Cai Xiujun

Application of binding pancreatogastrostomy in laparoscopic central pancreatectomy.

BACKGROUND The feasibility of binding pancreaticogastrostomy in laparoscopic central pancreatectomy is not known. METHODS In October 2011, a female patient with a pancreatic neck mass received laparoscopic central pancreatectomy with binding pancreaticogastrostomy. RESULTS The operation was successful. No complications occurred. The operative time was 210 min. Blood loss was 120 ml. On day 11 after the operation, the patient was discharged. The postoperative pathological result showed a 2 × 2 × 2-cm solid pseudopapillary tumor of the pancreas with intrapancreatic infiltration. The surgical margin was negative. CONCLUSIONS Laparoscopic central pancreatectomy with binding pancreaticogastrostomy might be feasible, facilitating further study in laparoscopic pancreatoduodenectomy. TRIAL REGISTRATION This study was waived from trial registration because it is a retrospective analysis of medical records.BackgroundThe feasibility of binding pancreaticogastrostomy in laparoscopic central pancreatectomy is not known.MethodsIn October 2011, a female patient with a pancreatic neck mass received laparoscopic central pancreatectomy with binding pancreaticogastrostomy.ResultsThe operation was successful. No complications occurred. The operative time was 210 min. Blood loss was 120 ml. On day 11 after the operation, the patient was discharged. The postoperative pathological result showed a 2 × 2 × 2-cm solid pseudopapillary tumor of the pancreas with intrapancreatic infiltration. The surgical margin was negative.ConclusionsLaparoscopic central pancreatectomy with binding pancreaticogastrostomy might be feasible, facilitating further study in laparoscopic pancreatoduodenectomy.Trial registrationThis study was waived from trial registration because it is a retrospective analysis of medical records.

A predictive model for survival of gallbladder adenocarcinoma

BACKGROUND Gallbladder cancer (GBC) is a life-threatening disease with a poor prognosis worldwide. Although several risk factors for survival have been identified, an ideal model for predicting prognosis has still not been developed due to the low incidence of GBC. This study aims to solve this dilemma by attempting to develop an efficient survival prediction model for GBC. METHODS This is a retrospective study. From January 2009 to June 2016, 164 patients with a confirmed histological diagnosis of gallbladder adenocarcinoma were enrolled in this study. The cohort was randomly divided into two cohorts, the development cohort (n = 110) and validation cohort (n = 54). On the basis of the risk factors identified in the development cohort, a nomogram-based predictive model (P-risk Plus), composed of carbohydrate antigen 199 and pathological characteristics, was established for prognosis. RESULTS In this model, the calibration curves for the 1-, 2-, and 3-year survival probabilities were well-matched with the actual survival rates. In addition, the highest C-index and best decision curve analysis were able to be obviously determined. Meanwhile, the P-risk Plus model result yielded a better fit for survival between the development and validation groups. CONCLUSION Compared with conventional tumor stages, our nomogram-based P-risk Plus model for gallbladder adenocarcinoma has a better predictive capacity and thereby has a better potential to facilitate decision-making clinically.

Hepatic regeneration by associating liver partition and portal vein ligation for staged hepatectomy (ALPPS) is feasible but attenuated in rat liver with thioacetamide-induced fibrosis

Background: The associating liver partition and portal vein ligation for staged hepatectomy (ALPPS) procedure promotes the proliferation of the future liver remnant, but evidence to support the feasibility of ALPPS in livers with fibrosis is needed. Therefore the aim of this study was to establish a fibrotic ALPPS model in the rat to compare the capacity of regeneration in the remnant liver with or without fibrosis. Methods: In our study we first established a thioacetamide‐induced fibrotic ALPPS model in rats. Then the ALPPS‐induced regenerative capacities of normal and fibrotic liver were compared in this animal model. In addition, markers of regeneration, including the proliferative index and cyclin D1 and proliferating cell nuclear antigen levels, as well as various indicators of liver function were determined to evaluate the quality of the hepatic regeneration. Results: Compared with that of the sham group (opening of the peritoneal cavity with no further operative manipulation), the proliferation of the future liver remnant in fibrotic rat liver after the ALPPS procedure was increased on postoperative days 1, 2, and 5 (P < .039 each). In addition, the proliferative response was greater in the ALPPS group than in the ligation group subjected only to portal vein ligation of the left lateral, left middle, right, and caudate lobes (P = .099, P = .006, and P = .020 on postoperative days 1, 2, and 5, respectively). In contrast, the ALPPS‐induced regenerative capacity in the fibrotic rat livers was attenuated compared with that in the normal liver on postoperative days 1, 2, and 5 (P < .031 for each) after stage I and on postoperative day 5 after stage II of the ALPPS procedure (P < .005). This attenuated the recovery of liver function, and the greater mortality rate indicated that functional proliferation was either delayed or not as extensive in the fibrotic rat livers. Conclusion: Through establishing a rat model of thioacetamide‐induced liver fibrosis, we found that ALPPS‐derived liver regeneration was present and feasible in fibrotic livers, but this effect was attenuated compared with that in normal liver.

Surgical Intervention for Hepatocellular Carcinoma with Bile Buct Thrombi

Objective: To summarize the experience of surgical intervention for hepatocellular carcinoma (HCC) with bile duct thrombi (BDT), and to evaluate the influence on prognosis.Methods: From 1994 to 2002, 15 patients with HCC and BDT who underwent surgical intervention were retrospectively analyzed.Results: The operative procedures included hepatectomy with removel of BDT (n=7), hepatectomy combined with extrahepatic bile duct resection (n=4), thrombectomy through choledochotomy (n=3), piggy back orthotopic liver transplantation (n=1). The 1- and 3-year survival rates were 73.3% and 40%, respectively. Two patients survived over 5 years.Conclusion: Surgical intervention was effective for patients with HCC and BDT. Operation for recurrent lesion can prolong survival period. Liver transplantation is a new treatment worthy of further investigation.