Objective: The aim of the study was to analyze the outcomes of patients who have undergone laparoscopic pancreaticoduodenectomy (LPD) in China. Summary Background Data: LPD is being increasingly used worldwide, but an extensive, detailed, systematic, multicenter analysis of the procedure has not been performed. Methods: We retrospectively reviewed 1029 consecutive patients who had undergone LPD between January 2010 and August 2016 in China. Univariate and multivariate analyses of patient demographics, changes in outcome over time, technical learning curves, and the relationship between hospital or surgeon volume and patient outcomes were performed. Results: Among the 1029 patients, 61 (5.93%) required conversion to laparotomy. The median operation time (OT) was 441.34 minutes, and the major complications occurred in 511 patients (49.66%). There were 21 deaths (2.43%) within 30 days, and a total of 61 (5.93%) within 90 days. Discounting the effects of the early learning phase, critical parameters improved significantly with surgeons’ experience with the procedure. Univariate and multivariate analyses revealed that the pancreatic anastomosis technique, preoperative biliary drainage method, and total bilirubin were linked to several outcome measures, including OT, estimated intraoperative blood loss, and mortality. Multicenter analyses of the learning curve revealed 3 phases, with proficiency thresholds at 40 and 104 cases. Higher hospital, department, and surgeon volume, as well as surgeon experience with minimally invasive surgery, were associated with a lower risk of surgical failure. Conclusions: LPD is technically safe and feasible, with acceptable rates of morbidity and mortality. Nonetheless, long learning curves, low-volume hospitals, and surgical inexperience are associated with higher rates of complications and mortality.

Postpancreatectomy hemorrhage (PPH) remains a rare but lethal complication following laparoscopic pancreaticoduodenectomy (LPD) in the modern era of advanced surgical techniques. The main reason for early PPH (within 24 hours following surgery) has been found to be a failure of hemostasis during the surgical procedure. The reasons for late PPH tend to be variate. Positive associations have been identified between late PPH and intraabdominal erosive factors such as postoperative pancreatic fistula, bile leakage, gastrointestinal fistula, and intraabdominal infection. Still, some patients suffer PPH who do not have these erosive factors. The severity of bleeding and clinical prognosis of erosive and nonerosive PPH following LPD is different. We analyzed the electronic clinical records of 33 consecutive patients undergoing LPD and experiencing one or more episodes of hemorrhage after postoperative day 1 in this study. All patients received an LPD with standard lymphadenectomy. The patient's hemorrhage-related information was extracted, such as interval from surgery to bleeding, presentation, bleeding site, severity, management, and clinical prognosis. Based on our clinical practice, we proposed a treatment strategy for these 2 forms of late PPH following LPD. Of these 33 patients, 8 patients (24.24%) developed nonerosive bleeding, and other 25 patients (75.76%) suffered from postoperative hemorrhage caused by various intraabdominal erosive factors. The median interval from the LPD surgery to postoperative hemorrhage for both groups was 11 days, and no significant differences were found ( P = .387). For patients with erosive bleeding, most (60%) underwent their episodes of bleeding on postoperative days 5 to 14. For patients with nonerosive bleeding, most (75%) began postoperative hemorrhage 2 weeks after surgery, and 50% of these patients had bleeding between postoperative days 20 and 30. In the present study, 64% (16/25) of patients with erosive bleeding and 87.5% (7/8) of patients with nonerosive bleeding had internal bleeding. The fact that 90% (9/10) of all gastrointestinal bleeding patients had intraabdominal erosive factors indicated strong relationships between gastrointestinal hemorrhage and these erosive factors. The bleeding sites were detected in most patients, except for 4 patients who received conservative treatments. For patients with erosive bleeding, the most common bleeding site detected was the pancreatic remnant (43.48%); others included the hepatic artery (39.13%), splenic artery (13.04%), and left gastric artery (4.35%). For patients with nonerosive bleeding, the most common bleeding site was the hepatic artery (83.33%), and the 2nd most frequent site was the splenic artery (16.67%). No hemorrhage from pancreaticojejunal anastomosis occurred in the patients with nonerosive bleeding. Statistical significance was noted between these 2 groups in hemorrhage severity ( P = .012), management strategies ( ...

Background: Pancreatic leakage remains one of the most serious complications after laparoscopic pancreaticoduodenectomy (LPD). At present, most medical centers use local materials for the common pancreatic duct catheters required for pancreaticoenterostomy. However, there is a lack of a measurable and variable-diameter pancreatic duct catheter. Recently, a measurable variable-diameter pancreatic duct catheter was developed to remedy the limitation of the common pancreatic duct catheters. This study sought to evaluate its preventive effect on pancreatic leakage in LPD.Methods: A total of 202 patients who underwent LPD using the Hong's single-stitch method from January 2021 to April 2022 were included in the study. Patients were divided into the 2 groups: the variable-diameter group (n=111) and the normal group (n=91) according to the application of different pancreatic duct catheters. Patient characteristics and perioperative data, including operation time, pancreatic fistula rate, postoperative bleeding rate and postoperative length of stay in the two groups were collected and analyzed.The Chi-square test was used to compare the differences between the groups in relation to the categorical variables.Results: Among the 202 patients, there were 123 males and 79 females, with an average age of 58.79±7.89 years (range: 15-79 years), and an average body mass index (BMI) of 23.55±4.25 kg/m 2 . There were no statistically significant differences between the variable-diameter group and the normal group in terms of age, sex, BMI, operation time, intraoperative blood loss, preoperative bilirubin, and pancreatic texture (P>0.05). The pancreatic fistula rate (2.70% vs. 9.89%) and postoperative median length of stay (15 vs. 16 days) of the variable-diameter group was significantly lower than that of the normal group. Conclusions:The measurable variable-diameter pancreatic duct catheter could decrease the pancreatic fistula rate and postoperative median length of stay in the application of laparoscopic duodenectomy.

Objective The aim of this study was to compare the short- and long-term outcomes of laparoscopic surgery (LS) and open surgery (OP) for perihilar cholangiocarcinoma (PHC) using a large real-world dataset in China. Methods Data of patients with PHC who underwent LS and OP from January 2013 to October 2018, across 10 centers in China, were extracted from medical records. A comparative analysis was performed before and after propensity score matching (PSM) in the LS and OP groups and within the study subgroups. The Cox proportional hazards mixed-effects model was applied to estimate the risk factors for mortality, with center and year of operation as random effects. Results A total of 467 patients with PHC were included, of whom 161 underwent LS and 306 underwent OP. Postoperative morbidity, such as hemorrhage, biliary fistula, abdominal abscess, and hepatic insufficiency, was similar between the LS and OP groups. The median overall survival (OS) was longer in the LS group than in the OP group (NA vs. 22 months; hazard ratio [HR] 1.19, 95% confidence interval [CI] 1.02–1.39, p = 0.024). Among the matched datasets, OS was comparable between the LS and OP groups (NA vs. 35 months; HR 0.99, 95% CI 0.77–1.26, p = 0.915). The mixed-effect model identified that the surgical method was not associated with long-term outcomes and that LS and OP provided similar oncological outcomes. Conclusions Considering the comparable long-term prognosis and short-term outcomes of LS and OP, LS could be a technically feasible surgical method for PHC patients with all Bismuth–Corlett types of PHC.

Summary The purpose of this study was to generate a selective radiosensitising effect by the intra-hepaticarterial infusion of misonidazole (MISO). MISO (10 mg) was infused after transcatheter hepatic-arterial embolisation into the livers of rabbits bearing VX2 liver cancer. This procedure was followed by 15 Gy electron irradiation. Evaluation of tumour volume and histological examination was carried out on the 7th day after treatment. The greatest tumour response was obtained in the group which received MISO followed by radiation and was characterised by extensive fibrosis around the tumour and nearly complete tumour necrosis. Liver cell regeneration was also noted in adjacent liver tissue. . In view of this, we have carried out a study to determine the possibility of obtaining a selective radiosensitising effect by intra-hepatic arterial infusion of misonidazole (MISO), an agent which has been shown to display a steep dose-response for radiosensitisation but also for neurotoxicity. Encouraging results have been obtained by regional administration of 10 mg MISO to rabbits bearing liver tumours and treated with 15 Gy of electron irradiation. Materials and methodsTwenty-two male New Zealand white rabbits weighing 2.0-2.5 kg were used. The VX2 tumour cell line was maintained by serial transplantation into the hind leg muscle. The rabbits were anesthetised by injection of thiopentalum natricum (20 mg kg-1, i.v.) for laparotomy and finely minced fragments of tumour were inoculated into the left medial hepatic lobes. Fourteen days after inoculation the tumours were 2.0-2.5 cm in diameter as measured from CT scans, accordingly the operation for transcatheter hepatic-arterial embolisation was performed on the 14th day after the tumour inoculation under sodium pentobarital anesthesia (30 mg kg-', i.v.). A longitudinal incision along the right inner inguinal was made, exposing the right femoral artery. A 2 F polyethylene guiding catheter connected to a 1 ml syringe was inserted via a very small incision into the artery, the position of the guiding cathether being monitored angiographically by the injection of 60% Urografin under fluoroescopic control. The final, critical positioning of the catheter was made when the tip of the catheter reached the space between the 12th thoracic vertebra and the first lumbar vertebra, thereby making certain that the entry of contrast agent into the hepatic-artery was after any arterial divisions. Microspheres were then injected. An angiograph of rabbit common hepatic artery is shown in Figure 1. Injection of the agents after selective catheterisation was monitored under fluoroscopy to avoid movement of the catheter tip.Macroaggregated albumin (MAA) microspheres, 20-50#m in diameter with cross-linked configuration, were chosen for embolisation. They were suspended in normal saline at a concentration of 3 x 106/0.5 ml for each animal. MISO was dissolved in normal saline in a 35'C water bath just before infusion. Five groups were used: (1) control (n = 5), 1.0 ml normal saline was injecte...