Open retroperitoneal lymph node dissection (O-RPLND) has historically been the established standard surgical procedure for managing retroperitoneal lymph node disease in testicular cancer. In recent years, however, the adoption of robotic surgical systems has led to a gradual shift in urological practice, with numerous procedures traditionally performed via open surgery being increasingly accomplished using robotic techniques. This study aims to systematically compare the perioperative safety and clinical efficacy of robotic-assisted retroperitoneal lymph node dissection (RA-RPLND) versus O-RPLND in the treatment of testicular cancer. Following the AMSTAR quality rating criteria and PRISMA principles, a thorough literature search was carried out. With no start date restrictions, databases such as Web of Science, Embase, PubMed, and the Cochrane Library were searched for pertinent papers until September 2025. The study was prospectively registered in PROSPERO with the registration number CRD420251147469. Statistical analyses were carried out with Review Manager version 5.4. WMD and OR were used as effect measures for continuous and dichotomous variables, respectively, with 95

There is ongoing debate on the relative safety and effectiveness of robot-assisted partial nephrectomy (RAPN) and percutaneous thermal ablation (PTA) in the treatment of cT1 renal cancers. The purpose of this study was to compare the oncological, functional, and perioperative results of these two approaches. Web of Science, PubMed, Cochrane Library, and EMBASE were used in a systematic review to find English-language research that was published before to August 2025. Review Manager 5.4 was used to do a meta-analysis, combining five trials with 773 patients (398 treated with PTA and 375 with RAPN). Weighted mean differences (WMD) were utilized for continuous variables, while odds ratios (OR) were used for dichotomous variables. PROSPERO registered the study (ID: CRD420251125197). PTA was associated to a reduced postoperative glomerular filtration rate (WMD: –14.14; 95

BACKGROUND:Improved cancer survival rates have highlighted second primary malignancies (SPMs), with the thyroid gland being one of the most common organs developing SPMs in cancer survivors. Second primary papillary thyroid carcinoma (2-PTC) is the predominant type, yet it remains poorly understood. This study aims to delineate the clinicopathological features and survival outcomes of 2-PTC and assess the efficacy of postoperative radioactive iodine therapy (post-RAIT) in reducing mortality risks in intermediate-risk 2-PTC patients. METHODS:Using the SEER-17 database (2004-2019), we identified 6399 2-PTC patients as Cohort 1 to analyze characteristics and outcomes, and 1743 as Cohort 2 to examine post-RAIT effects. Competing risk regression models were applied to assess mortality risks from prior primary malignancies (PPMs) and other causes. Propensity score matching and stabilized inverse probability treatment weighting with 500 bootstrap samples were used for robust analysis. RESULTS:Predominant demographic characteristics of 2-PTC patients included older age, female sex, and white ethnicity. Breast (25.5%), prostate (9.8%), and skin cancer (6.7%) were the most common PPMs. Unfavorable PPMs were found in 6.3% of patients. Despite lower cumulative mortality from 2-PTC compared to PPMs and other causes, post-RAIT did not significantly reduce mortality risks in Cohort 2, even among patients aged ≥ 55 years, with clinical stage IV disease, or unfavorable PPMs. Sensitivity analyses confirmed these findings. CONCLUSION:The survival prognosis for 2-PTC patients is generally favorable, and post-RAIT does not significantly affect mortality in intermediate-risk cases, indicating a need for reevaluation of its use.

Objective:The detection rate of sporadic medullary thyroid microcarcinoma (micro-sMTC) has increased with advancements in diagnostic techniques. In this study, we aimed to investigate the clinical characteristics, optimal management, prognosis, and the significance of calcitonin assays in fine-needle aspiration washout fluid (FNA-CT) for micro-sMTC, which remain unclear. Methods:This retrospective study included 73 patients with micro-sMTC who underwent initial surgery between November 2014 and November 2024 at the Division of Thyroid Surgery, Department of General Surgery, West China Hospital, Sichuan University. Clinicopathological features, factors associated with lymph node metastasis (LNM), dynamic risk stratification, and progression-free survival (PFS) were analyzed. Additionally, the significance of FNA-CT was investigated in relation to early diagnosis, surgical decision-making, and prognosis in these patients. Results:The mean age of the patients was 48.3 years, with a female predominance (60.3%). Following the introduction of FNA-CT in 2020, the detection rate of micro-sMTC increased. Most patients (91.8%) presented with asymptomatic suspicious thyroid nodules detected on ultrasonograms. The median tumor size and basal calcitonin level were 7.0 mm and 68.0 pg/mL, respectively. FNAC accurately identified MTC in only 20 (24.4%) of 82 nodules from the 73 patients. Hemithyroidectomy was performed in 13 (17.8%) patients, including 4 with contralateral nodules. After a median follow-up of 34.0 months (range: 6.0-124.0 months), 58 (79.5%) patients achieved an excellent response, while 12 (16.4%) and 3 (4.1%) patients exhibited biochemical incomplete and structural incomplete responses, respectively. LNM was significantly associated with suspicious lymph nodes on ultrasonograms, multifocality, and high-grade tumors. High-grade histology and advanced clinical stage were associated with an unfavorable response to initial surgery and independently predicted poor PFS (both p < 0.05). Patients in the FNA-CT group had lower basal calcitonin and carcinoembryonic antigen (CEA) levels, smaller tumors, less advanced staging, and fewer high-grade tumors (all p < 0.05) than those in the non-FNA-CT group. However, early diagnosis via FNA-CT was not associated with improved PFS. Conclusions:Despite its typically favorable prognosis, micro-sMTC may exhibit certain aggressive features. High tumor grade and advanced clinical stage are independent prognostic factors of poor PFS and may guide postoperative surveillance strategies. FNA-CT shows potential value in facilitating earlier diagnosis of micro-sMTC and identifying suitable candidates for hemithyroidectomy.

Background: Surgery is the only curative treatment strategy for parathyroid carcinoma (PC). However, the optimal extent of surgery remains uncertain, particularly regarding whether routine central lymph node dissection (LND) confers a survival advantage to patients with PC. This study aimed to evaluate the prognostic value of LND in PC patients. Methods: Patients diagnosed with PC between 2004 and 2018 were identified in the Surveillance, Epidemiology, and End Results (SEER) -18 registries. With inclusion and exclusion criteria, a total of 338 patients were included as cohort 1 to describe the characteristics of PC, while 215 patients were selected as cohort 2 to assess the effect of LND on cancer -specific survival (CSS). Univariate and multivariate Cox proportional hazards regression models were used to identify independent risk factors associated with CSS. Propensity score matching (PSM) was performed to adjust for potential confounding variables. The prognostic value of LND was further analyzed in subgroups stratified by predictors associated with CSS. Results: The 5- and 10 -year CSS were 94.4% and 87.9% respectively in cohort 1. LND failed to significantly improve CSS in the entire cohort 2 and the PSM cohort 2. Large tumor size (>40 mm) and distant metastasis were independently associated with poor CSS. Subgroup analyses revealed that LND was not significantly associated with improved CSS in patients with aggressive PC, such as those with a tumor size greater than 40 mm. Unexpectedly, LND may compromise CSS in patients with distant disease (P=0.03). Conclusions: PC is a rare and indolent endocrine malignancy. The presence of large tumors and distant metastases are independent predictors of poor CSS. Routine central LND as part of initial surgery does not significantly improve CSS in PC patients, even for those with large tumors, lymph node metastasis, or distant disease.

Thyroid carcinoma is the only cancer that regards age as an important predictor of thyroid cancer-specific survival (CSS). While the 8th American Joint Committee on Cancer (AJCC) staging system raised the age cutoff from 45 to 55 years for differentiated thyroid carcinoma (DTC) to more accurately predict the prognosis, there is no new information regarding the role of age in the prognosis of anaplastic thyroid carcinoma (ATC). The aim of this study was to determine the optimal age cutoff values for mortality risk stratification in ATC patients. Furthermore, a nomogram to predict ATC CSS was developed in each age group. Patients diagnosed with ATC between 2004 and 2015 were identified in the Surveillance, Epidemiology, and End Results (SEER) database. After applying inclusion and exclusion criteria, a total of 1140 patients were enrolled as cohort 1 to describe the characteristics of ATC, while a total of 556 patients were included as cohort 2 to determine age cutoff values for risk stratification by X-tile program. Training set and testing set were randomly generated to develop and validate a predictive nomogram of CSS in each age group. The 6-month, 1-year, and 2-year survival was 27.6%, 15.1%, and 6.2%, respectively, in cohort 1. X-tile program results showed that the optimal age cutoff values for mortality risk stratification were 65 and 85 years old (p < 0.001). Distant metastasis was independently associated with CSS in patients younger than 85 years old, and these patients benefited more from complete resection of the tumor and radiotherapy/chemotherapy. However, no predictors of CSS were identified in patients over 85 years old, and interventions (surgery, radiotherapy, and chemotherapy) targeting ATC had little role in disease control in these patients. The nomogram was developed and validated based on the independent CSS predictors in each age group. The C-index values of the training set and testing set were 0.735 [95% CI, 0.696–0.774] and 0.733 [95% CI, 0.663–0.804] for CSS in patients of ≤64 years old, while the values were 0.767 [95% CI, 0.730–0.804] and 0.783 [95% CI, 0.718–0.848] in patients of 65–84 years old. All of the C-index values were larger than 0.7, which showed acceptable prediction performance of the nomograms. Age can be used as an auxiliary stratification factor of prognosis in ATC patients. The survival may be improved in patients younger than 85 years old if combination therapy (surgery, radiotherapy, and chemotherapy) was indicated and applicable, while no optimal therapeutic strategy was determined in patients older than 85 years old. The established nomograms can provide good prediction of CSS according to age group.

OBJECTIVE:To evaluate the diagnostic performance and cost-effectiveness of calcitonin assays in fine-needle aspiration washout fluid (FNA-CT) compared to fine-needle aspiration cytology (FNAC) for medullary thyroid carcinoma (MTC). METHODS:A total of 27,404 patients from three medical centres between January 2020 and May 2022 were screened for serum calcitonin (sCT). Of whom, 223 patients met endpoints and were enroled for analyses. Based on sCT levels, patients were divided into two groups (group 1: 10 pg/ml< sCT ≤100 pg/ml and group 2: sCT > 100 pg/ml). The diagnostic performance and cost-effectiveness of FNA-CT and FNAC were compared. RESULTS:Most patients (N = 25,228; 92.1%) with thyroid nodules had normal sCT levels. In group 1, 24 and 167 nodules were diagnosed as MTC and non-MTC lesions, respectively. FNA-CT showed better performance in diagnosing MTC than FNAC in terms of sensitivity (100.0% vs. 58.3%), negative predictive value (100.0% vs. 94.3%), and overall accuracy (100.0% vs. 94.7%). In group 2, 67 and 7 nodules were diagnosed as MTC and non-MTC lesions, respectively. The diagnostic performance of FNA-CT was superior to FNAC in terms of sensitivity (100.0% vs. 64.2%), negative predictive value (100.0% vs. 22.6%), and overall accuracy (100.0% vs. 67.6%). Furthermore, analysis from the decision tree model showed that FNA-CT was a cost-effective tool for diagnosing MTC lesions. CONCLUSIONS:FNA-CT can serve as an auxiliary and cost-effective approach for patients with indeterminate sCT levels to detect occult MTC lesions. FNA-CT can be recommended for patients with sCT >100 pg/ml to overcome the high false-negative rate of FNAC.

It is of significance to evaluate central lymph node status in patients with papillary thyroid carcinoma (PTC), because it can decrease postoperative complications resulting from unnecessary prophylactic central lymph node dissection (CLND). Due to the low sensitivity and specificity of neck ultrasonography in the evaluation of central lymph node metastasis (CLNM), it is urgently required to find alternative biomarkers to predict CLNM in PTC patients, which is the main purpose of this study.RNA-sequencing datasets and clinical data of 506 patients with thyroid carcinoma from the Cancer Genome Atlas (TCGA) database were downloaded and analyzed to identify differentially expressed miRNAs (DEMs), which can independently predict CLNM in PTC. A nomogram predictive of CLNM was developed based on clinical characteristics and the identified miRNAs. Receiver operating characteristics curves were drawn to evaluate the predictive performance of the nomogram. Bioinformatics analyses, including target genes identification, functional enrichment analysis, and protein-protein interaction network, were performed to explore the potential roles of the identified DEMs related to CLNM in PTC.A total of 316 PTC patients were included to identify DEMs. Two hundred thirty-seven (75%) PTC patients were randomly selected from the 316 patients as a training set, while the remaining 79 (25%) patients were regarded as a testing set for validation. Two DEMs, miRNA-146b-3p (HR: 1.327, 95% CI = 1.135-1.551, P = .000) and miRNA-363-3p (HR: 0.714, 95% CI = 0.528-0.966, P = .029), were significantly associated with CLNM. A risk score based on these 2 DEMs and calculating from multivariate logistic regression analysis, was significantly lower in N0 group over N1a group in both training (N0 vs N1a: 2.04 ± 1.01 vs 2.73 ± 0.61, P = .000) and testing (N0 vs N1a: 2.20 ± 0.93 vs 2.79 ± 0.68, P = .003) sets. The nomogram including risk score, age, and extrathyroidal extension (ETE) was constructed in the training set and was then validated in the testing set, which showed better prediction value than the other three predictors (risk score, age, and ETE) in terms of CLNM identification. Bioinformatics analyses revealed that 5 hub genes, SLC6A1, SYT1, COL19A1, RIMS2, and COL1A2, might involve in pathways including extracellular matrix organization, ion transmembrane transporter activity, axon guidance, and ABC transporters.On the basis of this study, the nomogram including risk score, age, and ETE showed good prediction of CLNM in PTC, which has a potential to facilitate individualized decision for surgical plans.

Background: Parathyroidectomy (PTX) has been demonstrated as an effective treatment for patients with secondary hyperparathyroidism (SHPT) of renal origin. However, severe hypocalcemia, called hungry bone syndrome (HBS), is a common complication following PTX in these patients and can lead to poor clinical outcomes, even death. Therefore, exploring risk factors for HBS and establishing a prediction nomogram allow intensive monitoring and prompt treating this postoperative complication, which is the main purpose of this study. Methods: From October 2016 to October 2018, PTX with autotransplantation (PTX thorn AT) procedures were performed in 131 patients with SHPT of renal origin by a surgeon and his team in the Thyroid and Parathyroid Surgery Center, West China Hospital, Sichuan University, China. After applying the inclusion and exclusion criteria, a total of 114 patients were enrolled for analyses in this study. Comprehensive data including preoperative, intraoperative, and postoperative variables were prospectively collected and retrospectively analyzed. The univariate and multivariate logistic regression analyses with internal validation by bootstrapping were used to confirm independent risk factors for postoperative HBS. The nomogram was developed based on the statistical analysis results. Receiver operator characteristic (ROC) curves were drawn to compare the prediction performance among different predictors. Results: The occurrence of postoperative HBS was 76.3% (87 out of 114 patients) in this study. Univariate analysis showed that preoperative intact parathyroid hormone (iPTH), serum alkaline phosphatase, bone-specific alkaline phosphatase (bone-ALP) were significantly higher in HBS group than those in non-HBS group, while preoperative corrected serum calcium and albumin were significantly lower in HBS group than those in non-HBS group. Total weight of resected parathyroid glands was significantly heavier in HBS group versus non-HBS group. Multivariate logistic regression analysis with internal validation by bootstrapping demonstrated preoperative iPTH, bone-ALP, preoperative corrected serum calcium, and total weight of resected parathyroid glands were independently associated with postoperative HBS. The nomogram including the abovementioned four independent predictors was constructed and showed better prediction performance than the other four predictors in terms of postoperative HBS. Conclusions: On the basis of this study, we found higher preoperative iPTH level, higher bone-ALP level, heavier total weight of resected parathyroid glands, and lower preoperative corrected serum calcium level were independent predictors of postoperative HBS in patients with SHPT of renal origin. The nomogram can expediently, accurately, and objectively predict the risk of postoperative HBS in individual patient with SHPT of renal origin. (C) 2020 Elsevier Inc. All rights reserved.

RATIONALE:Recurrence of papillary thyroid carcinoma (PTC) usually requires a second operation, which carries a high complication rate, especially if central neck dissection (CND) is necessary. Recurrent PTC from pyramidal lobe is a rare entity, which is mainly due to non-standardized operation. However, literature on this topic is limited.PATIENTS CONCERNS:Here, we present a case of a 46-year-old woman with the recurrence of PTC from the thyroid pyramidal lobe (PL) following two thyroid operations.DIAGNOSES:The final pathological result revealed recurrent PTC from the residual pyramidal lobe tissue.INTERVENTIONS:The resection of the residual PL, the pretracheal nodes and the Delphian nodes plus intraoperative neuromonitoring (IONM) were performed, followed by TSH suppression therapy.OUTCOMES:After two previous operations, the recurrent PTC from the residual pyramidal lobe tissue was completed resected. Until the latest follow-up, the patient had an excellent response to the third intervention.LESSONS:Complete excision of the PL is mandatory in patients with PTC if thyroid surgery was indicated, considering the potential risk of recurrence from the PL and the high incidence of multifocality of PTC.

甲状旁腺功能低下是甲状腺术后最常见的并发症之一,如何有效降低其发生率一直是甲状腺外科领域研究的重点.2015年7月,中国医师协会外科医师分会甲状腺外科医师委员会(CTA)发表了《甲状腺手术中甲状旁腺保护专家共识》(以下简称“《共识》”)[1-3],得到了业界的广泛认可.然而在该共识的应用过程中反映出它的一些不足,为了进一步更新及完善甲状旁腺保护的相关知识,通过回顾大量甲状旁腺领域的相关文献,以及近年来对专家共识中的一些推荐进行的循证研究成果,发现围手术期多种因素可能与甲状腺手术后甲状旁腺功能低下有关.因此,2018年10月,CTA、中华医学会外科学分会甲状腺及代谢外科学组及中国研究型医院学会甲状腺疾病专业委员会发表了《甲状腺围手术期甲状旁腺功能保护指南(2018版)》(以下简称“《指南》”)[4],该指南对《共识》中的内容进行了补充及拓展,增加内容主要涉及甲状腺术前管理、术中甲状旁腺保护“1 +X+1”总原则、纳米炭再次手术中的应用、术中甲状旁腺的快速确认、术后甲状旁腺功能低下的治疗等.笔者将围绕上述内容逐一进行解读.

Minimally invasive surgery has gained increasing acceptance over the last few years, which has expanded to pancreaticoduodenectomy. Laparoscopic pancreaticoduodenectomy has been determined to be a feasible, safe, and effective procedure in an experienced surgeon's hands, but the adaptations to the clumsy instruments are needed. The improved dexterity of the Da Vinci robotic system provides a good opportunity to perform this challenging procedure in the minimally invasive context. The aim of this study was to share our preliminary experience of totally robotic pancreaticoduodenectomy. From April 2015 to August 2015, four patients were selected to undergo totally robotic pancreaticoduodenectomy in the Department of Pancreatic Surgery, West China Hospital, Sichuan University, China. The demographic characteristics, perioperative details, and pathological results were retrospectively reviewed. One female and two male patients underwent totally robotic pancreaticoduodenectomy, while another male patient underwent robotic total pancreatectomy due to the severe atrophy of pancreatic body and tail. The mean age of the four patients was 56.8 years. The average operation time and intraoperative blood loss were 563 min and 228 mL, respectively. No one needed blood transfusion, conversion to open pancreaticoduodenectomy, or postoperative analgesia. The postoperative courses of these patients were uneventful. The mean postoperative hospital stay was 10 days. No one required to be readmitted, and there was no death within 30 days following the surgery. Final pathologic examinations revealed one malignant pancreatic ductal adenocarcinoma, and three benign lesions. Based on this initial study, robotic pancreaticoduodenectomy is safe and feasible, with acceptable oncological outcomes for highly selected patients in experienced surgeons' hands. However, concerns such as long-term outcomes, cost-effectiveness analysis, and learning curve analysis should be fully demonstrated before the popularization of this challenging procedure.

objective To compare the short-term efficacy of laparoscopic pancreaticoduodenectomy (LPD) versus open pancreaticoduodenectomy (OPD). Methods A total of 30 consecutive patients between October 2010 and October 2014 underwent LPD. Thirty patients receiving OPD during the same period were recruited for comparison. Results The patients in LPD group had longer operative time [(519.0 ±86.0) min vs. (321.0 ±78.0) min, P<0.001], less intraoperative blood loss [225.0 mL (quartile: 187.0-400.0) vs. 490.0 mL (quartile: 345.0-555.0), P<0.001] and faster diet recover [(5.9 ± 1.8) d vs. (9.2±4.1) d, P<0.001] when compared to those in OPD group. There were fewer cases in LPD group to ICU for further care (13/43.3%vs. 22/73.3%, P<0.05) and fewer cases received postoperative analgesia (11/36.7% vs. 21/70.0%, P<0.05). The oncological outcome was similar between the two groups. Conclusions LPD is not only feasible technically and safe but also less blood loss, less need for ICU and analgesia as well as faster diet recovery. R0 resection rate and number of lymph node retrieved were same between the two groups.

Objective To investigate the safety of the laparoscopic pancreaticoduodenectomy (LPD) in 70 years of age or older patients.Methods The retrospective cohort study was conducted.The clinicopathological data of 40 patients (age ≥70 years old) who underwent pancreaticoduodenectomy in the West China Hospital of Sichuan University between January 2012 and December 2016 were collected.Twenty patients undergoing LPD were allocated into the LPD group,and 20 receiving open pancreaticoduodenectomy (OPD) who were selected by random number table during the same period were allocated into the OPD group.Observation indicators included:(1) intraoperative situations;(2) postoperative situations;(3) follow-up situation.Follow-up using outpatient examination and telephone interview was performed to detect the patients' survival after discharge and tumor recurrence and metastasis up to March 2017.Measurement data with normal distribution was represented as x±s,and comparison between groups were evaluated with the t test.Measurement data with skewed distribution were described as median (range) and comparison between groups was analyzed using the nonparametric test.Comparison of count data was analyzed using the chi-square test.Comparison of ranked data was analyzed by non parametric test.Results (1) Intraoperative situations:1 patient in the LPD group was converted to open surgery,with a conversive rate of 5.0％ (1/20).Operative time and volume of intraoperative blood loss were (463 ± 10) minutes,210.5 mL (152.5-300.0 mL) in the LPD group and (332± 25) minutes,420.0 mL (350.1-493.8 mL) in the OPD group,showing statistically significant differences between the 2 groups (t =5.48,Z =-3.98,P＜0.05).Cases with intraoperative blood transfusion and pylorus preservation were respectively 4,14 in the LPD group and 6,10 in the OPD group,showing no statistically significant difference between the 2 groups (x2=0.53,1.67,P＞0.05).The results of intraoperative rapid frozen pathological examination showed negative margin of the 40 patients.(2) Postoperative situations:cases in ICU,cases with postoperative analgesia,time for out-of-bed activity,time to anal exsufflation and time for intake were 17,7,(2.2±0.7)days,(4.2± 0.9)days,(4.8±0.7)days in the LPD group and 6,15,(3.6±0.8)days,(5.7±0.9)days,(7.1 ± 2.7)days in the OPD group,showing statistically significant differences between the 2 groups (x2 =12.34,6.47,t=-6.18,-6.55,-3.65,P＜0.05).Pancreatic fistula,delayed gastric emptying (Grade B),postoperative bleeding (Grade B),biliary fistula,pulmonary infection,intestinal obstruction,wound infection,reoperation and major complication were respectively detected in 2,3,1,1,3,1,0,2,3 patients of the LPD group and 2,4,1,1,4,1,2,3,4 in patients of the OPD group,showing no statistically significant difference between the 2 groups (x2 =0.00,0.17,0.00,0.00,0.17,0.00,2.11,0.23,0.17,P＞0.05).Results of postoperative pathological examination showed that duodenal adenocarcinoma,ampullary carcinoma,lower bile duct carcinoma,pancreatic ductal adenocarcinoma and pancreatic cystic tumor were respectively detected in 8,2,5,3,2 patients of the LPD group and 10,2,4,2,2 patients of the OPD group,showing no statistically significant difference between the 2 groups (x2 =0.53,P＞0.05).Duration of postoperative hospital stay in the LPD and OPD groups were (19± 13) days and (15±7) days,respectively,showing no statistically significant difference between the 2 groups (t =1.28,P＞ 0.05).Results of postoperative oncology showed that tumor diameter,number of lymph node dissected,number of positive lymph nodes,cases with negative margin,cases in T1N0M0,T2N0M0,T3N0M0,T3N1M0,T4N0M0,T4N1M0 of TNM staging were respectively (2.4±0.7)cm,15.4±2.3,2,20,2,7,8,2,1,0 in the LPD group and (2.8±0.9)cm,14.4±2.5,3,20,1,8,5,2,3,1 in the OPD group,with no statistically significant difference between the 2 groups (t =-1.64,1.32,x2 =0.23,0.00,Z =-0.69,P＞ 0.05).(3) Follow-up situation:1 patient died respectively in both groups within the postoperative 30 days.Thirty-eight patients were followed up for 1-26 months,with a median time of 14 months.During follow-up,2 patients had tumor recurrence and 1 died of myocardial infarction in the LPD group;3 had tumor recurrence and 1 died of tumor recurrence in the OPD group.Conclusion LPD in 70 years of age or older patients is not only safe and feasible,but also significantly reduce volume of intraoperative blood loss and demand of analgesia,as well as quickly resume normal diet and activities.

Laparoscopic pancreaticoduodenectomy (LPD), an advanced minimally invasive technique, has demonstrated advantages to open pancreaticoduodenectomy (OPD). However, this complex procedure requires a relatively long training period to ensure technical proficiency. This study was therefore designed to analyze the learning curve for LPD.

AIM To identify the possible predictors of early complications after the initial intervention in acute necrotizing pancreatitis. METHODS We collected the medical records of 334 patients with acute necrotizing pancreatitis who received initial intervention in our center. Complications associated with predictors were analyzed. RESULTS The postoperative mortality rate was 16% (53/334). Up to 31% of patients were successfully treated with percutaneous catheter drainage alone. The rates of intra-abdominal bleeding, colonic fistula, and progressive infection were 15% (50/334), 20% (68/334), and 26% (87/334), respectively. Multivariate analysis indicated that Marshall score upon admission, multiple organ failure, preoperative respiratory infection, and sepsis were the predictors of postoperative progressive infection (P < 0.05). Single organ failure, systemic inflammatory response syndrome upon admission, and C-reactive protein level upon admission were the risk factors of postoperative colonic fistula (P < 0.05). Moreover, preoperative Marshall score, organ failure, sepsis, and preoperative systemic inflammatory response syndrome were the risk factors of postoperative intra-abdominal bleeding (P < 0.05). CONCLUSION Marshall score, organ failures, preoperative respiratory infection, sepsis, preoperative systemic inflammatory response syndrome, and C-reactive protein level upon admission are associated with postoperative complications.

Background: While an increasing number of open procedures are now routinely performed laparoscopically or robotically, minimally invasive pancreaticoduodenectomy (MIPD) remains one of the most challenging operations in abdomen. The aim of this study is to evaluate the current status and development of MIPD.Methods: Embase, Medline, and PubMed databases were searched to identify studies up to and including Feb 2016 using the keywords "laparoscopic", or "laparoscopy", or "hand-assisted", or "minimally invasive", or "robotic", or "da vinci" combined with "pancreaticoduodenectomy", or "duodenopancreatectomy", "Whipple", or "pancreatic resection". Articles written in English with more than 10 cases were included for review.Results: Thirty-two articles representing 2209 patients were included for review. The weighted average operative time and intraoperative blood loss was 427.3 min and 289.4 mL respectively. A total of 375 patients required conversion to open pancreaticoduodenectomy (OPD), with an overall conversion rate of 17.8%. The postoperative severe complications (the ClavieneDindo Classification >= III) occurred in 3.8%-33.0% patients, with an overall severe morbidity of 14.3%. Particularly, the overall incidence of clinically significant postoperative pancreatic fistula (POPF) was 8.0%. There were 26 perioperative death cases in total, with an overall postoperative mortality rate of 2.3%. The weighted average number of collected lymph nodes was 17.9, and R0 resection ranged from 60.0% to 100.0%. Comparisons between MIPD and OPD showed that MIPD increased operative time, decreased intraoperative blood loss and shortened the length of hospital stay, but the overall morbidity and mortality were comparable.Conclusions: MIPD is technically feasible and safe in highly selected patients and can offer acceptable oncological outcomes. But concerns such as long-term outcomes, cost-effectiveness analysis, and learning curve analysis should be fully demonstrated before the popularization of this challenging procedure. (C) 2016 IJS Publishing Group Ltd. Published by Elsevier Ltd. All rights reserved.

A growing body of evidence has supported the benefits of laparoscopic splenectomy (LS) for hypersplenism due to liver cirrhosis. With the increased proportion of elderly persons worldwide, it is necessary to investigate the risks and benefits of LS in elderly liver cirrhotic patients. From September 2003 to March 2012, LS and open splenectomy (OS) were performed for 21 (Group 1) and 19 (Group 3) patients, respectively, all of whom were 65 years of age and older; in addition, 39 patients who were <65 years old were treated with LS and referred to as Group 2 .Data (i.e., demographic characteristics and preoperative, intraoperative, and postoperative information) were retrospectively collected. Between-group comparisons were performed for the above-mentioned data. Compared with the patients in Group 3, the patients in Group 1 required longer operative times, fewer transfusions, less intensive care, a shorter postoperative course, and a shorter time to the first oral intake, and they had less blood loss and fewer postoperative short-term complications. During the follow-up period, compared with the preoperative status, significant changes in hemoglobin, leukocyte, platelet, and albumin levels were observed in all groups, whereas changes in the total BILirubin (BIL), aspartate aminotransferase (AST), and alanine aminotransferase (ALT) levels were inconspicuous. Patients >65 years of age with hypersplenism caused by liver cirrhosis can safely undergo LS.

Introduction: Extrapancreatic necrosis (EPN) alone, i.e., in the absence of pancreatic parenchyma necrosis has gradually come to be regarded as a separate entity of acute necrotizing pancreatitis (ANP). However, data regarding the prognostic significance of EPN are quite limited, and the outcomes of interventions for patients with EPN alone are not well elucidated. The aim of this study was to explore the differences in the outcomes of patients with EPN alone and patients with both the pancreatic parenchyma and extrapancreatic necrosis (combined necrosis).Methods: From January 2009 to December 2013, a total of 334 patients with ANP who had received interventions in the West China Hospital in China were included. Based on the extent of necrosis as assessed with contrast-enhanced CT, the patients were divided into Group 1 (n = 285) in which the necrosis involved both the pancreatic parenchyma and extrapancreatic tissues (combined necrosis) and Group 2 (n = 49) in which the necrosis involved only the extrapancreatic tissues. Additionally, Group 3 included 443 patients with interstitial pancreatitis who were also included in the analyses. The demographic characteristics, support treatment information, organ failure information, infection necrosis, persistent systemic inflammatory response syndrome (SIRS) in the first week of onset, CT severity index, and intervention types, as well as the postoperative stay lengths, ICU utility, and complications were collected and compared.Results: Compared with the patients in Group 1, the patients in Group 2 suffered less persistent SIRS in the first week of onset (12/24.5% vs. 145/50.9%; P < 0.05), less persistent organ failure (6/12.2% vs. 95/33.3%; P < 0.05), less persistent multiple organ failure (3/6.1% vs. 67/23.5%; P < 0.05), and less bacteremia (5/10.2% vs. 107/37.5%; P < 0.001). The intervention types were significantly different between the two groups (P < 0.001); initial open necrosectomy was performed in 174/61.6% and 8/16.3% of the patients in Groups 1 and 2, respectively, and initial percutaneous catheter drainage (PCD) was performed in 73/25.6% and 29/59.2% of the patients in the two respective groups. Second open necrosectomies following PCD were required in 61/83.5% and 9/31.0% of the patients in Groups 1 and 2, respectively (P < 0.001). A greater number of patients in Group 1 were diagnosed with infected necrosis (204/71.6% vs. 10/20.4%; P < 0.001) and had to be sent to the ICU for further postoperative care (221/77.5% vs. 23/46.9%; P < 0.001). The postoperative stay was longer for Group 1 (median: 43.0 vs. 26.5 days; P < 0.001). Residual necrotic tissue or abscess was the most common postoperative complication in both groups. The mortality was higher in Group 1 (52/18.2% vs. 1/2.1%; P < 0.05). Compared with the patients in Group 2, the patients with interstitial pancreatitis exhibited milder courses and better outcomes. Subgroup comparisons with Group 1 indicated that early multiple organ failure was significantly associated with higher mortality.Conclusion: The patients with EPN alone exhibited significantly better prognoses than those with combined necrosis, and EPN alone should be regarded as a separate group of acute necrotizing pancreatitis. Open necrosectomy can be avoided in the majority of patients with EPN alone, who receive PCD as the initial first intervention. Copyright (C) 2015, IAP and EPC. Published by Elsevier India, a division of Reed Elsevier India Pvt. Ltd. All rights reserved.