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Objective:To investigate the correlation between modified Glasgow prognostic score (mGPS) and prognosis of intrahepatic cholangiocarcinoma (ICC) patients after radical surgical resection.Methods:The clinical data of 126 patients with intrahepatic cholangiocarcinoma undergoing radical surgical resection at Ningbo Medical Centre Lihuili Hospital from Jan 2011 to Dec 2020 were retrospectively analyzed. The patients were scored according to the mGPS-related scoring standards, and the differences in tumor clinicopathological characteristics and prognosis were compared between patients with different score levels.Results:Firty-eight cases were included in group 0, 41 cases in group 1, and 27 cases in group 2. The 1- and 3-year survival rates in group 0 were 85.8% and 52.3%, the 1- and 3-year survival rates in group 1 were 73.2% and 23%, and the 1- and 3-year survival rates in group 2 were 73.3% and 0. The difference was statistically significant ( P<0.05). Univariate analysis showed that age, mGPS, CA19-9, tumor diameter, and tumor differentiation were related at the prognosis of ICC. Multivariate analysis showed that age, tumor differentiation, tumor diameter and mGPS were independent risk factors for the prognosis of ICC. Conclusion:mGPS is an independent risk factor affecting the prognosis of ICC patients.
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Objective:To study the influencing factors in predicting conversion of laparoscopic liver tumor resection to open surgery to provide references for selection of patients for laparoscopic hepatectomy.Methods:The clinical data of 222 patients who were planned to undergo laparoscopic liver tumor resection at Ningbo Medical Center Lihuili Hospital from December 2015 to November 2018 were analyzed retrospectively. There were 146 males and 76 females, with an average age of 58.1 years. These patients were divided into the conversion group ( n=24) and the laparscopic group ( n=198) according to whether intraoperative conversion to open surgery was carried out. Chi-square test was used to evaluate relevant factors of conversion. Logistic regression analysis was used for multivariate analysis and to find out independent risk factors of conversion. Results:The conversion rate was 10.8% (24/222). Univariate analysis showed that hypertension, history of abdominal surgery, liver cirrhosis, tumors located at posterosuperior segments and major liver resection were significantly associated with conversion (all P<0.05). Multivariate analysis showed that the risk factors which were independently associated with conversion were liver cirrhosis ( OR=2.611, 95% CI: 1.018-6.701), tumors located at posterosuperior segments ( OR=6.115, 95% CI: 2.207-16.941), and major liver resection ( OR=3.361, 95% CI: 1.150-9.825)(all P<0.05). Conclusion:Patients who were planned for laparoscopic liver tumor resection with liver cirrhosis, tumors at posterosuperior segments or major liver resection were at higher risks of conversion to open surgery.
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Objective:To study the relationship between morphologic classification and prognosis of patients with intrahepatic cholangiocarcinoma (ICC).Methods:The clinicopathologic data of 125 ICC patients who underwent R 0 resection at the Ningbo Medical Center Li Huili Hospital from January 2011 to May 2019 were retrospectively analyzed. This cohort consisted of 67 males and 58 females, aged 26.0 to 82.0 (63.5±9.5) years old. Based on the resected specimens, the patients were divided into the mass forming type, periductal infiltrating type and mixed type. The survival rates and recurrence-free survival outcomes of the patients among the three types were compared, and the risk factors that influenced prognosis were analyzed. Results:Using the predetermined inclusion and exclusion criteria, 16 patients with missing data and other causes of death were excluded from the initial 125 patients. Also, as the number of the mixed type was small, these patients were excluded. Finally 62 patients in the mass forming type and 42 patients in the periductal infiltrating type were analyzed. In the mass forming group, there were 32 males and 30 females, aged (63.1±9.1) years. In the perivascular infiltration group, there were 22 males and 20 females, aged (64.1±10.2) years. The 1-, 3-, 5-year survival rates of the mass forming group were 78.1%, 33.2%, 18.9% (median survival 25 months). The 1-, 3-, 5-year survival rates of the periductal infiltrating type were 63.3%, 8.3%, 6.1% (median survival 15 months). There were statistically significant differences between the two groups ( P<0.05). The median recurrence-free survival for the mass forming and the periductal infiltrating groups were 18 and 11 months, respectively, with a statistically significant differences between them ( P<0.05). Univariate and multivariate analysis showed that TNM staging Ⅲ~Ⅳ ( HR=2.966, 95% CI: 1.549-5.679) and periductal infiltrating type ( HR=2.403, 95% CI: 1.236-4.670) were independent risk factors for survival of these patients after operations. TNM staging Ⅲ~Ⅳ ( HR=2.466, 95% CI: 1.325-4.589), low grade differentiation ( HR=0.528, 95% CI: 0.299-0.934) and periductal infiltrating type ( HR=2.432, 95% CI: 1.295-4.565) were independent risk factors for relapse-free survival of these patients ( P<0.05). Conclusions:Morphological classification was found to be an independent risk factor for prognosis of ICC patients in this study, with significantly worse long-term prognosis when compared with the mass forming type.
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Objective@#To explore the predictive significance of logarithm of lymph node positive number to lymph node negative number (LODDS) in patients with gallbladder cancer, and to establish a predictive model of gallbladder cancer based on LODDS.@*Methods@#The clinical data of 1321 gallbladder cancer patients who underwent lymphadenectomy in SEER database from 2010 to 2014 were collected. They were randomly divided into test group (n=793) and verification group (n=528). COX multivariate analysis was used to determine independent prognostic factor, and a Nomogram prediction model was established. C index was used to evaluate the accuracy of patient Nomogram and TNM. ROC curve was used to evaluate the accuracy of the contour map and TNM staging in predicting survival rates.@*Results@#Independent risk factors for COX analysis were selected including age, tumor size, grade, TNM stage and LODDS analysis, and the contour map was drawn. In the experimental group, the C index was 0.744 (95% CI, 0.707-0.781), and the AUC values of ROC curves predicting 3-year and 5-year survival were 0.815 and 0.823, respectively. The predictive value of C index for TNM staging in the test group was 0.699 (95% CI, 0.662-0.736), and the AUC value of ROC curve for TNM staging predicting 3-year and 5-year survival was 0.779 and 0.790, respectively.@*Conclusion@#LODDS is an independent prognostic factor for gallbladder cancer. The prediction model based on LODDS is more accurate than TNM staging.
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The incidence of intrahepatic cholangiocarcinoma (ICC) has been increasing year by year. For most patients, surgical resection is not suitable when they are diagnosed as ICC. Conventional chemotherapy and radiotherapy are not effective for the long-term survival rate of ICC patients and lead to the poor overall prognosis. In recent years, with the deepening understanding about the molecular mechanism of biliary malignant tumors, some key genes and signaling pathways related to the pathogenesis of ICC have been identified, providing new ideas for the targeted therapy. In this paper, major molecular mechanisms and targeted therapies of ICC are reviewed.
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Objective To explore the predictive significance of logarithm of lymph node positive number to lymph node negative number (LODDS) in patients with gallbladder cancer,and to establish a predictive model of gallbladder cancer based on LODDS.Methods The clinical data of 1321 gallbladder cancer patients who underwent lymphadenectomy in SEER database from 2010 to 2014 were collected.They were randomly divided into test group (n =793) and verification group (n =528).COX multivariate analysis was used to determine independent prognostic factor,and a Nomogram prediction model was established.C index was used to evaluate the accuracy of patient Nomogram and TNM.ROC curve was used to evaluate the accuracy of the contour map and TNM staging in predicting survival rates.Results Independent risk factors for COX analysis were selected including age,tumor size,grade,TNM stage and LODDS analysis,and the contour map was drawn.In the experimental group,the C index was 0.744 (95％ CI,0.707-0.781),and the AUC values of ROC curves predicting 3-year and 5-year survival were 0.815 and 0.823,respectively.The predictive value of C index for TNM staging in the test group was 0.699 (95 ％ CI,0.662-0.736),and the AUC value of ROC curve for TNM staging predicting 3-year and 5-year survival was 0.779 and 0.790,respectively.Conclusion LODDS is an independent prognostic factor for gallbladder cancer.The prediction model based on LODDS is more accurate than TNM staging.
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The incidence of intrahepatic cholangiocarcinoma(ICC)has been increasing year by year.For most patients,surgical resection is not suitable when they are diagnosed as ICC.Conventional chemotherapy and radiotherapy are not effective for the long-term survival rate of ICC patients and lead to the poor overall prognosis.In recent years,with the deepening understanding about the molecular mechanism of biliary malignant tumors,some key genes and signaling pathways related to the pathogenesis of ICC have been identified,providing new ideas for the targeted therapy.In this paper,major molecular mechanisms and targeted therapies of ICC are reviewed.
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Objective To investigate the clinical outcomes of liver transplantation by using donation after cardiac death (DCD) in single center.Methods The clinical data of 115 DCD donors and recipients of liver transplantation from Jan 2012 to Sep 2017 at our institution were analyzed,including preoperative general data,intraoperative status,and postoperative early complications.Patients were followed up to Oct 30th,2017.The measurement data with normal distribution were analyzed by t test,the enumeration data were analyzed by chi-square test or Fisher exact probability test,and the Kaplan-Meier method was used for survival analysis.Results All of the 115 donors were within China category Ⅲ using the classification of China donor after cardiac death.Donor graft mean warm ischemic time and cold ischemic time was (10 ± 4) min and (6.1 ± 1.7) h,respectively.All of the recipients underwent liver transplantation successfully.The mean preoperation MELD score was 14 ± 7.Seven patients were ABO-incompatible liver transplantation (A→O,3 cases,B→O 2 cases,AB→O 1 case,AB→A 1 case).19 patients (16.5％) had postoperative complications (Clavien-Dindo classification grade Ⅲ-Ⅴ).The perioperative mortality was 2.6％ (3 cases).All patients were followed up for an average (21 ± 17) mon.Patients 1-,3-,and 5-year survival rates were 93.6％,81.8％,and 77.5％,respectively.Conclusion The outcome of DCD liver transplantation is favorable at our institution under careful donor and recipient selection and intensive perioperative management.
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Objective To compare the clinical results of laparoscopic spleen-preserving distal pancreatectomy (LSPDP) and open spleen-preserving distal pancreatectomy (OSPDP).Methods From Jan 2014 to Aug 2017,the clinical results of 30 patients undergoing LSPDP were compared with those of 20 OSPDP patients.The postoperative pancreatic fistula rate was the main observation index.Results There was significant difference in operation time [(140.33 ±55.93) min vs.(182.71 ±43.51)min],blood loss [(175.61 ± 180.78) ml vs.(253.51 ± 176.06) ml],postoperative hospital stay [(6.16 ± 7.22) d vs.(8.85 ± 9.36) d],postoperative exhaust [(2.17 ± 1.43) d vs.(3.10 ± 1.89) d],and postoperative feeding time [(2.26 ± 1.78)d vs.(3.42 ±2.01)d] between LSPDP and OSPDP.LSPDP group was better than OSPDP group (all P ＜ 0.05).The rate of postoperative pancreatic fistula (66.7％ vs.70.0％) and overall complications (80％ vs.90.0％) were not statistically different between the two groups.Pancreatic leakage occurred in 20 cases,lung infection in 1 case,peritoneal infection in 1 case and chylous leakage in one case in LSPDP group,while pancreatic leakage in 14 cases,lung infection in 2 cases,and peritoneal infection in 2 cases in OSPDP group,all were cured by conservative therapy.Conclusions LSPDP is a safe,effective,less traumatic and more economic surgical approach for benign cystic tumors located at the body or tail of the pancreas.
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Objective To study the clinical outcomes of 28 pancreatic cancer patients who underwent total pancreaticoduodenectomy.Method The clinical data of 28 patients with pancreatic cancer who underwent total pancreaticoduodenectomy from January 2009 to March 2015 were retrospectively analyzed.Results Among the 28 patients,complications occurred in 11 (39.2％) after the operation.There were 7 patient having Grade Ⅱ,4 Grade] complications.No patient died within 30 days after the operation.Fol low-up of 25 patients showed a median survival of 13.5 months.There were 24 patients with pancreatic ductal adenocarcinoma,and the median survival was 13 months.Conclusions Total pancreaticoduodenectomy could not improve long-term survival but it decreased postoperative complications and improved postoperative quality of life.In selected patients,total pancreaticoduodenectomy could be a rational option.
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<p><b>OBJECTIVE</b>To investigate the value and safety of the surgery with vascular resection and reconstruction during pancreatectomy for pancreatic cancer.</p><p><b>METHODS</b>The clinical data of 206 patients with pancreatic cancer who underwent radical resection were retrospectively analyzed from January 2009 to March 2014 in Lihuili Hospital, Medical center of Ningbo.All cases were divided into non-vascular resection group(132 cases), the combined vein resection group(66 cases) and the combined arterial resection group(8 cases). The peri-operation data, the incidence of postoperative complications and the survival were compared in pairs among three groups.All patients were followed up till September 2014.</p><p><b>RESULTS</b>There were no statistical differences for the preoperative data among three groups.The operation time and the blood loss (M(QR)) were (347±96)minutes and (500(400)) ml in non-vascular resection group, (425±91)minutes and (800(500))ml in combined vein resection group, (508±120)minutes and (1 750(2 075))ml in combined arterial resection group, with significant differences among three groups(all P<0.01). The incidence of postoperative complication was 16.7%(22/132) in non-vascular resection group, 28.8%(19/66) in combined vein resection group, and 6 cases in combined arterial resection group, respectively.There were significant differences between non-vascular resection group and combined vein resection group(P<0.05), non-vascular resection group and combined arterial resection group(P<0.05), as well as between combined vein resection group and combined arterial resection group(P<0.05). The median survival time was 15 months for non-vascular resection group, 15 months for combined vein resection group, and 12 months for combined arterial resection group.No significant difference was found among three groups(all P>0.05). The postoperative mortality was nil for all of groups.</p><p><b>CONCLUSIONS</b>Compared with non-vascular resection, combined vein resection can be performed safely with a similar prognosis. The surgery of combined arterial resection could only be justified when R0 resection for pancreatic cancer could be achieved for highly selected patients.</p>
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Humans , Arteries , General Surgery , Pancreatectomy , Methods , Pancreatic Neoplasms , General Surgery , Postoperative Complications , Prognosis , Retrospective Studies , Veins , General SurgeryABSTRACT
Objective To analyze the related risk factors for delayed gastric emptying ( DGE) after pancreaticoduodenectomy .Methods Clinical data on 308 patients who underwent pancreaticoduodenectomy at Ningbo Lihuili hospital from January 2009 to December 2014 were retrospectively analyzed , and patients were divided into DGE group and non-DGE group.Univariate analysis and multivariate logistic regression analysis were used to study the risk factors associated with DGE during perioperative period .Results DGE occurred in 55 patients (17.9%).The incidences of grade A, grade B and grade C DGE were 7.1%(22/308), 6.2%(19/308) and 4.5%(14/308), respectively.The univariate analysis showed the method of pancreatic digestive tract reconstruction ( pancreaticogastrostomy or pancreaticojejunostomy ) , postoperative pancreatic fistula, postoperative biliary fistula and postoperative intraabdominal infection were risk factors for DGE after surgery. Multivariate analysis indicated that the method of pancreatic digestive tract reconstruction (OR=1.19, P=0.046), postoperative pancreatic fistula ( OR=1.33, P=0.014), postoperative biliary fistula (OR=1.43, P=0.047) and postoperative intraabdominal infection (OR=1.51, P=0.001) were independently associated with DGE . Postoperative pancreatic fistula (OR=3.692, P=0.021) and intraabdominal infection (OR=3.725,P=0.003)were also the independent risk factors for Grade B and Grade C DGE. Conclusions DGE after pancreaticoduodenectomy was strongly related to the postoperative complications .Postoperative pancreatic fistula , biliary fistula and intraabdominal infection were associated with increased risk of DGE , while pancreaticogastrostomy reduced the incidence of DGE by decreasing the incidence of pancreatic or biliary fistula .
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Objective To find the potential risk factors for pancreatic fistula after distal pancreatectomy.Methods Clinical data of 125 cases of consecutive distal pancreatectomy in Ningbo Lihuili Hospital from January 2006 to June 2013 were retrospectively analyzed.Results In all the 125 patients with distal pancreatectomy,pancreatic fistula was the most common surgical complication (43/125,34.4％),including 27 cases of grade A fistula,16 cases of grade B pancreatic fistula.Multivariate analysis showed that the texture of the pancreas and main pancreatic duct ligation were the independent risk factors for pancreatic fistula (all P ＜ 0.05).Conclusions Pancreatic fistula was the most common surgical complication of distal pancreatectomy.The texture of the pancreas and main pancreatic duct ligation effect the occurrence of postoperative pancreatic fistula.
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ObjectiveTo study the efficacy of transcatheter arterial chemoembolization (TACE) after liver resection for hepatocellular carcinoma (HCC) with tumor thrombus in the main trunk and/or first branch of portal vein,and to clarify prognostic factors affecting survival.Methods From 2005 to 2009,there were 358 consecutive patients with HCC who underwent surgical resection in our Department.In 55 patients (15 ％),portal vein tumor thrombus (PVTT) was found intraoperatively or postoperatively during histopathological examinations to involve the first portal branch,main portal trunk,or contralateral portal branch.In this retrospective study,these 55 patients were divided into two groups:Group A,29 patients received postoperative TACE,and Group B,26 patients who did not receive TACE.The clinical data and survivals were compared between the two groups.Prognostic factors were indentified using univariate analysis,followed by multivariate regression analysis using the Cox proportional hazards model.ResultsThere were no significant differences in the demographic clinical data between Group A and Group B.The overall 1-,2- and 3-year survivals for the 55 patients were 63.3 ％,51.4 ％ and 43.5 ％,respectively.The accumulative 1-,2- and 3-year survivals for group A were 71.4 ％,60.1 ％ and 50.1 ％,respectively.The corresponding figures for group B were 56.7％,21.7％ and 10.4％,respectively.Multiple tumors,intrahepatic metastases,hepatic vein thrombus,and invasive type of tumor thrombus were found to be risk factors for short-term survival on univariate analysis,while the latter 3 factors were further found to be significant prognostic factors in the Cox proportional hazards model.Postoperative TACE was shown to be a significant factor in both univariate and multivariate analyses.ConclusionLiver resection was beneficial for some patients with portal vein tumor thrombus.Postoperative TACE further improved the prognosis and prolonged survivals in these patients.