The "Expert consensus on diagnosis and treatment of acute biliary tract infection in the elderly (2025 edition)" was compiled and organized by the Hepatobiliary Pancreatic Surgery Committee of Chinese Aging Well Association. Acute biliary tract infections in the elderly are common among the acute abdominal diseases in the elderly, with atypical clinical manifestations, rapid progression and high fatality rate. The consensus puts forward targeted recommendations around multiple aspects such as the diagnosis, severity assessment, imaging examination, systemic assessment, rational application of antibiotics, intensive care treatment, nutritional support, surgical treatment and endoscopic treatment of acute biliary tract infections in the elderly. The consensus emphasizes that the diagnosis of elderly patients should be combined with comprehensive assessment of clinical manifestations, laboratory tests and imaging examinations, and that treatment should be individualized, and attach importance to multidisciplinary collaboration during the perioperative period. The consensus provides important references for the standardized diagnosis and treatment of acute biliary tract infections in the elderly.

To introduce and evaluate the application of a modified two-port laparoscopic cholecystectomy (LC) assisted by the Minilap.

Clinical data of 10 patients who underwent Minilap-assisted two-port LC in the Seventh Affiliated Hospital of Sun Yat-sen University from June to September 2019 were retrospectively analyzed. Among them, 6 patients were male and 4 female, aged 30-68 years with a median age of 46 years. 8 patients were diagnosed with cholecystolithiasis complicated with cholecystitis and 2 cases of polypoid lesions. The informed consents of all patients were obtained and the local ethical committee approval was received. Trocars were inserted at the lower margin of umbilicus and below the xiphoid process where the laparoscopy and conventional instruments were placed. The gallbladder was grasped with a Minilap with a diameter of 2.5 mm inserted below the right costal margin, and then LC was performed. Surgical conditions and complications were observed.

Minilap-assisted two-port LC were successfully performed in all 10 patients without conversion to open surgery. The median operation time was 38(25-55) min, the intraoperative blood loss was 5(2-8) ml, the postoperative pain score was 2(1-3), and the length of postoperative hospital stay was 2(1-3) d. No complications occurred during the perioperative period. The Minilap port was almost healed at postoperative 3 d. At 2 weeks after operation, the incisions at the lower margin of umbilicus and below the xiphoid process were healed in a line shape. The satisfaction degree of patients was 100%.

Minilap-assisted two-port LC yields equivalent convenience, better minimal invasiveness and aesthetic effect compared with three-port LC. Compared with single-port LC, it does not cause "chopstick effect" or require special instruments.

To evaluate the efficacy of TACE-hepatic arterial infusion chemotherapy (HAIC) combined with lenvatinib and PD-1 inhibitor in the treatment of stage Ⅲa liver cancer.

Clinical data of 96 patients with stage Ⅲa liver cancer admitted to Cancer Hospital of Guangzhou Medical University from January 2020 to May 2023 were retrospectively analyzed. The informed consents of all patients were obtained and the local ethical committee approval was received. Among them, 86 patients were male and 10 female, aged from 33 to 74 years, with a median age of 54 years. All patients were classified as CNLC stage Ⅲa. According to different treatment protocols, all patients were divided into the quadruple-treatment group (n=62) and triple-treatment group (n=34). In the quadruple-treatment group, patients were treated with TACE-HAIC combined with lenvatinib and PD-1 inhibitor, and those in the triple-treatment group were treated with TACE-HAIC combined with lenvatinib. Inter-group equilibrium was obtained by 1∶1 propensity score matching (PSM). Primary end points were overall survival (OS) and progression-free survival (PFS). The incidence of adverse reactions between two groups was compared by Chi-square test or Fisher’s exact test. Survival analysis was performed by Kaplan-Meier method and Log-rank test. The influencing factors of survival were identified by Cox proportional hazard regression model.

After PSM, the median OS in the quadruple-treatment group was 32.0 months (95%CI: 10.985-53.015), and 14.0 months in the triple-treatment group (95%CI: 6.548-21.452), and the difference was statistically significant (χ²=9.071, P=0.003). The median PFS in the quadruple-treatment group was 19.0 months (95%CI: 9.655-28.345), and 6.0 months in the triple-treatment group (95%CI: 3.197-8.803), and the difference was statistically significant (χ²=7.811, P=0.005). Cox’s regression analysis showed that treatment method (HR=0.318, 95%CI: 0.144-0.701; P=0.004) and frequency of TACE-HAIC (HR=0.415, 95%CI: 0.197-0.873; P=0.020) were the independent influencing factors of OS. Treatment method was an independent influencing factor of PFS (HR=0.439, 95%CI: 0.238-0.810; P=0.008). No toxicity-related death occurred in this study. No significant difference was found in the incidence of any grade and grade 3/4 adverse reactions (all P>0.05).

The quadruple therapy of TACE-HAIC combined with lenvatinib and PD-1 inhibitor can significantly improve the survival benefit of patients with stage Ⅲa liver cancer without sacrificing the incidence of adverse reactions.

To investigate the survival and prognosis of distal cholangiocarcinoma (DCCA) and its prognostic factors.

Clinicopathological data of 116 DCCA patients who underwent pancreaticoduodenectomy from January 2011 to December 2019 were retrospectively analyzed. The informed consents of all patients were obtained and the local ethical committee approval was received. Among them, 71 patients were male and 45 female, aged from 31 to 82 years, with a median age of 65 years. The survival and prognosis were followed up. Survival analysis was performed by Kaplan-Meier method and Log-rank test. The influencing factors of survival and prognosis were analyzed by multivariate Cox’s regression analysis.

The 1-, 3- and 5-year overall survival rates of patients with DCCA after operation were 75.2%, 41.9% and 31.5%, respectively. Multivariate Cox’s regression analysis showed that the expression level of epidermal growth factor receptor (EGFR) (RR=1.600, 95%CI: 1.086-2.357), metastatic lymph node ratio (MLNR) (RR=2.899, 95%CI: 1.365-6.158) and degree of tumor differentiation (RR=2.009, 95%CI: 1.245-3.243) were the independent risk factors for long-term survival of DCCA patients after operation. The 1-,3- and 5-year survival rates of patients with MLNR=0 were 83.0%, 50.7% and 42.5%, and 80.5%, 37.4% and 37.4% for those with 0<MLNR≤0.17, and 48.2%, 0 and 0 for those with MLNR>0.17, respectively. The higher the MLNR, the worse the prognosis (χ²=26.834, P=0.006). The 1-, 3- and 5-year survival rates of EGFR-negative patients were 80.3%, 50.3% and 41.2%, and 81.3%, 16.2% and 16.2% for those with weak expression of positive EGFR, and 27.8%, 0 and 0 for those with moderate and high expression of positive EGFR, respectively. The higher the EGFR expression, the worse the overall survival (χ²=20.848, P=0.017). The 1-, 3- and 5-year survival rates of highly-differentiated DCCA patients were 92.9%, 68.8% and 68.8%, and 83.8%, 40.3% and 32.3% for those with moderately-differentiated DCCA, and 50.8%, 19.8% and 19.8% for those with poorly-differentiated DCCA, respectively. The lower the degree of tumor differentiation, the worse the prognosis (χ²=32.493, P=0.004).

Pancreaticoduodenectomy remains the optimal treatment for patients with DCCA. The expression levels of MLNR, EGFR and the degree of tumor differentiation are the independent risk factors of postoperative survival of DCCA patients. The higher the MLNR, the worse the prognosis. The higher the EGFR expression level, the worse the prognosis. The lower the degree of tumor differentiation, the worse the prognosis.