Comparative study of the surgical treatment for supraduodenal distal cholangiocarcinoma and Bismuth-Corlette type I hilar cholangiocarcinoma / 中华普通外科杂志

Objective:To analyze the surgical efficacy and prognosis of supraduodenal distal cholangiocarcinoma (SDC) and Bismuth-Corlette type I hilar cholangiocarcinoma (BIC), and to explore the clinical characteristics of cholangiocarcinoma at different sites.Methods:The clinical data of 33 patients with SDC and 25 patients with BIC undergoing surgical treatment at the First Affiliated Hospital of Anhui Medical University from Jan 2009 to Dec 2016 were analyzed retrospectively.Results:In the BIC group, four patients (16.0%) had combined caudate lobectomy, while in SDC group no caudate lobectomy was needed ( P=0.030). The incidence of pancreatic fistulae in SDC group and BIC group was 18.2% (6/33) and 0 (0/25), respectively ( P=0.032). The cumulative survival rates 1, 3, and 5 years after operation were 94.0%, 54.5%, and 30.3% in SDC group and 88.0%, 28.0%, and 16.0% in BIC group, respectively ( P=0.045). Univariate analysis showed that location of cholangiocarcinoma, residual status and AJCC stage were correlated with postoperative prognosis of cholangiocarcinoma patients. Multivariate analysis showed that BIC, non-R 0 resection and AJCC stage Ⅲ/Ⅳ were independent risk factors for overall survival after surgery. Conclusion:The overall survival rate of SDC patients after radical surgical resection was significantly higher than that of the BIC group.

Epidemiological characteristics, diagnosis, treatment and prognosis of gallbladder cancer in China: a report of 6 159 cases / 中华消化外科杂志

Objective:To investigate the epidemiological characteristics, diagnosis, treat-ment and prognosis of gallbladder cancer in China from 2010 to 2017.Methods:The single disease retrospective registration cohort study was conducted. Based on the concept of the real world study, the clinicopathological data, from multicenter retrospective clinical data database of gallbladder cancer of Chinese Research Group of Gallbladder Cancer (CRGGC), of 6 159 patients with gallbladder cancer who were admitted to 42 hospitals from January 2010 to December 2017 were collected. Observation indicators: (1) case resources; (2) age and sex distribution; (3) diagnosis; (4) surgical treatment and prognosis; (5) multimodality therapy and prognosis. The follow-up data of the 42 hospitals were collected and analyzed by the CRGGC. The main outcome indicator was the overall survival time from date of operation for surgical patients or date of diagnosis for non-surgical patients to the end of outcome event or the last follow-up. Measurement data with normal distribu-tion were represented as Mean±SD, and comparison between groups was conducted using the t test. Measurement data with skewed distribution were represented as M( Q1, Q3) or M(range), and com-parison between groups was conducted using the U test. Count data were described as absolute numbers or percentages, and comparison between groups was conducted using the chi-square test. Univariate analysis was performed using the Logistic forced regression model, and variables with P<0.1 in the univariate analysis were included for multivariate analysis. Multivariate analysis was performed using the Logistic stepwise regression model. The life table method was used to calculate survival rates and the Kaplan-Meier method was used to draw survival curves. Log-rank test was used for survival analysis. Results:(1) Case resources: of the 42 hospitals, there were 35 class A of tertiary hospitals and 7 class B of tertiary hospitals, 16 hospitals with high admission of gallbladder cancer and 26 hospitals with low admission of gallbladder cancer, respectively. Geographical distribution of the 42 hospitals: there were 9 hospitals in central China, 5 hospitals in northeast China, 22 hospitals in eastern China and 6 hospitals in western China. Geographical distribution of the 6 159 patients: there were 2 154 cases(34.973%) from central China, 705 cases(11.447%) from northeast China, 1 969 cases(31.969%) from eastern China and 1 331 cases(21.611%) from western China. The total average number of cases undergoing diagnosis and treatment in hospitals of the 6 159 patients was 18.3±4.5 per year, in which the average number of cases undergoing diagnosis and treatment in hospitals of 4 974 patients(80.760%) from hospitals with high admission of gallbladder cancer was 38.8±8.9 per year and the average number of cases undergoing diagnosis and treatment in hospitals of 1 185 patients(19.240%) from hospitals with low admission of gallbladder cancer was 5.7±1.9 per year. (2) Age and sex distribution: the age of 6 159 patients diagnosed as gallbladder cancer was 64(56,71) years, in which the age of 2 247 male patients(36.483%) diagnosed as gallbladder cancer was 64(58,71)years and the age of 3 912 female patients(63.517%) diagnosed as gallbladder cancer was 63(55,71)years. The sex ratio of female to male was 1.74:1. Of 6 159 patients, 3 886 cases(63.095%) were diagnosed as gallbladder cancer at 56 to 75 years old. There was a significant difference on age at diagnosis between male and female patients ( Z=-3.99, P<0.001). (3) Diagnosis: of 6 159 patients, 2 503 cases(40.640%) were initially diagnosed as gallbladder cancer and 3 656 cases(59.360%) were initially diagnosed as non-gallbladder cancer. There were 2 110 patients(34.259%) not undergoing surgical treatment, of which 200 cases(9.479%) were initially diagnosed as gallbladder cancer and 1 910 cases(90.521%) were initially diagnosed as non-gallbladder cancer. There were 4 049 patients(65.741%) undergoing surgical treatment, of which 2 303 cases(56.878%) were initially diagnosed as gallbladder cancer and 1 746 cases(43.122%) were initial diagnosed as non-gallbladder cancer. Of the 1 746 patients who were initially diagnosed as non-gallbladder cancer, there were 774 cases(19.116%) diagnosed as gallbladder cancer during operation and 972 cases(24.006%) diagnosed as gallbladder cancer after operation. Of 6 159 patients, there were 2 521 cases(40.932%), 2 335 cases(37.912%) and 1 114 cases(18.087%) undergoing ultrasound, computed tomography (CT) or magnetic resonance imaging (MRI) examination before initial diagnosis, respec-tively, and there were 3 259 cases(52.914%), 3 172 cases(51.502%) and 4 016 cases(65.205%) undergoing serum carcinoembryonic antigen, CA19-9 or CA125 examination before initially diagnosis, respectively. One patient may underwent multiple examinations. Results of univariate analysis showed that geographical distribution of hospitals (eastern China or western China), age ≥72 years, gallbladder cancer annual admission of hospitals, whether undergoing ultrasound, CT, MRI, serum carcinoembryonic antigen, CA19-9 or CA125 examination before initially diagnosis were related factors influencing initial diagnosis of gallbladder cancer patients ( odds ratio=1.45, 1.98, 0.69, 0.68, 2.43, 0.41, 1.63, 0.41, 0.39, 0.42, 95% confidence interval as 1.21-1.74, 1.64-2.40, 0.59-0.80, 0.60-0.78, 2.19-2.70, 0.37-0.45, 1.43-1.86, 0.37-0.45, 0.35-0.43, 0.38-0.47, P<0.05). Results of multivariate analysis showed that geographical distribution of hospitals (eastern China or western China), sex, age ≥72 years, gallbladder cancer annual admission of hospitals and cases undergoing ultrasound, CT, serum CA19-9 examination before initially diagnosis were indepen-dent influencing factors influencing initial diagnosis of gallbladder cancer patients ( odds ratio=1.36, 1.42, 0.89, 0.67, 1.85, 1.56, 1.57, 0.39, 95% confidence interval as 1.13-1.64, 1.16-1.73, 0.79-0.99, 0.57-0.78, 1.60-2.14, 1.38-1.77, 1.38-1.79, 0.35-0.43, P<0.05). (4) Surgical treatment and prognosis. Of the 4 049 patients undergoing surgical treatment, there were 2 447 cases(60.435%) with complete pathological staging data and follow-up data. Cases with pathological staging as stage 0, stage Ⅰ, stage Ⅱ, stage Ⅲa, stage Ⅲb, stage Ⅳa and stage Ⅳb were 85(3.474%), 201(8.214%), 71(2.902%), 890(36.371%), 382(15.611%), 33(1.348%) and 785(32.080%), respectively. The median follow-up time and median postoperative overall survival time of the 2 447 cases were 55.75 months (95% confidence interval as 52.78-58.35) and 23.46 months (95% confidence interval as 21.23-25.71), respectively. There was a significant difference in the overall survival between cases with pathological staging as stage 0, stage Ⅰ, stage Ⅱ, stage Ⅲa, stage Ⅲb, stage Ⅳa and stage Ⅳb ( χ2=512.47, P<0.001). Of the 4 049 patients undergoing surgical treatment, there were 2 988 cases(73.796%) with resectable tumor, 177 cases(4.371%) with unresectable tumor and 884 cases(21.833%) with tumor unassessable for resectabi-lity. Of the 2 988 cases with resectable tumor, there were 2 036 cases(68.139%) undergoing radical resection, 504 cases(16.867%) undergoing non-radical resection and 448 cases(14.994%) with operation unassessable for curative effect. Of the 2 447 cases with complete pathological staging data and follow-up data who underwent surgical treatment, there were 53 cases(2.166%) with unresectable tumor, 300 cases(12.260%) with resectable tumor and receiving non-radical resection, 1 441 cases(58.888%) with resectable tumor and receiving radical resection, 653 cases(26.686%) with resectable tumor and receiving operation unassessable for curative effect. There were 733 cases not undergoing surgical treatment with complete pathological staging data and follow-up data. There was a significant difference in the overall survival between cases not undergoing surgical treatment, cases undergoing surgical treatment for unresectable tumor, cases undergoing non-radical resection for resectable tumor and cases undergoing radical resection for resectable tumor ( χ2=121.04, P<0.001). (5) Multimodality therapy and prognosis: of 6 159 patients, there were 541 cases(8.784%) under-going postoperative adjuvant chemotherapy and advanced chemotherapy, 76 cases(1.234%) under-going radiotherapy. There were 1 170 advanced gallbladder cancer (pathological staging ≥stage Ⅲa) patients undergoing radical resection, including 126 cases(10.769%) with post-operative adjuvant chemotherapy and 1 044 cases(89.231%) without postoperative adjuvant chemo-therapy. There was no significant difference in the overall survival between cases with post-operative adjuvant chemotherapy and cases without postoperative adjuvant chemotherapy ( χ2=0.23, P=0.629). There were 658 patients with pathological staging as stage Ⅲa who underwent radical resection, including 66 cases(10.030%) with postoperative adjuvant chemotherapy and 592 cases(89.970%) without postoperative adjuvant chemotherapy. There was no significant difference in the overall survival between cases with postoperative adjuvant chemotherapy and cases without postoperative adjuvant chemotherapy ( χ2=0.05, P=0.817). There were 512 patients with pathological staging ≥stage Ⅲb who underwent radical resection, including 60 cases(11.719%) with postoperative adjuvant chemotherapy and 452 cases(88.281%) without postoperative adjuvant chemotherapy. There was no significant difference in the overall survival between cases with postoperative adjuvant chemo-therapy and cases without post-operative adjuvant chemo-therapy ( χ2=1.50, P=0.220). Conclusions:There are more women than men with gallbladder cancer in China and more than half of patients are diagnosed at the age of 56 to 75 years. Cases undergoing ultrasound, CT, serum CA19-9 examination before initial diagnosis are independent influencing factors influencing initial diagnosis of gallbladder cancer patients. Preoperative resectability evaluation can improve the therapy strategy and patient prognosis. Adjuvant chemotherapy for gallbladder cancer is not standardized and in low proportion in China.

Selection of surgical treatment for Bismuth-Corlette type III and IV hilar cholangiocarcinoma / 中华肝胆外科杂志

Objective:To analyze the efficacy and prognosis of different surgical treatments for Bismuth-Corlette type III and IV hilar cholangiocarcinoma (HCCA).Methods:The clinical data of 86 Bismuth-Corlette type III and IV HCCA patients treated at the First Affiliated Hospital of Anhui Medical University from January 2010 to December 2016 were retrospectively analyzed. There were 45 males and 41 females with age of (59.5±10.5) years old. According to the operative method, 57 patients were included into the extended hepatectomy group, and 29 patients into the perihilar hepatectomy group. The perioperative clinical data and survival rates were compared between the two groups. Through inpatient interviews, regular outpatient or telephone follow-up, factors affecting prognosis were analyzed by univariate and multifactorial Cox regression.Results:The operative time and intraoperative blood loss in the extended hepatectomy group were significantly higher than those in the perihilar hepatectomy group, [320(270, 380) min vs. 270(210, 300) min, P<0.001; 300(200, 400) ml vs. 100(100, 150) ml, respectively P<0.001]. The incidences of ≥ Clavien-Dindo grade III complications and ISGLS grade C liver failure in the extended hepatectomy group were significantly higher than those in the perihilar hepatectomy group [36.4%(20/57) vs. 13.8% (4/29), P=0.037; 13.8% (7/57) vs. 0(0/29), respectively P=0.047]. The cumulative 1-, 3- and 5-year survival rates of the extended hepatectomy group were 89.5%, 38.6% and 19.3%, respectively. The cumulative 1-, 3- and 5-year survival rates of perihilar hepatectomy group were 86.2%, 20.7% and 10.3%, respectively. The difference between the two groups was statistically significant ( P=0.048). Multivariate analysis showed that perihilar hepatectomy ( HR=1.958, 95% CI: 1.174-3.268, P=0.010), non-R 0 resection ( HR=6.040, 95% CI: 2.915-12.513, P<0.001) and TNM stage III/IV( HR=2.144, 95% CI: 1.257-3.654, P=0.005) were independent risk factors for overall survival after surgery for HCCA patients ( P<0.01). Conclusions:Patients with Bismuth-Corlette type III and IV HCCA who received extended hepatectomy had significantly better overall survival than those patients who underwent perihilar hepatectomy. However, the incidences of surgical complications and liver failure in the extended hepatectomy group were also significantly higher.

Safety and efficacy of the controlled first hepaticportal blood flow occlusion in hepatectomy / 中华肝胆外科杂志

Objective:To determine the safety and efficacy of controlled first hepaticportal blood flow occlusion in hepatectomy.Methods:Patients who underwent hepatectomy from 1 September 2018 to 1 September 2020 at the Department of Hepatobiliary Surgery of the First Affiliated Hospital of Anhui Medical University were studied. There were 133 males and 70 females, with age of (52.9±19.2) years old. They were prospectively randomized into three groups: the intermittent Pringle’s maneuver group ( n=72), the controlled first hepaticportal blood flow occlusion group ( n=66) and the selective portal vein occlusion group ( n=65). The clinical data of these three groups before, during and after operation were analysed. Results:The amount of intraoperative bleeding in the selective portal vein occlusion group was significantly more than the intermittent Pringle’s maneuver group [(226.7±117.9) vs. (115.7±84.2) ml, P<0.05] and the controlled first hepaticportal blood flow occlusion group [(226.7±117.9) vs. (128.1±103.6) ml, P<0.05]. The total duration of operation in the selective portal vein occlusion group was significantly longer than the intermittent Pringle’s maneuver group [(173.6±51.7) vs. (128.4±36.5) min, P<0.05] and the controlled first hepaticportal blood flow occlusion group [(173.6±51.7) vs. (136.1±40.7) min, P<0.05]. The postoperative data showed the AST indexes on day 1 after surgery to be significantly different between the intermittent Pringle’s maneuver group with the controlled first hepaticportal blood flow occlusion group [(587.5±189.2) vs. (361.2±158.3) U/L, P<0.05], and the selective portal vein occlusion group [(587.5±189.2) vs. (358.2±162.7) U/L, P<0.05]. The ALT indexes on day 1 after surgery were significantly different between the intermittent Pringle’s maneuver group with the controlled first hepaticportal blood flow occlusion group [(609.4±172.5) vs. (414.8±162.2) U/L, P<0.05], and the selective portal vein occlusion group[(609.4±172.5) vs. (395.6±158.7) U/L, P<0.05]. The AST and ALT indexes on day 3 after surgery were significantly different between the intermittent Pringle’s maneuver group the controlled first hepaticportal blood flow occlusion group, and the selective portal vein occlusion group. Other liver functions, postoperative complications and recovery indexes showed no significantly differences among the three groups. Conclusions:All the three methods of hepatic blood flow occlusion were safe and efficacious. The controlled first hepaticportal blood flow occlusion method was simple to use and it provided some protective effect in alleviating hepatic ischemia reperfusion injury.

The clinical treatment strategy for Bismuth-Corlette type Ⅲ hilar cholangiocarcinoma / 中华普通外科杂志

Objective To evaluate the result of peri-hilar resection(extrahepatic bile duct resection plus local hepatectomy) and hepaticojejunostomy for the treatment of Bismuth-Corlette type Ⅲ hilar cholangiocarcinoma (HCCA).Methods This study was conducted on 37 patients divided into group A undergoing peri-hilar resection (extrahepatic bile duct resection combined with local hepatectomy) and hepaticojejunostomy (n =17) and group B treated by extrahepatic bile duct combined with hemihepatectomy and hemicaudatectomy and cholangioenterostomy (n =20).Results The incidence of postoperative acute liver failure was lower in group A than in group B (x2 =5,332,P =0.021).There was no significant difference in clinical data and survival rate (OS) between the two groups of patients and other complications.Conclusion For patients with Bismuth-Corlette type Ⅲ HCCA,the peri-hilar resection (extrahepatic bile duct combined with local hepatectomy)and hepaticojejunostomy reduces the incidence of postoperative acute liver failure.

Relationship between Talin and its signaling pathway and hepatocellular carcinoma / 国际外科学杂志

Alterations of cell adhesion of tumor cells is the initial step of invasion and metastasis of tumor cells.Integrin receptors are cell surface receptors with critical functions in cell adhesion and migration,which can mediate many signaling pathway occurred,including the integrin/FAK signaling pathway,directly or indirectly affecting tumor recurrence and metastasis.Integrin/FAK signaling pathway is thought to play an impartant role in integrin-mediated signaling transduction pathway leading to adhesion and metastasis of hepatocellular carcinoma.Talin is the first cytoskeletal protein that has been proposed to act as the final common step in integrin activation,which is a major component of the focal adhesion.This study reviews the construction and function of talin,its reaction with integrin/FAK signaling pathway,as well as its relationship with hepatocellular carcinoma and other tumors.

Effects of lipoxygenase inhibitor NDGA on expression of 5-LOX and its apoptosis related genes in HepG2 cell line / 国际外科学杂志

Objective To investigate the effects of lipoxygenase inhibitor NDGA on expression of 5-LOX and its apoptosis related genes in HepG2 cell line.Methods The expression of 5-LOX and apoptosis related genes hTERT,bcl-2 and bax mRNA was determined by reverse transcriptasepolymerase chain reaction (RT-PCR).Results After 25,50,100,200 μmol/L NDGA treatment for24,48 h,the expression of 5-LOX of HepG2 cell decreased,but the expression of bax was up-regulated and the expressions of bcl-2 and hTERT mRNA were down-regulated,(P＜0.05 compared with the control group).The decrease in the expression of 5-LOX,hTERT and bcl-2 in HepG2 cell was negtively correlated with the dose duration of action of NDGA.Conclusion In vitro,5-LOX is expressed highly in HepG2 cell.Overexpression of 5-LOX may be related to the progression of hepatocellular carcinoma,NDGA can significantly decrease the expression of 5-LOX,up-regulate of bax and downregulation of bcl-2 and telomerse.Lipoxygenase might be a novel therapeutic target for the hepatocellular carinoma.

Role of Wnt signaling pathway in hepatocellular carcinoma / 医学研究生学报

Wnt proteins,its receptors and regulators compose complex signaling pathways which are closely related to embryonic development,cell proliferation and differentiation,as well as tumour generation.In recent years,the involvement of Wnt signaling pathways in hepatocarcinogenesis has drawn the attention of international medical circles and been studied intensively.In this review,we summaries the interaction between Wnt signaling pathways and its regulators,the relationship between Wnt signaling pathways and cancerogenesis,angiogenesis,invasion and metabasis in hepatocellular carcinoma.

Treatment of organ transplant rejection with low doses of CsA and CTLA4-Ig / 中华外科杂志

<p><b>OBJECTIVE</b>To study on treating organ transplant rejection with low doses of CsA and CTLA4-Ig.</p><p><b>METHODS</b>We set up a rat's cardiac transplant rejection model by Ono's way. The experimental rats were divided into four groups: group A: without any treatment; group B: intraperitoneal injection of CsA at 10 mg / (-1) / (-1) 1 - 7 days; after operation group C: intraperitoneal injection of 100 microgram CTLA4-Ig after 2nd operative day; group D: intraperitoneal injection of CsA 2 mg / (-1) / (-1) 1- 7 days after operation. 50 microgram CTLA4-Ig was given intraperitoneally on the 2nd day postoperation. The survival days of allograft, serum concentration of IL-2, and histological changes were tested.</p><p><b>RESULTS</b>The allograft survival time of the four groups was 7.2 +/- 0.7 (group A), 19.4 +/- 2.07 (group B), 31.6 +/- 1.8 (group C) and 24.6 +/- 2.07 (group D) respectively. There were significantly differences among the groups (P < 0.05). The survival time in group D was more prolonged than that in group B (P < 0.05). The concentration of IL-2 was significantly decreased after operation. Significant difference was observed between the control group and each treated group (P < 0.01). In group A, B, C and D allograft rejection was graded IV, II, I and I respectively.</p><p><b>CONCLUSION</b>CTLA4-Ig had a stronger immunosuppression than did CsA. The low doses of CsA and CTLA4-Ig had show a synergistic immunosuppression in allograft transplantation.</p>

Comprehension in treatment of 7 patients with abdominal aortic aneurysm / 临床外科杂志

Objective To explore the diagnosis of abdominal aortic aneurysm(AAA), operative opportunity, the way of operation selecting and the application of blood vessel prosthesis. Method The clinical data of 7 patients with AAA were analysed retrospectively.Results The type of DeBakey I thoracoabdominal aortic aneurysm patient was died of aortic aneurysm broke suddenly before operation, the other 6 patients with AAA underwent aortic aneurysm blooking, opening and replacement of blood vessel prosthesis. Dumbbell thoracoabdominal aortic aneurysm was operated by stayes. No complications of operation occurred. Conclusions Operation is a efficient way in treatment of abdominal aortic aneurysm. Diagnosis timely and definitly, selecting the way of operation in reason and blood vessel prosthesis are the keys to operation, while the correct treatment of perioperation period is the important guaranty of successful therapy.

Methylation of MGMT, DAPK,THBS1 and RIZ1 genes in hepatocellular carcinoma / 中国普通外科杂志

Objective To study the methylation of MGMT, DAPK, THBS1 and RIZ1 genes in hepatocellular carcinoma. MethodsMethylation specific PCR was adopted to investigate the promoter methylation of these genes in 40 cases of HCC and 2 normal liver tissues. The relationship between the frequency of methylation of the genes and clinical data was analyzed. ResultsNormal liver has no genes methylation. In patients with HCC, the frequency of methylation in MGMT, DAPK, THBS1 and RIZ1 was 15%, 77 5%, 37 5% and 30%, respectively. Methylation of at least one gene could be detected in 87 5% HCC patients. In the non tumor liver tissues, the frequency of methylation in MGMT, DAPK, THBS1 and RIZ1 were detected in 5%, 77 5%, 27 5% and 5%, respectively. Methylation of RIZ1 was more frequent in HCC than in non tumor liver tissues (? 2=8 658, P