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Perineural invasion of hilar cholangiocarcinoma in Chinese population: One center’s experience

World Journal of Gastrointestinal Oncology 2020年第4期12卷 457-466页

作者： Cheng-Gang Li Zhi-Peng Zhou xiang-long tan Zhi-Ming Zhao Second Department of Hepatobiliary Surgery Chinese PLA General HospitalBeijing 100853China

BACKGROUND Hilar cholangiocarcinoma(HCCA)often produces perineural invasion(PNI)extending to extra-biliary sites,while significant confusion in the incidence of PNI in HCCA has occurred in the literature,and the mechanism of that procedure remains *** To summarize the incidence of PNI in HCCA and to provide the distribution of nerve plexuses around hepatic portal to clinical *** Reported series with PNI in HCCA since 1996 were reviewed.A clinicopathological study was conducted on sections from 75 patients with HCCA to summarize the incidence and modes of *** stains for CD34 and D2-40 in the cancer tissue were performed to clarify the association of PNI with microvessel and lymph *** of the hepatoduodenal ligament from autopsy cases were scanned and handled by computer to display the distribution of nerve plexuses around the hepatic *** The overall incidence of PNI in this study was 92%(69 of 75 patients),while the rate of PNI in HCCA in the literature ranging from 38%to 100%.The incidence of PNI did not show any remarkable differences among various differentiated groups and Bismuth-Corlette classification *** regression analysis identified the depth of tumor invasion was the only factor that correlated significantly with PNI(P<0.01).In spite of finding tumor cells that could invade microvessels and lymph ducts in HCCA,we did not find tumor cells invaded nerves via microvessels or lymph *** nerve plexuses in the hepatoduodenal ligament and Glisson’s sheath were classified,and they all surrounded the great vessels very *** The incidence of PNI of HCCA in Chinese population is around 92%and correlated significantly with a depth of tumor *** also should be considered when stratifying HCCA patients for further treatment.

关键词： Hilar cholangiocarcinoma Perineural invasion Pathology Nerve plexus Incidence Treatment

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Robotic isolated partial and complete hepatic caudate lobectomy:A single institution experience

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Hepatobiliary & Pancreatic Diseases International 2020年第5期19卷 435-439页

作者： Zhi-Ming Zhao Zhu-Zeng Yin Li-Chao Pan Ming-Gen Hu xiang-long tan Rong Liu The Second Department of Hepatopancreatobiliary Surgery The First Medical CenterChinese People’s Liberation Army General HospitalBeijing 100853China

Background:Current reports on robotic hepatic caudate lobectomy are limited to Spiegel *** study aimed to compare the safety and feasibility of robotic isolated partial and complete hepatic caudate ***:Clinical data of 32 patients who underwent robotic resection of the hepatic caudate lobe in our department from May 2016 to January 2020 were retrospectively *** patients were divided into three groups according to the lobectomy location:left dorsal segment lobectomy(Spiegel lobectomy),right dorsal segment lobectomy(caudate process or paracaval portion lobectomy),and complete caudate *** information and perioperative results of the three groups were compared and ***:Among the 32 patients,none had conversion to laparotomy,three received intraoperative blood transfusion(9.38%),and none had complications of Clavien-Dindo gradeⅢor higher or died in the perioperative *** them,17 patients(53.13%)underwent Spiegel lobectomy,7(21.88%)underwent caudate process or paracaval portion lobectomy,and 8(25.00%)underwent complete caudate *** operative time and blood loss in the left dorsal segment lobectomy group were significantly better than those in the right dorsal segment lobectomy and complete caudate lobectomy groups(operative time:P=0.010 and P=0.005;blood loss:P=0.005 and P=0.017,respectively).The postoperative hospital stay in the left dorsal segment lobectomy group was significantly shorter than that in the complete caudate lobectomy group(P=0.003);however,there was no difference in the postoperative hospital stay between the left dorsal segment lobectomy group and right dorsal segment lobectomy group(P=0.240).Conclusions:Robotic isolated partial and complete caudate lobectomy is safe and *** lobectomy is relatively straightforward and suitable for beginners.

关键词： Robotic surgery Caudate lobe Caudate lobectomy

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Radioactive 125I seed implantation for pancreatic cancer with unexpected liver metastasis:A preliminary experience with 26 patients

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World Journal of Clinical Cases 2021年第4期9卷 792-800页

作者： Cheng-Gang Li Zhi-Peng Zhou Yu-Ze Jia xiang-long tan Yu-Yao Song Second Department of Hepatobiliary Surgery Chinese PLA General HospitalBeijing 100853China

BACKGROUND Preoperative diagnosis rate of pancreatic cancer has increased year by *** prognosis of pancreatic cancer patients with unexpected liver metastasis found by intraoperative exploration is very poor,and there is no effective and unified treatment *** To evaluate the therapeutic effect of radioactive 125I seed implantation for pancreatic cancer patients with unexpected liver *** The demographics and perioperative outcomes of patients who underwent 125I seed implantation to treat pancreatic cancer with unexpected liver metastasis between January 1,2017 and June 1,2019 were retrospectively *** the operation,125I seeds were implanted into the pancreatic tumor under the guidance of intraoperative ultrasound,with a spacing of 1.5 cm and a row spacing of 1.5 *** patients with obstructive jaundice and digestive tract obstruction,choledochojejunostomy and gastroenterostomy were performed *** operation,the patients were divided into a non-chemotherapy group and a chemotherapy group that received gemcitabine combined with albumin-bound paclitaxel *** Preoperative imaging evaluation of all patients in this study showed that the tumor was resectable without liver *** were 26 patients in this study,including 18 males and 8 females,aged 60.5±9.7 *** most common tumor site was the pancreatic head(17,65.4%),followed by the pancreatic neck and body(6,23.2%)and pancreatic tail(3,11.4%).Fourteen patients(53.8%)underwent palliative surgery and postoperative pain relief occurred in 22 patients(84.6%).The estimated blood loss in operation was 148.3±282.1 mL and one patient received blood *** postoperative hospital stay was 7.6±2.8 *** patient had biliary fistula,one had pancreatic fistula,and all recovered after conservative *** operation,7 patients received chemotherapy and 19 did *** 1-year survival rate was significantly higher in patients who received ch

关键词： Pancreatic cancer Liver metastases Radioactive 125I seeds Radiotherapy Permanent implantation Therapeutic effect

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Radioactive ^125I seed implantation for locally advanced pancreatic cancer:A retrospective analysis of 50 cases

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World Journal of Clinical Cases 2020年第17期8卷 3743-3750页

作者： Cheng-Gang Li Zhi-Peng Zhou Yu-Ze Jia xiang-long tan Yu-Yao Song Second Department of Hepatobiliary Surgery Chinese PLA General HospitalBeijing 100853China

BACKGROUND Pancreatic cancer is one of the common malignant tumors of the digestive system,and radical resection is the first choice of treatment for pancreatic *** patients with locally advanced pancreatic cancer cannot be treated in time and effectively,their disease often develops rapidly and their survival period is very *** To evaluate the therapeutic effect of ^125I seed implantation in patients with locally advanced pancreatic *** The demographics and perioperative outcomes of a consecutive series of patients who underwent ^125I seed implantation to treat locally advanced pancreatic cancer between January 1,2017 and June 30,2019 were retrospectively *** to the results of preoperative computed tomography or magnetic resonance imaging,the treatment planning system was used to determine the area and number of ^125I seeds *** the operation,^125I seeds were implanted into the tumor under the guidance of intraoperative ultrasound,with a spacing of 1.5 cm and a row spacing of 1.5 *** patients with obstructive jaundice and digestive tract obstruction,choledochojejunostomy and gastroenterostomy were performed *** operation,the patients were divided into a non-chemotherapy group and a chemotherapy group that received gemcitabine combined with albumin-bound paclitaxel *** Among the 50 patients,there were 29 males and 21 females,with a mean age of 56.9±9.8 *** main reason for the failure of radical resection was superior mesenteric artery invasion(37,74%),followed by superior mesenteric vein invasion(33,66%).Twenty-one(62%)patients underwent palliative surgery and postoperative pain relief occurred in 40(80%)*** estimated blood loss in operation was 107.4±115.3 mL and none of the patient received blood *** postoperative hospital stay was 7.5±4.2 d;one patient had biliary fistula and three had pancreatic fistula,all of whom recovered after conservative treatment

关键词： Pancreatic cancer Radioactive^125I seeds Radiotherapy Permanent implantation

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Should temporary extracorporeal continuous portal diversion replace meso/porta-caval shunts in “small-for-size” syndrome in porcine hepatectomy?

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World Journal of Gastroenterology 2015年第3期21卷 888-896页

作者： Da-Dong Wang Yong Xu Zi-Man Zhu xiang-long tan Yu-Liang Tu Ming-Ming Han Jing-Wang tan Department of Hepatobiliary Surgery The First Affiliated Hospital of Chinese PLA General Hospital

AIM:To investigate the feasibility of temporary extracorporeal continuous porta-caval diversion(ECPD) to relieve portal hyperperfusion in "small-for-size" syndrome following massive hepatectomy in ***:Fourteen pigs underwent 85%-90% liver resection and were then randomly divided into thecontrol group(n = 7) and diversion group(n = 7).In the diversion group,portal venous blood was aspirated through the portal catheter and into a tube connected to a centrifugal *** filtration,the blood was returned to the pig through a double-lumen catheter inserted into the internal jugular or subclavian *** the conversion pump,portal venous inflow was partially diverted to the inferior vena cava through a catheter inserted via the gastroduodenal vein at 100-130 m L/*** hemodynamics,injury,and regeneration in the liver remnant were compared between the two ***:Compared to the control group,porta-caval diversion via ECPD significantly mitigated excessive portal venous flow and portal vein pressure(PVP); the portal vein flow(PVF),hepatic artery flow(HAF),and PVP in the two groups were not significantly different at baseline; however,the PVF(431.8 ± 36.6 vs 238.8 ± 29.3,P < 0.01; 210.3 ± 23.4 vs 122.3 ± 20.6,P < 0.01) and PVP(13.8 ± 2.6 vs 8.7 ± 1.4,P < 0.01; 15.6 ± 2.1 vs 10.1 ± 1.3,P < 0.05) in the control group were significantly higher than those in the diversion group,*** HAF in the control group was significantly lower than that in the diversion group at 2 h and 48 h post hepatectomy,and ECPD significantly attenuated injury to the sinusoidal lining and hepatocytes,increased the regeneration index of the liver remnant,and relieved damage that the liver remnant suffered due to endotoxin and bacterial ***:ECPD,which can dynamically modulate portal inflow,can reduce injury to the liver remnant and facilitate liver regeneration,and therefore should replace permanent meso/porta-caval shunts in "smallfor-size" synd

关键词： small-for-size syndrome Extracorporeal continuous

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Robotic pancreaticoduodenectomy for pancreatic ductal adenocarcinoma: Analysis of surgical outcomes and long-term prognosis in a high-volume center

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Hepatobiliary & Pancreatic Diseases International 2023年第2期22卷 140-146页

作者： Xiu-Ping Zhang Shuai Xu Zhi-Ming Zhao Qu Liu Guo-Dong Zhao Ming-Gen Hu xiang-long tan Rong Liu Faculty of Hepato-Biliary-Pancreatic Surgery The First Medical CenterChinese PLA General HospitalBeijing 100853China Department of Liver Transplantation and Hepatobiliary Surgery Shandong Provincial Hospital Affiliated to Shandong First Medical UniversityJinan 250021China

Background: Robotic pancreaticoduodenectomy(RPD) has been reported to be safe and feasible for patients with pancreatic ductal adenocarcinoma(PDAC) of the pancreatic head. This study aimed to analyze the surgical outcomes and risk factors for poor long-term prognosis of these patients. Methods: Data from patients who underwent RPD for PDAC of pancreatic head were retrospectively analyzed. Multivariate Cox regression analysis was used to seek the independent prognostic factors for overall survival(OS), and an online nomogram calculator was developed based on the independent prognostic factors. Results: Of the 273 patients who met the inclusion criteria, the median operative time was 280.0 minutes, the estimated blood loss was 100.0 m L, the median OS was 23.6 months, and the median recurrence-free survival(RFS) was 14.4 months. Multivariate analysis showed that preoperative carbohydrate antigen 19-9(CA19-9) [hazard ratio(HR) = 2.607, 95% confidence interval(CI): 1.560-4.354, P < 0.001], lymph node metastasis(HR = 1.429, 95% CI: 1.005-2.034, P = 0.047), tumor moderately(HR = 3.190, 95% CI: 1.813-5.614, P < 0.001) or poorly differentiated(HR = 5.114, 95% CI: 2.839-9.212, P < 0.001), and Clavien-Dindo grade ≥ Ⅲ(HR = 1.657, 95% CI: 1.079-2.546, P = 0.021) were independent prognostic factors for OS. The concordance index(C-index) of the nomogram constructed based on the above four independent prognostic factors was 0.685(95% CI: 0.640-0.729), which was significantly higher than that of the AJCC staging(8th edition): 0.541(95% CI: 0.493-0.589)( P < 0.001). Conclusions: This large-scale study indicated that RPD was feasible for PDAC of pancreatic head. Preoperative CA19-9, lymph node metastasis, tumor poorly differentiated, and Clavien-Dindo grade ≥ Ⅲ were independent prognostic factors for OS. The online nomogram calculator could predict the OS of these patients in a simple and convenient manner.

关键词： Robotic pancreaticoduodenectomy Nomogram long-term prognosis Pancreatic ductal adenocarcinoma

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Robotic resection of liver focal nodal hyperplasia guided by indocyanine green fluorescence imaging: A preliminary analysis of 23 cases

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World Journal of Gastrointestinal Oncology 2020年第12期12卷 1407-1415页

作者： Cheng-Gang Li Zhi-Peng Zhou xiang-long tan Zi-Zheng Wang Qu Liu Zhi-Ming Zhao Second Department of Hepatobiliary Surgery Chinese PLA General HospitalBeijing 100853China

BACKGROUND Focal nodal hyperplasia(FNH)is a common benign tumor of the *** occurs mostly in people aged 40-50 years and 90%of the patients are *** can be cured by local *** to locate and judge the tumor boundary in real time is often a challenge for *** To summarize the technique and feasibility of robotic resection of FNH guided by indocyanine green(ICG)fluorescence *** The demographics and perioperative outcomes of a consecutive series of patients who underwent robotic resection of liver FNH guided by ICG fluorescence imaging between May 1,2018 and September 30,2019 were retrospectively *** was injected through the median elbow vein in all the patients at a dose of 0.25 mg/kg 48 h before the *** the operation,the position of FNH in the liver was located in the fluorescence mode of the Da Vinci Si robot operating system and the tumor boundary was determined during the *** Among the 23 patients,there were 11 males and 12 females,with a mean age of 30.5±9.3 ***-two cases completed robotic resection,while one(4.3%)case converted to open *** the robotic surgery group,the operation time was 35-340 min with a median of 120 min,the intraoperative bleeding was 10-800 m L with a median of 50 m L,and the postoperative hospital stay was 1-7 d with a median of 4 *** fistula occurred in two(8.7%)patients after robotic operation and they both recovered after conservative ***(4.3%)patient received blood transfusion and there was no death in this *** postoperative hospital stay in the small tumor group was significantly shorter than that in the large tumor group(P<0.05).CONCLUSION ICG fluorescence imaging can guide the surgeon to perform robotic resection of liver FNH by locating the tumor and displaying the tumor boundary in real *** is a safe and feasible method to ensure the complete resection of the tumor.

关键词： Robotic surgery Indocyanine green Focal nodal hyperplasia Hepatectomy

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Impact of resection margins on long-term survival after pancreaticoduodenectomy for pancreatic head carcinoma

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World Journal of Clinical Cases 2019年第24期7卷 4186-4195页

作者： Cheng-Gang Li Zhi-Peng Zhou xiang-long tan Yuan-Xing Gao Zi-Zheng Wang Qu Liu Zhi-Ming Zhao Second Department of Hepatobiliary Surgery Chinese People’s Liberation Army General Hospital

BACKGROUND The impact of resection margin status on long-term survival after pancreaticoduodenectomy(PD) for patients with pancreatic head carcinoma remains controversial and depends on the method used in the histopathological study of the resected specimens. This study aimed to examine the impact of resection margin status on the long-term overall survival of patients with pancreatic head carcinoma after PD using the tumor node metastasis *** Consecutive patients with pancreatic head carcinoma who underwent PD at the Chinese People's Liberation Army General Hospital between May 2010 and May 2016 were included. The impact of resection margin status on long-term survival was retrospectively *** Among the 124 patients, R0 resection was achieved in 85 patients(68.5%), R1 resection in 38 patients(30.7%) and R2 resection in 1 patient(0.8%). The 1-and 3-year overall survival(OS) rates were significantly higher for the patients who underwent R0 resection than the rates for those who underwent R1 resection(1-year OS rates: 69.4% vs 53.0%;3-year OS rates: 26.9% vs 11.7%). Multivariate analysis showed that resection margin status and venous invasion were significant risk factors for *** Resection margin was an independent risk factor for OS for patients with pancreatic head carcinoma after PD. R0 resection was associated with significantly better OS after surgery.

关键词： Pancreatic head cancer Pancreaticoduodenectomy R0 resection margin Overall survival Disease-free survival R1 resection

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Robotic resection of duodenal gastrointestinal stromal tumour:Preliminary experience from a single centre

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World Journal of Gastrointestinal Oncology 2021年第7期13卷 706-715页

作者： Zhi-Peng Zhou xiang-long tan Zhi-Ming Zhao Yuan-Xing Gao Yu-Yao Song Yu-Ze Jia Cheng-Gang Li Department of Hepato-Pancreato-Biliary Surgery Chinese PLA General HospitalBeijing 100853China

BACKGROUND Experience in minimally invasive surgery in the treatment of duodenal gastrointestinal stromal tumors(DGISTs)is accumulating,but there is no consensus on the choice of surgical *** To summarize the technique and feasibility of robotic resection of *** The perioperative and demographic outcomes of a consecutive series of patients who underwent robotic resection and open resection of DGISTs between May 1,2010 and May 1,2020 were retrospectively *** patients were divided into the open surgery group and the robotic surgery ***(PD)or limited resection was performed based on the location of the tumour and the distance between the tumour and duodenal ***,sex,tumour location,tumour size,operation time(OT),estimated blood loss(EBL),postoperative hospital stay(PHS),tumour mitosis,postoperative risk classification,postoperative recurrence and recurrence-free survival were compared between the two *** Of the 28 patients included,19 were male and 9 were female aged 51.3±13.1 *** resection was performed in 17 patients,and PD was performed in 11 *** patients underwent open surgery,and 17 patients underwent robotic *** patients in the robotic surgery group underwent conversion to open *** the tumours were R0 resected,and there was no significant difference in age,sex,tumour size,operation mode,PHS,tumour mitosis,incidence of postoperative complications,risk classification,postoperative targeted drug therapy or postoperative recurrence between the two groups(P>0.05).OT and EBL in the robotic group were significantly different to those in the open surgery group(P0.05).CONCLUSION Robotic resection is safe and feasible for patients with DGI

关键词： Gastrointestinal stromal tumor Duodenum Pancreaticoduodenectomy Limited resection Robotic resection

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Clinical diagnosis and management of pancreatic mucinous cystadenoma and cystadenocarcinoma:Single-center experience with 82 patients

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World Journal of Gastrointestinal Oncology 2020年第6期12卷 642-650页

作者： Zhi-Ming Zhao Nan Jiang Yuan-Xing Gao Zhu-Zeng Yin Guo-Dong Zhao xiang-long tan Yong Xu Rong Liu Second Department of Hepatopancreatobiliary Surgery The First Medical Center of Chinese PLA General HospitalBeijing 100853China

BACKGROUND Mucinous cystic neoplasm(MCN)of the pancreas is characterized by mucinproducing columnar epithelium and dense ovarian-type stroma and at risk for malignant *** diagnosis and treatment of MCN are particularly *** To investigate the clinical characteristics of and management strategies for pancreatic mucinous cystadenoma(MCA)and mucinous cystadenocarcinoma(MCC).METHODS The clinical and pathological data of 82 patients with pancreatic MCA and MCC who underwent surgical resection at our department between April 2015 and March 2019 were retrospectively *** Of the 82 patients included in this study,70 had MCA and 12 had *** size of MCC was larger than that of MCA(P=0.049).Age and serum levels of tumor markers carcinoembryonic antigen(CEA),carbohydrate antigen(CA)19-9,and CA12-5 were significantly higher in MCC than in MCA patients(P=0.005,0.026,and 0.037,respectively).MCA tumor size was positively correlated with serum CA19-9 levels(r=0.389,P=0.001).Compared with MCC,MCA had a higher minimally invasive surgery rate(P=0.014).In the MCA group,the rate of major complications was 5.7%and that of clinically relevant pancreatic fistula was 8.6%;the corresponding rates in the MCC group were 16.7%and 16.7%,*** Tumor size,age,and serum CEA,CA19-9,and CA12-5 levels may contribute to management of patients with *** resection is the primary treatment modality for MCC and MCA.

关键词： Pancreatic neoplasms Mucinous cystadenoma Mucinous cystadenocarcinoma Biochemical indexes Diagnosis Surgery

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