 was retrospectively analyzed.Results:The most common operation was radical pancreatoduodenectomy for pancreatic cancer (75.7%), and the most common vascular replacement sites were the junction of portal vein system (53.9%), followed by superior mesenteric vein (23.5%) and portal vein (18.3%). In our group, 6 patients died (5.2%), 31 patients had complications (27.0%), and 2 patients had portal vein thrombosis (1.7%). During the follow-up period, 8 cases (7.5%) had mild stenosis, 12 cases (11.5%) had moderate stenosis and 14 cases (13.2%) had severe stenosis. The half-year, one-year and two-year incidence of moderate and severe stenosis were 8.0%, 24.4% and 34.5% respectively.Conclusions:The early and mid-term result of allogeneic vein replacement is satisfactory. Use of postoperative anticoagulation may help reduce the incidence of thrombogenesis or stenosis .
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Objective To investigate the role of tolerogenic dendritic cell (tolDC) in inducing immune tolerance in liver transplantation. Methods Liver transplantation rat models of spontaneous tolerance [Brown Norway (BN)→Lewis, tolerance group, n=6] and acute rejection (AR) (Lewis→BN) were established. In AR rat models, tolDC transfusion was performed in the study group (tolDC group, n=6) and no intervention was given in the control group (AR group, n=6). The survival time of rats in each group was observed. The transplant liver tissues of rats were prepared for pathological examination in each group. The expression of myeloid dendritic cell (mDC) and plasmacytoid dendritic cell (pDC) in rat peripheral blood, transplant liver, spleen and lymph nodes in each group was detected by flow cytometry. The expression levels of serum interleukin (IL)-10 and interferon (IFN)-γ in each group were measured by enzyme-linked immune absorbent assay. Results Pathological manifestations of rats in the AR group mainly included inflammatory cell infiltration and tissue structural disorder in transplant liver, and the survival time was 7-14 d. In the tolDC and tolerance groups, the transplant liver tissues were almost normal, and the longest survival time exceeded 100 d. Compared with the AR group, the expression levels of CD11+mDC in peripheral blood, transplant liver, spleen and lymph nodes of rats were significantly down-regulated in the tolerance and tolDC groups (all P < 0.05), and those of CD86 and major histocompatibility complex (MHC)Ⅱon the surface of CD11+mDC were also significantly down-regulated (all P < 0.05). Compared with the AR group, the expression levels of pDC in peripheral blood, transplant liver, spleen and lymph nodes of rats were significantly up-regulated in the tolerance and tolDC groups (all P < 0.05), whereas those of MHCⅡon the surface of pDC were all significantly down-regulated (all P < 0.05). Compared with the AR group, the expression levels of serum IL-10 were significantly up-regulated, and IFN-γ were significantly down-regulated in the tolerance and tolDC groups (all P < 0.05). Conclusions As tolDC subsets, mDC and pDC play a positive role in regulating the incidence of graft immune tolerance in rats after liver transplantation.
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In recent years, the MYB-related gene family has been found pivotal in plant growth and development. MYB-related gene family in Angelica dahurica var. formosana was systematically investigated based on "Chuanzhi No. 2" through transcriptome database search and bioinformatics and the temporal and spatial expression patterns were analyzed through real-time fluorescence-based quantitative polymerase chain reaction(PCR). The results showed that 122 MYB-related proteins family were identified, mainly including the unstable hydrophilic proteins with good thermal stability. Most of the proteins were located in nuclei. The majority of the proteins had the structures of random coil and α-helix. Five MYB-related proteins family of A. dahurica var. formosana had membrane-binding domains. The conserved domain analysis of MYB-related proteins family of A. dahurica var. formosana showed that the MYB domains of genes in five subgroups, similar to 2 R-, 3 R-, and 4 R-MYB proteins, contained three evenly distributed Trp(W) residues in the MYB repeat sequence. The phylogenetic analysis of MYB-related proteins family in A. dahurica var. formosana and Arabidopsis thaliana showed that the MYB-related members were unevenly distributed in five subgroups, and A. thaliana and A. dahurica var. formosana had almost the same number of genes in the CCA1-like subgroup. There were differences in the number, type, and distribution of motifs contained in 122 encoded proteins. Transcription factors with similar branches had similar domains and motifs. The expression pattern analysis showed that the transcription factors AdMYB53, AdMYB83, and AdMYB89 responded to hormones to varying degrees, and they were highly expressed in leaves and responded quickly in roots. This study lays a foundation for further investigating the function of MYB-related transcription factors of A. dahurica var. formosana and solving the corresponding biological problems such as bolting early.
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Animals , Angelica/chemistry , Computational Biology , Gastropoda , Phylogeny , Plant Leaves , Plant Proteins/genetics , Transcription Factors/geneticsABSTRACT
Hypersplenism is the most common splenic disease and usually refers to a clinical syndrome of increased splenic size and/or cytopenia due to various causes. Hypersplenism is most often secondary to cirrhotic hypertension. Liver transplantation can effectively relieve hypersplenism in patients with liver cirrhosis, but there are also some patients with persistent hypersplenism after liver transplantation or recurrence after remission. Other treatment modalities for postoperative intractable hypersplenism include splenectomy and partial splenic artery embolization. This article reviews the research progress of hypersplenism after liver transplantation for liver cirrhosis with hypersplenism.
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Objective To investigate the role of CD4+CD45RClow regulatory T cell (Treg) in the immune tolerance induction of rats undergoing liver transplantation. Methods Liver transplantation rat models of acute rejection (AR) [Lewis→Brown Norway (BN), AR group] and spontaneous tolerance (BN→Lewis, tolerance group) were established, with 6 rats in each group. Moreover, 3 Lewis rats and 3 BN rats were assigned into the sham operation group (control group). The liver tissues of rats in each group were subject to pathological staining. The expression of T cell subsets and plasmacytoid dendritic cells (pDC) in the peripheral blood, liver graft and spleen of rats was detected in each group. The correlation between pDC and CD4+CD45RClowTreg was analyzed. The expression levels of CD4, CD45RC and CD103 in the liver graft and spleen of rats were quantitatively measured in each group. Results In the AR group, pathological manifestations mainly consisted of inflammatory cell infiltration and structure disorders of transplant liver. Compared with the AR group, the expression levels of CD4+CD25+Treg and CD8+Treg in the peripheral blood were significantly up-regulated in the tolerance group (all P < 0.05). In the peripheral blood, the expression level of CD4+CD25+Treg was positively correlated with that of CD8+Treg (r=0.742, P=0.022). In the AR group, the expression level of CD4+CD45RChighT cell in the peripheral blood was significantly higher than those in the tolerance and control groups (both P < 0.05). Compared with the AR group, the expression level of CD4+CD45RClowTreg in the spleen, and the expression levels of CD8+CD45RClowTreg in the peripheral blood, transplant liver and spleen were significantly up-regulated in the tolerance group (all P < 0.05). Compared with the control and AR groups, the ratio of CD8+CD45RClowTreg/CD8+T in the peripheral blood and the expression levels of pDC in the peripheral blood, transplant liver and spleen were all significantly up-regulated in the tolerance group (all P < 0.05). The expression level of CD4+CD45RClowTreg was positively correlated with the changes of pDC (r=0.506, P=0.016). The expression levels of CD4, CD45RC and CD103 in the transplant liver and spleen of rats were up-regulated in the tolerance group. In the AR group, the expression levels of CD4 and CD45RC were up-regulated, whereas that of CD103 was down-regulated. Conclusions CD4+CD45RClowTreg is a cell subgroup with negative immune regulation, which may construct a regulatory cell network of immune tolerance induction along with CD8+CD45RClowTreg and pDC.
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Objective:To analyze the value and significance of surgical operation in the treatment of pancreatic carcinoma with portal venous system invasion.Methods:The clinical data of 66 patients of pancreatic carcinoma with portal venous system invasion admitted in Department of Hepatobiliary Surgery, Beijing Chaoyang Hospital Affiliated to Capital Medical University from January 2011 to December 2018 were retrospectively analyzed. Vascular resection and reconstruction was used on all patients who underwent radical resection for pancreatic carcinoma (portal vein system invasion group). The operation procedure was made according to the location of the pancreatic carcinoma, and the vascular reconstruction procedure was made according to the type and location of portal venous system invasion. The intraoperative and perioperative situation of the patients were analyzed. Then 129 patients of pancreatic carcinoma without portal venous system invasion in the same period were selected as the control group, and the long-term prognosis between the two groups was compared.Results:The operation was successfully in 66 patients. According to the location of the pancreatic carcinoma, 55 patients underwent pancreatoduodenectomy, 8 patients underwent total pancreatoduodenectomy and 3 patients underwent distal pancreatectomy. According to the type and location of portal venous system invasion, 43 patients underwent allogeneic vascular replacement, 16 patients underwent segmental resection with end-to-end anastomosis, and 7 patients underwent wedge resection with primary closure. There was no perioperative death in this group. The incidence of postoperative complications was 28.8%(19/66), and the incidence of biochemical fistula was 9.1%(6/66), intraperitoneal infection was 7.6%(5/66), intraperitoneal hemorrhage was 4.5%(3/66), delayed gastric emptying was 4.5%(3/66), pancreatic fistula of Grade C was 1.5%(1/66) and biliary fistula was 1.5%(1/66). All the patients were discharged successfully, and the postoperative hospital stay was (20.8±9.7) days. 65 patients were followed up, and the follow-up rate was 98.5%. The median survival time of portal venous system invasion group and control group was 13 months and 22 months, respectively. The overall 1-year, 2-year and 3-year survival rates of portal venous system invasion group and control group were 53.3%, 30.4%, 23.4% and 73.1%, 45.8% and 40.1%, respectively ( P=0.006). Conclusions:Prognosis of pancreatic carcinoma patients with portal venous system invasion was poor, but it was safe and feasible to perform surgery for such patients. During the operation, different ways of venous reconstruction can be used according to the specific situation of venous invasion.
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Objective:To investigate the genetic characteristics of pancreatic cancer-associated diabetes mellitus (PCDM) and screen out the possible molecular markers for PCDM.Methods:The clinical data of pancreatic cancer (PC) cohort from The Cancer Genome Atlas (TCGA) were selected and collected, and the patients were divided into PCDM( n=11) and PC groups( n=109) according to whether the patients were diagnosed as diabetes within 2 years of PC diagnosis. Then, the mRNA microarray data of genome expression were extracted from TCGA PC cohort, and the differentially expressed genes (DEGs) were screened out by the " limma" package of R software based on (|log2 fold change|>2 and P<0.05). The functions of DEGs were revealed with gene ontology (GO) and Kyoto Encyclopedia of Genes and Genomes (KEGG) pathway enrichment analysis. Finally, a protein-protein interaction (PPI) network was constructed with the STRING database, and the hub genes were identified by the molecular complex detection (MCODE) module of Cytoscape software. Results:The analysis showed that among 20 531 genes, 47 genes were significantly upregulated, and 60 genes were significantly downregulated in the PCDM group. GO analyses revealed that 107 DEGs were mainly involved in the positive regulation of secretory function in terms of biological function (gene number=9, P<0.01); in the regulation of receptor function of molecular function (gene number=10, P<0.01); and in the intracavitary components of cytoplasmic microtubules of cellular components (gene number=8, P<0.01). The results of KEGG pathway enrichments revealed that DEGs mainly affected PCDM via cytokine interactions (gene number=8, P<0.01). Finally, five hub genes, including GNG8, CNR2, GALR2, CXCL13, and NPY2R, were identified for PCDM in PPI network analysis. Conclusions:The feature genes of PCDM are mainly different from PC in terms of secretion function, receptor function, cytoplasmic microtubule composition, and cytokine interaction. Five genes including GNG8, CNR2, GALR2, CXCL13, and NPY2R may become potential molecular markers for PCDM.
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Objective:To evaluate the prognosis and related risk factors of distal cholangiocarcinoma after surgical treatment.Methods:The clinical data of 123 patients of distal cholangiocarcinoma in Beijing Chaoyang Hospital between January 2011 and December 2019 were retrospectively analyzed, which including 72 males and 51 females, the average age was (64.9±9.2) years (range from 29 to 84 years). All patients underwent pancreatoduodenectomy. The observation measures contains: (1) Perioperative outcomes; (2) Follow-up outcomes; (3) Risk factors for long-term survival of distal cholangiocarcinoma. Follow-up was carried out to understand the long-term survival of patients, and follow-up method contains the outpatient reexamination and telephone. The deadline of follow-up date was March 2020. The normal distribution data were expressed by ( Mean± SD), and the non-normal distribution data were expressed by M ( P25, P75). Count data were expressed by cases and percentage. Kaplan-Meier method was used to calculate and draw the survival curve. Log-rank test was used to compare the survival rate. Cox proportional risk model was used in multivariate factor analysis. Results:(1) Perioperative outcomes: In our research, all of 123 patients were successfully completed the operations, and 6 patients dead during the perioperative. (2) Follow-up outcomes: The incidence of postoperative complications was 27.6%(34/123). One hundred and twenty-one patients were followed up, the follow-up rate was 98.4%, and the median follow-up time was 41.0 months.The overall 1-year, 2-year, 3-year and 5-year survival rates were 71.8%, 50.5%, 35.5% and 30.2%. And the median survival time was 42.7 months. (3) Risk factors for long-term survival of distal cholangiocarcinoma: Multivariate analysis showed that preoperative CA19-9 ( RR=1.470, 95% CI: 1.028-2.101), portal venous system invasion ( RR=2.020, 95% CI: 1.012-4.035) and tumor differentiation ( RR=1.735, 95% CI: 1.195-2.520) were independent risk factors for the prognosis. Conclusions:Radical pancreatoduodenectomy is the best treatment for distal cholangiocarcinoma. Preoperative CA19-9 level, portal venous system invasion and tumor differentiation are independent risk factors for the prognosis.
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Objective:To analyze the risk factors of lymph node metastasis of distal cholangiocarcinoma.Methods:We retrospectively analyzed the clinical data of 123 patients of distal cholangiocarcinoma in Beijing Chaoyang Hospital between Jan 2011 and Dec 2019. All patients underwent pancreatoduodenectomy. The prognosis was evaluated according to the follow-up results. The survival rate was compared by log-rank test. Logistic regression was used to analyze the risk factors for lymph node metastasis.Results:One hundred and twenty-three patients successfully underwent the operations, 6 patients died during the perioperative time. The overall 1-year, 3-year and 5-year survival rates were 75.2%, 41.9% and 31.5%. The median survival time was 44.7 months. Fifty-one patients had lymph node metastasis, and the rate of lymph node metastasis was 41.5%. The median survival time was 55.5 months and 27.5 months for patients without and with lymph node metastasis, respectively. Correspondingly, the survival rates of 1-year, 3-year, 5-year were 83.0%, 50.7%, 42.5% vs. 63.5%, 19.0%, 19.0% ( P=0.000). Multivariate analysis showed that preoperative CA19-9 ( RR=7.064, 95% CI: 2.489-20.051) and portal venous system invasion ( RR=4.610, 95% CI: 1.252-16.972) were independent risk factors for lymph node metastasis. Conclusions:Lymph node metastasis is an important factor affecting the long-term survival of patients with distal cholangiocarcinoma. Preoperative CA19-9 level and portal venous system invasion are independent risk factors for lymph node metastasis.
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Pancreatic carcinoma is one of the most common digestive malignant tumor. It has a high degree of malignancy and poor prognosis. The overall 5-year survival rate is less than 10%. Portal vein system invasion is one of risk factors for poor long-term prognosis of pancreatic carcinoma, and radical surgery is the only effective way to achieve long-term survival. According to the clinical practice, our center proposed a new classification of pancreatic carcinoma with portal vein system invasion for the purpose of reconstructing the portal vein system. We also formulated treatment strategies for different classification and carried out operation of allogeneic vascular replacement in clinical practice. This paper introduces our relevant clinical experience.
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Objective:To evaluate the prognosis and related risk factors in patients who underwent surgical resection for pancreatic cancer with portal vein invasion.Methods:The clinical data of 66 patients with pancreatic cancer with portal vein invasion who underwent pancreatic combined with vascular resection and reconstruction at the Department of Hepatobiliary Surgery, Beijing Chaoyang Hospital Affiliated to Capital Medical University between January 2011 and December 2018 were retrospectively studied. There were 30 males and 36 females. Their age ranged from 35 years to 81 years, with a mean of 61.5 years. Post-operative survival outcomes were evaluated on follow-up, and the related risk factors for prognosis were analyzed. Kaplan-Meier method was used to construct survival curves, and the survival rates were compared by the log-rank test. Multivariate Cox regression was used to analyze prognostic factors.Results:All 66 patients successfully underwent the operations. There was no perioperative death. The postoperative complication rate was 28.8% (19/66). Sixty-five patients were followed up (follow-up rate 98.5%, 65/66). The overall 1-, 2- and 3-year survival rates were 53.3%, 30.4%, 23.4%, respectively, with a median survival of 13 months. Multivariate analysis showed that preoperative CA19-9 >400 U/ml ( RR=1.871, 95% CI: 1.123-3.117) and depth of venous invasion ( RR=1.713, 95% CI: 1.072-2.736) were independent risk factors of prognosis. The higher the preoperative CA19-9, and the deeper the venous invasion, the worse was the prognosis. Conclusion:Long-term prognosis of pancreatic carcinoma patients with portal vein invasion was poor. Preoperative CA19-9 >400 U/ml and depth of vascular invasion were the main risk factors of prognosis for patients with pancreatic carcinoma and portal vein invasion after surgical resection.
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Objective To analyze the application and effect of non-penetrating vascular and tubular tissue closure system in radical resection of adenocarcinoma of pancreatic head combined with venous resection and reconstruction.Methods A retrospective analysis was made on the clinical data of 78 patients with pancreatic head cancer who underwent radical resection of venous vessels from Feb 2014 to Feb 2018.According to the intraoperative venous resection and anastomosis,the patients were divided into vascular clip group (41 cases) and traditional suture group (37 cases).The preoperative data,intraoperative and postoperative recovery of the two groups were analyzed and compared.Results There were no perioperative deaths and no significant differences in perioperative complications between the two groups (P ＞ 0.05).The anastomotic time of the clip group was (18.6 ± 3.3) min,which was significantly shorter than that of the traditional suture group (39.7 ± 8.5) min,(P ＜ 0.05).There were no significant differences in operation time,intraoperative bleeding volume,ICU time,hospital stay and anastomotic stenosis between the two groups(P＞ 0.05).Conclusion It is safe and feasible to use vascular clip in venous vascular reconstruction in radical resection of carcinoma of the head of the pancreas combined with venous vascular resection.
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Objective To analyse the experience and prognosis of surgical treatment of hilar cholangiocarcinoma.Methods Clinical data of 49 patients of hilar cholangiocarcinoma underwent surgical treatment were analyzed retrospectively from January 2011 to December 2017 in Department of Hepatobiliary Surgery,Beijing Chaoyang Hospital affiliated to Capital Medical University.Of the 49 patients,29 patients underwent R0 resection and 10 patients underwent R1 resection according to the patient's condition.The overwall prognosis and R0 resection rate were analyzed.All patients were followed up by outpatient or telephone.The follow-up deadline was December 2017.The long-term prognosis of R0 and R1 resection were compared.Normal distribution data were expressed as (Mean ± SD),while non-normal distribution data were expressed as M(P25,P75).Survival curve was depicted by Kaplan-Meier method,and survival rate was compared by Log-Rank test.Results All patients underwent surgical treatment.There were 5 complications (10.2％) during the perioperative period,and no deaths occurred.Radical resection was performed in 39 patients,with a radical resection rate of 79.6％.The overall median survival time was (27.0± 1.2) months.The survival rates in 6 months,1,3 and 5 years were 95.9％,85.6％,34.5％,6.6％ respectively.The total median survival time of R0 resection and R1 resection was (28.0 ± 6.5) months and (16.0 ± 0.7) months respectively.The 6 months,1,2,and 3 years survival rates were 94.9％,89.7％,43.5％,8.3 ％ and 80.0％,68.6％,0,0 respectively.Conclusion Surgical treatment is safe and effective,and it can improve the prognosis of patients.
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Objective To investigate the clinical efficacy of total pancreaticoduodenectomy combined with portal vein resection and allograft vascular grafts for pancreatic cancer with vascular invasion.Methods The retrospective and descriptive study was conducted.The clinicopathological data of 9 patients with pancreatic cancer who underwent total pancreaticoduodenectomy combined with portal vein resection and allograft vascular grafts in the Beijing Chao Yang Hospital of Capital Medical University from January 2014 to September 2016 were collected.There were 4 males and 5 females,aged from 53 to 78 years,with a median age of 60 years.Involvement of portal vein (PV) and (or) superior mesenteric vein (SMV),splenic vein or convergence was detected in patients by preoperative evaluation,which indicated borderline resectable pancreatic cancer.Patients underwent complete surgical resection of tumor and involved portal veins,and then underwent vascular and digestive tract reconstruction.Observation indicators:(1) intraoperative situations;(2) postoperative situations;(3) follow-up.Patients were followed up by telephone interview and outpatient examination to detect survival of patients up to October 2018.Measurement data with normal distribution were represented as Mean±SD,measurement data with skewed distribution were expressed as M (range),and count data were expressed as absolute number.Results (1) Intraoperative situations:9 patients underwent total pancreaticoduodenectomy combined with portal vein resection and allograft vascular grafts successfully,including 1 undergoing total pancreaticoduodenectomy due to positive margin of pancreatic neck during pancreatico-duodenectomy for pancreatic head carcinoma,3 of pancreatic head carcinoma with portal vein involvement and atrophy of pancreatic body and tail,and 5 of carcinoma of pancreatic neck and body with portal vein involvement.The operation time,portal vein occlusion time,and volume of intraoperative blood loss were (573± 19) minutes,(21 ±4) minutes,and (717±33) mL.(2) Postoperative situations:4 of 9 patients had postoperative complications,including 2 with grade Ⅰ complication and 2 with grade Ⅱ complication.There was no grade Ⅲ or above complication.No anastomotic stenosis or thrombus formation after reconstruction for portal vein.The perioperative complications were cured after conservative treatment.Duration of postoperative hospital stay was 17 days (range,10-25 days).Nine patients underwent subcutaneous injection of insulin to control blood glucose during the period fasting for solids and liquids.After resuming the semi-liquid diet of diabetes,patients received subcutaneous injection of rapid acting insulin before meals combined with subcutaneous injection of long-acting insulin before bedtime,with a insulin need of 24-36 U/d.Patients had postprandial blood sugar level of 8-11 mmol/L,without unmanageable hyperglycemia orlong-term application of insulin pump.Patients received oral trypsin pancreatin instead of trypsin,with no gastrointestinal symptoms such as bloating and steatorrhea,no malnutrition.Of 9 patients,2 had well-differentiated adenocarcinoma,4 had moderately differentiated adenocarcinoma,and 3 had poor-differentiated adenocarcinoma.There were 3 patients with no vascular invasion,1 with endangidic invasion,5 with tumor infiltration of tunica adventitia vasorum.One of 9 patients was in IIA stage of TNM staging,3 were in the II B stage,and 5 were in IIIB stage.The negative rate of pathological sections for excised specimen margin was 8/9.(3) Follow-up:9 patients were followed up for 7-37 months,with a median follow-up time of 15 months.Four patients survived,4 died of tumor recurrence and metastasis,and 1 died of cerebrovascular accident.Conclusion Total pancreaticoduodenectomy combined with portal vein resection and allograft vascular grafts is safe and feasible for pancreatic cancer involving portal vein,splenic vein or junction.
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Objective To evaluate rapid frozen pathology in the operation of hilar cholangiocarcinoma.Methods Clinical data of 49 patients of hilar cholangiocarcinoma undergoing surgical treatment were analyzed retrospectively from Jan 2011 to Dec 2017 at Department of Hepatobiliary Surgery,Beijing Chaoyang Hospital Affiliated to Capital Medical University to evaluate rapid frozen pathology on operative strategy of hilar cholangiocarcinoma and the prognosis of patients.Results All patients with hilar cholangiocarcinoma underwent intraoperative frozen pathological examination.5 patients adjusted the operation approach because of the discrepancy between frozen pathological examination and preoperative imaging results.47 intraoperative frozen pathological results were consistent with postoperative pathological diagnosis,and the accuracy rate was 95.9％,sensitivity 90％,specificity 97.4％,false positive rate 2.6％,false negative rate 10％.Frozen section margin negative patients had significantly longer survival time(P ＜ 0.05).Conclusions Intraoperative frozen pathological examination can guide the operation approach,greatly improve the resection rate of R0 and the prognosis of patients.
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Objective To evaluate the prognosis and related risk factors in patients with primary liver cancer after liver transplantation. Methods We retrospectively analyzed the clinical data of 298 patients who underwent liver transplantation between January 2013 and December 2017 at Beijing Chaoyang Hospital of Capital Medical University. 121 patients with primary liver cancer on postoperative pathological diagnosis were included into this study. The patients included 108 males and 13 females, aged from 31 to 70 years, with an average of (52. 7 ± 8. 7) years. The prognosis and the related risk factors on prognosis were analyzed. The survival curve was drawn by the Kaplan-Meier method, and the survival rate was compared by the log-rank test. Multivariate Cox regression was used to analyze the prognostic factors. Results Of the 121 patients who were enrolled in this study, 5 patients died during the perioperative period, making a perioperative mortality rate of 4. 1% (5/121). The remaining 115 patients were followed up and the followed up rate was 95. 0% (115/121). The overall 1-, 2- and 3-year survival rates were 81. 0% , 74. 6% and 70. 2% , respectively. The median survival was 41. 5 months. Multivariate analysis showed that preoperative Child grading (RR=3. 028, 95% CI: 1. 625～5. 643) and microvascular invasion (RR=7. 165, 95% CI: 2. 237～22. 951) were independent risk factors of prognosis. The worse the preoperative Child grading, the worse was the prognosis. The prognosis of patients with microvascular invasion was also poor. Conclusions The overall prognosis of patients with primary liver cancer after liver transplantation was good. Preoperative Child grading and pathological microvascular invasion were the main risk factors of prognosis after liver transplantation carried out for primary liver cancer.
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Objective To study the impact on the use of branched vascular allografts in the prevention of left regional portal hypertension after pancreatic cancer operations.Methods This retrospective study included 25 patients who underwent pancreaticoduodenectomy for pancreatic head cancer which involved the portal vein,superior mesenteric vein and splenic venous confluence between January 2011 to December 2017 in the Beijing Chao Yang Hospital,Capital Medical University.These patients underwent "en bloc" resection of the spleno-mesenterio-portal (SMS) venous axis with replacement of a branched vascular allografts.They were studied to see whether gastroesophageal varices were found on gastroscopy and whether there were any changes in leukocyte,platelet and splenic volume before and after the operation to determine the incidence of left regional portal hypertension after operation.Results During the follow-up period,all the portal vein,superior mesenteric vein and splenic vein anastomoses were unobstructed and without any thrombosis.No new varices were found on gastroscopy.There were no significant differences in the white blood cell count,platelets count and splenic volume before and after the operations (all P＞0.05).The 25 patients had no left regional portal hypertension.Survival time and one year survival rate of the patients were (20.2±3.7) months and 44.0％.Conclusion Branched vascular allografts effectively prevented the occurrence of left regional portal hypertension after radical pancreaticoduodenectomy with resection of SMP.