Objective: To investigate the efficacy and prognosis of surgical treatment for hepatocellular carcinoma. Methods: This is a retrospective case series study. Clinical data of 927 consecutive patients who underwent initial hepatectomy for hepatocellular carcinoma(HCC) at the Department of Hepatobiliary and Pancreatic Surgery,Affiliated Hospital of Qingdao University from January 2013 to December 2020 were retrospectively collected. There were 766 males (82.6%) and 161 females (17.4%),with an age of (57.6±9.7)years (range: 17 to 85 years). Prognostic data were obtained through outpatient follow-up visits and telephone follow-up,and follow-up was continued until December 31,2024. Kaplan-Meier method was used to estimate survival rates and plot survival curves,and Log-rank test was used to compare survival differences among different tumor stages. Cox proportional hazards model was used to identify independent prognostic factors for recurrence and survival. When comparing the prognostic impact of laparoscopic versus open hepatectomy and postoperative adjuvant transcatheter arterial chemoembolization(TACE),propensity score matching was performed using 1∶1 nearest-neighbor matching with a caliper of 0.02. Results: (1) Among 927 patients,the median overall survival (OS) time was 130.5 months,and the 1-,3-,5-,and 10-year OS rates were 94.2%,79.9%,68.4%,and 52.3%,respectively. The median disease-free survival(DFS) was 37.8 months,and the 1-,3-,and 5-year DFS rates were 74.0%,52.0%,and 39.8%,respectively. The 5-year OS rates of patients with China Liver Cancer (CNLC) stage (Ⅰa,Ⅰb,Ⅱ,and Ⅲa were 78.0%,63.5%,43.1%,and 43.6%,respectively,and the corresponding 5-year DFS rates were 48.5%,35.0%,16.0%,and 20.1%,respectively. (2) Univariate and multivariate Cox analyses showed that sex,age,albumin,tumor differentiation,tumor number,microvascular invasion,and macrovascular invasion were independent prognostic factors for recurrence after initial hepatectomy for HCC (all P<0.05); age,albumin,tumor differentiation,tumor number,microvascular invasion,liver capsule invasion,and intraoperative blood loss were independent prognostic factors for survival after initial hepatectomy for HCC (all P<0.05). (3) Patients were divided into an adjuvant TACE group and a non-adjuvant TACE group according to whether postoperative TACE was administered. After propensity score matching,no significant differences in DFS or OS were observed between the two groups (both P>0.05). After adjustment for independent prognostic factors for recurrence using multivariate Cox regression,patients with microvascular invasion,maximum tumor diameter>5 cm,or multiple tumors had significantly better DFS in the adjuvant TACE group than in the non-adjuvant TACE group(all P<0.05). (4) Patients were divided into laparoscopic and open surgery groups according to whether laparoscopic hepatectomy was performed. After propensity score matching,no significant differences in DFS or OS were observed between the two groups (both P>0.05). Within the same CNLC stage subgroups (stage Ⅰa,Ⅰb,Ⅱ,and Ⅲa),no significant differences in DFS or OS were observed between the laparoscopic and open surgery groups (all P>0.05). Conclusions: Surgical treatment is an important means of achieving long-term survival in patients with HCC. Routine postoperative adjuvant TACE is not recommended after hepatectomy for HCC. However,postoperative adjuvant TACE may provide DFS benefits in patients with microvascular invasion,maximum tumor diameter >5 cm, or multiple tumors.
Liver resection for hepatocellular carcinoma (HCC) still faces the dual challenges of operative safety and high postoperative recurrence. Traditional precision surgery mainly focuses on operative manipulation, whereas the concept of scientific hepatectomy incorporates cirrhosis background, tumor biological behavior, and coordination with systemic therapy into a unified decision-making framework. This article discusses perioperative refined management strategies guided by scientific hepatectomy. Preoperatively, the severity of cirrhosis should be evaluated to define the safe extent of resection. Intraoperatively, oncological radicality should be balanced against liver parenchymal preservation. During the perioperative period, neoadjuvant therapy, conversion therapy, and adjuvant therapy should be integrated to promote the transition of HCC surgery toward comprehensive treatment. The focus of scientific hepatectomy is not merely to improve operative precision, but to select a more appropriate resection timing, resection extent, and treatment coordination strategy according to cirrhosis severity, tumor biological risk, and the need for subsequent treatment.
Associating liver partition and portal vein ligation for staged hepatectomy (ALPPS) offers a curative surgical opportunity for patients with initially unresectable hepatocellular carcinoma (HCC) and insufficient future liver remnant(FLR), owing to its unique advantage of rapidly inducing FLR hypertrophy. With breakthrough advances in first-line systemic therapies for advanced HCC-including immune checkpoint inhibitor-antiangiogenic combinations, dual immunotherapy regimens, and locoregional combined with systemic therapies-conversion therapy has emerged as a pivotal strategy in liver surgery, and the integration of ALPPS with HCC conversion therapy has advanced its clinical application into a more individualized era. This article systematically analyzes the evolving role of ALPPS in the era of conversion therapy and delineates four distinct clinical application modalities:(1) conventional staged ALPPS aimed at improving the surgical resection rate;(2) salvage ALPPS for patients with persistently insufficient FLR following HCC conversion therapy;(3) the"dual conversion"strategy, in which stage Ⅰ liver partition is followed by systemic conversion therapy prior to stage Ⅱ hepatectomy, thereby achieving concurrent oncological and surgical conversion;(4) conversion therapy followed by portal vein embolization (PVE) as a minimally invasive approach, with salvage ALPPS as a rescue option when PVE-induced hypertrophy proves insufficient. The rationale for selecting among these four modalities is further elaborated across multiple dimensions, including the severity of FLR insufficiency, tumor burden and response to conversion therapy, and patient-specific conditions. The organic integration of surgical innovation with oncological advances, together with precise and individualized decision-making within a multidisciplinary team framework, holds the promise of achieving the transition from "unresectable" to "resectable", and ultimately from "tumor-bearing survival" to "tumor-free，drug-free，high-quality survival".
In recent years, a cluster of digital intelligence technologies, represented by artificial intelligence, three-dimensional visualization, augmented reality and optical imaging, has been reshaping the cognitive foundation and clinical practice of liver surgery. From the frontier perspective of medical-engineering integration, this article systematically reviews eight major advances and breakthroughs in digital intelligence-empowered liver surgery, encompassing preoperative precision diagnosis, intelligent three dimensional planning, augmented reality combined with fluorescence navigation, multimodal optical imaging, intraoperative dynamic perception, large language model-based decision support, personalized prognosis prediction, and standardized ecosystem development. The clinical value of these advances is thoroughly examined in terms of tumor diagnosis, navigational decision-making, postoperative management, and homogeneous promotion. This review aims to provide a theoretical reference for the intelligent transformation of hepatobiliary surgery.
Objective: To explore the optimal time window for evaluating gallbladder contraction function by oral standardized protein bar combined with olive oil, and verify the measurement stability of this novel method compared with the traditional fried egg test. Methods: This is a prospective, multicenter, single-blind, randomized crossover controlled trial. A total of 112 healthy volunteers from 4 centers (the First Hospital of Lanzhou University, First Hospital of Qinhuangdao, the Liaoning Jinqiu Hospital, and the Honghui Hospital Affiliated to Xi'an Jiaotong University) were enrolled and randomly assigned to two groups using a random number table, with a 1-week washout period between two intervention cycles. Group A received oral fried egg intervention in the first cycle and oral standardized protein bar plus 50 ml extra virgin olive oil in the second cycle; while group B received the interventions in reverse order. Gallbladder ultrasound was performed at fasting state and 30, 50, 70, 90 and 110 min after intervention to measure the long diameter, wide diameter and anteroposterior diameter of the gallbladder, and calculate the gallbladder volume and gallbladder contraction rate. The changing trends of gallbladder contraction rate at each time point were compared between the two interventions, the coefficient of variation (CV) was used to evaluate the measurement stability of the two methods, and paired t-test, repeated measures analysis of variance, and Feltz-Miller asymptotic test were used for statistical analysis. Results: Among the 112 subjects, 47 were male and 65 were female, with an age of (30.6±7.1) years(range:19 to 62 years) and a fasting gallbladder volume of (20.0±7.1) ml. Under both interventions, the gallbladder contraction rate of the subjects began to increase at 30 min after intervention, reached the peak at 50 to 70 min, and then gradually decreased. There was no significant difference in the level of gallbladder contraction rate between the two groups at the peak time point (t=0.421,P=0.674). The intragroup CV of gallbladder contraction rate at each time point in the oral protein bar plus olive oil group was significantly lower than that in the fried egg group (all P<0.05), indicating better measurement stability. No serious adverse events such as acute pancreatitis and gastrointestinal bleeding occurred in either group, and the incidence of mild gastrointestinal adverse events showed no significant difference between the two groups (χ²=0.269, P=0.604). Conclusions: The optimal measurement time window for evaluating gallbladder contraction function with oral protein bar combined with olive oil is 50-70 min after intervention. This method is easy to operate with favorable safety, and its measurement stability is significantly better than the traditional fried egg test, providing a new method option for standardized clinical evaluation of gallbladder contraction function.
With the convergence of minimally invasive surgery and enhanced recovery after surgery, day-case surgery minimally invasive liver resection (DCS-MILR) has emerged as a potential care model. Available evidence, derived predominantly from single-center retrospective case series and supplemented by database analyses, suggests that DCS-MILR may be feasible and achieve acceptable short-term safety outcomes in carefully selected patients when supported by experienced surgical teams and standardized perioperative care. It may also shorten hospital stay and provide potential health-economic benefits. However, the evidence remains limited by selection bias, heterogeneous definitions, insufficient follow-up, and a lack of prospective controlled studies. This review summarizes the available evidence and its limitations, identifies major risks including postoperative nausea and vomiting, inadequate pain control, and gaps in surveillance for delayed complications, and proposes an implementation pathway incorporating multidimensional eligibility assessment, standardized perioperative management, structured risk-stratified follow-up, and expedited access to emergency reassessment. This framework is intended to reduce post-discharge safety risks and support the stepwise implementation of DCS-MILR in appropriately resourced centers.
Intrahepatic cholangiocarcinoma (ICC) is highly aggressive and prone to lymph node metastasis or invasion of adjacent bile ducts, blood vessels, and organs. In recent years, reports on laparoscopic radical resection for ICC have increased annually, demonstrating short-and long-term outcomes comparable to those of open surgery. However, further standardization is still required in areas such as surgical indications, major hepatectomy or resection in difficult anatomical locations, combined resection of bile ducts, blood vessels, or multiple organs, and surgery following conversion or downstaging therapy. To this end, the Branch of Biliary Surgery, Chinese Society of Surgery, Chinese Medical Association and the Biliary Surgery Expert Working Group of Surgical Branch, Chinese Medical Doctor Association convened domestic experts to formulate recommendations on key issues, encompassing surgical safety and efficacy, preoperative evaluation and indications, operative procedures, lymph node dissection and hepatectomy, combined resection of bile ducts, blood vessels, or organs, and conversion/downstaging surgery. This initiative aims to provide guidance for the standardized implementation of laparoscopic radical resection for ICC.
Objective: To analyze and evaluate the real-world clinical efficacy of immuno-targeted combined protocol as a neoadjuvant regimen for high-risk recurrent hepatocellular carcinoma. Methods: This is a retrospective case-series study. Real-world data from patients with high-risk recurrent HCC who received neoadjuvant therapy at Faculty of Hepato-Pancreato-Biliary Surgery,the First Medical Center of Chinese People's Liberation Army General Hospital, from January 2019 to September 2025, were analyzed. The cohort included 46 patients,among which there were 38 male patients (82.6%) and 8 female patients (17.4%), with an age at initial diagnosis(M(IQR)) of 56.5(15.0) years (range: 35 to 73 years). According to the Barcelona Clinic Liver Cancer staging system,there were 19 cases of stage A,15 cases of stage B and 12 cases of stage C. Survival curves were plotted using the Kaplan-Meier method,and comparisons were performed using the Log-rank test. A Cox regression analysis was performed on factors that may influence postoperative recurrence in patients. Results: Based on the modified Response Evaluation Criteria in Solid Tumors,the results of preoperative assessment were: 10 patients achieved complete response,30 patients achieved partial response,and 6 patients achieved stable disease. Based on the proportion of residual viable tumor cells in pathological specimens,there were 28 patients achieved major pathological response or above (60.9%). For the 46 enrolled patients,the recurrence-free survival(RFS) rates at 1,2,3 years were 74.7%,54.6%,45.5%,respectively,with a median recurrence-free survival of 28 months. The overall survival rates at 1,2,3 years were 97.6%,95.1%,91.8%,respectively. Cox regression analysis indicated that preoperative alpha-fetoprotein (AFP)≥400 μg/L was an independent high-risk factor for tumor recurrence. The 46 patients were divided into two groups based on their preoperative AFP levels. The 1-and 2-year RFS rates in the AFP<400 μg/L group were significantly higher than those in the AFP≥400 μg/L group, with a statistically significant difference (P<0.05). Conclusion: Immuno-targeted combined protocol as a neoadjuvant regimen can bring encouraging short-term and long-term survival outcomes to patients with high-risk recurrent hepatocellular carcinoma.
The publication of "Guideline for quality control of laparoscopic radical resection for biliary tract cancer（2026 edition）" marks the transition of laparoscopic radical resection for biliary tract cancer from technical exploration to a developmental stage centered on stratified indications, team credentialing, and whole-process quality control. The clinical value of laparoscopic radical resection for biliary tract cancer should not be evaluated solely by minimally invasive benefits, but should be established on the basis of strict patient selection, standardized margin assessment, adequate regional lymphadenectomy, high-quality biliary or gastrointestinal reconstruction, and standardized postoperative quality feedback. Focusing on the core recommendations of the guideline across different biliary tract cancer subtypes, this article provides in-depth interpretation of indication selection and team credentialing criteria, quality assessment of intraoperative margin control and lymph node dissection, as well as controversial issues such as the timing of surgery after conversion therapy and the choice of surgical procedures for mid-bile duct cancer. The aim is to promote the standardized, cautious, and high-quality implementation of laparoscopic radical resection for biliary tract cancer.
Objective: To evaluate the clinical value of the Japanese Study Group on Pancreaticobiliary Maljunction(JSGPM) classification in the diagnosis and treatment of pancreaticobiliary maljunction (PBM). Methods: A retrospective cohort analysis was conducted on 103 patients diagnosed with PBM via endoscopic retrograde cholangiopancreatography at the Department of General Surgery, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine from January 2010 to September 2018. There were 32 male cases and 71 female cases; the age (M(IQR)) was 5.1 (39.0) years (range: 2.2 to 56.1 years), with 74 cases aged <12 years and 29 cases aged ≥12 years.The distribution characteristics, clinical manifestations, and treatment strategies of different JSGPM subtypes were compared between pediatric (<12 years) and adolescent/adult (≥12 years) patients. Normally distributed quantitative data were compared between two groups using the independent samples t-test, and among multiple groups using analysis of variance (ANOVA). Skewed quantitative data were compared using non-parametric tests. Categorical variables were compared using the χ² test or Fisher's exact test. Results: Among the 103 PBM patients, JSGPM classified 40 cases as type A (39.2%), 31 cases as type B (30.4%), 25 cases as type C (24.5%), and 6 as type D (5.9%), with no unclassifiable cases. Among patients aged ≥12 years, the incidence of type B PBM was higher than that in children <12 years (51.7% (15/29) vs. 21.6% (16/74); χ²=8.974, P<0.01), and type B was the predominant subtype without concurrent common bile duct dilation (≥12 years vs. <12 years: 12/15 vs. 7/16). Among the 7 pediatric cases (7/16) and 12 adult patients (12/15) with type B PBM without concurrent common bile duct dilation, none underwent extrahepatic bile duct resection; instead, they received only endoscopic sphincterotomy plus cholecystectomy. All patients were followed up for (36±26) months (range: 6 to 96 months), with no recurrence of biliary tract infections, obstructive jaundice, or pancreatitis. Conclusions: The JSGPM classification is concise, practical, and highly correlated with clinical features and prognostic risks, providing clear guidance for individualized diagnosis and treatment. This classification helps identify high-risk type B PBM patients and guides the implementation of precise preventive strategies, avoiding undertreatment or overtreatment.
Objective: To investigate the prevalence and the risk factors of gallstone in Xuhui District of Shanghai,providing a scientific basis for developing targeted prevention and control measures. Methods: This is a cross-sectional study,which was conducted on permanent resident elderly individuals aged 65 and above who had established health records and completed annual health examinations between January and December 2024,across 13 community health centers in Xuhui District,Shanghai. A total of 48 844 elderly participants were included in the study, including 21 483 males and 27 361 females, aged (72.0±6.1) years (range: 65 to 106 years). The gender, age, height, weight, results of fasting venous blood and ultrasound results were collected.The absolute standardized mean difference (ASMD) was calculated to assess the balance of covariates between groups.Based on the presence of gallbladder stones detected by ultrasonography, the participants were divided into the study group and the control group. Rank-sum test and χ2 test were used for data analysis, and logistic regression analysis was performed to explore the risk factors for gallbladder stone formation. Results: The ASMD values of the total population and study sample were all≤0.2. The overall prevalence of gallstone in the study population was 14.44% (7 054/48 844), with a prevalence of 13.67% (3 741/27 361) in female and 15.42% (3 313/21 483) in males The prevalence of gallbladder polyps was 5.50%(2 682/48 844).The proportion of fatty liver was 45.50%(22 224/48 844). Additionally, a statistically significant difference in total cholesterol levels was observed between the gallstone group (range:4.34 to 5.77 mmol/L) and the non-gallstone groups (range: 4.39 to 5.82 mmol/L)(Z=-2.093, P<0.05). Multivariate Logistic regression analysis revealed that body mass index (BMI) ≥28 kg/m2 (OR=1.19, 95%CI: 1.17 to 1.20) and fatty liver disease (OR=1.22, 95%CI: 1.05 to 1.41) were independent influencing factors for gallstone formation (both P<0.05). Compared with the 65 to 69 years group, the risks of gallstones were significantly higher in the 70 to 74 years group (OR=1.25, 95%CI: 1.05 to 1.48) and the group aged 80 years and above (OR=1.28, 95%CI: 1.03 to 1.61). Conclusions: The prevalence of gallstone is relatively high among the elderly population in Xuhui District, Shanghai. BMI ≥28 kg/m2 and fatty liver disease are independent risk factors for gallstones. Compared with people aged 65 to 69 years, those aged 70 to 74 years and ≥80 years have an increased risk of developing gallstones.
Liver transplantation is the most effective treatment for end-stage liver disease. This article presents a review focusing on the research progress of complex liver transplantation. First, it analyzes two core clinical challenges currently restricting the development of liver transplantation: the shortage of donor liver resources and the increasing complexity of recipient conditions. Second, it categorically reviews the current development status of various complex liver transplantation techniques, sequentially elaborating on the technical key points, domestic innovative achievements, and clinical bottlenecks of non-whole graft liver transplantation (including living donor, auxiliary, autologous, split, and reduced-size liver transplantation), Domino multi-recipient liver transplantation, as well as cutting-edge new technologies such as combined organ transplantation, ischemia-free liver transplantation, and xenogeneic liver transplantation. The efficacy of each technique is summarized by integrating data from domestic and international literature. Finally, leveraging the advantage in the large volume of liver transplantation cases of China, the article summarizes multiple original technological breakthroughs in domestic complex liver transplantation and prospects the future development directions of the field from the perspectives of surgical technique optimization, individualized precise recipient management, donor liver resource coordination, and multidisciplinary collaboration, aiming to provide reference for the clinical diagnosis and treatment of complex liver transplantation and subsequent research.
The liver is characterized by abundant blood supply and intricate anatomical architecture,rendering intraoperative and postoperative hemorrhage a primary clinical challenge. Conventional compression and suture ligation fail to enable precise perioperative hemorrhage prediction. Driven by the integration of precision medicine,artificial intelligence,and biomaterials,hemostatic strategies are undergoing a paradigm shift from passive compression to precise targeted intervention. This paper systematically reviews advances and future perspectives in hemostatic strategies for hepatic surgery. Preoperative individualized intervention is achieved via tranexamic acid prophylaxis,portal vein embolization,and radiological assessment; intraoperatively,Peng's curettage-suction technique enhances hemorrhage control; postoperatively,tiered "pharmacological-interventional-surgical" management allows proactive whole-course hemostatic regulation. Looking ahead,nano-drug delivery systems coupled with artificial intelligence closed-loop frameworks will facilitate the integrated development of hemostasis,liver regeneration promotion,and postoperative recurrence inhibition.
Biliary tract cancer (BTC) are a group of highly malignant gastrointestinal tumors with poor prognosis, whose aggressiveness and therapeutic resistance are partly attributable to the complex interplay between perineural invasion (PNI) and the tumor microenvironment (TME). In recent years, accumulating evidence has shown that PNI not only promotes local tumor invasion and distant metastasis, but may also contribute to tumor immune evasion through modulation of the TME. This review summarizes the pathological features and molecular mechanisms of PNI in biliary tract tumors, including signal transduction between nerves and tumor cells, characteristics of the TME, intratumoral neural features, and alterations in immune cell function. In addition, the interactive mechanisms between PNI and the immune microenvironment are discussed, with a particular focus on the direct regulation of immune cells by neural signaling and the reciprocal effects of immune cells on PNI. Furthermore, this article reviews PNI-related prognostic models and therapeutic strategies, with the aim of providing new insights into precision diagnosis and treatment for BTC. By synthesizing current evidence, this review seeks to provide a theoretical basis for future investigations into the interplay between PNI and the immune microenvironment, as well as for the development of combinatorial therapeutic strategies.
Objectives: To investigate the impact of liver metastatic burden on the prognosis of patients with pancreatic neuroendocrine tumor (pNET) complicated by synchronous liver metastases who undergo curative resection,and to evaluate the value of preoperative systemic therapy/postoperative adjuvant therapy in subgroups with different metastatic burdens. Methods: This is a retrospective case series study. A total of 54 patients with pNET and liver metastases who underwent synchronous curative resection at Peking University Third Hospital from January 2016 to December 2025 were enrolled. 26 males and 28 females; with an age (M(IQR)) of 52(38)years(range:17 to 78 years). A combined scoring system based on the number and maximum diameter of liver metastatic lesions was constructed, and patients were divided into a high-burden group (n=33) and a low-burden group (n=21) using X-tile software. Kaplan-Meier method,log-rank test, and Cox regression analysis were used to identify prognostic factors, and the value of different systemic therapy regimens was evaluated by stratification. Results: Liver metastatic burden was an independent adverse prognostic factor for recurrence-free survival (RFS) in patients with pNET and liver metastases after curative resection (HR=3.323,95%CI:1.455 to 7.594,P=0.001). Subgroup analysis showed that preoperative systemic therapy significantly affected RFS in the high-burden group (P=0.013). Among patients receiving preoperative systemic therapy,those treated with chemotherapy or targeted therapy achieved significantly superior RFS compared with patients receiving somatostatin analog (SSA) monotherapy (HR=10.27, 95%CI: 1.262 to 83.580, P=0.008) and patients without preoperative therapy (HR=6.537, 95%CI: 0.789 to 54.150, P=0.047). Preoperative systemic therapy exerted no significant influence on OS in either the high-or low-burden group (both P>0.05). Similarly, postoperative adjuvant therapy showed no significant effects on RFS or OS in both subgroups (all P>0.05). Preoperative chemotherapy or targeted therapy, preoperative SSA combined with chemotherapy or targeted therapy followed by postoperative SSA could significantly improve RFS in high-burden patients (P<0.01). Conclusions: Liver metastatic burden is an independent prognostic factor for RFS after synchronous curative resection. Preoperative chemotherapy or targeted therapy can improve RFS in high-burden patients,and the sequential systemic therapy strategy based on chemotherapy or targeted therapy and SSA can further enhance RFS in this subgroup.
The pancreas is deeply located anatomically and adjacent to important blood vessels, making pancreatic surgery technically challenging and high-risk. As an important tributary of the portal vein, the peripancreatic venous system exhibits complex and diverse anatomical variations. These variations are key factors leading to intraoperative vascular injury and postoperative complications. Currently, the clinical understanding of venous variations in this region remains insufficient, with a lack of targeted surgical strategy guidance. Based on existing anatomical and imaging studies, this article systematically analyzes the variation types and clinical impacts of structures such as the superior mesenteric vein, splenic vein, left gastric vein, Henle trunk, pancreaticoduodenal vein and jejunal vein. It focuses on discussing preoperative evaluation methods and intraoperative management strategies, aiming to provide a reference for improving the precision and safety of pancreatic surgery.
Objective: To report the outcomes and evaluate the safety of the "2+3"pancreaticojejunostomy in pancreaticoduodenectomy. Methods: This retrospective case series analyzed clinical data from 110 consecutive pancreaticoduodenectomy patients who underwent "2+3" pancreaticojejunostomy, performed by a single surgeon at Qilu Hospital of Shandong University between December 2022 and July 2025. The cohort comprised 61 males and 49 females, with an age of (60.9±10.9) years (range: 21 to 83 years). Four patients (3.6%) received neoadjuvant therapy preoperatively. The technique features a modified duct-to-mucosa anastomosis: the "2" denotes a double-layer continuous suture of the anterior and posterior pancreatic parenchyma to the jejunum using 4-0 non-absorbable suture, with the posterior line incorporating the dorsal pancreatic duct wall and the jejunotomy; the "3" signifies three interrupted duct-to-mucosa sutures placed at the 6, 12, and 3 o'clock positions using 4-0 absorbable suture. Clinical and pathological data were compared using Student's t-test, Mann-Whitney U test, χ2 test, or Fisher's exact test. Results: The overall postoperative complication rate was 20.0% (22/110), with a 9.1% (10/110) incidence of clinically relevant postoperative pancreatic fistula (CR-POPF). No instances of grade C postoperative pancreatic fistula, reoperations, or perioperative deaths occurred. The postoperative hospital stay was (13.6±4.0) d (range: 7 to 27 d). The pathological types included pancreatic cancer (n=54, 49.1%), duodenal cancer (n=29, 26.4%), distal cholangiocarcinoma (n=10, 9.1%) and other tumors (n=17,15.5%). Patients were categorized based on surgical approach into laparoscopic pancreaticoduodenectomy (LPD) (n=44) and open pancreaticoduodenectomy (OPD) (n=66) groups. There was no statistically significant difference in the CR-POPF rate between the LPD group and the OPD group (15.9% (7/44) vs. 4.5% (3/66), P=0.086). Based on pancreatic duct diameter, patients were divided into a non-dilated duct group (n=79) and a dilated duct group (n=31). Compared with the dilated duct group(0 (0/31)), the CR-POPF incidence in the non-dilated duct group(12.7% (10/79)) showed no statistically significant difference (P=0.059). There were no statistically significant differences in operative time, intraoperative blood loss, CR-POPF rate, or postoperative hospital stay between patients with soft pancreas (n=68) and hard pancreas (n=42) (all P>0.05). Conclusion: The "2+3" pancreaticojejunostomy technique for pancreatic reconstruction during pancreaticoduodenectomy is effective and reliable.
The pancreas is local in the retroperitoneal space,in close proximity to critical blood vessels such as celiac trunk, superior mesenteric artery, hepatic artery, splenic artery, and gastroduodenal artery. The high incidence of anatomical variations in these arteries significantly increases the complexity of pancreatic surgery. Such variations-particularly aberrant origins of the right hepatic artery, dorsal pancreatic artery, and gastroduodenal artery, as well as an anomalous course of the splenic artery,are strongly associated with complications such as intraoperative hemorrhage, positive resection margins, and hepatic ischemia. Currently, the clinical application of high-resolution computed tomography angiography, three-dimensional reconstruction, three-dimensional printing, and artificial intelligence-assisted imaging analysis has facilitated highly precise preoperative evaluation of these vascular networks. This review systematically summarizes the common arterial variations encountered during pancreatic surgery. By specifically analyzing the anatomical anomalies of the hepatic, dorsal pancreatic, inferior pancreaticoduodenal, gastroduodenal, and splenic arteries, corresponding surgical strategies are proposed to provide a practical reference for the safe and precise execution of pancreatic procedures.
Pancreatic surgery faces severe challenges regarding intraoperative bleeding risk due to complex anatomy and dense vascularity, which is a common difficulty in both open and minimally invasive procedures. Based on the blood supply characteristics of the pancreatic region, this article systematically proposes a blood flow control technical system covering three regions: the pancreatic head, the mid-pancreas, and the pancreatic body-tail. It emphasizes the strategy of “priority devascularization and pre-blocking” to prioritize the identification and control of critical vessels, thereby creating a bloodless or low-bleeding surgical field, improving surgical safety and oncological radicality, and promoting blood flow control technology as a new paradigm in pancreatic surgery.
Population aging is one of the most defining societal transformations of the 21st century. Transcending a mere demographic change, it exerts a profound influence on national development strategies while directly impacting the health and well-being of families. Geriatric surgery, as a frontline field addressing these challenges, has emerged as a cornerstone of surgical care. Herein, we delineate the current state and prevailing constraints of geriatric surgery in China, and propose strategic pathways for its future evolution; all of which aims to provide actionable guidance for the implementation of the “Healthy China 2030” Planning Outline and to foster the high-quality advancement of geriatric surgical care nationwide.
