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

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(Psurgery group and the robotic surgery group(P>0.05).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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A scoring system for prediction of early recurrence after liver resection for Barcelona Clinic Liver Cancer stage B hepatocellular carcinoma

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Chinese Medical Journal 2014年第24期127卷 4171-4176页

作者： Qian Honggang Wei Meng Qiu Hu Wu Jianhui Liu Bonan Lyu Ang Liu Qiao Li Chengpeng Leng Jiahua Department of hepato-pancreato-biliary surgery Peking University School of Oncology Beijing Cancer Hospital Beijing 100142 China

Background The management of Barcelona Clinic Liver Cancer （BCLC） stage B hepatocellular carcinoma （HCC） is controversial due to the early recurrence after curative hepatectomy, and many variables were related to the prognosis. The purpose of this study was to predict the tumor recurrence in early postoperative period of the patients with BCLC stage B HCC. Methods From January 2004 to January 2012, 104 patients with BCLC stage B HCC underwent hepatectomy. Clinicopathological factors and follow-up data were statistically analyzed to establish a predicting scoring system. Results The overall survival rates for one, three, and five years were 69.2%, 52.7%, and 42.3%, and the disease-free survival rates for one, three, and five years were 52.9%, 47.3%, and 37.5%, respectively. The multiple factors analysis showed that the micro-vessel invasion, lymph nodes metastasis, multiple lesions, and the high expression of HMGB1 were independent factors （P 〈0.05）. A scoring system was established to predict the early recurrence within one year after the surgery for BCLC stage B HCC, according to the analysis results with a specificity of 85.1% and a sensitivity of 80.3%. Conclusion Variant clinicopathological factors were associated with early postoperative recurrence for BCLC stage B HCC and recurrence early after hepatectomy was more likely in patients with a higher score of the scoring system.

关键词： hepatocellular carcinoma hepatectomy postoperative recurrence high mobility group box 1 protein

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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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Derivation and validation of a preoperative prognostic model for resectable pancreatic ductal adenocarcinoma

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hepatobiliary & Pancreatic Diseases International 2023年第2期22卷 160-168页

作者： Shuai Xu Xiu-Ping Zhang Guo-Dong Zhao Wen-Bo Zou Zhi-Ming Zhao Qu Liu Ming-Gen Hu 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: The prognosis of patients with pancreatic ductal adenocarcinoma(PDAC) remains poor even after radical pancreaticoduodenectomy(PD). The study aimed to develop and validate a novel preoperative prognostic model to accurately predict the long-term survival of patients with ***: Patients with PDAC of pancreatic head from Chinese PLA General Hospital were included. The preoperative PDAC model with contour plots was developed using a non-linear model in the training cohort and then tested in the validation ***: Of 421 patients who met the inclusion criteria, 280 were in the training cohort and 141 in the validation cohort. Contour plots for preoperative PDAC model were established to visually predict the survival probabilities of these patients, based on preoperative carbohydrate antigen 19-9, preoperative fibrinogen to albumin ratio and pain symptoms. This model stratified patients into low-and high-risk groups with distinctly different long-term survival in the training cohort [median overall survival(OS)32.1 vs. 17.5 months;median recurrence-free survival(RFS) 19.3 vs. 10.0 months, both P < 0.001] and the validation cohort(median OS 28.3 vs. 19.0 months;median RFS 17.5 vs. 11.2 months, both P < 0.001).Time-dependent receiver operating characteristic and decision curve analyses revealed that the model provided higher diagnostic accuracy and superior net benefit compared to other staging ***: This study constructed and validated a novel preoperative prognostic model that can accurately and conveniently predict the long-term survival of patients with resectable PDAC of pancreatic head. Besides, the model can screen high-risk patients with poor prognosis, which may provide references for personal treatment strategies in the future.

关键词： Pancreatic ductal adenocarcinoma Pancreaticoduodenectomy Contour plot Overall survival Recurrence-free survival

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Navigated liver surgery:State of the art and future perspectives

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hepatobiliary & Pancreatic Diseases International 2022年第3期21卷 226-233页

作者： Paschalis Gavriilidis Bjørn Edwin Egidijus Pelanis Ernest Hidalgo Nicola de’Angelis Riccardo Memeo Luca Aldrighetti Robert P Sutcliffe Department of hepato-pancreato-biliary and Liver Transplant surgery Queen Elizabeth University Hospitals Birmingham NHS Foundation TrustB152THUK The Intervention Centre and Department of HPB surgery Oslo University Hospital and Faculty of MedicineUniversity of OsloOsloNorway Department of hepato-Pancreatico-biliary surgery and Transplantation Hospital Universitari Vall d’HebronBarcelonaSpain Department of Digestive surgery University Hospital Henri Mondor(AP-HP)94010 Creteil and University of Paris EstCreteilFrance Department of hepatobiliary and Pancreatic surgery Miulli HospitalAcquaviva delle FontiBari 70021Italy Division of hepatobiliary surgery San Raffaele HospitalVia Olgettina 60Milan 20132Italy

Background:In recent years,the development of digital imaging technology has had a significant influence in liver *** ability to obtain a 3-dimensional(3D)visualization of the liver anatomy has provided surgery with virtual reality of simulation 3D computer models,3D printing models and more recently holograms and augmented reality(when virtual reality knowledge is superimposed onto reality).In addition,the utilization of real-time fluorescent imaging techniques based on indocyanine green(ICG)uptake allows clinicians to precisely delineate the liver anatomy and/or tumors within the parenchyma,applying the knowledge obtained preoperatively through digital *** combination of both has transformed the abstract thinking until now based on 2D imaging into a 3D preoperative conception(virtual reality),enhanced with real-time visualization of the fluorescent liver structures,effectively facilitating intraoperative navigated liver surgery(augmented reality).Data sources:A literature search was performed from inception until January 2021 in MEDLINE(Pub Med),Embase,Cochrane library and database for systematic reviews(CDSR),Google Scholar,and National Institute for Health and Clinical Excellence(NICE)***:Fifty-one pertinent articles were retrieved and *** different types of digital imaging technologies and the real-time navigated liver surgery were estimated and ***:ICG fluorescent imaging techniques can contribute essentially to the real-time definition of liver segments;as a result,precise hepatic resection can be guided by the presence of ***,3D models can help essentially to further advancing of precision in hepatic surgery by permitting estimation of liver volume and functional liver remnant,delineation of resection lines along the liver segments and evaluation of tumor *** liver transplantation and especially in living donor liver transplantation(LDLT),3D printed models of the donor’s live

关键词： Navigated Hepatic surgery 3D Computer assistance Image guidance Image guided surgery Indocyanine green 3D print Visual simulation Virtual reality Augmented reality Real-time navigated liver surgery

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Radiofrequency ablation vs hepatic resection for solitary colorectal liver metastasis:A meta-analysis

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World Journal of Gastroenterology 2011年第36期17卷 4143-4148页

作者： Yun-Zi Wu Bin Li Tao Wang Shuang-Jia Wang Yan-Ming Zhou Department of hepato-biliary-pancreato-Vascular surgery the First Affiliated Hospital of Xiamen UniversityXiamen 361003Fujian ProvinceChina

AIM:To evaluate the comparative therapeutic efficacy of radiofrequency ablation (RFA) and hepatic resection (HR) for solitary colorectal liver metastases (CLM).METHODS:A literature search was performed to identify comparative studies reporting outcomes for both RFA and HR for solitary *** odds ratios (OR) with 95% confidence intervals (95% CI) were calculated using either the fixed effects model or random effects ***:Seven nonrandomized controlled trials studies were included in this *** studies included a total of 847 patients:273 treated with RFA and 574 treated with *** 5 years overall survival rates in the HR group were significantly better than those in the RFA group (OR:0.41,95% CI:0.22-0.90,P=0.008).RFA had a higher rate of local intrahe-patic recurrence compared to HR (OR:4.89,95% CI:1.73-13.87,P=0.003).No differences were found between the two groups with respect to postoperative morbidity and ***:HR was superior to RFA in the treatment of patients with solitary ***,the findings have to be carefully interpreted due to the lower level of evidence.

关键词：射频消融切除术肝脏大肠癌人力资源随机效应模型固定效应模型随机对照试验

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RASSF1A methylation as a biomarker for detection of colorectal cancer and hepatocellular carcinoma

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World Journal of Gastrointestinal Oncology 2022年第8期14卷 1574-1584页

作者： Jian Li Huan Li Zeng-Ci Run Zhen-Lei Wang Tao Jiang Yang An Zhi Li Department of General surgery Affiliated Tumor Hospital of Zhengzhou UniversityHenan Tumor HospitalZhengzhou 450000Henan ProvinceChina Department of Gastroenterology Sixth Medical Center of Chinese PLA General HospitalBeijing 100048China Medicine Innovation Research Division of Chinese PLA General Hospital Beijing 100853China Faculty of hepato-pancreato-biliary surgery Sixth Medical Center of Chinese PLA General HospitalBeijing 100048China

BACKGROUND Studies have validated the potential of methylated cell-free DNA as a biomarker in various tumors,and methylated DNA in plasma may be a potential biomarker for *** To evaluate the diagnostic value of RASSF1A methylation in plasma for colorectal cancer(CRC)and hepatocellular carcinoma(HCC).METHODS A total of 92 CRC patients,67 colorectal polyp(CRP)patients,63 HCC patients,and 66 liver cirrhosis(LC)patients were *** plasma DNA was subjected to DNA extraction,double-strand DNA concentration determination,bisulfite conversion,purification,single-strand DNA concentration determination,and digital polymerase chain reaction(PCR)*** methylation rate was *** diagnostic value was evaluated by the area under the curve(AUC).RESULTS The age and sex in the CRC and CRP groups and the HCC and LC groups were also *** DNA methylation rate of RASSF1A in plasma in the CRC group was 2.87±1.80,and that in the CRP group was 1.50±*** methylation of RASSF1A in plasma showed a significant difference between the CRC and CRP *** AUC of RASSF1A methylation for discriminating the CRC and CRP groups was 0.82(0.76-0.88).The AUCs of T1,T2,T3 and T4 CRC and CRP were 0.83(0.72-0.95),0.87(0.78-0.95),0.86(0.77-0.95),and 0.75(0.64-0.85),*** DNA methylation rate of RASSF1A in plasma in the HCC group was 4.45±2.93,and that in the LC group was 2.46±*** methylation of RASSF1A in plasma for the HCC and LC groups showed a significant *** AUC of RASSF1A methylation for discriminating the HCC and LC groups was 0.70(0.60-0.79).The AUCs of T1,T2,T3 and T4 HCC and LC were 0.80(0.61,1.00),0.74(0.59-0.88),0.60(0.42-0.79),and 0.68(0.53-0.82),*** RASSF1A methylation in plasma detected by digital PCR may be a potential biomarker for CRC and HCC.

关键词： RASSF1A Methylation Digital polymerase chain reaction Colorectal cancer hepatocellular carcinoma

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Para-aortic lymph node involvement should not be a contraindication to resection of pancreatic ductal adenocarcinoma

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World Journal of Gastrointestinal surgery 2022年第5期14卷 429-441页

作者： Rupaly Pande Shafiq Chughtai Manish Ahuja Rachel Brown David C Bartlett Bobby V Dasari Ravi Marudanayagam Darius Mirza Keith Roberts John Isaac Robert P Sutcliffe Nikolaos A Chatzizacharias Department of hepato-pancreato-biliary and Liver Transplant surgery University Hospitals Birmingham NHS Foundation TrustBirmingham B152GWUnited Kingdom Department of Pathology University Hospitals Birmingham NHS Foundation TrustBirmingham B152GWUnited Kingdom

BACKGROUND Para-aortic lymph nodes(PALN)are found in the aortocaval groove and they are staged as metastatic disease if involved by pancreatic ductal adenocarcinoma(PDAC).The data in the literature is conflicting with some studies having associated PALN involvement with poor prognosis,while others not sharing the same *** resection is not included in the standard lymphadenectomy during pancreatic resections as per the International Study Group for Pancreatic surgery and there is no consensus on the management of these *** To investigate the prognostic significance of PALN metastases on the oncological outcomes after resection for *** This is a retrospective cohort study of data retrieved from a prospectively maintained database on consecutive patients undergoing pancreatectomies for PDAC where PALN was sampled between 2011 and *** comparison of the data between PALN+and PALN-subgroups,survival analysis with the Kaplan-Meier method and risk analysis with univariable and multivariable time to event Cox regression analysis were performed,specifically assessing oncological outcomes such as median overall survival(OS)and disease-free survival(DFS).RESULTS 81 cases had PALN sampling and 17(21%)were *** N stage was significantly different between PALN+and PALN-patients(P=0.005),while no difference was observed in any of the other *** imaging diagnosed PALN positivity in one *** and DFS were comparable between PALN+and PALN-patients with lymph node positive disease(OS:13.2 mo vs 18.8 mo,P=0.161;DFS:13 mo vs 16.4 mo,P=0.179).No difference in OS or DFS was identified between PALN positive and negative patients when they received chemotherapy either in the neoadjuvant or in the adjuvant setting(OS:23.4 mo vs 20.6 mo,P=0.192;DFS:23.9 mo vs 20.5 mo,P=0.718).On the contrary,when patients did not receive chemotherapy,PALN disease had substantially shorter OS(5.5 mo vs 14.2 mo;P=0.015)and DFS(4.4 mo

关键词： Para-aortic lymph node Pancreatectomy Survival Pancreatic adenocarcinoma Chemotherapy Lymph node sampling

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Neoadjuvant therapy in the treatment of hilar cholangiocarcinoma:Review of the literature

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World Journal of Gastrointestinal surgery 2019年第6期11卷 279-286页

作者： Fabio Frosio Federico Mocchegiani Grazia Conte Enrico Dalla Bona ANDrea Vecchi Daniele Nicolini Marco Vivarelli Unit of hepato-pancreato-biliary and Transplant surgery Department of Experimental and Clinical Medicine Polytechnic University of Marche

Cholangiocarcinoma(CCA)is a malignant tumor of the biliary system and includes,according to the anatomical classification,intra hepatic CCA(iCCA),hilar CCA(hCCA)and distal CCA(dCCA).Hilar CCA is the most challenging type in terms of diagnosis,treatment and *** is the only treatment possibly providing long-term survival,but only few patients are considered resectable at the time of *** fact,tumor’s extension to segmentary or subsegmentary biliary ducts,along with large lymph node involvement or intrahepatic metastases,precludes the surgical *** achieve R0 margins is mandatory for the disease-free survival and overall *** case of unresectable locally advanced hCCA,radiochemotherapy(RCT)as neoadjuvant treatment demonstrated to be a therapeutic option before either hepatic resection or liver *** liver surgery,RCT is believed to enhance the R0 margins *** patients meeting the Mayo Clinic criteria,RCT prior to orthotopic liver transplant(OLT)has proved to produce acceptable 5-years *** this review,we analyze the current role of neoadjuvant RCT before resection as well as before OLT.

关键词： Hilar cholangiocarcinoma Klatskin tumor Neoadjuvant treatement Radiotherapy Chemotherapy Hepatic resection Liver transplantation

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Natural orifice transluminal endoscopic surgery in pancreatic diseases

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World Journal of Gastroenterology 2010年第31期16卷 3859-3864页

作者： Sonja Gillen Jrg Kleeff Michael Kranzfelder Shailesh V Shrikhande Helmut Friess Hubertus Feussner Department of surgery Tech-nische Universitt München Department of Gastrointestinal and hepato-pancreato-biliary surgery Tata Memorial Hospital

Natural orifice transluminal endoscopic surgery (NOTES) is a surgical technique that has received considerable interest in recent years. Although minimal access surgery has increasingly replaced traditional open abdominal surgical approaches for a wide spectrum of indications, in pancreatic diseases its widespread use is limited to few indications because of the challenging and demanding nature of major pancreatic operations. Nonetheless, there have been attempts in animal models as well as in the clinical setting to perform diag- nostic and resectional NOTES for pancreatic diseases. Here, we review and comment upon the available data regarding currently analyzed and performed pancreatic NOTES procedures. Potential indications for NOTES include peritoneoscopy, cyst drainage, and necrosectomy, palliative procedures such as gastroenterostomy, as well as resections such as distal pancreatectomy or enucleation. These procedures have already been shown to be technically feasible in several studies in animal models and a few clinical trials. In conclusion, NOTES is a rapidly developing concept/technique that could potentially become an integral part of the armamentarium dealing with surgical approaches to pancreatic diseases.

关键词： Natural orifice transluminal endoscopic surgery Pancreatic disease Chronic pancreatitis Pancreatic resection Pancreatic drainage

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