SciCombinator

Discover the most talked about and latest scientific content & concepts.

Journal: Zhonghua wai ke za zhi [Chinese journal of surgery]

22

Objective: To compare the clinical efficacy of transcystic biliary drainage with nasobiliary drainage during primary closure following laparoscopic choledochotomy. Methods: The clinical data of 106 patients with cholecystolithiasis and choledocholithiasis treated by laparoscopy at Department of General Surgery, Danyang People’s Hospital from May 2014 to June 2017 were analyzed prospectively. The patients were divided into 2 groups by means of random number method: the study group was treated with transcystic biliary drainage, and the control group adopted nasobiliary drainage. The operation time, postoperative drainage volume, postoperative hospital stay and postoperative complications were compared between the 2 groups. Results: All patients in the two groups completed the operation successfully. Compared with nasobiliary drainage, the operation time of transcystic biliary drainage was shortened ((133.9±14.7) minutes vs. (143.3±21.7) minutes, t=-2.617, P<0.05). Postoperative hospital stay ((8.2±1.7) days vs. (7.7±2.5) days), the difference between the two groups was not statistically significant(P>0.05). The quantity of bile drainage was no significant difference in the two groups of patients. There were 1 case of duct obstruction and 2 cases of catheter slippage during transcystic biliary drainage, without causing bile leakage. During nasobiliary drainage, there were 3 cases of catheter obstruction, 1 case of catheter slippage, 2 cases of self extubation, 1 case of bile peritonitis caused by catheter blockage, transferred to laparotomy and T tube drainage. The patients were followed up for 1 month to 17 months, with an average of 8 months. B-ultrasound showed no bile duct stenosis and hepatic function was normal. Conclusions: Transcystic biliary drainage could achieve the same biliary drainage as well as nasobiliary drainage during primary closure following laparoscopic choledochotomy. In addition, transcystic biliary drainage maintain the physiological function of bile duct, it is simple and minimally invasive under certain conditions.

Concepts: Surgery, Statistical significance, Liver, Addition, Hepatology, Bile, Bile duct, Gallstone

0

Intrahepatic cholangiocarcinoma(ICC)is a primary liver cancer with its incidence only after hepatocellular carcinoma.Liver resection is currently the only established effective treatment for patients with ICC.However,the resectability of ICC is low and the long-term survival after surgery is far from satisfactory. With the advances in the understanding of the biological characteristics and prognostic characteristics of ICC, surgical strategy and techniques have improved in recent years, and the long-term survival has also been increased. The accurate clinical diagnosis of ICC, R0 resection, routine lymphadenectomy, effective adjuvant therapy after R0 resection, and multidisciplinary treatment including re-hepatectomy for recurrent ICC are important for achieving an optimal outcome.Down-staging management for patients with unresectable ICC may provide a chance of R0 resection in some patients. Further research on the biological heterogeneity of ICC,and the improvement of surgical treatment or the establishment of new treatment methods are the main research directions in the future.

0

Intrahepatic cholangiocarcinoma(ICC) is the second common primary liver cancer originated from epithelium of the sub-branches of intrahepatic bile ducts with extremely poor prognosis and lack of effective treatment.The prognosis of ICC is mostly affected by the origin,the type and the size of the tumor as well as the intrahepatic metastasis(satellite lesion) and lymph node metastasis etc.Surgical resection remains the first choice of treatment to patients with ICC.However, there are multiple issues in surgical treatment of ICC, which have not been reached a consensus.Among them, the value of systematic lymphadenectomy during hepatic resection for ICC patient remains one of the hot spot issues.Given the heterogeneity of ICC,we recommend planning the procedure of the radical resection and lymphadenectomy personally, according to the type and origin of the tumor, the number and locationof the lesion.The pre-operation imaging examination and the intra-operation lymph node tracing technique could provide valuable information to help the surgeon decide the range of systematic lymphadenectomy.Routine systematic lymphadenectomy is recommended in the surgical treatment of ICC patients by experienced surgeons even without evidence of lymph node metastasis.The resected lymph tissue should be labeled by the provenance for further study.

0

Digital intelligent diagnostic and treatment technology is a novel technology which is based by combining modern medicine with digitalized and intelligent high-tech to form a multidisciplinary and multi-knowledge domain. This technology plays an important role in areas including precision diagnosis, preoperative planning and surgical navigation. Its core technologies are: (1) quality control research on high-quality CT imaging data acquisition; (2) quality control and homogenization research on three-dimensional (3D) reconstruction; (3) high-quality 3D printed physical models; (4) virtual reality 3D simulation platform; (5) molecular fluorescence imaging to define tumor boundaries; (6) non-rigid registration multi-mode image fusion surgical navigation system; (7) image feature extraction and prediction model establishment. The workflow of this system includes: First, CT data acquisition and 3D visualization of hepatobiliary and pancreatic diseases; followed by individualized vascular assessment, liver volume calculation and surgical planning using the 3D model; then virtual simulation surgery, 3D printing, virtual reality technology and molecular fluorescence imaging accordance to the required specific conditions. Preoperative radiomics are used to predict the risk of complications and long-term follow-up results. Intraoperative multi-modal fusion image navigation and its consistency are evaluated with the findings in actual surgery and preoperative planning. This technology, hopefully, will bring in novel strategies and approaches in the diagnosis and treatment of hepatobiliary and pancreatic diseases.

0

Objectives: To propose a novel clinical classification system of gallbladder cancer, and to investigate the differences of clinicopathological characteristics and prognosis based on patients who underwent radical resection with different types of gallbladder cancer. Methods: The clinical data of 1 059 patients with gallbladder cancer underwent radical resection in 12 institutions in China from January 2013 to December 2017 were retrospectively collected and analyzed.There were 389 males and 670 females, aged (62.0±10.5)years(range:22-88 years).According to the location of tumor and the mode of invasion,the tumors were divided into peritoneal type, hepatic type, hepatic hilum type and mixed type, the surgical procedures were divided into regional radical resection and extended radical resection.The correlation between different types and T stage, N stage, vascular invasion, neural invasion, median survival time and surgical procedures were analyzed.Rates were compared by χ(2) test, survival analysis was carried by Kaplan-Meier and Log-rank test. Results: Regional radical resection was performed in 940 cases,including 81 cases in T1 stage,859 cases in T2-T4 stage,119 cases underwent extended radical resection;R0 resection was achieved in 990 cases(93.5%).The overall median survival time was 28 months.There were 81 patients in Tis-T1 stage and 978 patients in T2-T4 stage.The classification of gallbladder cancer in patients with T2-T4 stage: 345 cases(35.3%)of peritoneal type, 331 cases(33.8%) of hepatic type, 122 cases(12.5%) of hepatic hilum type and 180 cases(18.4%) of mixed type.T stage(χ(2)=288.60,P<0.01),N stage(χ(2)=68.10, P<0.01), vascular invasion(χ(2)=128.70, P<0.01)and neural invasion(χ(2)=54.30, P<0.01)were significantly correlated with the classification.The median survival time of peritoneal type,hepatic type,hepatic hilum type and mixed type was 48 months,21 months,16 months and 11 months,respectively(χ(2)=80.60,P<0.01).There was no significant difference in median survival time between regional radical resection and extended radical resection in the peritoneal type,hepatic type,hepatic hilum type and mixed type(all P>0.05). Conclusion: With application of new clinical classification, different types of gallbladder cancer are proved to be correlated with TNM stage, malignant biological behavior and prognosis, which will facilitate us in preoperative evaluation,surgical planning and prognosis evaluation.

0

Objective: To investigate the rationale for appropriate diagnostic methods and treatment protocols for unexpected gallbladder carcinoma(UGC). Methods: The clinical and pathological data of 45 patients with UGC admitted at Department of General Surgery, Xin Hua Hospital, Shanghai Jiao Tong University School of Medicine,from January 2008 to December 2017 were retrospectively collected and analyzed.There were 11 males(28.9%) and 34 females(71.1%),aged 68 years(range:27 to 68 years).And there were 20 cases who aged above 70 years. Twenty-four cases were diagnosed preoperatively as cholecystolithiasis plus chronic cholecystitis.Ten cases were diagnosed preoperatively as cholecystolithiasis plus actue cholecystitis.Six cases were diagnosed preoperatively as cholecystolithiasis plus choledocholith.Six cases were admitted because of gallbladder polyp and 1 case was admitted because of gallbladder adenomyomatosis. Results: Thirty-four patients with UGC received radical surgery.Among them,11 patients experienced postoperative complication and no posterative mortality occoured during hospital stay.Thirteen patients were diagnosed with T1b UGC, the harvested lymph node of Nx, N0, N1 and N2 was 2, 9, 1 and 1, respectively.In addition, 2 cases were identified to have local-regional tumor recurrence during our rescue radical surgery.The median overall survival time of the patients who did not receive radical surgery was 7 months(range:2-56 months).Nevertheless,the median overall survival time for patients diagnosed with T1, T2 and T3 tumors who received radical surgery, was 41 months(range: 19-82 months), 33.5 months(range: 31-36 months) and 17 months(range: 7-46 months), respectively. Conclusions: For patients with UGC, rescue radical surgery can achieve a better survival time.Furhtermore, our experience proved that rescue radical surgery for UGC is safe and feasible.Therefore,rescue radical surgery should be performed in patients with diagnose with UGC especially those T1b patients.

0

Objective: To explore the clinical efficacy of S-1 single agent adjuvant chemotherapy for the patients undergoing radical resection of extrahepatic biliary carcinoma. Methods: The clinical data of 108 patients with extrahepatic biliary carcinoma receiving radical resection who were admitted from January 2014 to June 2017 were retrospectively analyzed. There were 62 males(57.4%)and 46 females(42.6%),with a median age of 59 years (range:26 to 79 years),10 cases(9.3%) in stage Ⅱ,85 cases(78.7%) in stage Ⅲ, and 13 cases (12.0%) in stage Ⅳ, 40 cases(37.0%) of hilar cholangiocarcinoma, 8 cases(7.4%) of middle cholangiocarcinoma, 25 cases (23.2%) of distal cholangiocarcinoma, 35 cases(32.4%) of gallbladder carcinoma.After radical resection of extrahepatic biliary carcinoma, 49 patients receiving S-1 single agent chemotherapy and 59 patients receiving non-special treatment were divided into the chemotherapy group and the operation group,respectively. All the dates of the patients were followed up and collected with the overall survival time,tumor-free survival time,1,2 and 3-year survival rate after operation,and the rate of major toxic reaction during chemotherapy of the chemotherapy group. Survival curve was drawn by the Kaplan-Meier method, and survival analysis was done using the Log-rank test. Results: There were no significant differences in the general date of two groups(sex, age, tumor size, tumor site, TNM stages, degree of differentiation). The median overall survival time and the median tumor-free survival time in the chemotherapy group were 27 months and 21 months,respectively,and in the operation group were 21 months and 17 months,respectively. There were differences between the two groups in the overall survival rates(χ(2)=3.967,P<0.05) and the 2 and 3-year survival rate(63.3%,36.6%;41.6%,20.4%;χ(2)=4.510,P<0.05;χ(2)=6.143,P<0.05),but the 1-year overall survival rate (83.4%,79.7%)was not statistically significant(χ(2)=0.286,P>0.05). There were no significant differences in the tumor-free survival time,1,2 and 3-year tumor-free survival rate(77.6%,41.4%,33.1%;62.7%,30.9%,21.2%)between the two groups(χ(2)=0.876,P>0.05;χ(2)=0.252,P>0.05;χ(2)=1.571,P>0.05;χ(2)=3.323,P>0.05,respectively). The main toxic reaction during chemotherapy were dyspepsia(28.6%, 14/49), anemia(26.5%, 13/49), and leukopenia(22.5%, 11/49), all of which were mild. Conclusion: S-1 single agent chemotherapy after radical reseetion of extrahepatic biliary carcinoma could effectly improve the survival of patients and all of the main toxic reaction during chemotherapy were mild.

0

Objective: To explore the feasibility of laparoscopic treatment for incidental gallbladder cancer(IGBCA) and analyze the factors influencing prognosis. Methods: A retrospective study of 71 patients with IGBCA received laparoscopic treatment at Department of General Surgery, Peking University Third Hospital from January 2007 to December 2016 was conducted,the clinicopathological data and prognosis were analyzed. There were 18 males and 53 females,aged 23 to 81 years. They were divided into two groups based on the presence of intraluminal mass in the gallbladder. Sixty-five of the 71 patients received laparoscopic radical resection, the prognosis of them were compared with 14 patients with open radical resection. Results: Among the 71 patients,65 patients received radical resection,3 patients simple gallbaldder resection and 3 patients palliative resection. Postoperative complications occurred in 6 patients. IGBCA were detected by frozen section in 57 patients,with the accuracy of 96.5%,while the accuracy of T stage is 43.8% in the 48 patients received T stage evaluation during frozen section examination. The T stages based on final pathology were Tis(n=6),T1a(n=5),T1b(n=10),T2(n=46),and T3(n=4).The number of harvested lymph node was 4.7±2.9(range:2-12).There are 14 patients with lymph node metastasis. The 50 patients with intraluminal gallbladder mass include 21 patients with ≤T1b stage and 29 patients with ≥T2 stage, while the 21 patients without intraluminal gallbladder mass are all with ≥T2 stage. The median survival time of the 71 patients was 33 months, with the 5-year cumulative survival rate 67.3%. The 5-year cumulative survival rate is 78.5% for the 65 patients who received radical resection,comparable with those who received open radical resection(P=0.485).Univariate analysis demonstrated that T stage, lymph node metastasis, G grade, lymphovascular invasion, neural invasion, acute cholecystectomy, bile spillage, gallbladder mass and preoperative CA19-9/CEA were the most important prognostic factors(P<0.05). Conclusions: Laparoscopic treatment for IGBCA is feasible, especially for those with intraluminal gallbladder mass. The accuracy of frozen section examination in evaluating T stage is low.

0

Objective: To explore the selection method and technology of laparoscopic surgery for gallbladder stones and common bile duct stones(GCBDS). Methods: Data was collected from 318 in-patients of GCBDS at Department of General Surgery,Xuanwu Hospital of Capital Medical University from January 2013 to December 2017, and 298 in-patients acceptedlaparoscopic cholecystectomy(LC) and choledocholithotomy were recruited into final analysis.There were 138 males and 160 females,aged (60.4±18.6)years (range:25-89 years).Retrospective analysis was done on method distribution,effect and safety of laproscopic surgery.Comparisons of basic characters and therapeutic effects were performed betweenlaparoscopic common bile duct exploration (LCBDE) combined with primary closure and T tube drainage(TTD). Results: Among therecruited in-patients,LC combined with common bile duct exploration was performed in 7 cases(2.3%, 7/298), LC combined with LCBDE was performed in 291 cases(97.7%,291/298).There were 133 cases (45.7%,133/291) who treated by LCBDE combined with TTD and 158 cases(54.3%,158/291) who treated by LCBDE combined with primary closure.In LCBDE combined with primary closure group,18 cases (11.4%,18/158)had intraoperative biliary manometry.All patients were followed up for 6 months at least and there no death.Postoperative complications rate was 10.0% (29/291).There were no significant differences in sex ratio,age,American Society of Anesthesiologists score,concomitant diseases and previous abdominal surgery history between LCBDE combined with primary closure and LCBDE combined with TTD group.Patients in LCBDE combined with primary closure group were accompanied with less acute cholangitis than TTD group (43.3% vs.76.7%; χ(2)=9.061, P=0.002).There were no significant differences in the diameter of common bile duct, the number of stones, hospitalization expenses and the incidence of complications between the two groups(all P>0.05).LCBDE combined with primary closure had shorter operation time ((134.2±28.3)minutes vs.(148.3±19.6)minutes; t=-1.830, P=0.011)and post-operative hospitalization time ((5.6±2.6)days vs. (7.2±2.4)days; t=-1.847,P=0.014).Bile duct leakage rate was higher in primary closure group(6.3% vs.0.8%, χ(2)=3.934, P=0.047) and TTD group had higher residual stones rate(6.8% vs.1.3%; χ(2)=6.008, P=0.014). Conclusion: Strategy for treating GCBDS by laparoscopic surgery should be considered preoperative evaluation and intraoperative exploration to select appropriate minimally invasive surgical methods and techniques.

0

Objective: To investigate the effects of preoperative percutaneous transhepatic biliary drainage on surgical treatment of type Ⅲ and Ⅳ hilar cholangiocarcinoma. Methods: Clinical data of 72 patients with hilar cholangiocarcinoma of the Bismuth-Corlette type Ⅲ and Ⅳ treated at Department of General Surgery,First Affiliated Hospital of Bengbu Medical College from January 2010 to December 2017 were analyzed retrospectively.Patients were divided into two groups based on whether PTBD was performed:a drained group and an undrained group.In the drained group,there were 31 patients,20 males and 11 females,aged (59.9±9.7)years (range: 39-73 years).Among them,14 patients underwent hepatectomy with half or more than half of the liver removed (extended hepatectomy)and 17 patients underwent non-anatomical hepatectomy in the hilar region (limited hepatectomy).In the undrained group,there were 41 patients, 26 males and 15 females, aged (60.8±7.8)years(range: 45-75 years).Among them, 17 patients underwent hepatectomy with half or more than half of the liver removed (extended hepatectomy)and 24 patients underwent non-anatomical hepatectomy in the hilar region (limited hepatectomy).Percutaneous transhepatic biliary drainage(PTBD)was used in the drained group.Under the guidance of ultrasound,one or more hepatobiliary ducts could be sufficiently drained,which had good effect and was not restricted by the obstruction location of hilar cholangiocarcinoma.The analysis of the measurement data was performed using t test,and the analysis of the count data was performed using χ(2) test,and the survival curve was plotted using Kaplan-meier method. Results: In total, 72 jaundiced patients with hilar cholangiocarcinoma underwent surgical treatment: 31 had PTBD prior to operation while 41 did not had PTBD.There were significant differences in ALT((93.2±21.4)U/L vs.(207.4±65.1)U/L),AST((87.6±18.1)U/L vs.(188.9±56.6)U/L)and total bilirubin((68.8±12.6)μmol/L vs.(227.5±87.7)μmol/L)between the patients after treatment and those before treatment(t=10.958, P=0.000; t=10.845, P=0.000; t=10.386, P=0.000).Compared with those in the undrained group, the operation time was shorter, the amount of intraoperative bleeding and the incidence of complications were lower in the drained group(t=-2.840, P=0.006; t=-3.698, P=0.000; χ(2)=4.108, P=0.043).There were no perioperative death cases in drained group and 2 perioperative death cases in undrained group.There was no significant difference in R0 resection rate between the two groups(χ(2)=0.778,P=0.378).The 1-,3-,5-year survival rate of patients in the drained group and the undrained group was 72.7%,34.2%, 13.7% and 72.8%, 31.5%, 11.8%, respectively.The difference was not statistically significant(all P>0.05). Conclusions: The preoperative percutaneous transhepatic biliary drainage in patients with hilar cholangiocarcinoma of Bismuth-Corlette type Ⅲ and Ⅳ could effectively shorten operative time, reduce amount of intraoperative bleeding and incidence of postoperative complications,but have no significant effect on the R0 resection rate and survival rate.