To evaluate the safety and efficacy of a modified duct-to-mucosa pancreaticojejunostomy in laparoscopic pancreaticoduodenectomy (LPD) and open pancreaticoduodenectomy (OPD).

Clinical data of 162 patients undergoing PD in the Third Affiliated Hospital of Soochow University from January 2021 to December 2022 were retrospectively analyzed. The informed consents of all patients were obtained and the local ethical committee approval was received. Among them, 113 patients were male and 49 female, aged (66±11) years on average. Primary diseases: 66 patients were diagnosed with pancreatic cancer, 47 cases of cholangiocarcinoma, 23 cases of duodenal cancer, 6 cases of ampullar cancer, 1 case of gallbladder cancer, 1 case of adenocarcinoma in the lesser curvature of gastric antrum and 18 cases of benign pancreatic tumors. A modified duct-to-mucosa pancreaticojejunostomy was adopted in the operations including 95 cases undergoing LPD (LPD group) and 67 cases of OPD (OPD group). The overall perioperative conditions and postoperative complications of all patients were observed. The safety and efficacy were compared between two groups. The operation time and intraoperative blood loss between two groups were compared by t test or rank-sum test. The incidence of postoperative complications, such as pancreatic fistula, between two groups was compared by Chi-square test or Fisher's exact test.

All 162 patients successfully completed the surgery. The overall operation time was (317±71) min. The median intraoperative blood loss was 140(100, 200) ml. The length of postoperative hospital stay was 17(12, 25) d.The 30-d mortality rate was 0.6%(1/162). The re-operation rate was 1.9%(3/162). The incidence of postoperative grade B/C pancreatic fistula was 24.7%(40/162). The incidence of gastric emptying disorder was 23.5%(38/162). The incidence of abdominal infection was 13.6%(22/162). The operation time in the LPD group was (338±70) min, significantly longer than (287±63) min in the OPD group (t=4.754, P<0.05). Intraoperative blood loss in the LPD group was 100(100, 150) ml, significantly less than 200(170, 200) mlin the OPD group (Z=-6.075, P<0.05). The length of postoperative hospital stay in the LPD group was 14(12, 21) d, significantly shorter than 18(12, 33) d in the OPD group (Z=-2.040, P<0.05). The incidence of grade B/C pancreatic fistula in the LPD group was 17.7%(17/95), significantly lower than 34.3%(23/67) in the OPD group (χ²=3.659, P<0.05).

The overall incidence of pancreatic fistula is low in patients undergoing modified duct-to-mucosa pancreaticojejunostomy, which is a safe and efficacious procedure. Compared with OPD, LPD probably requires longer operation time, whereas lowers the incidence of postoperative pancreatic fistula. Meantime, LPD has advantages of minimal invasiveness and rapid postoperative recovery, which is recommended for experienced teams.

To investigate the clinical application value of new pancreaticogastrostomy in laparoscopic middle segment pancreatectomy.

Clinical data of 7 patients who underwent laparoscopic middle segment pancreatectomy in the Second Hospital of Hebei Medical University from May 2022 to June 2023 were retrospectively analyzed. The informed consents of all patients were obtained and the local ethical committee approval was received. Among them, 1 patient was male and 6 female, aged from 43 to 68 years, with a median age of 52 years. 6 patients were diagnosed with serous cystadenoma of pancreas and 1 case of lobulated pancreas complicated with chronic inflammation. After laparoscopic middle segment pancreatectomy, the proximal pancreas was subject to locking suture, and the distal pancreas was anastomosed with new pancreaticogastrostomy of pancreatic duct-to-mucosa. The operation time, anastomosis time, intraoperative blood loss and postoperative complications were observed.

All 7 patients successfully completed the surgery without conversion to open surgery. The operation time was 160-260 min with a median of 200 min. The time of new pancreaticogastrostomy was 14-20 min with a median of 18 min. The intraoperative blood loss was 50-200 ml with a median of 80 ml. Postoperative abdominal infection occurred in 1 case, and no pancreatic fistula, gastric emptying disorder, postoperative bleeding or perioperative death occurred.

New pancreaticogastrostomy is simple, safe and feasible in laparoscopic middle segment pancreatectomy, which is worthy of clinical application.

To investigate the risk factors of biliary complications after organ-preserving pancreatectomy.

Clinical data of 210 patients who underwent organ-preserving pancreatectomy in Tongji Hospital affiliated to Tongji Medical College of Huazhong University of Science and Technology from May 2015 to April 2022 were retrospectively analyzed. The informed consents of all patients were obtained and the local ethical committee approval was received. Among them, 79 patients were male and131 female. According to the incidence of complications, all patients were divided into the biliary complication group and non-biliary complication group. 50 patients were assigned into the biliary complication group, aged (39±4) years on average, and 160 cases in the non-biliary complication group, aged (37±3) years on average. All patients were followed up for 90 d after surgery. The differences in perioperative indexes were compared between two groups. The risk factors of postoperative biliary complications were also analyzed. Surgical methods between two groups were compared by Chi-square test. The independent risk factors of postoperative biliary complications were assessed by Logistic regression analysis.

The incidence of biliary complications within postoperative 90 d was 23.8%(50/210). The incidence of postoperative biliary complications was associated with surgical method, tumor site, tumor size, pancreatic texture, operative time. The incidence of biliary complications in patients treated with local tumoral enucleation was 4%(2/50), the lowest among all groups (χ²=14.19, P<0.05). Logistic regression analysis showed that history of preoperative diabetes mellitus, postoperative ALT elevation, postoperative AST elevation, prolonged postoperative taking of semi-liquid diet and increased total dosage of octreotide were the independent risk factors for postoperative biliary complications (OR=2.63, 1.03, 1.02, 1.06, 1.14; P<0.05).

History of preoperative diabetes mellitus, time of postoperative semi-liquid diet and dosage of octreotide are the independent risk factors for biliary complications after organ-preserving pancreatectomy. The incidence of postoperative biliary complications was associated with surgical method, tumor site, tumor size, pancreatic texture, operative time. Selection of local tumoral enucleation, and reducing the use of somatostatin analogues contribute to lowering the risk of biliary complications.

To compare clinical efficacy of three surgical procedures in the treatment of benign or low-grade malignant tumors in the neck and body of pancreas.

Clinical data of88 patients with benign or low-grade malignant pancreatic tumors admitted to the First Affiliated Hospital of Nanchang University from January 2009 to December 2021 were retrospectively analyzed. The informed consents of all patients were obtained and the local ethical committee approval was received. Among them, 20 patients were male and 68 female, aged from 10 to 77 years, with a median age of 46 years. According to surgical procedures, all patients were divided into the central pancreatectomy group (CP group, n=23), spleen-preserving distal pancreatectomy group (SPDP group, n=26) and distal pancreatectomy combined with splenectomy group (DPS group, n=39). The operation time and intraoperative blood loss among three groups were compared by one-way ANOVA. Paired comparison was performed by SNK-q test. The incidence rate of complications was compared by Chi-square test or Fisher's exact test.

The average operation time in the CP group was (232±54) min, significantly longer than (196±39) min in the SPDP group and (191±35) min in the DPS group (q=1.169, 3.591; P<0.05). Intraoperative blood loss in the CP and SPDP groups were (167±51) ml and (185±77) ml, significantly less than (253±130) ml in theDPS group (q=-6.537, -3.270; P<0.05). The overall incidence of complications in the CP group was 57%(13/23), significantly higher than 22%(5/26) and 23%(9/39) respectively in the SPDP and DPS groups (χ²=7.302, 6.700; P<0.016 7). The incidence of pancreatic fistula in the CP group was 57%(13/23), significantly higher than 12%(3/26) and 21%(8/39) in the SPDP and DPS groups (χ²=11.230, 7.985; P<0.016 7).The incidence of clinically relevant pancreatic fistula (grade B/C) in the CP group was 30%(7/23), significantly higher than 6%(4/65) in the SPDP+DPS group (χ²=9.157, P<0.05). The incidence of elevated Plt in the DPS group was 26%(10/39), significantly higher than 0 in the CP and SPDP groups (P=0.010, 0.004). No reoperation, operation-related death or portal vein thrombosis occurred in all three groups. The follow-up time was ranged from 12 to 167 months, with a median of 84 months. In the SPDP group,6 cases suffered from pancreatic endocrine insufficiency and 6 cases of pancreatic exocrine insufficiency, 7 and 8 cases in the DPS group, and 0 and 0 cases in the CP group, respectively. In the SPDP+DPS group, the incidence of postoperative pancreatic endocrine and exocrine insufficiency was 20%(13/65) and 22%(14/65), significantly higher than 0 in the CP group (P<0.001). All patients experienced no tumor recurrence or metastasis during follow-up.

For the benign or low-grade malignant tumors in the neck and body of pancreas, SPDP yields better short-term efficacy compared with DPS and CP, while CP has long-term advantage of properly preserving the endocrine and exocrine functions of pancreas.

To investigate the risk factors for clinical prognosis in patients with pancreatic neuroendocrine carcinoma (Pan-NEC) on the head of pancreas, and to construct a nomogram.

In this retrospective cohort study, baseline data and treatment information of 210 patients diagnosed with Pan-NEC on the head of pancreas were obtained from National Cancer Institute Surveillance, Epidemiology, and End Results (SEER) database from 2005 to 2019. All patients were randomly divided into the training and validation sets according to the ratio of 7:3. Cox proportional hazard regression model was used to construct the nomogram, and the predictive efficiency of the nomogram was validated and compared with the 8^th edition staging system of American Joint Commission on Cancer (AJCC).

Tumor differentiation, T stage and treatment pattern were the independent risk factors for the prognosis of patients with Pan-NEC on the head of pancreas (HR=2.934, 1.511, 0.250; P<0.05). The C-index of nomogram was 0.852 and 0.927 in the training and validation sets. The area under the ROC curve (AUC) of nomogram in predicting the 1-, 2- and 3-year overall survival (OS) in the training and validation sets was 0.912, 0.924, 0.922, and 0.973, 0.969, 0.988, respectively. Compared with AJCC staging, the nomogram yielded higher C-index and AUC. Calibration curve showed that the nomogram was well calibrated. Decision curve analysis revealed that the nomogram had higher net income and prediction accuracy than AJCC staging.

Tumor differentiation, T stage and treatment method are the independent risk factors for the prognosis of patients with Pan-NEC on the head of pancreas. The nomogram constructed based on SEER database can accurately evaluate the prognosis of the patients, preferably predict the survival of the patients, and provide a feasible statistical model for clinical decision-making.

To evaluate the safety and efficacy of laparoscopic transcystic common bile duct exploration (LTCBDE) in the treatment of common bile duct stones.

Clinical data of 103 patients with common bile duct stones admitted to Chuzhou Hospital Affiliated to Anhui Medical University from January 2020 to December 2022 were retrospectively analyzed. The informed consents of all patients were obtained and the local ethical committee approval was received. Among them, 46 patients were male and 57 female, aged from 16 to 80 years, with a median age of 56 years. According to different surgical methods, all patients were divided into the LTCBDE group (n=41) and choledocholithotomy+T tube drainage group (TTD group, n=62). The number and size of common bile duct stones, common bile duct diameter, perioperative parameters and postoperative liver function between two groups were compared by rank-sum test. The rates were compared by Chi-square test or Fisher's exact test.

All patients successfully completed the surgery. No conversion to open surgery was performed. No perioperative death occurred. The median number of stones in the LTCBDE group was 1(1,1), significantly less than 2(1,3) in the TTD group (Z=-4.296, P<0.05). The diameter of stones in the LTCBDE group was 5(5,6) mm, significantly less than 8(5,10) mm in the TTD group (Z=-4.013, P<0.05). The operation time in the LTCBDE group was 70(63,78) min, significantly shorter than 114(88,146) min in the TTD group (Z=-6.639, P<0.05). The indwelling rate of drainage catheter in the LTCBDE group was 54%(22/41), significantly lower than 100%(62/62) in the TTD group (P<0.05). The drainage volume in the LTCBDE group was 20(15,36) ml, significantly less than 60(50,70) ml in the TTD group (Z=-6.562, P<0.05). The indwelling time of drainage catheter in the LTCBDE group was 4(4,5) d, significantly shorter than 7(6,8) d in the TTD group (Z=-6.188, P<0.05). The length of postoperative hospital stay in the LTCBDE group was 5(3,7) d, significantly shorter than 10(8,13) d in the TTD group (Z=-7.738, P<0.05). The treatment expense in the LTCBDE group was 12 000(11 000, 13 000) Yuan, significantly less than 20 000(19 000, 24 000) Yuan in the TTD group (Z=-8.078, P<0.05). The ALT, AST, ALP and GGT levels in the LTCBDE group were significantly lower than those in the TTD group (Z=-2.372, -1.988, -2.230, -2.341; P<0.05). In the LTCBDE group, acute cholangitis was reported in 2 cases, and no patient developed stone recurrence and common bile duct stenosis, and 3 cases of acute cholangitis, 3 cases of stone recurrence and 1 case of common bile duct stenosis in the TTD group, with no statistical significance between two groups (P>0.05).

LTCBDE is a simple, safe and effective treatment, which can minimize the risk of common bile duct injury and accelerate rapid postoperative recovery, especially for patients with a single stone with a diameter of ≤ 5 mm.

To evaluate the safety and efficacy of primary duct closure after laparoscopic common bile duct exploration (LCBDE).

Clinical data of 128 patients with common bile duct stones admitted to Zhujiang Hospital of Southern Medical University from February 2020 to February 2023 were retrospectively analyzed. The informed consents of all patients were obtained and the local ethical committee approval was received. Among them, 84 patients were male and 44 female, aged from 21 to 89 years with the median of 59 years. All patients were treated with LCBDE. According to different closure methods of common bile duct, all patients were divided into primary duct closure group (PDC group, n=60) and T-tube drainage group (TTD group, n=68). Perioperative liver function and incidence of complications were observed between two groups. Liver function between two groups was compared by independent sample t test or nonparametric test. The incidence of complications was compared by Chi-square test or Fisher's exact test.

In the PDC group, the average AST and ALT levels at postoperative 3 dwere (25.6±1.5) and (52.5±5.4) U/L, significantly lower than (38.8±4.6) and (97.1±15.5) U/L in the TTD group (t=-2.752, -2.197; P<0.05). In the PDC group, the operation time, time to first flatus, length of postoperative hospital stay and hospitalization expense were respectively (134±5) min, (36.6±2.2) h, (4.47±0.14) d and (4.70±0.15)×10⁴ Yuan, significantly less than (163±7) min, (53.6±2.2) h, (6.15±0.35) dand (5.78±0.17)×10⁴ Yuan in the TTD group (t=-3.029, -5.307, -3.573, -5.171; P<0.05). The overall incidence of complications in two groups was 29%(20/68) and 15%(9/60) respectively, and the difference was not statistically significant (χ²=3.778, P>0.05). In the TTD group, 6 patients had residual stones, whereas no case had residual stones in the PDC group, and the difference was statistically significant (P=0.018). No death or postoperative biliary stricture was observed in two groups.

Compared with TTD, PDC in LCBDE can shorten operation time, accelerate postoperative recovery, decrease treatment cycle, reduce medical expenses and increase one-time stone clearance rate without increasing the overall incidence of complications, which is a safe and efficient minimally invasive procedure.

To systematically evaluate the efficacy and safety of perioperative enteral nutrition (EN) in patients with primary liver cancer (PLC) undergoing hepatectomy.

Studies related to perioperative EN in PLC patients undergoing hepatectomy were retrieved from China Biomedical Literature Service System (CBM), Wanfang Data, CNKI, Chongqing VIP, PubMed, Cochrane Library, Web of Science and Embase databases from the database inception to June 2022. The searching words included hepatectomy, liver resection, partial hepatectomy, liver neoplasms, perioperative nutrition, enteral feeding and postoperative nutrition in both Chinese and English. The main outcome indexes were postoperative ALB, liver function and gastrointestinal function recovery, etc. Meta-analysis was carried out by RevMan 5.4 software.

16 RCTs consisting of 1 390 patients were finally included. Meta-analysis showed that compared with routine nutrition or intravenous nutrition support, perioperative EN increased postoperative ALB level (MD=2.22, 95%CI: 0.96-3.49, P<0.05) and decreased ALT level (MD=-9.45, 95%CI: -17.71--1.20, P<0.05) and TB level (MD=-3.92, 95%CI: -5.37--2.11, P<0.05), shorten the first postoperative exhaust time (SMD=-1.42, 95%CI: -1.95--0.90, P<0.05), the defecation time (SMD=-1.46, 95%CI: -2.12--0.81, P<0.05) and the length of postoperative hospital stay (MD=-2.28, 95%CI: -3.04--1.52, P<0.05), and reduce the incidence of postoperative gastrointestinal discomfort (OR=0.35, 95%CI: 0.22-0.57, P<0.05).

Compared with routine nutrition, perioperative EN can improve the nutritional status, promote the recovery of postoperative liver and gastrointestinal function, reduce the incidence of postoperative gastrointestinal adverse reactions, shorten the length of postoperative hospital stay and accelerate postoperative rehabilitation of PLC patients.

To evaluate the diagnostic value of dual-detector spectral CT in early primary liver cancer (PLC).

60 patients with PLC and/or cirrhosis admitted to the Third Affiliated Hospital of Sun Yat-sen University were enrolled in this study. The informed consents of all patients were obtained and the local ethical committee approval was received. Among them, 49 patients were male and 11 female, aged from 50 to 70 years, with a median age of 57 years. The diameter of liver cancer was 1.2-3.0 cm, with a median diameter of 1.8 cm. 21 patients had a single lesion and 9 cases of multiple lesions. All patients received by dual-detector spectral enhanced CT. After CT scan, virtual 40 keV single-energy enhanced CT images, iodine density enhanced CT images and effective atomic number enhanced CT images were reconstructed. The suspected patients further received MRI. The results were evaluated by two radiologists experienced in liver cancer diagnosis by double-blind method. Pathological examination was considered as the diagnostic gold standard. The diagnostic rates of three imaging methods or the combined for early PLC were assessed by Chi-square test. The diagnostic value was analyzed by the area under the ROC curve (AUC).

Pathological examination showed that 30 patients were diagnosed with early PLC and 30 cases of liver cirrhosis. The diagnostic rate for early PLC by 120 kV conventional CT images was 63%(19/30), including 11 suspected patients diagnosed by MRI. The diagnostic rate of virtual 40 keV single-energy enhanced CT images for early PLC was 67%(20/30), 80%(24/30) for the iodine density enhanced CT images, 83%(25/30) for the effective atomic number enhanced CT images, and 93%(28/30) for the combination of three images, respectively. Compared with single use of three enhanced CT images, the diagnostic rate of the three combined was significantly enhanced (χ²=17.37, 5.43, 4.01; P<0.05). ROC curve analysis showed that the AUC of three images and the three combined was 0.638, 0.760, 0.782 and 0.904, respectively. The diagnostic value of the three combined was the highest.

The combination of three dual-detector spectral CT images yields a high diagnostic rate for early PLC, which can assist physicians to promptly identify PLC lesions, and improve therapeutic effect and clinical prognosis.

To evaluate the value of routine ultrasound and contrast-enhanced ultrasound (CEUS) in differential diagnosis of benign and malignant lymph nodes in the upper abdomen after liver transplantation.

Clinical data of 70 patients with lymph node enlargement in the upper abdomen after liver transplantation who received routine ultrasound and CEUS simultaneously in the Third Affiliated Hospital of Sun Yat-sen University from January 2008 to November 2021 were retrospectively analyzed. Among them, 62 patients were male and 8 female, aged (48±11) years on average. The informed consents of all patients were exempted and the local ethical committee approval was received. According to CT, MRI, PET-CT and pathological diagnosis, 41 patients were diagnosed with benign lymph nodes (benign group) and 29 patients with malignant lymph nodes (malignant group). Routine ultrasound and CEUS features of benign and malignant lymph nodes in the upper abdomen after liver transplantation were analyzed. The diameter of lymph nodes between two groups was compared by t test. The rate comparison was performed by Chi-square test or Fisher's exact test.

Routine ultrasound showed that the percentage of patients with multiple malignant lymph nodes was 100% (29/29), and 56% (23/41) for benign lymph nodes, and the difference was statistically significant (P<0.05). The maximum and minimum diameters of lymph nodes in the malignant group were (33±13) and (21±9) mm, and (16±4) and (11±4) mm in the benign group, and the differences were statistically significant (t=7.754, 6.648; P<0.05). In the malignant group, the lymph nodes had unclear margins and irregular morphology and complicated with intrahepatic space-occupying lesions, which accounted for 24%(7/29), 14%(4/29) and 52%(15/29), and 0 in the benign group, the differences were statistically significant (P<0.05). In the malignant group, color blood flow signal was observed in 28%(8/29), and 7%(3/41) in the benign group, and the difference was statistically significant (χ²=3.850, P<0.05). CEUS showed that the perfusion patterns of uniform enhancement, uneven enhancement and thick-ring enhancement were seen in 4, 10 and 15 cases in the malignant group, and 30, 11 and 0 cases in the benign group, and the differences were statistically significant (P<0.05).

After liver transplantation, malignant lymph nodes in the upper abdomen are mainly large, featuring unclear margins and visible blood flow signals, primarily complicated with intrahepatic space-occupying lesions. CEUS shows uneven enhancement and thick-ring enhancement. Ultrasound can be employed as an effective imaging approach for auxiliary diagnosis and monitoring of upper abdominal lymph nodes after liver transplantation.

To identify the risk factors of post-hepatectomy liver failure (PHLF) in patients with hepatocellular carcinoma (HCC), and to construct a nomogram prediction model for PHLF.

Clinical data of 188 patients with HCC who underwent radical hepatectomy in the Third Affiliated Hospital of Sun Yat-sen University from January 2022 to April 2023 were retrospectively analyzed. The informed consents of all patients were obtained and the local ethical committee approval was received. Among them, 165 patients were male and 23 female, aged from 24 to 75 years, with a median age of 55 years. The independent risk factors of PHLF were determined by Logistic regression analysis. The nomogram model was constructed. The discrimination and calibration degree of the model were evaluated by using the area under the ROC curve (AUC) and calibration curve. The constructed model was compared with the actual score of comprehensive liver function.

The incidence of PHLF was 25%(47/188), including3 cases of grade A PHLF, 42 cases of grade B and 2 cases of grade C, and one of them died of PHLF. Logistic regression analysis showed that ALT (OR=1.037, 95%CI: 1.007-1.068), TB (OR=1.176, 95%CI: 1.013-1.365), maximal tumor diameter (OR=1.414, 95%CI: 1.148-1.742), ALBI score (OR=0.173, 95%CI: 0.031-0.962) and ICGR15 (OR=1.081, 95%CI: 1.005-1.162) were the independent risk factors for PHLF (P<0.05). Based on ALT, ICGR15, TB and maximal tumor diameter (ARTL), the AUC of ARTL model was 0.816 (95%CI: 0.747-0.885), indicating it had high predictive capability. The calibration curve and calibration prediction curve fit well, and the predicted value was in high agreement with the observed value. The predictive efficiency and clinical benefit of ARTL model were better than those of ALBI score (AUC=0.607), FIB-4 index (AUC=0.672) and APRI score (AUC=0.730).

ALT, ICGR15, TB, maximal tumor diameter and ALBI score are the independent risk factors for PHLF. ARTL model has high predictive capability, which is superior to the existing three comprehensive scoring systems for liver function.

To identify the risk factors of re-hemorrhage in patients with cirrhotic portal hypertension after treatments, and to construct a nomogram prediction model.

Clinical data of143 patients with cirrhotic portal hypertension treated in Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine from January 2015 to January 2020 were retrospectively analyzed. The informed consents of all patients were obtained and the local ethical committee approval was received. Among them, 77 patients were male and 66 female, aged (56±12) years on average. 109 cases were diagnosed with liver cirrhosis after hepatitis B. Baseline data, medical history and laboratory examination results upon admission were collected. Follow-up time was 3 years. Re-hemorrhage after treatments was regarded as the main outcome event. All patients were divided into the re-hemorrhage (n=32) and non-hemorrhage groups (n=111) according to the incidence of re-hemorrhage. The risk factors of re-hemorrhage were identified by Logistic univariate and multivariate regression analyses. Relevant variables were screened by stepwise regression method. Nomogram prediction model was constructed by R software, and internal verification was carried out by Bootstrap method. Finally, the prediction efficiency and clinical effectiveness of this model were analyzed and validated based on the ROC curve, calibration curve and decision curve analysis (DCA).

Logistic univariate and multivariate regression analyses showed that age, weight, Child-Pugh grading above grade A and surgical treatment were the independent influencing factors of re-hemorrhage in patients with cirrhotic portal hypertension after treatment (OR=1.048, 0.947, 5.980, 0.238; P<0.05). Based on 4 independent influencing factors, the nomogram prediction model for re-hemorrhage was constructed. The area under the ROC curve of this prediction model was 0.806 (0.811 after validation), both of which were >0.75, indicating that this prediction model yielded high discrimination. Brier score was calculated as 0.114 (0.102 after validation), equally <0.25, and R² was 0.437 (0.477 after validation), equally >0.4, suggesting that the model had high calibration. The net benefit of DCA curve of this model was higher than those of two extreme curves, indicating that the prediction model had clinical effectiveness.

Surgery is an important approach to prevent and treat re-hemorrhage in patients with cirrhotic portal hypertension. Constructing nomogram prediction model contributes to identifying high-risk post-treatment re-hemorrhage patients with cirrhotic portal hypertension at early clinical stage.

To evaluate the safety and efficacy of three-dimensional visualization technology in laparoscopic resection of huge liver tumors.

Clinical data of 50 patients who underwent huge liver tumor resection in No. 900 Hospital from July 2016 to June 2021 were retrospectively analyzed. Among them, 19 patients were male and 31 female, aged from 38 to 65 years, with a median age of 45 years. The informed consents of all patients were obtained and the local ethical committee approval was received. The tumor diameter was ranged from 10 to 17 cm, with a median diameter of 13 cm. 23 patients were diagnosed with benign tumors and 27 cases of malignant tumors. According to different surgical methods, they were divided into two groups. In the combination group, 24 cases underwent three-dimensional visualization technology combined with laparoscopic resection. In the control group, 26 cases were treated with open resection of huge liver tumors. Intraoperative and postoperative conditions of patients betweentwo groups were compared by t test or Chi-square test. Survival analysis was performed by Kaplan-Meier analysis and Log-rank test.

All patients in two groups successfully completed the surgery, and no conversion to open surgery was reported in the combination group. In the combination group, the median C-reactive protein level at postoperative 1 d was 26(18, 72) mg/L, significantly lower than 57(44, 81) mg/L in the control group (Z=-2.700, P<0.05). At postoperative 1 d, the average time to first flatus, postoperative ambulation time and the length of postoperative hospital stay were (2.6±0.8), (3.1±1.3) and (13±4) d, significantly shorter than (3.1±1.1), (4.4±1.6) and (16±6) d in the control group (t= -2.180, -3.137, -2.062; P<0.05). The incidence of postoperative complications in the combination group was 25% (6/24) and 42% (11/26) in the control group, with no statistical significance between two groups (χ²=1.666, P>0.05). The postoperative 1-, 3- and 5-year overall survival and disease-free survival rates in the combination group were 78.8%, 52.5%, 26.3% and 57.1%, 28.6%, 0, and 70.6%, 36.4%, 12.1% and 51.3%, 22.0%, 0 in the control group, with no statistical significance between two groups (χ²=0.292, 0.764; P>0.05).

Three-dimensional visualization technology can be utilized to deliver accurate preoperative evaluation for patients undergoing laparoscopic resection of huge liver tumors, and to guide accurate intraoperative operation, thus mitigating inflammatory reactions and accelerating postoperative rehabilitation.

To investigate the prognostic value of platelet-related parameters in patients with intrahepatic cholangiocarcinoma (ICC) undergoing radical resection.

Clinical data of63 patients with ICC who underwent radical resection in No.909 Hospital from January 1, 2016 to December 31, 2019 were retrospectively analyzed. Among them, 41 patients were male and 22 female, aged from 39 to 65 years, with a median age of 52 years. The informed consents of all patients were obtained and the local ethical committee approval was received. Prognostic factors of ICC patients were identified by univariate and multivariate Cox regression models. Survival analysis of ICC patients with different platelet-related parameters was conducted by using Kaplan-Meier method and Log-rank test. Receiver operating characteristic (ROC) curve was drawn to evaluate the predictive efficiency of Plt, platelet distribution width (PDW) and mean platelet volume (MPV) on disease-free survival (DFS) and overall survival (OS).

Univariate and multivariate Cox analyses showed that Plt≥185×10⁹/L, PDW≥16.5%, MPV≤9.25 fl and hilar invasion were the independent risk factors for DFS in ICC patients (HR=2.384, 2.546, 2.853, 3.933; P<0.05). Plt≥185×10⁹/L, PDW≥16.5%, MPV≤9.25 fl, hilar invasion and vascular invasion were the independent risk factors for OS (HR=3.100, 2.617, 3.313, 3.708, 3.685; P<0.05). Survival analysis showed that the postoperative 3-year DFS rates of patients with Plt≥185×10⁹/L, PDW≥16.5% and MPV≤9.25 fl were respectively 18.74%, 19.54%, 23.54%, and 89.34%, 78.21%, 85.45% in the control group (χ²=41.500, 29.545, 19.973; P<0.05). The postoperative 3-year OS of patients with Plt≥185×10⁹/L,PDW≥16.5% and MPV≤9.25 fl were respectively 19.53%, 18.64%, 20.43%, and 91.53%, 77.64%, 87.94% in the control group (χ²=41.352, 30.128, 19.909; P<0.05). ROC curve analysis revealed that the area under the ROC curve of Plt for predicting postoperative 3-year OS was 0.942, 0.968 for the sensitivity and 0.744 for the specificity, and 0.843, 0.742, 0.875 for PDW, and 0.886, 0.781, 0.935 for MPV, respectively.

Preoperative platelet-related parameters including Plt, PDW and MPV are the independent prognostic factors for ICC patients undergoing radical resection, which possess a great predictive value for survival and prognosis of ICC patients.

To analyze the relationship between cholecystectomy and colorectal and anal cancers based on two-sample Mendelian randomization (TSMR).

The data of single nucleotide polymorphism (SNP) related to colorectal and anal cancers after cholecystectomy were obtained from open biological databases, and all retrieved data were analyzed based on genome-wide association studies (GWAS) database. The genetic loci closely associated with cholecystectomy were selected as instrumental variables. TSMR analysis was performed by using MR-Egger regression method, median weighted (MW) and inverse-variance weighted (IVW) methods, respectively. The causal relationship between cholecystectomy and the risk of colorectal and anal cancers was evaluated by P value.

A total of 32 SNPs related to cholecystectomy were screened. There was no causal relationship between cholecystectomy and cecum cancer (OR=22.222, 95%CI: 6.280e-02, 7.864e+03; P=0.300), no causal relationship between cholecystectomy and the ascending colon cancer (OR=3.176, 95%CI: 1.939e-03, 5.204e+03; P=0.760), and no causal relationship between cholecystectomy and transverse colon cancer (OR=0.093, 95%CI: 6.683e-06, 1.297e+03; P=0.626), and no causal relationship between cholecystectomy and the descending colon cancer (OR=0.093, 95%CI: 6.683e-06, 1.297e+03; P=0.626), and no causal relationship between cholecystectomy and sigmoid colon cancer (OR=2.737, 95%CI: 4.24e-02, 176.696; P=0.636), and no causal relationship between cholecystectomy and rectal cancer (OR=0.306, 95%CI: 7.153e-03, 13.099; P=0.537), and no causal relationship between cholecystectomy and anal cancer (OR=13.14, 95%CI: 6.683e-07, 2.600e+06, P=0.764), respectively. Subsequent sensitivity analysis confirmed the robustness of the correlation.

Based on TSMR analysis, there is no genetic evidence supporting the correlation between cholecystectomy and the risk of colorectal and anal cancers. Cholecystectomy does not lead to the incidence of colorectal and anal cancers.

To visualized analysis the overall trend of immunotherapy for gallbladder cancer by scientometrics.

Relevant studies (articles or reviews) related to immunotherapy for gallbladder cancer were searched in the Web of Science Core Collection (WoSCC) database from January 1, 2000 to December 31, 2021, and input into VOSviewer 1.6.18.0 and CiteSpace 5.1.R8 SE (32-bit) software in plain-text format. All data were processed by using scientometrics. Authors, countries, institutions, highly cited publication, co-citation, keywords and references were subject to visualization analysis, and the research hotspots and trends were obtained.

121 studies were retrieved, including 860 authors, 306 institutions, 21 countries/regions and 82 journals. The data showed that the United States was the country with the largest number of published articles in the field of immunotherapy for gallbladder cancer (n=40), followed by China (n=36) and Japan (n=14). The top three authors with the largest number of published articles were Valle JW (n=5), Javle M (n=4) and Zhu AX (n=4). Chinese Academy of Medical Sciences (Peking Union Medical College), Christie NHS Foundation Trust, Nanjing Medical University and the University of Manchester were the institutions with the largest number of published articles. Cancers was the journal with the largest number of published articles in this field. Keyword analysis indicated that "immunotherapy", "cholangiocarcinoma" and "gallbladder cancer" were the high-frequency keywords. Current research hotspots gradually focused on immunotherapy, targeted therapy and drug use for gallbladder cancer.

In recent 21 years, the number of published articles in the field of immunotherapy for gallbladder cancer has been gradually increased, which has become a potential hotspot. The United States, China and Japan occupy a central position in this field.

To evaluate the application of intelligent auxiliary real-time image defogging technology in laparoscopic cholecystectomy (LC).

Clinical data of 128 patients with gallstones treated with LC in the First Affiliated Hospital of Xi'an Jiaotong University from September 2022 to April 2023 were retrospectively analyzed. Among them, 78 patients were male and 40 female, aged from 31 to 66 years, with a median age of 53 years. The informed consents of all patients were obtained and the local ethical committee approval was received. Intelligent auxiliary technology was adopted to identify and process the images. The grades and duration of different levels of fog identified by intelligent equipment were recorded. The defogging time was also recorded. The actual duration of fog and that identified by intelligent images were compared by the rank-sum test.

The duration of fog was ranged from 8 to 17 min, with a median duration of 13 min. Intraoperatively, the laparoscope was wiped for 3-11 times, with a median of6 times. The overall used time was 69-230 s, with a median time of 141 s. Application of intelligent defogging system could effectively identify the grade of fog generated during LC, and remove the fog as required. The processing time of single-frame image was 0.02-0.08 s, with a median time of 0.04 s. The success rate of image processing was 97%(15 522/16 000), which effectively shortened intraoperative image defogging time (Z=-2.167, P<0.05).

Intelligent auxiliary real-time image defogging technology is safe and feasible in LC, which can effectively process intraoperative fog, assist the surgeons to identify surgical margins, enhance surgical efficiency and lower the incidence of complications.

To evaluate the safety and efficacy of transumbilical single-port laparoscopic cholecystectomy (LC) in the treatment of cholecystolithiasis.

Clinical data of 201 patients with cholecystolithiasis who underwent LC in Hainan Cancer Hospital from June 2018 to June 2022 were retrospectively analyzed. Among them, 91 patients were male and 110 female, aged from 27 to 74 years, with a median age of 51 years. The informed consents of all patients were obtained and the local ethical committee approval was received. According to surgical methods, all patients were divided into single-port LC group (single-port group, n=107) and three-port LC group (three-port group, n=94). Operation time and satisfaction score between two groups were compared by t test. The incidence of complications and the conversion rate to open surgery were compared by using Chi-square test or Fisher's exact test.

All patients intwo groups successfully completed the surgery. 1 patient in the single-port group was converted to open surgery, and none in the three-port group, with no statistical significance between two groups (P=0.347). No statistical significance was found in intraoperative blood loss, operation time, length of hospital stay and hospitalization expenses between two groups (P>0.05). Subgroup analysis showed that for patients with cholecystolithiasis of >2 cm, the average operation time in the single-port group was (44±8) min, significantly shorter than (55±7) min in the three-port group (t=-12.685, P<0.05). The incidence of postoperative complications in the single-port group was 1.9%(2/107), and 2.1%(2/94) in the three-port group, with no statistical significance (χ²=0.418, P>0.05). In single-port group, the satisfaction score of patients was 42.8±2.8, significantly higher than 33.7±4.9 in the three-port group (t=32.710, P<0.05).

Transumbilical single-port LC is safe and efficacious treatment of cholecystolithiasis, which has the advantages of better cosmetic effect and higher satisfaction score. For patients with cholecystolithiasis of >2 cm, the operation time of single-port LC is shorter.

To investigate the incidence of postoperative complications and influencing factors after duodenum, common bile duct and sphincter of Oddi-preserving pancreatic head total resection (DCOPPHTR).

Clinical data of 32 patients with pancreatic tumors who underwent DCOPPHTR in Chongqing General Hospital from June 2020 to November 2022 were retrospectively analyzed. Among them,19 patients were male and 13 female, aged (44±16) years on average. The informed consents of all patients were obtained and the local ethical committee approval was received. According to the incidence of postoperative complications, all patients were divided into the complication (n=12) and non-complication groups (n=20). The influencing factors of postoperative complications were analyzed. Studies related to DCOPPHTR were retrieved. The incidence of postoperative complications was analyzed. The risk factors of complications were identified by multivariate Logistic regression analysis.

All patients successfully completed DCOPPHTR. The operation time was (469±81) min, and intraoperative blood loss was (195±120) ml.Postoperative complications occurred in 12 patients, including pancreatic fistula in 6, bile leakage in 1, postoperative bleeding in 2, abdominal infection in 2 and delayed gastric emptying in 1, respectively. According to Clavien-Dindo classification system, 7 patients developed gradeⅠcomplications, 1 case of grade Ⅱand 4 cases of grade Ⅲa. No grade Ⅲb, Ⅳand Ⅴcomplications were reported. In the complication group, preoperative diameter of main pancreatic duct was (6±3) mm, significantly shorter than (9±4) mm in thenon-complication group (t=-2.070, P<0.05). In the complication group, the length of hospital stay was (31±10) d, significantly longer than (17±5) d in the non-complication group (t=4.551, P<0.05). Multivariate Logistic regression analysis indicated that preoperative diameter of main pancreatic duct (OR=0.74, 95%CI: 0.56-0.99) and operation time (OR=1.01, 95%CI: 1.00-1.03) were the independent influencing factors for postoperative complications of DCOPPHTR in patients with pancreatic tumors (P<0.05).

DCOPPHTR is an ideal surgical treatment for inflammatory masses and benign or low-grade malignant tumors in pancreatic head. Preoperative diameter of main pancreatic duct and operation time are the independent influencing factors for postoperative complications of DCOPPTR in patients with pancreatic tumors.

To evaluate the effect of microvascular invasion (MVI) and surgical margin on postoperative survival and prognosis of hepatocellular carcinoma (HCC) patients.

Clinical data of 513 patients with HCC admitted to the First People's Hospital of Foshan from January 2016 to December 2020 were retrospectively analyzed. The informed consents of all patients were obtained and the local ethical committee approval was received. Among them, 419 patients were male and 94 female, aged from 25 to 86 years, with a median age of 54 years. MVI was divided into three grades: M0 (non-MVI group), M1 (low-risk group) and M2 (high-risk group). The tumor surgical margin was divided into narrow surgical margin (<1 cm) and wide surgical margin (≥1 cm). The influencing factors of MVI in HCC patients were identified by Chi-square test and Logistic regression analysis. Survival analysis was conducted by Kaplan-Meier method and Log-rank test.

Univariate analysis showed that AFP, tumor diameter, number of tumors and China liver cancer (CNLC) staging system were correlated with the incidence of MVI in HCC patients (χ²=28.068, 29.657, 4.375, 10.208; P<0.05). Multivariate Logistic regression analysis showed that AFP and tumor diameter were the independent influencing factors of MVI in HCC patients (OR=0.408, 0.394; P<0.05). In the M0 group, the postoperative 1-,2- and 3-year disease-free survival rates were 79.6%, 71.0% and 63.4%, and 59.6%, 48.0% and 43.3% in the M1 group, and 31.0%, 27.5% and 25.2% in theM2 group, respectively. The differences were statistically significant (χ²=61.889, P<0.05). In the M0 group, the postoperative 1-, 2- and 3-year overall survival rates were 97.3%, 88.2% and 84.6%, 87.0%, 71.5% and 66.1% in the M1 group, and 79.3%, 61.9% and 52.6% in the M2 group, respectively. The differences were statistically significant (χ²=44.138, P<0.05). For MVI-negative patients, the postoperative 1-,2- and 3-year disease-free survival rates in the wide margin group were 82.6%, 70.7% and 65.4%, and 79.4%, 64.7% and 60.5% in the narrow margin group, with no statistical significance (χ²=0.983, P>0.05). In the wide margin group, the 1-, 2- and 3-year overall survival rates were 97.5%, 89.6% and 85.2%, and 97.1%, 86.0% and 82.8% in the narrow margin group, with no statistical significance (χ²=0.051, P>0.05). For MVI-positive patients, the postoperative 1-, 2- and 3-year disease-free survival rates in the wide margin group were 58.1%, 45.4% and 40.3%, and 42.9%, 37.3% and 36.1% in the narrow margin group. The differences were statistically significant (χ²=4.874, P<0.05). In the wide margin group, the postoperative 1-, 2- and 3-year overall survival rates were 88.8%, 71.9% and 64.3%, and 82.6%, 64.8% and 61.0% in the narrow margin group. The differences were statistically significant (χ²=4.604, P<0.05).

Tumor size and AFP are the independent risk factors for MVI in HCC patients. The higher the MVI grade, the worse the prognosis. For patients with positive MVI, long-term prognosis of patients with wide surgical margin is better than that of those with narrow surgical margin. However, for patients with negative MVI, tumor surgical margin exerts no significant effect upon clinical prognosis.