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Pancreatic cancer is a common malignancy with the worst prognosis.Radical surgery has been the only curative treatment for pancreatic cancer.With the advancement of surgical techniques and the implementation of the concept of comprehensive treatment for cancer in recent years,neoadjuvant therapy for pancreatic cancer has received more attention.There are continuing controversies in the hotspots and difficulties,with opportunities and challenges coexisting.Four famous experts and their teams in pancreatic surgery discussed selection strategy of neoadjuvant therapy for pancreatic cancer based on clinical experiences.Professor Wang Chunyou proposed that surgery was prior for patients with a higher likelihood of achieving R0 resection for pancreatic cancer to avoid the possibility of tumor progression and loss the opportanity of radical resection during neoadjuvant therapy.For patients with less chance of radical resection for pancreatic cancer and unresectable pancreatic cancer,neoadjuvant therapy is worthy of a positive attempt.Professor Jin Gang and his team believed that neoadjuvant therapy played an important role in improving the survival time of patients with pancreatic head cancer,especially with borderline resectable pancreatic head cancer.After neoadjuvant therapy,pancreatic surgeons should pay attention to improvement of surgery safety and R0 resection rate.Professor Dai Menghua and his team suggested that patients with resectable pancreatic cancer and borderline resectable pancreatic cancer could benefit from neoadjuvant therapy,which required proof from clinical trials.Surgeons should choose the appropriate treatment strategy based on guidelines and individual conditions for patients with pancreatic cancer.Professor Shao Cheghao and his team suggested that surgical treatment after neoadjuvant therapy or translational therapy for locally advanced pancreatic head cancer is safe,effective and feasible,especially for pancreaticoduodenectomy with combined revascularization.For the treatment of patients with pancreatic head cancer after neoadjuvant chemotherapy,the choice of next treatment options,evaluation indicators,timing of surgery and surgical methods need to be further studied.
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Objective To explore the short-term outcome of laparoscopic pancreaticoduodenectomy (LPD) and open pancreaticoduodenectomy (OPD) for pancreatic head cancer.Methods The retrospective cohort study was conducted.The clinicopathological data of 108 patients with pancreatic head cancer who were admitted to the Affiliated Tongji Hospital of Huazhong University of Science and Technology between July 2014 and July 2015 were collected.Among 108 patients,47 and 61 who respectively underwent LPD and OPD were allocated into LPD and OPD groups.Observation indicators:(1) intraoperative situations;(2) postoperative situations;(3) postoperative pathological situations;(4) follow-up and survival situations.Follow-up using outpatient examination and telephone interview was performed to detect chemotherapy and postoperative survival situations at 1 and 3 years postoperatively up to June 2018.Measurement data with normal distribution were represented as x±s and comparison between groups was analyzed using the t test.Comparison between groups of count data was analyzed using the chi-square test.Results (1) Intraoperative situations:operation time in the LPD and OPD groups was respectively (288±24)minutes and (265±29)minutes,with no statistically significant difference between groups (t=5.138,P＞0.05).Volume of intraoperative blood loss in the LPD and OPD groups was respectively (136±14)mL and (388±21)mL,with a statistically significant difference between groups (t=-7.297,P＜0.05).Cases with blood transfusion were respectively 3 and 7 iu the LPD and OPD groups,with no statistically significant difference between groups (x2 =0.325,P ＞ 0.05).(2) Postoperative situations:of 47 patients in the LPD group,16 with postoperative complications were improved by conservative treatment,including 7 with pancreatic fistula (5 with biochemical pancreatic fistula and 2 with grading B and C of pancreatic fistula);4 with delayed gastric emptying were cured by gastrointestinal decompression and gastric motility promoting treatment;2 with postoperative bleeding were improved by conservative treatment;2 with intraabdominal infection were improved by enhanced antibiotic therapy and transabdominal percutaneous drainagc;1 with biliary fistula was improved by transabdominal percutaneous drainage;there was no wound infection and perioperative death.Of 61 patients in the OPD group,28 with postoperative complications were improved by conservative treatment,including 12 with pancreatic fistula (9 with biochemical pancreatic fistula and 3 with grading B and C of pancreatic fistula);8 with delayed gastric emptying were cured by gastrointestinal decompression and gastric motility promoting treatment;3 with intra-abdominal infection were improved by enhanced antibiotic therapy and transabdominal percutaneous drainage;2 with postoperative bleeding were improved by conservative treatment;2 with wound infection were c ured by conservative treatment;1 with biliary fistula was improved by transabdominal percutaneous drainage;there was no perioperative death.There was no statistically significant difference in the cases with postoperative complications between groups (x2 =1.546,P＞ 0.05).Duration of hospital stay in the LPD and OPD groups was (13.6±2.1)days and (19.3 ±4.4)days,respectively,with a statistically significant difference (t =-4.354,P＜0.05).(3) Postoperative pathological situations:R0 resection rate was respectively 100.0％ (47/47) and 98.4％ (60/61) in the LPD and OPD groups,with no statistically significant difference (x2 =0,P＞0.05),and there was 1 patient with R1 resection in the OPD group.The total number of lymph node dissected in the LPD and OPD groups was respectively 19±4 and 13±4,with a statistically significant difference (t=-4.126,P＜0.05).The cases with high-and moderate-differentiated tumor and low-differentiated tumor (tumor differentiation),staging T1-T2 and T3-T4 (T stage),staging N0 and N1 (N stage),staging Ⅰ and Ⅱ-Ⅲ (TNM staging) and nerve or vascular invasion were respectively 35,12,28,19,20,27,16,31,21 in the LPD group and 50,11,36,25,36,25,14,47,32 in the OPD group,with no statistically significant difference (x2=0.891,0.003,2.882,1.628,0.643,P＞0.05).(4) Follow-up and survival situations:44 and 55 patients in the LPD and OPD group respectively underwent postoperative adjuvant therapy during the follow-up,with no statistically significant difference (x2=0,P＞0.05).The postoperative 1-year follow-up:47 patients in the LPD group were followed up,37 survived and 10 died;of 61 patients in the OPD group,3 lost to follow-up,and 58 were followed up (43 survived and 15 died);there was no statistically significant difference in survival between groups (x2=0.301,P＞0.05).The postoperative 3-year follow-up:of 47 patients in the LPD group,3 lost to follow-up,and 44 were followed up (21 survived and 23 died);of 61 patients in the OPD group,6 lost to follow-up,and 55 were followed up (23 survived and 32 died);there was no statistically significant difference in survival between groups (x2 =0.346,P＞0.05).Conclusion LPD is safe and feasible for pancreatic head cancer,with advantages of less bleeding,shorter duration of hospital stay and more total number of lymph node dissected,and its survival effect is equivalent to that of OPD.
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Objective To explore the efficacy difference of biliary stent combined with 125I seed intracavity irradiation and palliative biliary drainage in the treatment of obstructive jaundice caused by pancreatic head cancer. Methods The clinic date of 95 patients with pancreatic head cancer who underwent palliative surgery from June 2010 to June 2015 were analyzed retrospectively. 46 of the cases were treated with percutaneous biliary metal stent implantation combined with 125I seed intracavity irradiation (stent group), and the other 49 cases were treated with palliative biliary enterostomy (surgery group). The levels of jaundice, liver function, tumor size, survival time and hospitalization cost were compared between the patients before and after treatment. Paired t-test was applied for statistical analysis. Results Both the two treatment coulel effectively relieve jaundice and improve liver function. The mean TBIL of surgery group and stent group was (29.4±9.6) and (21.0±8.0)μmol/L after three months treanment, (40.3±11.0) and (24.4±9.6)μmol/L after six months treatment, respectively. Tumor maximum diameter of the two groups were (37.9 ± 4.5) mm and (33.5 ± 6.0)mm after three months treatment, (45.9 ± 5.0) mm and (37.0 ± 6.5) mm after six months, respectively. Each time point between them had statistical significance (t=-4.235,-5.476,-3.654,-6.702, P<0.05). The mean survival time was (12.83 ± 0.80) months in the stent group and (9.06±0.49) months in the surgery group, the difference was statistically significant (t=-3.49, P<0.01). The mean hospitalization cost of the stent group was (38 453.0 ± 7 282.0) yuan and the surgery group was (43 057.0 ± 7 667.4) yuan, the difference was statistically significant (t= 2.759, P<0.05). Conclusion For inoperable pancreatic head cancer patients, compared with palliative biliary enteric drainage, percutaneous biliary stent placement combined with 125I seed intracavity irradiation can effectively relieve biliary obstruction, improve liver function, inhibit tumor growth and prolong survival time.
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Objective To investigate the application effect of fast secure multipath exposure of portal vein ( PV) and superior mesenter-ic vein ( SMV) in pancreaticoduodenectomy. Methods Retrospective analyzed the clinical data of 80 cases of pancreatic head cancer pa-tients who underwent pancreatoduodenectomy in our hospital from October 2005 to October 2013. According to the different PV/SMV expo-sure methods, they were divided into 2 groups with 40 cases in each group. The observation group used fast secure multipath exposure meth-od while the control group were given traditional method of exposure, and curative effect of the 2 groups were compared. Results In the ob-servation group, the success rate of operation was 90. 0%(36/40) which is significantly higher than 72. 5% (29/40) in the control group;in the observation group , operation time was ( 3 6 0 . 6 ± 5 8 . 7 ) min and intraoperative bleeding was ( 6 0 0 . 4 ± 3 6 . 8 ) mL which were significantly lower than that(414. 2 ± 81. 3)min and (788. 8 ± 57. 9) mL in the control group;3 year mortality rate in observation group was 65.0%(26/40) which was significantly lower than 86. 1% (31/36) in control group, these differences were statistically significant (P<0. 05). Conclusion Fast and secure multipath PV/SMV applied in pancreatoduodenectomy could improve the operation success rate, shorten the operation time, reduce the intraoperatve blood soss and postoperative adverse reactions, and improve the long-term survival rate.
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Objective To investigate differential diagnostic value of dual-source computed tomography (DSCT)for the benign or malignant lymph node of pancreatic head cancer.Methods The plain and contrast DSCT data of 1 1 9 patients with pancreatic head cancer proved by operation and pathology were analyzed retrospectively.The distributions,number,short and long axis diameters and ratio of short-to long-axis diameter,enhancement modality and enhancement degree of lymph nodes were recorded.A1l data were analyzed using the t test or chi-square test.Results The positive rate of lymph node metastasis was 68.1% (81/1 1 9).Lymph node metastases were found in 239 out of 334 lymph nodes,and reactive hyperplasia were found in 95 lymph nodes (28.4%,95/334).The positive rate of lymphatic metastasis with rim-1ike enhancement was 99.1% (1 1 1/1 12),which was significantly higher than 57.7% (128/222)of lymphatic metastasis with homogeneous enhancement.The increased CT value of metastatic lymph nodes was (23.8±3.2)HU,which was significantly higher than (14.3±2.3)HU of patients with reactive hyperplasia lymph nodes.The short-and long-axis diameters and the ratio of short-to long-axis diameter showed significant difference between benign or malignant lymph nodes (P <0.05 ).Conclusion DSCT could detect lymph node metastasis of the cancer of the pancreatic head.When the short axis diameter of the lymph nodes ≥8 mm,long axis diameter of the lymph nodes ≥12 mm,the ratio of short-to long-axis di-ameter ≥0.75,and the rim-1ike enhancement and increased value after enhancement ≥25 HU,high sensitivity of dual-source CT for the diagnosis of lymph node metastasis of cancer of the head of pancreas could be achieved.
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Radical pancreaticoduodenectomy is extremely important for patients who suffered from pancreatic head cancer achieving long-term survival.Accurate understanding on composition of resection margin of pancreaticoduodenectomy specimens is pivotal for standardized labeling and testing.Standardization of pathological examination and accurate diagnosis of surgical margin status play an important role in prognosis of patients.Currently,different centers have a different definition of surgical margins for pancreatic head cancer.In this paper,based on the related literature,the authors discuss issues related to surgical margins of pancreatic head cancer.
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Objective To retrospeetivley explore the expanded radicM resectable range and improved Surgical approach of the progressive pancreatic head cancer with metastasis of portal vein(PV) and liver,and try to improve the resectable rate.survival rate and quality of life.Methods The patients witll late pancreatic cancer sis of partial PV resection and 8 cases of left leaf or right leaf sectional hepatectomy partial were involved in 27 cases,reconstructed gastrointestinal tract with improved Whipple interposed Y-type jejunostomy and PV.27 cases were randomly divided into intervention chemotherapy of treatment groups(n=13) and control groups(n=14).Results Severe complications or dead cases were not found in 27 cases after operation.The 2-,3-,5-years survival rates were 61.5%,38.4%,23.0%,and 42.8%,21.4%,14.3% in treatment group and control group,respectively.The survival rate was statistically different(P<0.05).Conclusions The expanded radical pancreatoduodenectomy and its improved surgical approach can improve not only the survival rate but also the quality of life.