Background: Pancreatic fistula after distal pancreatectomy is a common and potentially lethal complication. The optimal closure method for the pancreatic remnant during minimally invasive distal pancreatectomy (MDP) remains unclear. Methods: Data of consecutive patients who underwent MDP in our institution between July 2018 and June 2021 were collected. The outcomes of MDP with stapler and hand-sewn closure were compared. The primary outcome was clinically relevant postoperative pancreatic fistula (CR-POPF) per the International Study Group of Pancreatic Surgery definition. Results: Of the 384 patients (stapler closure, 339; hand-sewn closure, 45) enrolled, 249 developed CR-POPF (grades B and C: 242 and 7 patients, respectively). The rates of grade B and grade C POPF in the stapler group were similar to the corresponding rates in the hand-sewn group (64.6% and 1.5% vs 51.1% and 4.4%, P = .078 and P = .223, respectively). No differences between the stapler and hand-sewn groups were observed regarding the median operation time (207 vs 222 minutes, P = .139), incidence of major complications (16.5% vs 20.0%, P = .559), and mortality (0.2% vs 0%, P = 1.000). The independent risk factors of CR-POPF were abdominal abscess, prolonged operation time, and transection site (P = .004, .006, and .001, respectively). Conclusion: The incidence and severity of CR-POPF by stapler closure of the pancreatic stump were comparable to those associated with hand-sewn closure in MDP in this retrospective cohort. Randomized controlled trials are needed to verify this finding.

BackgroundAnastomotic hemangioma is a rare subtype of capillary hemangioma primarily found in the genitourinary tract. We present a case of a patient with an anastomotic hemangioma located in the retroperitoneal space; then, we explore and summarize the imaging features from previously reported cases for accurate diagnosis.Case presentationA 57-year-old woman complained of left lower back pain. Contrast-enhanced ultrasound revealed a hypoechoic mass with “slow-in and slow-out” enhancement. Abdominal CT scan displayed a well-defined, round soft tissue mass in the right retroperitoneal region with obvious enhancement. MRI indicated low signal on T1-weighted imaging, high signal on T2-weighted imaging and diffusion-weighted imaging, and progressive enhancement after enhancement. Surgical removal of the tumor was performed. Histopathological examination exhibited a distinct tumor border with interconnected blood vessels and a cavity lined by a single layer of cubic endothelial cells. Immunohistochemistry confirmed the presence of CD31[+] and CD34[+]. The final pathological diagnosis was anastomotic hemangioma. No recurrence was observed during a 40-month follow-up.ConclusionRetroperitoneal anastomotic hemangioma is a rare and benign neoplasm that may be misdiagnosed as ectopic pheochromocytoma or angiosarcoma. This case report presents and analyzes the imaging characteristics of a series of retroperitoneal anastomotic hemangiomas, which can be valuable for future diagnoses and help prevent unnecessary surgeries.

BackgroundPrevious studies have shown that cortical superficial siderosis (cSS) can increase hematoma volume and predict poor outcomes following primary intracerebral hemorrhage (ICH).ObjectiveWe aimed to determine whether a large hematoma volume was the essential factor contributing to worse outcomes of cSS.MethodsPatients with spontaneous ICH underwent a CT scan within 48 h after ictus. Evaluation of cSS was performed using magnetic resonance imaging (MRI) within 7 days. The 90-day outcome was assessed using the modified Rankin Scale (mRS). In addition, we investigated the correlation between cSS, hematoma volume, and 90-day outcomes using multivariate regression and mediation analyses.ResultsAmong the 673 patients with ICH [mean (SD) age, 61 (13) years; 237 female subjects (35.2%); median (IQR) hematoma volume, 9.0 (3.0–17.6) ml], 131 (19.5%) had cSS. There was an association between cSS and larger hematoma volume (β = 4.449, 95% CI 1.890–7.009, p < 0.001) independent of hematoma location and was also related to worse 90-day mRS (β = 0.333, 95% CI 0.008–0.659, p = 0.045) in multivariable regression. In addition, mediation analyses revealed that hematoma volume was an essential factor mediating the effect of cSS on unfavorable 90-day outcomes (proportion mediated:66.04%, p = 0.01).ConclusionLarge hematoma volume was the major charge of directing cSS to worse outcomes in patients with mild to moderate ICH, and cSS was related to a larger hematoma in both lobar and non-lobar areas.Clinical trial registrationhttps://clinicaltrials.gov/ct2/show/NCT04803292, identifier: NCT04803292.

With the dawn of organ donation after a citizen's death in China, the use of split-liver transplantation (SLT) can effectively increase the source of donor liver, reduce the waiting time for organ transplantation in patients, and particularly solve the problem of organ shortage in children. In recent years, many transplantation centers have been performing SLT to varying degrees and efficacy. At the current stage, the experiences of countries with advanced transplantation techniques should be used to establish an SLT consensus that is suitable for China to further increase the ratio and efficacy of SLT. In this paper, we combined expert experiences to generate an SLT expert consensus that included donor and donor liver evaluation, recipient selection criteria, donor and recipient matching, selection of splitting form and tools, blood vessels and bile ducts dissection and allocation, perioperative management of SLT, and organ allocation.& COPY; 2020 The Third Affiliated Hospital of Sun Yat-sen University. Publishing Services by Elsevier B. V. on behalf of KeAi Communications Co., Ltd. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).

Objective To explore the cause,treatment and prognosis of delayed massive haemorrhage (DMH) after pancreatic resection.Method Clinical data of 1554 patients undergoing pancreatectomy in our hospital from Aug 2003 to Aug 2013 were retrospectively analyzed.Results 16 patients suffered from DMH,including 13 patients who had undergone pancreaticoduodenectomy,and 3 patients who had had resection of pancreatic body and tail.Gastrointestinal haemorrhage occurred in 6 patients,intra-abdominal haemorrhage occurred in 10 patients,respectively.Reoperations were performed in 11 patients,transcatheter arterial embolization (TAE) undertaken in 2 patients,and endoscopic treatment in 3 patients.10 patients recovered after treatment,6 patients (6/16) died.Conclusions The mortality of DMH after pancreatic surgery is high.Postoperative pancreatic leak and gastrointestinal stress ulcer are the most possible risk factors,intra-abdominal arterial haemorrhage is the main cause of death.

BACKGROUND:Multidrug resistance (MDR) is a serious problem in chemotherapy and is one of the main reasons for a poor outcome of gastric cancer. Study on the key proteins in multidrug resistance is necessary for the treatment of gastric cancer. METHODS:The expression of ToPo II, MRP and GST-π in 119 gastric cancers was retrospectively examined, and the results were analyzed in correlation with clinicopathological data. ToPo II negative, MRP positive and GST-π positive were regarded as three risk factors which may be associated with chemotherapy resistance and poor prognosis. Patients were divided into two groups: high-risk group (≥2 risk factors) and the low-risk group (<2 risk factors), and the tumor recurrence and patients' survival time of the two groups were also analyzed. RESULTS:The positive rates of ToPo II, MRP and GST-π were 73.9%, 42.9% and 51.3%, respectively. The positively correlation between the expression of MRP and GST-π had been found. A significant correlation was shown between ToPo II expression and the level of differentiation. Significant differences with GST-π expression were also found in relation to the sex and differentiation. In the high-risk group, the 3-year survival rate of patients with/without chemotherapy were 62.1% and 52.0%, 5-year survival rates were 44.8% and 40.0%, but the difference was not statistically significant (P>0.05). In the low-risk group, the 3-year survival rate of patients with/without chemotherapy were 81.2% and 51.5%, 5-year survival rates were 71.9% and 45.5%, and the difference was statistically significant (P<0.05). CONCLUSIONS:Combined detection of MDR-related proteins ToPo II, MRP and GST-π may be prospectively valuable for postoperative individualized chemotherapy, and further predict the outcomes of gastric cancer patients.

Biliary infection, including bacteria and cytomegalovirus (CMV), can induce inflammatory response and lead to bile duct damage after liver transplantation. This process may involve a major class of pattern recognition receptors-TLRs (Toll-like receptors). Stimulation of these receptors by pathogens (CMV, bacteria, etc.) in bile duct can induce the secretion of a series of cytokines/chemokines mainly via a TLR-2/4-MyD88-dependent pathway. Strategies for prevention and treatment of biliary infection, such as selective digestive decontamination (SDD) and preemptive therapy with gancyclovir and antibiotics are not so satisfactory. Statin, a HMG-CoA reductase inhibitor, have special anti-inflammatory abilities. They can inhibit the expression of TLR-4 and TLR-2, and block the signaling pathways of LPS (TLR-2/4), virus-encoded envelope proteins (TLR-2) and HSP70 (TLR-2/4), This process can lead to a reduction of effector cytokines/chemokines. In addition, statins can suppress the replication of CMV by reducing NF-kappaB binding activity. We hypothesized that statins can be useful for reducing infection evoked cholangiopathy after liver transplantation. We provide reliable evidence supporting the hypothesis and offer proposals for future application.

OBJECTIVETo study the clinical features and treatment of recurrent hepatocellular carcinoma after liver transplantation.METHODSClinical data of 95 patients with recurrent hepatocellular carcinoma (HCC) after liver transplantation from January 2003 to November 2005 were analyzed retrospectively.RESULTSDuring follow-up, 42 patients (43.2%) were diagnosed HCC recurrence. The predominant sites of recurrence were liver graft (32 cases), lung (21 cases), bone (7 cases). Tumor size, tumor distribution, liver cirrhosis, pre-transplant AFP level, tumor differentiation, macrovascular invasion were considered risk factors of both post-transplant survival and HCC recurrence in univariate analysis. Tumor distribution, tumor differentiation, macrovascular invasion were considered independent risk factors of both overall post-transplant survival and HCC recurrence in multivariate analysis. Intervention therapy and internal radiation of recurrent HCC could delay tumor progression and resection of recurrent HCC in selected patients can significantly prolong post-recurrence survival.CONCLUSIONSCarefully selection of HCC patients as candidates for liver transplantation can significantly reduce HCC recurrence. At the present stage, surgical resection of recurrent HCC is the best treatment method in selected patients.

BACKGROUND It is not certain whether Klatskin tumor should be a routine indication for orthotopic liver transplantation (OLT). This study was to summarize the indication and value of orthotopic liver transplantation for patients with Klatskin tumor. METHODS Forty patients with Klatskin tumors including 5 patients who had had liver transplantation (LTx) and 35 patients who had not undergone LTx (WLTx) from January 1992 to December 2003 were analyzed retrospectively. Their TNM stages were comparable in both groups. In the LTx group, 4 patients had Klatskin tumor including recurrent tumor after resection(1), and 1 cancerization from Carolis disease. Biliary duct anastomosis was made by Roux-en-Y choledochojejunostomy in 2, and end-to-end choledochocholedochostomy (C-C) in 3. RESULTS In the LTx group, the total resection rate and radical resection rate were both 100%. Four patients have been surviving for 48, 38, 21 and 5 months, respectively, except one died from bile leakage at day 40 after transplantation. All 4 survivors enjoyed good life without tumors at local and distant sites, even though 2 of these patients developed biliary stricture, which was soon resolved by radiological intervention. The 1-,3-year survival rates were both 80% in this group. The total resection rate and radical resection rate in the WLTx group were 63.0%(17/27)and 40.7%(11/27)and, the 1-, 3-, 5-year survival rates were 32.2%, 8.0%, 0%, respectively. There were significant differences between the two groups in radical resection rates and survival rates(P=0.016). CONCLUSIONS OLT is a good choice for patients with unresectable Klatskin tumor by routine modalities. The prognosis of patients undergoing OLT is encouraging.

目的评估肝移植治疗肝细胞癌(HCC)合并门静脉癌栓(PVTT)病人的临床疗效,探讨其临床应用价值.方法回顾性分析自1999年7月至2003年3月收治的24例施行肝移植的HCC合并PVTT病人(移植组)临床资料和生存情况.对照组分别选取同时期HCC合并PVTT行常规肝叶切除、门静脉癌栓取出术者(手术切除组,27例)和非手术治疗者(未手术组,59例).结果移植组手术死亡率(1个月内)为0;6个月、1年以及2年累积生存率分别为66.7%、29.5%和23.6%,均高于手术切除组的33.3%、22.2%和14.8%(P=0.0335)和非手术组的42.1%、24.4%和4.1%(P=0.0316);移植组的6个月、1年和2年无瘤生存率分别为51.5%、23.2%和0;随访期间肝外转移或肝内复发的总发生率为66.7%.结论现阶段HCC合并PVTT病人的肝移植治疗是一种有效的姑息性手术方式.

OBJECTIVES To explore the relation between tumor TNM of pancreatic cancer and treatment, and to summarize the experience in diagnosis and treatment of pancreatic cancer. METHODS The data on 321 patients with pancreatic cancer treated at our hospital between January 1990 and December 2000 were reviewed retrospectively. Radical resection and survival for various TNM stages were analyzed. RESULTS The rates of radical resection for stage I, stage II, stage III, stage IVA, and stage IVB were 100%, 100%, 82.6%, 12.3% and 2.1% respectively. The 1-, 3- and 5-year survivals of stage I, II were 73.3%, 40.0% and 30.0% respectively, and higher than those of other groups. CONCLUSIONS The patients with pancreatic cancer diagnosed early can undergo radical resection. The elevation of early diagnosis rate is significant for the improvement of survival.