Objective To explore the expression of EpCAM (epithelial cell adhesion molecule) in patients with intrahepatic cholangiocarcinoma(ICC) and explore its relationship with prognosis, recurrence and lymphatic metastasis.Methods Clinicopathological and prognostic data were retrospectively reviewed for 42 ICC patients undergoing surgery from January 2015 to December 2017. The expression level of EpCAM was detected by immunohistochemistry stain and the correlations between EpCAM and prognosis, recurrence and metastasis were analyzed.Results In 42 cases of ICC tumor tissue, proportion of EpCAM high expression group accounted for 85.7%(36/42). Among them, patients with a high expression level of EpCAM had a tumor recurrence rate of over 90.0% and EpCAM expression level was significantly correlated with lymphatic metastasis (r=0.356, P=0.021). In addition, Log-rank univariate survival analysis indicated that 3-year overall survival (30.6% vs.83.3%, χ²=4.043, P=0.044), 3-year disease-free survival (16.7% vs.66.7%, χ²=4.599,P=0.032), 5-year overall survival (22.2% vs.83.3%, χ²=6.355, P=0.012) and 5-year disease-free survival (11.1% vs. 66.7%,χ²=7.006,P=0.008) of ICC patients with a high expression level of EpCAM was significantly lower than those with a low expression level of EpCAM. Cox multivariate survival analysis revealed that expression level of EpCAM was an independent predictor for 3-year disease-free survival(P=0.030), 5-year overall survival(P=0.041) and 5-year disease-free survival(P=0.019) of ICC postoperative patients.The 3-year recurrence risk [HR=4.902, 95%CI(1.162, 20.679),P=0.030], 5-year mortality risk[HR=8.069, 95%CI(1.094, 59.532), P=0.041] and 5-year recurrence risk[HR=5.594, 95%CI(1.328, 23.558), P=0.019] of ICC patients with a high expression level of EpCAM were higher than those with a low expression level of EpCAM.Conclusion With a high expression level in ICC patients,EpCAM is associated with long-term postoperative survival, recurrence and lymphatic metastasis. It may become a potential molecular marker for assisting the early diagnosis and prognosis assessment of ICC. Also it serves as a predictor of tumor recurrence and metastasis of postoperative patients.

Objective To explore the prognostic impact of different gross pathological types of intrahepatic cholangiocarcinoma (ICC) and elucidate the relationship between different gross pathological types and clinical features.Methods For this retrospective case-control study, clinicopathological data were retrospectively reviewed for 660 ICC patients undergoing radical resection at 13 tertiary care hospitals in China from 2010 to 2020.A 1∶1 propensity score matching (caliper value: 0.02) was performed. Survival curves were plotted with Kaplan-Meier method and log-rank tests employed for survival analysis. χ² test was used for univariate analysis and P＜0.05 denoted significant statistical difference.Results After propensity score matching, significant statistical difference existed in prognosis between patients with mass ICC and those with peritubular infiltrative ICC (P＜0.05). For ICC patients in T1 stage, significant statistical difference existed in prognosis between patients with mass ICC and those with peritubular infiltrative ICC(P＜0.05). The differences were statistically significant(P＜0.05) when comparing region, age, stone history,Child-Pugh classification, abdominal pain, abdominal distension, jaundice, fever, neutrophil count, lymphocyte count, alanine aminotransferase (ALT), total bilirubin, total albumin, tumor location and tumor size in patients with mass ICC and peritubular infiltrative ICC; As for region, age, ALT and tumor size in patients with mass ICC and intraductal growth ICC, the differences were statistically significant (P＜0.05) when comparing the situation of mass-type ICC and intraductal growth-type ICC patients in terms of region, age, ALT and tumor size.Conclusion Compared with mass type, patients with peritubular infiltrative ICC have a better prognosis. The effectiveness of immunotherapy in patients with peritubular infiltrative ICC and the sensitivity of patients with mass ICC to targeted therapy may be further explored.

Objective To explore the clinical features of patients with hepatocellular carcinoma(HCC) by preoperative imaging examination and examine the proportion and risk factors of ICC or combined hepatocellular-cholangiocarcinoma (cHCC-ICC) patients by postoperative pathology.Methods All patients with preoperative HCC imaging features from Tongji Hospital and Tianyou Hospital between 2016 and 2021 were recruited. Univariate and multivariate Logistic regression analyses were employed for identifying the independent risk factors of HCC-like imaging features.Results A total of 2 402 patients with preoperative HCC imaging features were included. There were 111 patients(4.6%) with ICC(n=66) or cHCC-ICC (n=45) confirmed on pathological examination. Univariate and multivariate analyses revealed that females, alpha-fetoprotein (AFP)≤400 μg/L,CA19-9＞37 kU/L, viral-infected hepatitis, non/mild cirrhosis, low differentiation and nodules with the largest diameter ≤5 cm were the independent risk factors of HCC-like imaging patterns.Conclusion It is imperative to improve preoperative diagnostics for patients with high-risk factors of HCC-like imaging patterns.

Objective According to the Edition V WHO Classification of Tumors of Digestive System in 2019, intrahepatic cholangiocarcinoma (ICC) may be classified into large duct and small duct types. There is a lack of clinical knowledge about two type of ICC. The aim of this study was to explore the clinicopathological characteristics of different subtypes of ICC and examine their correlation with treatment and prognosis.Methods Clinicopathological and prognostic data were retrospectively collected from 189 ICC cases from July 2012 to March 2022. And the differences in clinical history data between two types were evaluated. Univariate and multifactorial analyses were performed for identifying tumor-independent risk factors. Kaplan-Meier survival analysis was applied.Results Among them, 58 (30.7%) were of large duct type and 131 (69.3%) of small bile duct type. Comparison between groups indicated that small duct type had larger tumor size. And preoperative levels of blood total bilirubin, direct bilirubin and CA19-9 were significantly lower than those of large duct type. Survival analysis revealed that the prognosis of large duct type ICC was worse than that of small duct type (P＜0.05). Independent risk factor for prognosis of both small and large bile duct type ICC was TNM stage [HR=1.586, 95%CI(1.035, 2.432), P=0.034]; independent risk factors for prognosis of the overall ICC cohort were tumor number [HR=2.152, 95%CI(1.116, 4.152), P=0.022], tumor size [HR=1.104, 95%CI(1.007, 1.211), P=0.035], tissue type [HR=1.853, 95%CI(1.091, 3.149), P=0.023], TNM stage [HR=1.540, 95%CI(1.161, 2.042), P=0.003] and history of biliary stones [HR=2.279, 95%CI(1.333, 3.896), P=0.003].Conclusion ICC histologic staging has important prognostic implications for both tumor prognosis and tumor management. And pathologic assessment of lymph node metastasis also has important prognostic implications. Regional lymph node dissection should be performed according to the recommendations of American Joint Committee on Cancer (AJCC).

Patients with colorectal peritoineal metastases have poor prognosis. A definite diagnosis is usually confirmed at advanced stages. Imaging examination is a major diagnostic tool and the frequency of laparoscopic exploration has been rising gradually in recent years. Currently it is well-known that peritoneal metastasis is a locoreginal disease. And standard treatments include chemotherapy, cytoreductive surgery and hyperthermic intraperitoneal chemotherapy. And such an emerging modality as pressurized intraperitoneal aerosol chemotherapy is gaining popularity in clinical practices. Patient prognosis is generally decent after aggressive and appropriate interventions. The review summarized the research status and recent advances of disease characteristics, pathogenesis, diagnosis, evaluation systems, risk factors and managements of colorectal peritoineal metastases.

Objective To explore the role of preoperative liver stiffness measurement by transient elastography during perioperative period of hepatectomy.Methods Serial cases of hepatectomy performed at Tongji Hospital were retrospectively reviewed from September 2021 to December 2021. Liver stiffness was detected preoperatively by transient elastography. They were assigned into two groups of cirrhosis and control according to the critical value of 12 kPa of liver stiffness. The inter-group differences in perioperative conditions and postoperative complications were statistically analyzed. Then risk factors associated with postoperative complications were analyzed by logistic regression.Results Compared with control group(n=46), cirrhosis group(n=34) had higher levels of bilirubin [(15.19±10.23) vs. (10.74±5.85) μmol/L,P=0.029], alanine aminotransferase[(34.26±19.33) vs.(24.09±11.91) U/L, P=0.010] and aspartate aminotransferase [(39.71±19.57) vs. (24.26±11.26) U/L,P＜0.001], as well as lower levels of platelet[(140.10±77.93)×10⁹/L vs.(189.80±81.62)×10⁹/L,P=0.008]and albumin[(38.18±3.48) vs.(40.31±5.14) g/L,P=0.032].Cirrhosis group were more likely to undergo open surgery [61.8%(21/34) vs. 30.4%(14/46), P=0.005] with a higher rate of major complications[38.2%(13/34) vs. 2.2%(1/46),P＜0.001] and a longer postoperative hospital stay[(10.88±5.61) vs.(8.15±3.17) days,P=0.015].Logistic regression analysis indicated that LSM≥12 kPa[OR=1.069,95%CI(1.022,1.126),P=0.006] was an independent risk factor for major complications.Conclusion Liver stiffness value is an important indicator for evaluating perioperative condition of patients. And it is necessary to focus upon the complications of patients with LSM≥12 kPa after hepatectomy.

Surgery has been the most important radical option for intrahepatic cholangiocarcinoma (ICC). However, its postoperative recurrence rate remains high and the prognosis is poor. Adjuvant therapy is helpful to further improve the long-term survival of ICC patients. It is a research hotspot in the field of ICC. In recent years, with continuous developments of immunotherapy, targeted therapy, chemotherapy and local therapy, researchers have paid greater attention to the research of adjuvant therapy for ICC. This review summarized the latest research results and ongoing clinical trials of adjuvant therapy for ICC and discussed the roles of chemotherapy, radiotherapy, transcatheter arterial chemoembolization (TACE), targeted therapy and immunotherapy for ICC.

Intrahepatic cholangiocarcinoma (ICC) is a malignant liver tumor with an incidence secondary only to hepatocellular carcinoma (HCC). Radical surgical resection remains a sole curative option. It has the biological characteristics of both liver and biliary tract malignant tumors. There are still many outstanding controversies on number of resection margins, clinical significance of anatomical hepatectomy, whether or not combined vascular resection beneficial, correlation between lymph node dissection and prognosis, significance of lymph node dissection and preoperative decision-making, whether mini-invasive procedure ensured the safety and effectiveness of surgery and significance of comprehensive treatment during perioperative period. This review summarized several hot issues in surgery for ICC.

Intrahepatic cholangiocarcinoma (ICC) is one primary liver cancer derived from intrahepatic bile duct epithelial cells. With an insidious onset, its malignancy is high and efficacy remains poor. Radical resection represents a sole curative option for ICC. Selection of surgical approaches, resection scope and lymph node dissection are vital for improving the long-term prognosis of patients. Some locally advanced patients may achieve tumor down-staging through multi-dimensional conversion therapy to obtain an opportunity of surgical resection. Among them, precise targeted therapy based upon molecular typing has become a research hotspot in recent years. And there is a great potential for ICC transformation therapy. With rapid development and updating of concepts and techniques of surgery and conversion therapy for ICC, treatment mode has shifted to multidisciplinary protocols based upon surgery. However, some controversial issues should be resolved through multi-center and large-sample prospective studies. Clinical consensus helps to standardize the treatment protocols and improve the overall prognosis of patients.

Objective To evaluate the safety and feasibility of laparoscopic hepatic resection of caudate lobe.Methods From October 2017 to October 2022, a retrospective study was conducted for 34 patients undergoing simple caudate lobectomy. Based upon specific surgical approaches, they were assigned into two groups of laparoscopic caudate lobectomy (Lap, n=12) and open caudate lobectomy (open, n=22). The perioperative clinical data of two groups were compared.Results All surgical procedures were completed successfully. Baseline data of two groups were compared. No significant inter-group differences existed. Median values of operative duration [3.0(2.0,3.4) vs.3.8(2.7,4.4) h,P=0.027], occlusion time[31.5(15.0,56.3) vs.47.5(30.0,87.5) min,P=0.043] and intraoperative blood loss [125(35,200) vs. 250(175,300) mL, P=0.012] were significantly less in laparoscopic group than those in open group. Total bilirubin level(P=0.013) was significantly lower in Lap group than that in open group while albumin level was significantly higher in Lap group (P=0.018). And mean length of hospital stay differed significantly between two groups[8.0(6.0,10.0) vs. 11.0(7.8,14.3) day,P＜0.05].Conclusion With a better intraoperative view and mini-invasiveness, laparoscopic hepatic caudate lobe resection is both safe and feasible.

Cholangiocarcinoma is a malignant tumor originating from intrahepatic or extrahepatic bile duct. According to its anatomy, it is divided largely into intrahepatic cholangiocarcinoma (ICC) and extrahepatic cholangiocarcinoma (ECC). The incidence of ICC has been rising over the last decade. Because of concealing nature of ICC, most diagnosed patients have wasted the opportunity of operation and its high invasiveness renders resection and cure rates quite low. For resectable cases, surgical resection is perferred. Unoperable individuals respond well to adjuvant radiochemotherapy, liver transplantation and local therapy.

Due to anatomical factors, language factors, as well as an obvious heterogeneity of bile duct structure, the nomenclature and classification of malignant tumors occurring in intrahepatic bile duct epithelium have not been completely standardized. There have been many terms, such as "cholangiocellular carcinoma", "intrahepatic cholangiocellular carcinoma", "cholangiocyte carcinoma of liver" and so on. Currently most scholars recommend using the term "intrahepatic cholangiocarcinoma" and divide it into large bile duct type tumor and small bile duct type tumor according to tumor morphology. These two tumors have different characteristics in terms of etiology, pathological morphology, pattern of growth and infiltration, molecular characteristics and immunophenotypes. Considering these factors comprehensively, it is suggested that large bile duct tumor and extrahepatic cholangiocarcinoma should belong to cholangiocarcinoma and small bile duct tumor and hepatocellular carcinoma to carcinoma of liver. The authors proposed that according to the Chinese grammar habit, primary liver cancer can be classified as hepatocarcinoma of liver, cholangiocarcinoma of liver (occurring in small bile duct tumor) and combined hepato-cholangiocarcinoma. Cholangiocarcinoma is classified into proximal cholangiocarcinoma (occurring in large bile duct), hilar cholangiocarcinoma and distal cholangiocarcinoma.

Objective To evaluate the safety and effectiveness of the "five-step" procedure of laparoscopic right posterior hepatectomy.Methods Retrospective analysis was performed for clinical data, surgical findings and pathological results of 47 patients undergoing laparoscopic right posterior hepatectomy from May 2020 to March 2023. For measurement data conforming to a normal distribution, $\mathop x\limits^ - $ ±s was utilized while M(Q₁,Q₃) for data not conforming to a normal distribution. "Five-step" procedure of laparoscopic right posterior hepatectomy included left supine position, transected caudate process and controlled right posterior liver pedicle, indocyanine green fluorescence guidance, liver transection in situ and guidance of liver parenchyma transection plane along anterior space of inferior vena cava and right hepatic vein. Clinical outcomes were analyzed.Results All 47 patients successfully completed laparoscopic right posterior hepatectomy, including benign lesions(n=7) and malignant tumors(n=40).There were 26 cases of hepatocellular carcinoma. Maximal diameter of tumor was 12 cm, operative duration 330(138, 582) min, hilar occlusion time 60(15,151) min and intraoperative blood loss 200.0(100.0, 312.5) mL. Postoperative complications occurred in 10 patients, including Clavien-Dindo grade Ⅰ(n=4), grade Ⅱ(n=6) and grade Ⅲ or above (n=0). The postoperative hospital stay was (8.3±3.0) day.Conclusion The "five-step" procedure of laparoscopic right posterior hepatectomy may improve the exposure of operative area, highlight the principle of tumor-free operation, simplify the handling of right posterior liver pedicle and optimize the grasp of liver parenchyma disconnection plane. It is safe, effective and easy to learn.

Objective To explore the clinical features, diagnoses and treatments of appendiceal adenocarcinoma(AA).Methods The relevant clinical data were retrospectively reviewed for 5 hospitalized AA patients.Results Among them, 3 cases were diagnosed as acute appendicitis at the first time, one-stage appendectomy was performed, second-stage right hemicolectomy was performed, 2 cases were diagnosed as ileocecal space-occupying lesions before operation, enteroscopic biopsy was performed for diagnosing appendiceal adenocarcinoma, and first-stage right hemicolectomy was performed. Among the 5 patients, colonic adenocarcinoma (moderately differentiated, n=2), mucinous adenocarcinoma (moderately differentiated, n=2) and goblet cell adenocarcinoma (moderately differentiated, n=1).Conclusion In clinical practices, AA is extremely rare. Due to a lack of specific symptoms, a preoperative diagnosis is rather difficult. Preoperative CT and colonoscopy may aid a definite diagnosis. Radical operation of right colon is routinely performed. Intraoperative and postoperative intraperitoneal hyperthermic perfusion chemotherapy is feasible for tumors invading serosa. And postoperative chemotherapy should be supplemented according to clinical stages.

Objective To explore the application of Hassan triple-tube versus double-tube method for repairing duodenal rupture.Methods For this retrospective cohort study, clinical data were retrospectively reviewed for 52 patients undergoing duodenal rupture repairing with Hassan tube at both hospitals from July 2011 to July 2021. They were divided into two groups of triple-tube (n=29) and double-tube (n=23). Baseline profiles, injury characteristics, postoperative complications, decompression tube removal time and duration of hospital stay were recorded.Results During postoperative hospitalization, no significant inter-group differences existed in occurrences of duodenal fistula (3 vs. 5 cases), abdominal infection (4 vs. 8 cases), intestinal obstruction (2 vs. 5 cases), biliary fistula (9 vs.11 cases) or pancreatic fistula (11 vs. 13 cases)(P＞0.05). Average length of hospital stay was shorter in double-tube group than that in triple-tube group [(26.8±10.6) vs.(34.1±11.6) days](P＜0.05). Duodenal decompression tube was removed earlier in double-tube group than in triple-tube group [(19.6±9.5) vs.(25.7±10.4) days] (P＜0.05).Conclusion Both techniques are efficacious for repairing duodenal rupture. Decompression tube extubation time and hospital stay are shorter in double-tube group than those in triple-tube group. During duodenal repair, reasonable and effective double-tube insertion may be more advantageous than triple-tube.

Intrahepatic cholangiocarcinoma (ICC) is a malignant tumor derived from intrahepatic cholangiocytes with an insidious onset, a rapid progression, a high degree of malignancy and a poor prognosis. Early diagnosis of ICC is rather difficult. Although surgery is an ideal curative approach, most patients are diagnosed so late that R0 resection is impossible. Multidisciplinary diagnosis and treatment (MDT) approaches offer ICC a comprehensive plan. It offers optimal perioperative therapy for operable cases and conversion or palliative therapy for non-operable cases. However, there is still much controversy over comprehensive management of ICC and further studies with large samples are required for validations.

Objective To construct a novel prognostic prediction model for intrahepatic cholangiocarcinoma(ICC) based upon Scissor algorithm.Methods A high-throughout bulk sequencing dataset of ICC was downloaded from the database of Cancer Genome Atlas(TCGA) and a high-quality single cell dataset acquired from the gene expression omnibus(GEO) database of National Center for Biotechnology Information Carcinoma. In R software, Scissor package was employed for selecting cell subpopulations related to the prognosis in tumor microenvironment of ICC and the differentially expressed genes(DEGs) were identified through the FindMarkers function in the Seurat package. Then ClusterProfiler was utilized for enrichment analysis based upon gene ontology (GO), Kyoto Encyclopedia of Genes and Genomes (KEGG), Hallmark and Reactome. By applying STRING, protein-protein interaction (PPI) network of DEGs were analyzed and further plotted by Cytoscape software. The immune escape score of each patient tumor in the TCGA dataset was estimated by tumor immune dysfunction and exclusion(TIDE) tool and the correlation of individual DEGs with TIDE score was calculated. Finally key genes were screened and their prognostic impact on ICC was verified in the literature dataset(DOI:10.1016/j.ccell.2021.12.006).Finally the key genes were screened out by multi-factor Cox regression analysis and a prediction model was constructed.Results A total of 604 cells associated with adverse prognosis of ICC were screened and 366 DEGs were further identified, including 281 up-regulated genes and 85 down-regulated genes(P＜ 0.05, |Fold change|＞1.5), which were mainly enriched in PD-1, IL-10 and tumor necrosis factor signaling pathways. STRING network analysis constructed 4 modular PPI networks. Through calculating the correlation between each module gene and patient TIDE score, a total of 18 key genes closely related to immunotherapy were identified (P＜0.05), three pivotal genes CDK1, FCGR2A and CTSD were identified by multivariate Cox regression analysis. And a prognostic prediction model (1-year survival AUC=0.672, 2-year survival AUC=0.692, 3-year survival AUC=0.742) was constructed based upon multivariate Cox regression analysis. And model effect was verified on external datasets (1-year survival AUC=0.584,2-year survival AUC=0.651,3-year survival AUC=0.668).Conclusion The prognostic prediction models based upon CDK1, FCGR2A and CTSD have good performance and can provide important references for ICC patients benefiting from immunotherapy.

Objective To compare the short-term efficacy of open liver resection(OLR) versus laparoscopic liver resection (LLR) for liver cancer patients with microvascular invasion(MVI).Methods The relevant clinical data were retrospectively reviewed for 88 surgical patients with primary liver cancer complicated with MVI from December 2019 to February 2023.They were assigned into two groups of OLR(n=51) and LLR(n=37).Preoperative profiles, surgery-related parameters, postoperative liver functions, postoperative stress response parameters, postoperative complications, recovery status and outcomes were compared between two groups.Results No significant differences existed in age, gender, body mass index (BMI), hepatitis B, liver cirrhosis, history of abdominal operation, age-adjusted Charlson comorbidity index(aCCI),American Society of Anesthesiologists(ASA) score,tumor number,degree of differentiation,Child-Pugh score,China liver cancer staging(CNLC), alanine aminotransferase (ALT), aspartate aminotransferase (AST), total bilirubin(TBIL), lactate dehydrogenase(LDH), alpha-fetoprotein(AFP), indocyanine green-R15(ICG-R15), prothrombin time(PT), hemoglobin(Hb),platelet(PLT) count,blood creatinine(Scr), total cholesterol,serum potassium,serum sodium and such surgical parameters as surgical site, hepatic segmental resection range, anatomic hepatectomy, operative marginal properties, operative duration, hepatic portal occlusion time, blood transfusion and such postoperative stress parameters as leukocyte count, neutrophil count, lymphocyte count, neutrophil-to-lymphocyte ratio(NLR),controlling nutritional status(CONUT) and such postoperative liver function parameters as ALT/AST,TBLI and model for end-stage liver disease(MELD) score(all P＞0.05). Significant inter-group differences existed in tumor diameter, ALB, intraoperative blood loss,intraoperative mean arterial pressure and albumin-bilirubin(ALBI) score (all P＜0.05). Gastrointestinal recovery time, drainage tube placement time and total postoperative hospitalization stay were significantly lower in LLR group than those in OLR group (all P＜0.05).As for complication rate, LLR group was better than OLR group [(8.1%,3/37)vs.(25.5%, 13/51)] and inter-group difference was statistically significant(P＜0.05).No postoperative mortality occurred in neither groups within 30 days.Conclusion LLR is both safe and feasible and it has better short-term efficacy than OLR for LC complicated with MVI.

Objective To explore the clinical efficacy of fecal microbiota transplantation (FMT) plus probiotics and prebiotics for slow transit constipation (STC).Methods From May 2021 to October 2022, 30 STC patients underwent FMT. There were 11 males and 19 females with an age range of (67.13±7.16) years. History of constipation pre-treatment was (13.97±4.43) years and weekly frequency of defecation (2.15±0.67). Clinical curative rate, clinical remission rate, colonic transit test results, weekly frequency of autonomous defecation, Wexner constipation score and Bristol stool character score pre/post-transplantation were recorded during a follow-up period of 8 weeks.Results After FMT plus probiotics and prebiotics, clinical curative rate at Week 8 was maintained at 50.0%(15/30), clinical remission rate reached 60.0%(18/30), weekly frequency of spontaneous defecation increased markedly [(3.03±1.17) vs. (2.15±0.67) times/week], score of colon transit test declined markedly [(5.53±2.41) vs.(10.13±1.41) points], score of Wexner constipation decreased markedly [(9.83±4.53) vs. (15.63±3.69) points] and Bristol score improved [(2.80±0.99) vs. (1.26±0.52)]. The differences were statistically significant (P＜0.05). No serious adverse reactions occurred after treatment and during follow-ups.Conclusion FMT plus probiotics and prebiotics can safely and effectively treat STC and improve constipation symptoms of patients.

Sleeve gastrectomy (SG) has been a mainstream procedure for metabolic and bariatric surgery(MBS) in the world due to its simple handling and a definite efficacy. However, there are still many shortcoming, such as a high rate of weight gain, a high incidence of postoperative reflux esophagitis and a high probability of postoperative revision surgery. Therefore, based upon sleeve gastrectomy, a large variety of additional procedures have been recently pioneered, including sleeve gastrectomy plus jejunojejunal bypass (SG-JJB), sleeve gastrectomy transit bipartition(SG-TB), single-anastomosis duodenoileal bypass plus sleeve gastrectomy/stomach intestinal pylorus-sparing(SADI-S/SIPS), and sleeve gastrectomy plus duodenojejunal bypass(SG-DJB). Better outcomes have been obtained with fewer long/short-term postoperative complications. In the future, multi-center, larger sample size and randomized controlled trials shall offer more optimized procedures for MBS.

Objective To employ a perfusion curve for defining pipe blockage and exploring the causes of blockage events during hyperthermic intraperitoneal chemotherapy (HIPEC).Methods From May 2021 to September 2021,clinical data were retrospectively reviewed for 221 cancer patients receiving HIPEC. Through a perfusion chemotherapy curve, pipe blockage events were defined and classified. Then the related factors leading to the occurrence of pipe blocking events and the greater difficulty of adjusting pipe were analyzed.Results A total of 401 HIPEC were completed, including unobstructed(n=214, 53.4%) were, unobstructed after adjusting pipeline (n=136, 33.9%) and (n=51, 12.7%). Multivariate analysis revealed that radical tumor resection boosted the occurrence of HIPEC blockage events[OR=0.522,95%CI(0.281,0.969),P＜0.05] and ileostomy was an independent risk factor for impeded events[OR=1.052,95%CI(0.124,8.965),P＜0.05].Conclusion During HIPEC, radical tumor resection is an independent risk factor for tube blockage events.And ileostomy enhances the difficulty of pipeline adjustment and causes poor perfusion.

Hyperlipidemic acute pancreatitis (HLAP) occurs in patients with underlying disorders of lipid metabolism and is often precipitated by other metabolic disorders. In the last decade or so, the incidence of HLAP has been on the rise, surpassing alcohol as the second leading cause of pancreatitis, and is often associated with more severe local and systemic complications. The pathogenesis of HLAP has been widely accepted to include the Havel theory, pancreatic microcirculatory disorders and calcium overload, and endoplasmic reticulum stress. Treatment is currently based on conventional therapy (dietary abstinence, fluid replacement, etc.), non-invasive lipid-lowering therapy such as insulin combined with low-molecular heparin and oral lipid-lowering drugs, and with the increase in pregnant women and people with severe disease, blood purification therapy is increasingly used because of its rapid reduction of plasma triacylglycerols. This article reviews the disease characteristics of HLAP, the hot spots of domestic and international research, and the progress of treatment.

Objective To explore the prognostic and risk factors of textbook outcome (TO) in patients with pancreatic head cancer after radical pancreaticoduodenectomy.Methods From January 2016 to December 2018, clinicopathological data were retrospectively reviewed for 92 patients with pancreatic head cancer undergoing radical pancreaticoduodenectomy. Logistic regression univariate and multivariate analyses were utilized for identifying the independent risk factors affecting TO. And survival curves of TO and non-TO patients were plotted by Kaplan-Meier method.Results Among them, 20(21.7%) attained TO and 72(78.3%) non-TO. Logistic regression univariate analysis indicated that preoperative high total bilirubin, high CA19-9, high TNM stage, intraoperative hemorrhage ≥400 mL and prolonged operative duration were more difficult to attain TO. The difference was statistically significant (P＜0.05); Multivariate analysis revealed that operative duration [OR=1.023, 95%CI(1.006-1.041)], blood loss ≥400 mL [OR=5.317, 95%CI(1.346-21.002)] and advanced TNM stage [OR=4.766, 95%CI(1.191-19.067)] were independent risk factors for TO (P＜0.05). Kaplan-Meier survival curve indicated that overall survivals at Year 1/3 were 91.5% and 32.4% in TO group and 25.6% and 13.7% in non-TO group respectively. The differences were statistically significant (P＜0.05).Conclusion Based upon whether or not TO is attained, it may effectively predict the prognosis of patients with pancreatic head cancer after duopancreaticotomy. Those with shorter operative duration, minimal intraoperative blood loss and low TNM stage are more likely to attain TO.

Objective To explore the clinicopathological characteristics and management strategies of gallbladder neuroendocrine carcinoma (GB-NEC) patients.Methods A retrospective review was conducted for clinicopathological data of 15 GB-NEC patients admitted into Tongji Hospital from January 2010 to December 2021.According to surgical protocol, they were assigned into two groups of radical surgery (n=9) and non-radical surgery (n=6). Chemotherapy group (n=7) and non-chemotherapy group (n=8) were assigned according to whether or not chemotherapy was performed, SPSS25.0 software was utilized for data processing and Kaplan-Meier method for survival analysis.Results There were 4 males and 11 females with an average age of (57.3±12.8) years. Major clinical manifestations included abdominal pain and jaundice. There were elevated levels of carbohydrate antigen 19-9 (CA19-9, n=5) and carcinoembryonic antigen (CEA, n=3). Ultrasonography revealed high echogenicity in gallbladder (n=10). Postoperative pathological examination confirmed GB-NEC in all patients. All of them were discharged smoothly without perioperative mortality. The median overall survival time was 9.0(3.0-35.0) month. There was statistically significant prognostic difference between radical and non-radical surgery groups (P=0.001), as well as between chemotherapy and non-chemotherapy groups (P=0.015).Conclusion GB-NEC is an extremely rare malignant tumor with nonspecific clinical manifestations and laboratory parameters. As a result, preoperative diagnosis is rather difficult. A definite diagnosis is confirmed through routine pathological and immunohistochemical examinations. Radical surgery is a preferred option and concurrent chemotherapy may prolong patient survival.

Intrahepatic cholangiocarcinoma(ICC) is the second most common primary liver malignancy after hepatocellular carcinomama. Its unique biological characteristics are different from primary hepatocellular carcinoma and extrahepatic cholangiocarcinoma. It has a high degree of malignancy and a very poor prognosis. Currently radical surgery remains a sole curative option for ICC. However, many controversies persist, including operative approaches, resection range, lymph node dissection and reoperation for recurrent patients. How to improve the effect of surgical treatment and prolong survival time of patients still needs further exploration by clinicians.

Objective To explore the predictive value of preoperative Naples prognostic score (NPS) on the prognosis of patients with gallbladder cancer (GC) undergoing radical surgery.Methods A total of 102 patients undergoing radical surgery for GC were recruited from Tongji Hospital between January 2016 and December 2021. They were assigned into three groups of NPS1 (n=19), NPS2 (n=46) and NPS3 (n=37). Clinicopathological data of three groups were compared. Univariate and multivariate Cox analyses and Kaplan-Meier (K-M) survival curve were employed for examining the survival data. A line plot prediction model was constructed and prognostic calibration curve for further validating the model. Time-dependent receiver operating characteristic (ROC) curves were plotted for evaluating the discriminative capabilities of various prognostic scoring systems.Results NPS was significantly correlated with T stage, tumor differentiation, liver invasion and CA19-9. K-M curve indicated that patients with a higher NPS had a worse prognosis. NPS, age, N stage, liver invasion, CA19-9 and carcinoembryonic antigen (CEA) were independent prognostic factors affecting overall survival (OS). A line plot prediction model was constructed from the above independent risk factors. Calibration curve revealed an excellent predictive capability of the model. ROC curve indicated that NPS had better a prognostic performance than other inflammation prognostic scores.Conclusion Preoperative NPS has a great predictive value for GC patients undergoing radical surgery. This scoring system is more reliable than other nutritional and inflammatory prognostic scores for GC patients.

Gallbladder cancer is one of the most common malignant tumors in biliary system and its incidence is rising yearly. Due to a non-specificity of early symptoms, most patients are already in a middle-to-late stage when they are clinically diagnosed. Thus an opportunity of radical surgery is lost so that there is a poor overall prognosis. As a representative of precision medicine, molecular targeted therapy has such advantages as high specificity and low toxic side effects. Currently molecular targets for GC are focused upon epidermal growth factor receptor, human epidermal growth factor receptor-2 and vascular endothelial growth factor. However, related studies still lack the support of large-sample clinical studies so that more targets and biological markers should be further explored to achieve individualized targeted therapy.

Objective To construct and validate an effective prognostic nomogram for metastatic gallbladder carcinoma (MGBC).Methods This study retrospectively analyzed 709 MGBC patients from 2004 to 2017 in the database of Surveillance,Epidemiology and End Results (SEER). The data were randomized into the sets of discovery (n=496) and validation (n=213). The independent prognostic factors affecting the gallbladder carcinoma cancer-specific survival (GCSS) of patients were obtained from univariate and multivariate Cox regression analyses. A nomogram was constructed from the discovery sets. The comprehensive survival probability scores of each patient were assessed by the independent prognostic factors and the results validated in validation sets. The predictive accuracy of the nomogram was determined by concordance index (C-index), calibration curve and receiver operating characteristic (ROC). Kaplan-Meier survival analysis and log-rank test were performed for examining the difference in survival between the high/low-risk groups.Results Multivariate analysis of the discovery sets revealed that independent factors for GCSS were age, degree of tumor differentiation, whether or not surgery, radiotherapy or chemotherapy. In the discovery sets, C-index of the nomogram for predicting survival was 0.702. In the validation sets, C-index of nomogram discrimination was 0.732. Risk stratification was performed with the nomogram. Kaplan-Meier survival analysis indicated that for both discovery and validation sets, low-risk group had a significantly better prognosis than high-risk group.Conclusion The above nomogram can accurately and intuitively predict the survival probability of MGBC patients.

As the most common malignancy of biliary system, gallbladder carcinoma is characterized by a low early diagnostic rate, aggressive tumor invasion and a high rate of lymphatic metastasis. In recent years, with a rapid development of artificial intelligence (AI) technology, machine learning and deep learning algorithm-based technology have been applied in the diagnosis and treatment of malignancies, prognostic assessments and medical imaging, It has brought revolutionary changes to the diagnostic and therapeutic modes. AI technology has been initially utilized for early detection and diagnosis, preoperative lymph node status assessing, intraoperative lymph node dissection, surgery and prognostic assessment of gallbladder carcinoma. AI is promising in the diagnosis and treatment of gallbladder carcinoma.

Objective To compare the accuracy of six screening tools for obstructive sleep apnea (OSA) in preoperative patients scheduled for bariatric and metabolic surgery (BMS).Methods Convenient sampling was conducted among 357 patients scheduled for BMS from June 2022 to July 2023. The questionnaire of STOP-Bang, Epworth, Berlin, No-Apnea, four-variable score and GOAL score were utilized preoperatively. Based upon the result of a portable monitoring device, DeLong test was employed for compare the area under the receiver operating characteristic (ROC) curve, sensitivity, specificity and predicted value. Additionally, optimal cut-off value of each screening tool was determined by calculating Youden index.Results In preoperative BMS patients, the incidence of OSA was 61.6%(220/357) and the prevalence of OSA risk(40.7%-91.0%). When screening for OSA (hourly apnea hypopnea index≥5), the area under curve (AUC) of Berlin and STOP-Bang scales were relatively higher (0.82, 0.79) with a higher sensitivity (69.90%, 67.96%) and a better specificity (82.81%, 76.56%). The corresponding optimal cut-off values were both 4 points.Conclusion The above six screening tools for OSA have definite practicability and accuracy. And Berlin and STOP-Bang scales offer better sensitivity, specificity and accuracy.

Objective To compare the efficacy and security of sleeve gastrectomy plus jejunojejunal bypass (SG+JJB) versus sleeve gastrectomy (SG) for obesity and metabolic diseases.Methods From January 2019 to January 2021, the relevant clinical data were retrospectively reviewed for 45 obese patients with 40 kg/m²≤ body mass index (BMI) ≤50 kg/m² undergoing SG or SG+JJB. They were assigned into two groups of SG(n=27) and SG+JJB (n=18). During 2-year follow-ups, two groups were compared in terms of weight loss and relief status of type 2 diabetes mellitus(T2DM),hypertension, hyperuricemia and nutritional complications.Results As compared with SG group, the percentage of excess weight loss was not statistically significant in SG+JJB group at Month 1 [(20.0±10.5)% vs.(23.6±8.5)%,P＞0.05].Yet at Month 6[(35.7±16.5)% vs.(48.4±13.1)%],Month 12[(47.8±22.0)% vs.(66.8±16.6)%] and Month 24[(50.1±23.4)% vs.(71.9±19.8)%], all differences were statistically significant (all P＜0.05). Meanwhile, both procedures were effective in improving T2DM and hyperuricemia. And SG+JJB was more advantageous in improving obstructive sleep apnea syndrome (OSAS). No nutritional complications occurred in neither groups during mid-term follow-ups.Conclusion SG+JJB is both safe and effective during 2-year follow-ups. For obese patients with 40 kg/m²≤BMI≤50 kg/m², it offers better weight loss than SG and significantly improves the outcomes of T2DM with OSAS.

Objective To explore the clinicopathological features of xanthogranulomatous cholecystitis (XGC) and examine its differential diagnosis and treatment tactics from gallbladder carcinoma (GBC).Methods Clinical data were retrospectively reviewed for XGC and GBC patients over the past 12 years. The results of various parameters and imaging examinations were analyzed along with a literature search to seek possible preoperative diagnostic methods and evaluate the effects of operative approaches and field selections on the prognosis of XGC patients.Results The expressions of CA50 versus CA19-9 (r=0.84) and CA19-9 versus CA242 (r=0.72) were strongly correlated among XGC patients. And the expressions of CA50 versus CA19-9 (r=0.81), CA50 versus CA242 (r=0.64) and CA125 versus CA72-4 (r=0.68) were strongly correlated in GBC patients. The expressions of CA125 (P=0.014), CA72-4 (P=0.005) and CA242 (P＜0.001) in blood tumor markers were strongly correlated in GBC patients. Carcinoembryonic antigen (CEA) was higher in GBC group (P＜0.001). And enhanced computed tomography (CT) examination revealed intrabial nodules in gallbladder wall, blood flow, peripheral organ involvement, uneven enhancement of cyst wall, blurred hepatobiliary interface and "fast forward & rewind" after enhancement. Laparoscopic cholecystectomy remains a primary treatment for XGC. However, unnecessary invasive operation and expansion of operative scope had adverse effects on postoperative recovery of XGC patients. CEUS plays an important role in the differential diagnosis of XGC and offers a higher diagnostic efficiency than conventional imaging.Conclusion Plasma tumor markers are valuable in the diagnosis of XGC. A combination of various imaging examinations helps to distinguish between benign and malignant diseases. However, surgery is still a first option for suspected XGC and a definite diagnosis is dependent upon postoperative pathological examination.

Objective To explore the disparity of clinical outcome in patients with obesity after sleeve gastrectomy (SG) by gender.Methods Between May 2013 and January 2018, retrospective review was conducted for 113 consecutive patients undergoing SG. There were 73 female and 40 males.Follow-ups were performed at Month 1/3/6/12 post-operation. Demographics, obesity and comorbidities at baseline and all follow-up timepoints were compared by gender.Results This cohort had 73 females (64.6%) and 40 males (35.4%) with a median age of (31 vs.29 year, P＞0.05) and a mean body mass index (BMI) of (37.2 vs.40.2 kg/m², P＜0.05). The baseline levels of fasting plasma glucose (FPG), HbA₁c, lipid panel and blood pressure showed no significant difference between two genders. The proportions of female/male were HbA₁c ＞6.5% (47.9% vs.60.0%,P＞0.05) and FPG＞7 mmol/L(35.6% vs.35.0%, P＞0.05). At Month 12 post-SG, percentage of total weight loss (%TWL) had no difference [(29.6±7.0)% in female vs. (31.8±8.7)% in male, P＞0.05]. Males had a greater reduction of BMI than females [(13.0±5.1) vs.(10.9±3.1) kg/m², P＜0.001]. Mean FPG was [(5.27±0.62) vs.(5.48±1.24) mmol/L, P＞0.05] and HbA₁c [(5.69±0.49)% vs.(5.71±1.00)%,P＞0.05]. In individuals with FPG＞7 mmol/L at baseline, 84.6% (female) and 85.7% (male) achieved FPG ＜7 mmol/L(P＞0.05).In patients with HbA₁c＞6.5%, 80.0% (female) and 79.2% (male) decreased to＜6.5%(P＞0.05).No significant inter-group differences existed in triglyceride, low/high-density lipoprotein cholesterol or systolic blood pressure(SBP).However,females had lower SBP than males at Month 12 post-SG(73.4 vs.79.4 mmHg,P＜0.001).Conclusion With comparable age and comorbidities at baseline, BMI is higher in males. Both genders achieve drastic and equivalent weight loss. However, males have a greater reduction of BMI post-SG. Both genders also have equivalent improvements in hyperglycemia and dyslipidemia. However, there is a larger decline of DBP in females. Further researches are warranted for elucidating the underlying mechanism.

Laparoscopic sleeve gastrectomy(LSG) is one of the most widely performed bariatric operations. With constant technical refining, the proportion of revisional operations due to various causes is rapidly rising. Selecting appropriate and individualized revisional procedures is becoming one of hot issues. Based upon literature and clinical experiences, this review summarized the causes for revisional operations after LSG and the criteria for selecting proper approaches. It was intended to offer rationales for standardizing revisional operations.

Objective To explore the effect of preserving the integrity of gastric antrum and His angle during laparoscopic sleeve gastrectomy (LSG) on postoperative nausea and vomiting (PONV) and dosing of antiemetics.Methods The relevant clinical data were retrospectively reviewed for 80 obese patients undergoing LSG. They were assigned into two groups of A and B according to whether or not integrity of gastric antrum and His angle was preserved intraoperatively. Group A had intact gastric antrum and His angle while group B underwent routine operation. The inter-group differences of PONV, dosing of antiemetics, postoperative intestinal function recovery and postoperative discharge time were compared.Results The incidence of PONV between group A and group B was compared [12 h after surgery: 27.8%(10/36) vs.59.1%(26/44), 24 h after surgery: 33.3%(12/36) vs. 65.9%(29/44)], and the differences were statistically significant (all P＜0.05). The use times of antiemetics 24 h after surgery were (0.7±1.2) times in group A and (1.4±1.1) times in group B, respectively, and the difference was statistically significant(P＜0.05). The first time of anal exhaust in group A was earlier (P＜0.05). There was no significant difference in the first postoperative water intake and hospital stay between the two groups (all P＞0.05).Conclusion Preserving the integrity of gastric antrum and His angle is conducive to lowering the incidence of PONV post-LSG, reducing postoperative dosing of antiemetics and promoting the recovery of gastrointestinal function.

Objective To explore the feasibility and safety of unidirectional barbed thread during primary suturing after laparoscopic common bile duct (CBD) exploration.Methods From January 2019 to December 2021, retrospective review was performed for clinical data of patients with choledocholithiasis and cholecystolithiasis. According to different suturing methods of bile duct, they were assigned into two groups of primary suturing with barbed suture (n=66) and primary suturing with vicryl suture (n=70). Preoperative baseline profiles, intraoperative and postoperative parameters were compared between two groups.Results No significant inter-group difference existed in terms of preoperative baseline demographic, intraoperative blood loss, total hospitalization expense or incidence of postoperative biliary stenosis and residual stones (P＞0.05). Compared with primary suturing group with vicryl suture, primary suturing group with barbed suture offered shorter time for bile duct suturing [(12.0±1.3) vs. (23.6±3.6) min], shorter operative duration [(108.1±11.8) vs. (134.6±11.7) min], shorter indwelling time for drainage tube [(4.2±1.3) vs. (5.1±1.3) days], shorter postoperative hospital stay [(6.0±1.4) vs. (7.0±1.4) days] and lower incidence of postoperative bile leakage (0 vs. 5 cases). The differences were statistically significant (P＜0.05).Conclusion Unidirectional barbed thread is both safe and feasible during primary suturing after laparoscopic CBD exploration. It may shorten operative duration, lower the incidence of postoperative biliary leakage complications and thus accelerate postoperative patient recovery.

Objective To introduce an endoscopically placed hanging-type self-expandable metallic stent for output obstruction after subtotal gastrectomy and discuss its application efficacy.Methods From December 2018 to August 2021, clinical data were retrospectively reviewed for 4 patients with output obstruction after gastric tumor surgery undergoing endoscopic stenting.Results All of them developed output obstruction after subtotal gastrectomy. Endoscopic hanging-type stent was successfully implanted. Obstruction symptoms improved immediately after stenting. Three cases of anastomotic abnormalities had no recurrence and one case of efferent intestinal loop obstruction were stented thrice. After stent removal, obstruction symptoms recurred and resolved by secondary surgery. No stent-related adverse events were observed during hospitalization and follow-ups.Conclusion For obstruction caused by stenosis, angulation and mild torsion of anastomotic stoma or efferent loop after Billroth Ⅱ subtotal gastrectomy, self-expandable metallic stenting under endoscope may immediately relieve obstruction symptoms. And obstruction symptoms will not recur in some cases after stent removal. As an alternative or supplement to traditional conservative measures, hanging-type stent can significantly reduce digestive fluid loss, restore enteral nutrition promptly and avoid unnecessary unplanned secondary surgery.

Pancreatic surgery is vital for treating acute severe pancreatitis, chronic pancreatitis and benign/malignant pancreatic tumors. Traditional pancreatic surgery removes a large amount of normal pancreatic tissue so that reconstructing digestive tract is rather complicated. As an important endocrine organ, postoperative loss of pancreatic function may seriously affect the quality-of-life and survival of patients. For a better prognosis, pancreatic resection with preserved organ function and "Step-up" treatment model have become hot research topics. Currently function-preserving pancreatic procedures include pylorus preserving pancreatic head-duodenectomy, duodenum preserving pancreatic head resection, pancreatic tumor enucleation and central pancreatectomy. This review summarized the latest researches of organ function preserving pancreatectomy and selecting procedures.

华中科技大学同济医学院附属武汉中心医院近年来收治4例原发性肝癌合并重度肝硬化伴有术前黄疸病人,术中行脾动脉结扎,术后门静脉直径缩小,血清胆红素下降。术后均无大量腹水及肝衰竭等严重并发症发生。重度肝硬化合并黄疸的肝癌病人若选择外科治疗,围手术期并发症和死亡风险可能更高,而术中行脾动脉结扎对于此类病人是安全有效的,且能改善血清高胆红素水平,预防术后肝衰竭等严重并发症。