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Is irreversible electroporation safe and effective in the treatment of hepatobiliary and pancreatic cancers?

hepatobiliary & pancreatic Diseases International 2019年第2期18卷 117-124页

作者： Li-Ming Wu Le-Le Zhang Xin-Hua Chen Shu-Sen Zheng Division of hepatobiliary and pancreatic Surgery the First Affiliated Hospital Zhejiang University School of Medicine

Background: Irreversible electroporation(IRE) is a novel ablative technique for hepatobiliary and pancreatic cancers. This review summarizes the data regarding the safety and efficacy of IRE in the treatment of hepatobiliary and pancreatic cancers. Data sources: Studies were identified by searching Pub Med and Embase for articles published in English from database inception through July 31, 2017. For inclusion, each clinical study had to report morbidity and survival data on hepatobiliary and pancreatic cancers treated with IRE and contain at least 10 patients. Studies that met these criteria were included for analysis. Two authors assessed each clinical study for data extraction. The controversial parts were resolved through discussion with seniors. Results: A total of 24 clinical studies were included. Fourteen focused on hepatic ablation with IRE comprising 437 patients with 666 lesions of different tumor types. Two patients(0.5%) died after the IRE procedure. Morbidity of hepatic ablation with IRE ranged from 7% to 35%. Most complications were mild. Complete response for hepatic tumors was reported as 57%–97%. Ten studies with 455 patients focused on pancreatic IRE. The overall mortality of IRE in pancreatic cancer was 2%. Overall severe morbidity of IRE in pancreatic cancer ranged from 0 to 20%. The median overall survival after IRE ranged from 7 to 23 months. Patients treated with IRE combined with surgical resection showed a longer overall survival. Conclusions: IRE significantly improves the prognosis of advanced hepatobiliary and pancreatic malignances, and companied with less complications. Hence, IRE is a relatively safe and effective non-thermal ablation strategy and potentially recommended as an option for therapy of patients with hepatobiliary and pancreatic malignances.

关键词： Irreversible electroporation Hepatic cancer pancreatic cancer

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Minireview on laparoscopic hepatobiliary and pancreatic surgery

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World Journal of Gastrointestinal Endoscopy 2014年第3期6卷 60-67页

作者： Clara Tan-Tam Stephen W Chung Department of hepatobiliary and pancreatic Surgery and Liver Transplant Division of General Surgery University of British Columbia Vancouver General Hospital and BC Transplant Society

The first laparoscopic cholecystectomy was performed in the mid-1980s. Since then, laparoscopic surgery has continued to gain prominence in numerous fields, and has, in some fields, replaced open surgery as the preferred operative technique. The role of laparoscopy in staging cancer is controversial, with regards to gallbladder carcinoma, pancreatic carcinoma, hepatocellular carcinoma and liver metastasis from colorectal carcinoma, laparoscopy in conjunction with intraoperative ultrasound has prevented nontherapeutic operations, and facilitated therapeutic operations. Laparoscopic cholecystectomy is the preferred option in the management of gallbladder disease. Meta-analyses comparing laparoscopic to open distal pancreatectomy show that laparoscopic pancreatectomy is safe and efficacious in the management of benign and malignant disease, and have better patient outcomes. A pancreaticoduodenectomy is a more complex operation and the laparoscopic technique is not feasible for this operation at this time. Robotic assisted pancreaticoduodenectomy has been tried with limited success at this time, but with continuing advancement in this field, this operation would eventually be feasible. Liver resection remains to be the best management for hepatocellular carcinoma, cholangiocarcinoma and colorectal liver metastases. Systematic reviews and meta-analyses have shown that laparoscopic liver resections result in patients with equal or less blood loss and shorter hospital stays, as compared to open surgery. With improving equipment and technique, and the incorporation of robotic surgery, minimally invasive liver resection operative times will improve and be more efficacious. With the incorporation of robotic surgery into hepatobiliary surgery, donor hepatectomies have also been completed with success. The management of benign and malignant disease with minimally invasive hepatobiliary and pancreatic surgery is safe and efficacious.

关键词： Laparoscopic Liver resection Pancreatectomy Cholecystectomy pancreaticoduodenectomy Cancer Tumour

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Diagnosis and Treatment Value of Ultrasound for hepatobiliary and pancreatic Disease

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International Journal of Technology Management 2014年第9期 26-28页

作者： Hongfeng LIN department of hepatobiliary surgery weifang people's hospitalweifangShandong 261041 China

As an innovative technology, ultrasound has been applied to agriculture, medical, military, aerospace, machinery and other fields widely, as well as the medical industry, such as ultrasound diagnosis, ultrasound therapy. Ultrasonic technology has many advantages, and it certainly will promote the progress in medical area as a new method.

关键词： Ultrasonic technology hepatobiliary and pancreatic surgery treatment diagnosis

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Integration of perioperative features and intragraft TCF7L2 expression to predict lipid metabolic disorder in liver transplant recipients

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Science China Life Sciences 2025年第1期 297-299页

作者： Junbin Zhou Rongli Wei Guanghan Fan Zhengxing Lian Xuanyu Zhang Linsong Tang Zhetuo Qi Haiyang Xie Shusen Zheng Qiang Wei Xiao Xu Department of hepatobiliary and pancreatic Surgery People's Hospital of LishuiAffiliated Lishui Hospital of Wenzhou Medical UniversityThe First Affiliated Hospital of Lishui University NHFPC Key Laboratory of Combined Multi-Organ Transplantation Key Laboratory of Integrated Oncology and Intelligent Medicine of Zhejiang Province Department of Hepatobiliary and Pancreatic SurgeryHangzhou First People's Hospital Department of hepatobiliary and pancreatic Surgery The First Affiliated HospitalZhejiang University School of Medicine Department of Urology The Second Affiliated HospitalZhejiang University School of Medicine Department of hepatobiliary and pancreatic Surgery Department of Liver TransplantationShulan (Hangzhou) Hospital Hangzhou Medical College Zhejiang University School of Medicine

Dear Editor, Liver transplantation(LT) is the only curative therapy for patients with endstage liver disease(He et al., 2023; Ling et al., 2022). Post-transplant hypertriglyceridemia(PTHT), which has an incidence of up to 32.8% in 6 months after LT, is one of the major post-transplant complications(Toshima et al., 2020).

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Inhibition of pancreatic stellate cell activity by adipose-derived stem cells

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hepatobiliary & pancreatic Diseases International 2015年第2期14卷 215-221页

作者： Fu-Xiang Yu Long-Feng Su Chun-Lei Dai Yang Wang Yin-Yan Teng Jun-Hui Fu Qi-Yu Zhang Yin-He Tang Department of hepatobiliary and pancreatic Surgery FirstAffiliatedHospital WenzhouMedicalCollege Department of hepatobiliary and pancreatic Surgery FirstAffiliatedHospitalWenzhouMedicalCollege

BACKGROUND：pancreatic stellate cells（PSCs）play a critical role in the development of pancreatic *** this study we used a novel method to isolate and culture rat PSCs and then investigated the inhibitory effects of adipose-derived stem cells（ADSCs）on activation and proliferation of ***：pancreatic tissue was obtained from SpragueDawley rats for PSCs *** cell cultures were adopted for co-culture of ADSCs and PSCs. PSCs prolifera- tion and apoptosis were determined using CCK-8 and flow cytometry, respectively, a-SMA expressions were analyzed using Western blotting. The levels of cytokines [nerve growth factor （NGF）, interleukin-10 （IL-10） and transforming growth factor-ill （TGF-[31）] in conditioned medium were detected by ELISA. Gene expression （MMP-2, MMP-9 and TIMP-1） was analyzed using qRT-PCR. RESULTS： This method produced 17.6_＋6.5 ~ 103 ceils per gram of the body weight with a purity of 90%-95% and a viability of 92%-97%. Co-culture of PSCs with ADSCs significantly inhib- ited PSCs proliferation and induced PSCs apoptosis. Moreover, a-SMA expression was significantly reduced in PSCs＋ADSCs compared with that in PSC-only cultures, while expression of fibrinolytic proteins （e.g., MMP-2 and MMP-9） was upregulated and anti-fibrinolytic protein （TIMP-1） was downregulated. In addition, NGF expression was up-regulated, but IL-10 and TGF-β1 expressions were down-regulated in the coculture conditioned medium compared with those in the PSC- only culture medium. CONCLUSIONS： This study provided an easy and reliable technique to isolate PSCs. The data demonstrated the inhibitory effects of ADSCs on the activation and proliferation of PSCs in vitro.

关键词： pancreatic stellate cells isolation mesenchymal stem cells pancreatic fibrosis fibrinolytic protein

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Withdrawal of immunosuppression in liver transplantation and the mechanism of tolerance

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hepatobiliary & pancreatic Diseases International 2015年第5期14卷 470-476页

作者： Chi-Xian Zhang Pei-Hao Wen Yu-Ling Sun Institute of hepatobiliary and pancreatic Diseases Department of Hepatobiliary and Pancreatic Surgery First Affiliated Hospital Zhengzhou University School of Medicine

BACKGROUND： Immunosuppression reagents have side effects and cause considerable long-term morbidity and mortality in patients after liver transplantation. Sufficient evidences showed that minimization or withdrawal of immunosuppression reagents does not deteriorate the recipient＇s immune response and physiological function and therefore, is feasible in some recipients of liver transplantation. However, the mechanisms are not clear. The present review was to update the current status of immunosuppression in liver transplantation and the mechanism of minimization or withdrawal of immunosuppression in liver *** SOURCES： We searched articles in English on minimization or withdrawal of immunosuppression in liver transplantation in Pub Med. We focused on the basic mechanisms of immune tolerance in liver transplantation. Studies on immunosuppression minimization or withdrawal protocols and biomarker in tolerant recipients were also ***： Minimization or withdrawal of immunosuppression can be achieved by the induction of immune tolerance, which may not be permanent and can be affected by various factors. However, accurately evaluating immune status post-transplant is a prerequisite to achieve individualized immunosuppression. Numerous mechanisms for immune tolerance have been found, including immunophenotypic shift of memory CD8＋ T cells and CD4＋ T cell subsets. Activation of the inflammasome through apoptosis-associated speck-like protein containing a C-terminal caspase recruitment domain（ASC） in dendritic cells is associated with rejection after liver transplantation. CONCLUSIONS： Minimization or withdrawal of immunosuppression can be achieved by the induction of immune toler-ance via different mechanisms. This process could be affected by immunophenotypic shift of memory CD8＋ T cells and CD4＋ T cell subsets, which may be correlated with activation of the inflammasome through ASC in dendritic cells.

关键词： liver transplantation immunosuppression minimization withdrawal tolerance

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Prognosis of hepatocellular carcinoma with bile duct tumor thrombus after R0 resection:a matched study

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hepatobiliary & pancreatic Diseases International 2016年第6期15卷 626-632页

作者： Ding-Ding Wang Li-Qun Wu Zu-Sen Wang Division of hepatobiliary pancreatic Surgery The Affiliated Hospital of Qingdao University

BACKGROUND： Hepatocellular carcinoma （HCC） with bile duct tumor thrombus （BDTT） is rare. The present study aimed to determine post-surgical prognoses in HCC patients with BDTT, as outcomes are currently unclear. METHODS： We compared the prognoses of 110 HCC patients without BDTT （group A） to 22 cases with BDTT （group B）. The two groups were matched in age, gender, tumor etiology, size, number, portal vascular invasion, and TNM stage. Additionally, 28 HCC patients with BDTT were analyzed to identify prognostic risk factors. RESULTS： The 1-, 3-, and 5-year overall survival rates were 90.9%, 66.9%, and 55.9% for group A and 81.8%, 50.0%, and 37.5% for group B, respectively. The median survival time in groups A and B was 68.8 and 31.4 months, respectively （P=0.043）. The patients for group B showed higher levels of serum total bilirubin, alanine aminotransferase and gammaglutamyl transferase, a larger hepatectomy range, and a higher rate of anatomical resection. In subgroup analyses of patients with BDTT who underwent R0 resection, TNM stage Ⅲ-Ⅳ was an independent risk factor for overall survival; these patients had worse prognoses than those with TNM stage Ⅰ-Ⅱ after R0 resection （hazard ratio=6.056, P=0.014）. Besides, univariate and multivariate analyses revealed that non-R0 resection and TNM stage Ⅲ-Ⅳ were independent risk factors for both disease-free survival and overall survival of 28 HCC patients with BDTT. The median overall survival time of patients with BDTT who underwent R0 resection was longer than that of patients who did not undergo R0 resection （31.0 vs 4.0 months, P=0.007）.CONCLUSIONS： R0 resection prolonged survival time in HCC patients with BDTT, although prognosis remains poor. For such patients, R0 resection is an important treatment that determines long-term survival.

关键词： hepatocellular carcinoma bile duct tumor thrombus prognosis recurrence R0 resection

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Laparoscopic fenestration vs open fenestration in patients with congenital hepatic cysts: A meta-analysis

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World Journal of Gastroenterology 2011年第28期17卷 3359-3365页

作者： Prasoon Pankaj Department of hepatobiliary pancreatic Surgery West China HospitalSichuan University

AIM: To determine whether the outcomes of laparoscopic fenestration (LF) were superior to open fenestration (OF) for congenital liver ***: Comparative studies published between January 1991 and May 2010 on Medline (Ovid),Emsco,PubMed,Science Direct;Cochrane Reviews;CNKI;Chinese Biomedical Database,VIP and other electronic databases were *** controlled trials (RCTs) and retrospective case-control studies on the management of congenital hepatic cysts were collected according to the pre-determined eligibility criteria to establish a literature *** was ended in May ***-analysis was performed using RevMan 5.0 software (Cochrane library).RESULTS: Nine retrospective case-control studies involving 657 patients,comparing LF with OF were included for the final pooled *** meta-analysis results showed less operative time [mean difference (MD): -28.76,95% CI: -31.03 to 26.49,P < 0.00001];shorter hospital stay (MD: -3.35,95% CI: -4.46 to -2.24,P < 0.00001);less intraoperative blood loss (MD: -40.18,95% CI: -52.54 to -27.82,P < 0.00001);earlier return to regular diet (MD: -29.19,95% CI: -30.65 to -27.72,P < 0.00001) and activities after operation (MD: -21.85,95% CI: -31.18 to -12.51,P < 0.0001) in LF group;there was no significant difference between the two groups in postoperative complications (odds ratio: 0.99,95% CI: 0.41 to 2.38,P = 0.98) and cysts recurrence ***: The short-term outcomes of LF for patients with congenital hepatic cysts were superior to open approach,but its long-term outcomes should be verified by further RCTs and extended follow-up.

关键词： Congenital hepatic cysts Laparoscopic fenestration Open fenestration Systematic review Metaanalysis

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Total closure of pancreatic section for end-to-side pancreaticojejunostomy decreases incidence of pancreatic fistula in pancreaticoduodenectomy

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hepatobiliary & pancreatic Diseases International 2017年第3期16卷 310-314页

作者： Yu-Ling Sun Ya-Lei Zhao Wen-Qi Li Rong-Tao Zhu Wei-Jie Wang Jian Li Shuai Huang Xiu-Xian Ma Department of hepatobiliary and pancreatic Surgery the First Affiliated Hospital of Zhengzhou University Zhengzhou 450052 China Institute of hepatobiliary and pancreatic Diseases Zheng- zhou University Zhengzhou 450052 China

BACKGROUND： Postoperative pancreatic fistula （POPF） is a serious complication and results in prolonged hospitalization and high mortality. The present study aimed to evaluate the safety and effectiveness of total closure of pancreatic section for end-to-side pancreaticojejunostomy in pancreaticoduodenectomy （PD）. METHODS： This was a prospective randomized clinical trial comparing the outcomes of PD between patients who un- derwent total closure of pancreatic section for end-to-side pancreaticojejunostomy （Group A） vs those who underwent conventional pancreaticojejunostomy （Group B）. The primary endpoint was the incidence of pancreatic fistula. Secondary endpoints were morbidity and mortality rates. RESULTS： One hundred twenty-three patients were included in this study. The POPF rate was significantly lower in Group A than that in Group B （4.8% vs 16.7%, P〈0.05）. About 38.3% patients in Group B developed one or more complications; this rate was 14.3% in Group A （P〈0.01）. The wound/abdomi- nal infection rate was also much higher in Group B than that in Group A （20.0% vs 6.3%, P〈0.05）. Furthermore, the average hospital stays of the two groups were 18 days in Group A, and 24 days in Group B, respectively （P〈0.001）. However, there was no difference in the probability of mortality, biliary leakage,delayed gastric emptying, and pulmonary infection between the two groups. CONCLUSION： Total closure of pancreatic section for end-to- side pancreaticojejunostomy is a safe and effective method for pancreaticojejunostomy in PD.

关键词： periampullary tumor pancreatic fistula pancreaticoduodenectomy pancreaticojejunostomy biliary leakage

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Complete resection of the gastric antrum decreased incidence and severity of delayed gastric emptying after pancreaticoduodenectomy

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hepatobiliary & pancreatic Diseases International 2021年第2期20卷 182-189页

作者： Yu-Ling Sun Jian-Jun Gou Kai-Ming Zhang Wen-Qi Li Xiu-Xian Ma Lin Zhou Rong-Tao Zhu Jian Li Institute of hepatobiliary and pancreatic Diseases Department of Hepatobiliary and Pancreatic Surgerythe First Affiliated Hospital of Zhengzhou UniversityZhengzhou 450052China Department of Digestive the First Affiliated Hospital of Zhengzhou UniversityZhengzhou 450052China

Background:Delayed gastric emptying(DGE)is the main complication after pancreaticoduodenectomy(PD),but the mechanism is still *** aim of this study was to elucidate the role of complete resection of the gastric antrum in decreasing incidence and severity of DGE after ***:Sprague-Dawley rats were divided into three groups:expanded resection(ER group),complete resection(CR group),and incomplete resection(IR group)of the gastric *** tension(g)of remnant stomach contraction was *** analyzed the histological morphology of the gastric wall by different excisional methods after distal ***,patients underwent PD at our department between January 2012 and May 2016 were included in the *** cases were divided into IR group and CR group of the gastric antrum,and the clinical data were retrospectively ***:The ex vivo remnant stomachs of CR group exhibited much greater contraction tension than others(P<0.05).The contraction tension of the remnant stomach increased with increasing acetylcholine concentration,while remained stable at the concentration of 10×10^(-5 )mol/***,174 consecutive patients were included and retrospectively analyzed in the *** incidence of DGE was significantly lower(3.5%vs.21.3%,P<0.01)in CR group than in IR *** addition,hematoxylin-eosin staining analyses of the gastric wall confirmed that the number of transected circular smooth muscle bundles were higher in IR group than in CR group(8.24±0.65 vs.3.76±0.70,P<0.05).Conclusions:The complete resection of the gastric antrum is associated with decreased incidence and severity of DGE after *** electrophysiological and physiopathological disorders caused by damage to gastric smooth muscles might be the mechanism underlying DGE.

关键词： Delayed gastric emptying Gastric antrum Gastric electrophysiology Histological morphology pancreaticoduodenectomy

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