Laparoscopic pancreaticoduodenectomy: right-inferior-posterior "artery first" approach / 中华胃肠外科杂志

<p><b>OBJECTIVE</b>To discuss the application of right-inferior-posterior "artery first" approach in laparoscopic pancreaticoduodenectomy.</p><p><b>METHODS</b>Clinical data of 17 patients who underwent laparoscopic pancreaticoduodenectomy through right-inferior-posterior "artery first" approach in our department from February 2014 to April 2015 were retrospectively analyzed. The operation began at the inferior flexure of duodenum. After entering the Toldt's space, the left renal vein (LRV) was revealed and the root of superior mesenteric artery (SMA) was exposed just above the LRV. SMA was dissected along its trunk till the horizontal part of duodenum.</p><p><b>RESULTS</b>Of these 17 cases, adenocarcinoma of pancreatic head was observed in 5 cases, adenosquamous carcinoma in 2 cases, mucinous cycstic neoplasm in 1 case, adenocarcinoma of lower common bile duct in 4 cases, and duodenal papilla cancer in 5 cases. Fifteen cases were accomplished successfully with laparoscopy and 2 cases were converted to open approach. The average operating time was (320 ± 85) min and mean intraoperative blood loss was (305 ± 175) ml. The cutting margins were tumor negative in all the patients. The average number of harvested lymph node was 15.4 ± 6.5. Postoperative complication occurred in 5 cases. Two cases of bile leakage and 2 cases of pancreatic fistula were cured with conservative treatment. One case of delayed abdominal hemorrhage was resolved with reoperation.</p><p><b>CONCLUSION</b>Right-inferior-posterior "artery first" approach is safe and feasible in laparoscopic pancreaticoduodenectomy.</p>

Concurrent chemoradiotherapy for 90 patients in different parts of esophageal carcinoma / 国际肿瘤学杂志

Objective To explore the effectiveness and esophageal strictures of concurrent chemoradiotherapy in patients with cervical and upper-thoracic esophageal cancer (EC) and middle-thoracic and lower-thoracic EC.Methods Between January 2011 and December 2014,ninety patients with different parts of EC were treated with radiotherapy combined with concurrent chemotherapy in People's Hospital of Subei.The median irradiation dose was 60 Gy.The chemotherapy regimens consisted of Paclitaxel and Nedaplatin.Of all the patients,48 patients had cervical and upper-thoracic EC,42 patients had middle-thoracic and lowerthoracic EC.The response rates,the local control rates,the survival rates and esophageal strictures were evaluated between two groups.Results The follow-up rate was 100％.The response rates of the patients with cervical and upper-thoracic EC and middle-thoracic and lower-thoracic EC were 81.2％ and 73.8％ (x2 =0.717,P =0.397),respectively.The 1-year local control rates of the patients with cervical and upper-thoracic EC and middle-thoracic and lower-thoracic EC were 90.3％ and 71.8％ (x2 =5.865,P =0.015),respectively.The 1-year survival rates of the patients with cervical and upper-thoracic EC and middle-thoracic and lower-thoracic EC were 87.5％ and 69.0％ (x2 =4.580,P =0.032),respectively.The moderate-to-severe esophageal strictures rates of the patients with cervical and upper-thoracic EC and middle-thoracic and lower-thoracic EC were 55.6％ and 29.4％ (x2 =5.360,P =0.021),respectively.There were no significant differences in shortterm effects between the cervical and upper-thoracic EC and middle-thoracic and lower-thoracic EC.The patients with cervical and upper-thoracic EC showed significantly higher 1-year local control rates,1-year survival rates and esophageal strictures rates than those with middle-thoracic and lower-thoracic EC.Conclusion The effectiveness of concurrent chemoradiotherapy is better in the patients with cervical and upper-thoracic EC than in those with middle-thoracic and lower-thoracic EC,but the esophageal stenosis is more severe in the patients with cervical and upper-thoracic EC than in those with middle-thoracic and lower-thoracic EC.