To study the risk factors for early complications after pancreaticoduodenectomy （PD）. Methods： Two hundred patients undergoing PD at our hospital between December 1996 and September 2002 were reviewed retrospective...To study the risk factors for early complications after pancreaticoduodenectomy （PD）. Methods： Two hundred patients undergoing PD at our hospital between December 1996 and September 2002 were reviewed retrospectively. Standard PD was performed on 176 cases, standard PD with extended lymphadenectomy on 24 patients, whereas pylorus-preserving PD was not used. An end-toside combined with mucosa-to-mucosa pancreaticojejunostomy was performed on the patients with a hard pancreas and a dilated pancreatic duct, and a traditional end-to-end invagination pancreaticojejunostomy on the patients with a soft pancreas and a non-dilated duct. The risk factors with the potential to affect the incidence of complications were analyzed with SAS 8.12 software. Logistic regression was then used to determine the effect of multiple factors on early complications. Results： The overall rate of the major com- plications was 21% （42/200）, with the failure of pancreaticojejunal anastomosis being the most frequently encountered. Age （odds ratio [OR] 2.162）, diabetes mellitus （OR 4.086）, total serum bilirubin level （OR 7.556）, end-to-end pancreaticojejunostomy （OR 2.616）, T tube through the choledochojejunostomy （OR 0.100）, and blood transfusion over 1000 mL （OR 2.410） were the significant risk factors for the morbidity. Conclusion： The results from published series concerning morbidity after pancreaticoduodenectomy are not comparable because of lack of homogeneity between them. The knowledge of the complications rate in each particular department turns out essentially to provide the patient with tailored information about risks before surgery. Additionally, management of postoperative complications is essential for improving the results of this operation.展开更多
AIM： To determine factors affecting the outcome of patients with cirrhosis undergoing surgery and to compare the capacities of the Child-Turcotte-Pugh （CTP） and model for end-stage liver disease （MELD） score to p...AIM： To determine factors affecting the outcome of patients with cirrhosis undergoing surgery and to compare the capacities of the Child-Turcotte-Pugh （CTP） and model for end-stage liver disease （MELD） score to predict that outcome. METHODS： We reviewed the charts of 195 patients with cirrhosis who underwent surgery at two teaching hospitals over a five-year period. The combined endpoint of death or hepatic decompensation was considered to be the primary endpoint. RESULTS： Patients who reached the endpoint had a higher MELD score, a higher CTP score and were more likely to have undergone an urgent procedure. Among patients undergoing elective surgical procedures, no statistically significant difference was noted in the mean MELD （12.8 ＋ 3.9 vs 12.6 ＋ 4.7, P = 0.9） or in the mean CTP （7.6 ± 1.2 vs 7.7 ± 1.7, P = 0.8） between patients who reached the endpoint and those who did not. Both mean scores were higher in the patients reaching the endpoint in the case of urgent procedures （MELD： 22.4 ± 8.7 vs 15.2 ± 6.4, P = 0.0007; CTP： 9.9 ± 1.8 vs 8.5 ± 1.8, P = 0.008）. The performances of the MELD and CTP scores in predicting the outcome of urgent surgery were only fair, without a significant difference between them （AUC = 0.755 ± 0.066 for MELD vs AUC = 0.696 ± 0.070 for CTP, P = 0.3）. CONCLUSION： The CTP and MELD scores performed equally, but only fairly in predicting the outcome of urgent surgical procedures. Larger studies are needed to better define the factors capable of predicting the outcome of elective surgical procedures in patients with cirrhosis.equally, but only fairly in predicting the outcome of urgent surgical procedures. Larger studies are needed to better define the factors capable of predicting the outcome of elective surgical procedures in patients with cirrhosis.展开更多
Peritoneal adhesions represent an important clinical challenge in gastrointestinal surgery. Peritoneal adhesions are a consequence of peritoneal irritation by infection or surgical trauma, and may be considered as the...Peritoneal adhesions represent an important clinical challenge in gastrointestinal surgery. Peritoneal adhesions are a consequence of peritoneal irritation by infection or surgical trauma, and may be considered as the pathological part of healing following any peritoneal injury, particularly due to abdominal surgery. The balance between fi brin deposition and degradation is critical in determining normal peritoneal healing or adhesion formation. Postoperative peritoneal adhesions are a major cause of morbidity resulting in multiple complications, many of which may manifest several years after the initial surgical procedure. In addition to acute small bowel obstruction, peritoneal adhesions may cause pelvic or abdominal pain, and infertility. In this paper, the authors reviewed the epidemiology, pathogenesis and various prevention strategies of adhesion formation, using Medline and PubMed search. Several preventive agents against postoperative peri-toneal adhesions have been investigated. Their role aims in activating fi brinolysis, hampering coagulation, diminishing the inflammatory response, inhibiting col-lagen synthesis or creating a barrier between adjacentwound surfaces. Their results are encouraging but most of them are contradictory and achieved mostly in animal model. Until additional fi ndings from future clinical researches, only a meticulous surgery can be recommended to reduce unnecessary morbidity and mortality rates from these untoward effects of surgery. In the current state of knowledge, pre-clinical or clini-cal studies are still necessary to evaluate the effective-ness of the several proposed prevention strategies of postoperative peritoneal adhesions.展开更多
We report a case of the rare solid-pseudopapillary tumor of the pancreas. In contrast to other pancreatic tumors,the solid-pseudopapillary tumor has a favorable prognosis.The 60-year-old female patient we report on he...We report a case of the rare solid-pseudopapillary tumor of the pancreas. In contrast to other pancreatic tumors,the solid-pseudopapillary tumor has a favorable prognosis.The 60-year-old female patient we report on here was treated by left pancreatic resection combined with splenectomy for a non-metastasizing tumor of the pancreas. A solid-pseudopapillary tumor was found on histology. The patient had no signs of metastases at present.Since a microscopically invasive tumor growth is assumed,oncologically curative resection should be preferred vs the less radical enucleation. The rare solid-pseudopapillary tumor of the pancreas has a good prognosis after successful oncological resection.展开更多
Objective： The outcome of surgical treatment of patients with intrahepatic cholangiocarcinoma （ICC） is poor. This study was designed to analyze prognostic factors after surgical procedure for ICCs. Methods： A retr...Objective： The outcome of surgical treatment of patients with intrahepatic cholangiocarcinoma （ICC） is poor. This study was designed to analyze prognostic factors after surgical procedure for ICCs. Methods： A retrospective clinical analysis was made in 183 cases of ICC, admitted to Department of Hepatic Surgery, Eastern Hepatobiliary Surgery Hospital, Second Military Medical University, Shanghai, China, from December 1996 to July 2003. Fifteen clinicopathologic factors that could possibly influence survival were selected. A multivariate analysis of these individuals was performed using the Cox Proportional Hazards Model. Results： The accumulative 1-, 3-and 5-year survival rates of the patients were 51.3%, 21.6% and 11.8% respectively. The statistical analysis showed that surgical procedure, lymph node metastasis, serum level of CA19-9 and pathological differentiation grade affected postoperative survival significantly, but transfusion, postoperative radiotherapy and chemotherapy, diameter of tumor, serum level of AFP, cirrhosis, preoperative total serum bilirubin level （TBIL）, ratio of albumin to globulin （A/G）, sex and age were not significant factors influencing postoperative survival. Conclusion： Major hepatectomy with systematic lymph node dissection may be recommended for the surgical treatment of ICC. Aggressive treatment and prevention on postoperative intrahepatic recurrence and lymph node metastasis are important strategy to improve the survival for ICC.展开更多
AIM： To analyze the prognostic impact of lymphade-nectomy extent in advanced gastric cancer located in the cardia and fundus. METHODS： Two hundred and thirty-six patients with advanced gastric cancer located in the ...AIM： To analyze the prognostic impact of lymphade-nectomy extent in advanced gastric cancer located in the cardia and fundus. METHODS： Two hundred and thirty-six patients with advanced gastric cancer located in the cardia and fundus who underwent D2 curative resection were analyzed retrospectively. Relationships between the numbers of lymph nodes （LNs） dissected and survival was analyzed among different clinical stage subgroups. RESULTS： The 5-year overall survival rate of the entire cohort was 37.5%. Multivariate prognostic variables were total LNs dissected （P 〈 0.0001; or number of negative LNs examined, P 〈 0.0001）, number of positive LNs （P 〈 0.0001）, T category （P 〈 0.0001） and tumor size （P = 0.015）. The greatest survival differences were observed at cutoff values of 20 LNs resected for stage Ⅱ（p = 0.0136）, 25 for stage Ⅲ（P 〈 0.0001）, 30 for stage Ⅳ（P = 0.0002）, and 15 for all patients （P = 0.0024）. Based on the statistically assumed linearity as best fit, linear regression showed a significant survival enhancement based on increasing negative LNs for patients of stages Ⅲ （P = 0.013） and Ⅳ（P = 0.035）. CONCLUSION： To improve the long-term survival of patients with advanced gastric cancer located in the cardia and fundus, removing at least 20 LNs for stage Ⅱ,25 LNs for stage Ⅲ, and 30 LNs for stage N patients during D2 radical dissection is recommended.展开更多
AIM:To identify the determinants of endoscopic submucosal dissection(ESD) operation time.METHODS:This investigation was conducted as a single-center,prospective study in which ESD was performed by the same endoscopist...AIM:To identify the determinants of endoscopic submucosal dissection(ESD) operation time.METHODS:This investigation was conducted as a single-center,prospective study in which ESD was performed by the same endoscopist at the Chinese PLA General Hospital.A total of 173 patients underwent ESD operations performed by Dr.Lu from July 2007 to December 2011,and 183 lesions were enrolled.Patient gender,age,tumor location,gross type,tumor size,pathological type and adhesions were recorded prospectively.The order of treatment represented the experience of the operator.Univariate analysis and multivariate analysis were performed to evaluate the relationships between these factors and ESD procedure time.RESULTS:Univariate analysis showed the ESD time was closely related to the gender(P = 0.0210),tumor size(P < 0.0001),location(P < 0.0001),gross type(P < 0.0001) and adhesion(P = 0.0010).The surgical proficiency level was associated with ESD time in unit area(P < 0.0001).Multivariate analysis revealed that the ESD time was positively correlated with tumor size(P < 0.0001),adhesion(P < 0.0001) and location(P < 0.0001),but negatively correlated with surgical proficiency level(P = 0.0046).CONCLUSION:Large tumor size,adjacency to the cardia,and adhesion are predictors of a long ESD time,whereas high surgical proficiency level predicts a short ESD time.展开更多
AIM： To investigate the prognostic factors of 96 young patients with colon cancer within a cancer center by univariate and multivariate analysis. METHODS： A total of 723 patients with colon cancer were treated surgi...AIM： To investigate the prognostic factors of 96 young patients with colon cancer within a cancer center by univariate and multivariate analysis. METHODS： A total of 723 patients with colon cancer were treated surgically during a period of 10 years. Ninty six of them were 40 years old or younger. R0, R1 and R2 operations were performed in 69 （71.9%）, 4 （4.1%） and 23 patients （24%）, respectively. Left hemicolectomy was performed in 43 patients, right hemicolectomy in 37 patients, transverse colon resection in 9 patients and low anterior resection in 7 patients. Cox multivariate regression analysis was performed to identify predictors of survival. RESULTS： The operation mortality was 0%, 54 patients died within 111 mo after operation due to occurrence or metastases of the tumor. Liver, lung and bone metastases occurred in 3, 1 and 5 patients, respectively. The mean survival time for all patients was 77.9 ± 5.01 mo and the overall 3-, 5- and 10- year survival rates were 66.68%, 58.14% and 46.54%, respectively. In the univariate survival analysis, patient age, type of operation, radical resection, blood transfusion, histological type, diameter of tumor, depth of tumor invasion, lymphatic invasion, distant metastases, liver metastases and TNM stage were found to be predictors of survival in young patients with colon cancer. In the Cox-regression analysis, blood transfusion and lymphatic invasion were determined as independent prognostic factors of survival. CONCLUSIONS： Age, type of operation, radical resection, blood transfusion, histological type, diameter of tumor, depth of tumor invasion, lymphatic invasion, distant metastasis and TNM stage are the predictors of survival in young patients with colon cancer after surgery.展开更多
文摘To study the risk factors for early complications after pancreaticoduodenectomy （PD）. Methods： Two hundred patients undergoing PD at our hospital between December 1996 and September 2002 were reviewed retrospectively. Standard PD was performed on 176 cases, standard PD with extended lymphadenectomy on 24 patients, whereas pylorus-preserving PD was not used. An end-toside combined with mucosa-to-mucosa pancreaticojejunostomy was performed on the patients with a hard pancreas and a dilated pancreatic duct, and a traditional end-to-end invagination pancreaticojejunostomy on the patients with a soft pancreas and a non-dilated duct. The risk factors with the potential to affect the incidence of complications were analyzed with SAS 8.12 software. Logistic regression was then used to determine the effect of multiple factors on early complications. Results： The overall rate of the major com- plications was 21% （42/200）, with the failure of pancreaticojejunal anastomosis being the most frequently encountered. Age （odds ratio [OR] 2.162）, diabetes mellitus （OR 4.086）, total serum bilirubin level （OR 7.556）, end-to-end pancreaticojejunostomy （OR 2.616）, T tube through the choledochojejunostomy （OR 0.100）, and blood transfusion over 1000 mL （OR 2.410） were the significant risk factors for the morbidity. Conclusion： The results from published series concerning morbidity after pancreaticoduodenectomy are not comparable because of lack of homogeneity between them. The knowledge of the complications rate in each particular department turns out essentially to provide the patient with tailored information about risks before surgery. Additionally, management of postoperative complications is essential for improving the results of this operation.
文摘AIM： To determine factors affecting the outcome of patients with cirrhosis undergoing surgery and to compare the capacities of the Child-Turcotte-Pugh （CTP） and model for end-stage liver disease （MELD） score to predict that outcome. METHODS： We reviewed the charts of 195 patients with cirrhosis who underwent surgery at two teaching hospitals over a five-year period. The combined endpoint of death or hepatic decompensation was considered to be the primary endpoint. RESULTS： Patients who reached the endpoint had a higher MELD score, a higher CTP score and were more likely to have undergone an urgent procedure. Among patients undergoing elective surgical procedures, no statistically significant difference was noted in the mean MELD （12.8 ＋ 3.9 vs 12.6 ＋ 4.7, P = 0.9） or in the mean CTP （7.6 ± 1.2 vs 7.7 ± 1.7, P = 0.8） between patients who reached the endpoint and those who did not. Both mean scores were higher in the patients reaching the endpoint in the case of urgent procedures （MELD： 22.4 ± 8.7 vs 15.2 ± 6.4, P = 0.0007; CTP： 9.9 ± 1.8 vs 8.5 ± 1.8, P = 0.008）. The performances of the MELD and CTP scores in predicting the outcome of urgent surgery were only fair, without a significant difference between them （AUC = 0.755 ± 0.066 for MELD vs AUC = 0.696 ± 0.070 for CTP, P = 0.3）. CONCLUSION： The CTP and MELD scores performed equally, but only fairly in predicting the outcome of urgent surgical procedures. Larger studies are needed to better define the factors capable of predicting the outcome of elective surgical procedures in patients with cirrhosis.equally, but only fairly in predicting the outcome of urgent surgical procedures. Larger studies are needed to better define the factors capable of predicting the outcome of elective surgical procedures in patients with cirrhosis.
文摘Peritoneal adhesions represent an important clinical challenge in gastrointestinal surgery. Peritoneal adhesions are a consequence of peritoneal irritation by infection or surgical trauma, and may be considered as the pathological part of healing following any peritoneal injury, particularly due to abdominal surgery. The balance between fi brin deposition and degradation is critical in determining normal peritoneal healing or adhesion formation. Postoperative peritoneal adhesions are a major cause of morbidity resulting in multiple complications, many of which may manifest several years after the initial surgical procedure. In addition to acute small bowel obstruction, peritoneal adhesions may cause pelvic or abdominal pain, and infertility. In this paper, the authors reviewed the epidemiology, pathogenesis and various prevention strategies of adhesion formation, using Medline and PubMed search. Several preventive agents against postoperative peri-toneal adhesions have been investigated. Their role aims in activating fi brinolysis, hampering coagulation, diminishing the inflammatory response, inhibiting col-lagen synthesis or creating a barrier between adjacentwound surfaces. Their results are encouraging but most of them are contradictory and achieved mostly in animal model. Until additional fi ndings from future clinical researches, only a meticulous surgery can be recommended to reduce unnecessary morbidity and mortality rates from these untoward effects of surgery. In the current state of knowledge, pre-clinical or clini-cal studies are still necessary to evaluate the effective-ness of the several proposed prevention strategies of postoperative peritoneal adhesions.
文摘We report a case of the rare solid-pseudopapillary tumor of the pancreas. In contrast to other pancreatic tumors,the solid-pseudopapillary tumor has a favorable prognosis.The 60-year-old female patient we report on here was treated by left pancreatic resection combined with splenectomy for a non-metastasizing tumor of the pancreas. A solid-pseudopapillary tumor was found on histology. The patient had no signs of metastases at present.Since a microscopically invasive tumor growth is assumed,oncologically curative resection should be preferred vs the less radical enucleation. The rare solid-pseudopapillary tumor of the pancreas has a good prognosis after successful oncological resection.
文摘Objective： The outcome of surgical treatment of patients with intrahepatic cholangiocarcinoma （ICC） is poor. This study was designed to analyze prognostic factors after surgical procedure for ICCs. Methods： A retrospective clinical analysis was made in 183 cases of ICC, admitted to Department of Hepatic Surgery, Eastern Hepatobiliary Surgery Hospital, Second Military Medical University, Shanghai, China, from December 1996 to July 2003. Fifteen clinicopathologic factors that could possibly influence survival were selected. A multivariate analysis of these individuals was performed using the Cox Proportional Hazards Model. Results： The accumulative 1-, 3-and 5-year survival rates of the patients were 51.3%, 21.6% and 11.8% respectively. The statistical analysis showed that surgical procedure, lymph node metastasis, serum level of CA19-9 and pathological differentiation grade affected postoperative survival significantly, but transfusion, postoperative radiotherapy and chemotherapy, diameter of tumor, serum level of AFP, cirrhosis, preoperative total serum bilirubin level （TBIL）, ratio of albumin to globulin （A/G）, sex and age were not significant factors influencing postoperative survival. Conclusion： Major hepatectomy with systematic lymph node dissection may be recommended for the surgical treatment of ICC. Aggressive treatment and prevention on postoperative intrahepatic recurrence and lymph node metastasis are important strategy to improve the survival for ICC.
基金The Follow-up Office established by the Department of Oncology,Affiliated Union Hospital of Fujian Medical University,Fujian Province,China
文摘AIM： To analyze the prognostic impact of lymphade-nectomy extent in advanced gastric cancer located in the cardia and fundus. METHODS： Two hundred and thirty-six patients with advanced gastric cancer located in the cardia and fundus who underwent D2 curative resection were analyzed retrospectively. Relationships between the numbers of lymph nodes （LNs） dissected and survival was analyzed among different clinical stage subgroups. RESULTS： The 5-year overall survival rate of the entire cohort was 37.5%. Multivariate prognostic variables were total LNs dissected （P 〈 0.0001; or number of negative LNs examined, P 〈 0.0001）, number of positive LNs （P 〈 0.0001）, T category （P 〈 0.0001） and tumor size （P = 0.015）. The greatest survival differences were observed at cutoff values of 20 LNs resected for stage Ⅱ（p = 0.0136）, 25 for stage Ⅲ（P 〈 0.0001）, 30 for stage Ⅳ（P = 0.0002）, and 15 for all patients （P = 0.0024）. Based on the statistically assumed linearity as best fit, linear regression showed a significant survival enhancement based on increasing negative LNs for patients of stages Ⅲ （P = 0.013） and Ⅳ（P = 0.035）. CONCLUSION： To improve the long-term survival of patients with advanced gastric cancer located in the cardia and fundus, removing at least 20 LNs for stage Ⅱ,25 LNs for stage Ⅲ, and 30 LNs for stage N patients during D2 radical dissection is recommended.
文摘AIM:To identify the determinants of endoscopic submucosal dissection(ESD) operation time.METHODS:This investigation was conducted as a single-center,prospective study in which ESD was performed by the same endoscopist at the Chinese PLA General Hospital.A total of 173 patients underwent ESD operations performed by Dr.Lu from July 2007 to December 2011,and 183 lesions were enrolled.Patient gender,age,tumor location,gross type,tumor size,pathological type and adhesions were recorded prospectively.The order of treatment represented the experience of the operator.Univariate analysis and multivariate analysis were performed to evaluate the relationships between these factors and ESD procedure time.RESULTS:Univariate analysis showed the ESD time was closely related to the gender(P = 0.0210),tumor size(P < 0.0001),location(P < 0.0001),gross type(P < 0.0001) and adhesion(P = 0.0010).The surgical proficiency level was associated with ESD time in unit area(P < 0.0001).Multivariate analysis revealed that the ESD time was positively correlated with tumor size(P < 0.0001),adhesion(P < 0.0001) and location(P < 0.0001),but negatively correlated with surgical proficiency level(P = 0.0046).CONCLUSION:Large tumor size,adjacency to the cardia,and adhesion are predictors of a long ESD time,whereas high surgical proficiency level predicts a short ESD time.
文摘AIM： To investigate the prognostic factors of 96 young patients with colon cancer within a cancer center by univariate and multivariate analysis. METHODS： A total of 723 patients with colon cancer were treated surgically during a period of 10 years. Ninty six of them were 40 years old or younger. R0, R1 and R2 operations were performed in 69 （71.9%）, 4 （4.1%） and 23 patients （24%）, respectively. Left hemicolectomy was performed in 43 patients, right hemicolectomy in 37 patients, transverse colon resection in 9 patients and low anterior resection in 7 patients. Cox multivariate regression analysis was performed to identify predictors of survival. RESULTS： The operation mortality was 0%, 54 patients died within 111 mo after operation due to occurrence or metastases of the tumor. Liver, lung and bone metastases occurred in 3, 1 and 5 patients, respectively. The mean survival time for all patients was 77.9 ± 5.01 mo and the overall 3-, 5- and 10- year survival rates were 66.68%, 58.14% and 46.54%, respectively. In the univariate survival analysis, patient age, type of operation, radical resection, blood transfusion, histological type, diameter of tumor, depth of tumor invasion, lymphatic invasion, distant metastases, liver metastases and TNM stage were found to be predictors of survival in young patients with colon cancer. In the Cox-regression analysis, blood transfusion and lymphatic invasion were determined as independent prognostic factors of survival. CONCLUSIONS： Age, type of operation, radical resection, blood transfusion, histological type, diameter of tumor, depth of tumor invasion, lymphatic invasion, distant metastasis and TNM stage are the predictors of survival in young patients with colon cancer after surgery.
