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Zhou WT, Lou WH. [Predictors of malignant intraductal papillary mucinous neoplasm of the pancreas]. Zhonghua Wai Ke Za Zhi 2023; 61:1032-1036. [PMID: 37767672 DOI: 10.3760/cma.j.cn112139-20230826-00058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Subscribe] [Scholar Register] [Indexed: 09/29/2023]
Abstract
Intraductal papillary mucinous neoplasm (IPMN) is the most common pancreatic cystic neoplasm with a tendency to malignancy,and the 5-year survival rate of patients with invasive IPMN is less than 40%. Therefore,early detection of malignant cases and surgical intervention will significantly improve patient outcomes. The clinical guidelines recommended risk factors for IPMN malignancy according to imaging characteristics,clinical manifestations and serum tumor markers,among which dilation of the main pancreatic duct≥10 mm,the presence of solid components or enhanced mural nodules,and obstructive jaundice were recognized as high-risk factors. However,clinical practice has shown that the risk factors recommended by the current guidelines are not highly accurate in predicting IPMN malignancy,and the main problem is that the guidelines are less specific and allow follow-up cases to undergo unnecessary surgical resection. In recent years,the development of new technologies and methods such as genomics,radiomics,and artificial intelligence has greatly promoted the research progress of IPMN. Endoscopic ultrasound-guided fine needle aspiration of cystic fluid combined with molecular detection such as DNA and RNA,as well as radiomics combined with machine learning modeling,have shown superiority in improving the prediction accuracy of malignant IPMN,and will become an important tool to assist the diagnosis and treatment of IPMN in the future.
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Affiliation(s)
- W T Zhou
- Department of General Surgery,Shanghai Geriatric Medical Center,Shanghai 201104,China
| | - W H Lou
- Department of Pancreatic Surgery,Zhongshan Hospital,Fudan University,Shanghai 200032,China
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Yin HL, Pu N, Chen QD, Zhang JC, Xu YL, Shi CY, Lyu MZ, Lou WH, Wu WC. [The beginnings and evolution of a pancreatic surgeon: a technical morphological analysis in first 5 years]. Zhonghua Wai Ke Za Zhi 2023; 61:511-518. [PMID: 37088485 DOI: 10.3760/cma.j.cn112139-20221027-00462] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Subscribe] [Scholar Register] [Indexed: 04/25/2023]
Abstract
Objective: To explore the development of the pancreatic surgeon technique in a high-volume center. Methods: A total of 284 cases receiving pancreatic surgery by a single surgeon from June 2015 to December 2020 were retrospectively included in this study. The clinical characteristics and perioperative medical history were extracted from the medical record system of Zhongshan Hospital,Fudan University. Among these patients,there were 140 males and 144 females with an age (M (IQR)) of 61.0 (16.8) years(range: 15 to 85 years). The "back-to-back" pancreatic-jejunal anastomosis procedure was used to anastomose the end of the pancreas stump and the jejunal wall. Thirty days after discharge,the patients were followed by outpatient follow-up or telephone interviews. The difference between categorical variables was analyzed by the Chi-square test or the CMH chi-square test. The statistical differences for the quantitative data were analyzed using one-way analysis of variance or Kruskal-Wallis H test and further analyzed using the LSD test or the Nemenyi test,respectively. Results: Intraoperative blood loss in pancreaticoduodenectomy between 2015 and 2020 were 300,100(100),100(100),100(0),100(200) and 150 (200) ml,respectively. Intraoperative blood loss in distal pancreatectomy was 250 (375),100 (50),50 (65),50 (80),50 (50),and 50 (100) ml,respectively. Intraoperative blood loss did not show statistical differences in the same operative procedure between each year. The operative time for pancreaticoduodenectomy was respectively 4.5,5.0(2.0),5.5(0.8),5.0(1.3),5.0(3.3) and 5.0(1.0) hours in each year from 2015 to 2020,no statistical differences were found between each group. The operating time of the distal pancreatectomy was 3.8 (0.9),3.0 (1.5),3.0 (1.8),2.0 (1.1),2.0 (1.5) and 3.0(2.0) hours in each year,the operating time was obviously shorter in 2018 compared to 2015 (P=0.026) and 2020 (P=0.041). The median hospital stay in 2020 for distal pancreatectomy was 3 days shorter than that in 2019. The overall incidence of postoperative pancreatic fistula gradually decreased,with a incident rate of 50.0%,36.8%,31.0%,25.9%,21.1% and 14.8% in each year. During this period,in a total of 3,6,4,2,0 and 20 cases received laparoscopic operations in each year. The incidence of clinically relevant pancreatic fistula (grade B and C) gradually decreased,the incident rates were 0,4.8%,7.1%,3.4%,4.3% and 1.4%,respectively. Two cases had postoperative abdominal bleeding and received unscheduled reoperation. The overall rate of unscheduled reoperation was 0.7%. A patient died within 30 days after the operation and the overall perioperative mortality was 0.4%. Conclusion: The surgical training of a high-volume center can ensure a high starting point in the initial stage and steady progress of pancreatic surgeons,to ensure the safety of pancreatic surgery.
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Affiliation(s)
- H L Yin
- Department of Pancreatic Surgery,Zhongshan Hospital,Fudan University,Shanghai 200032,China
| | - N Pu
- Department of Pancreatic Surgery,Zhongshan Hospital,Fudan University,Shanghai 200032,China
| | - Q D Chen
- Department of Pancreatic Surgery,Zhongshan Hospital,Fudan University,Shanghai 200032,China
| | - J C Zhang
- Department of Pancreatic Surgery,Zhongshan Hospital,Fudan University,Shanghai 200032,China
| | - Y L Xu
- Department of Pancreatic Surgery,Zhongshan Hospital,Fudan University,Shanghai 200032,China
| | - C Y Shi
- Department of Pancreatic Surgery,Zhongshan Hospital,Fudan University,Shanghai 200032,China
| | - M Z Lyu
- Department of Biostatistics,Zhongshan Hospital,Fudan University,Shanghai 200032,China
| | - W H Lou
- Department of Pancreatic Surgery,Zhongshan Hospital,Fudan University,Shanghai 200032,China
| | - W C Wu
- Department of Pancreatic Surgery,Zhongshan Hospital,Fudan University,Shanghai 200032,China
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Gao Q, Lin YP, Li BS, Wang GQ, Dong LQ, Shen BY, Lou WH, Wu WC, Ge D, Zhu QL, Xu Y, Xu JM, Chang WJ, Lan P, Zhou PH, He MJ, Qiao GB, Chuai SK, Zang RY, Shi TY, Tan LJ, Yin J, Zeng Q, Su XF, Wang ZD, Zhao XQ, Nian WQ, Zhang S, Zhou J, Cai SL, Zhang ZH, Fan J. Unintrusive multi-cancer detection by circulating cell-free DNA methylation sequencing (THUNDER): development and independent validation studies. Ann Oncol 2023; 34:486-495. [PMID: 36849097 DOI: 10.1016/j.annonc.2023.02.010] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2022] [Revised: 02/10/2023] [Accepted: 02/20/2023] [Indexed: 02/27/2023] Open
Abstract
BACKGROUND Early detection of cancer offers the opportunity to identify candidates when curative treatments are achievable. The THUNDER study (THe UNintrusive Detection of EaRly-stage cancers, NCT04820868) aimed to evaluate the performance of ELSA-seq, a previously described cfDNA methylation-based technology, in the early detection and localization of six types of cancers in the colorectum, esophagus, liver, lung, ovary and pancreas. PATIENTS AND METHODS A customized panel of 161,984 CpG sites was constructed and validated by public and in-house (cancer: n=249; non-cancer: n=288) methylome data, respectively. The cfDNA samples from 1,693 participants (cancer: n=735; non-cancer: n=958) were retrospectively collected to train and validate two multi-cancer detection blood test models (MCDBT-1/2) for different clinical scenarios. The models were validated on a prospective and independent cohort of age-matched 1,010 participants (cancer: n=505; non-cancer: n=505). Simulation using the cancer incidence in China was applied to infer stage-shift and survival benefits to demonstrate the potential utility of the models in the real world. RESULTS MCDBT-1 yielded a sensitivity of 69.1% (64.8%‒73.3%), a specificity of 98.9% (97.6%‒99.7%) and tissue origin accuracy of 83.2% (78.7%‒87.1%) in the independent validation set. For early stage (I‒III) patients, the sensitivity of MCDBT-1 was 59.8% (54.4%‒65.0%). In the real-world simulation, MCDBT-1 achieved the sensitivity of 70.6% in detecting the six cancers, thus decreasing late-stage incidence by 38.7%‒46.4%, and increasing 5-year survival rate by 33.1%‒40.4%, respectively. In parallel, MCDBT-2 was generated at a slightly low specificity of 95.1% (92.8%-96.9%) but a higher sensitivity of 75.1% (71.9%-79.8%) than MCDBT-1 for populations at relatively high risk of cancers, and also had ideal performance. CONCLUSION In this large-scale clinical validation study, MCDBT-1/2 models showed a high sensitivity, specificity, and accuracy of predicted origin in detecting six types of cancers.
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Affiliation(s)
- Q Gao
- Department of Liver Surgery and Transplantation, Liver Cancer Institute, Zhongshan Hospital, and Key Laboratory of Carcinogenesis and Cancer Invasion of Ministry of Education, Fudan University, Shanghai 200032, China; Key Laboratory of Medical Epigenetics and Metabolism, Institutes of Biomedical Sciences, Fudan University, Shanghai 200032, China
| | - Y P Lin
- Department of Liver Surgery and Transplantation, Liver Cancer Institute, Zhongshan Hospital, and Key Laboratory of Carcinogenesis and Cancer Invasion of Ministry of Education, Fudan University, Shanghai 200032, China; Key Laboratory of Medical Epigenetics and Metabolism, Institutes of Biomedical Sciences, Fudan University, Shanghai 200032, China
| | - B S Li
- Burning Rock Biotech, Guangzhou 510300, China
| | - G Q Wang
- Burning Rock Biotech, Guangzhou 510300, China
| | - L Q Dong
- Department of Liver Surgery and Transplantation, Liver Cancer Institute, Zhongshan Hospital, and Key Laboratory of Carcinogenesis and Cancer Invasion of Ministry of Education, Fudan University, Shanghai 200032, China; Key Laboratory of Medical Epigenetics and Metabolism, Institutes of Biomedical Sciences, Fudan University, Shanghai 200032, China
| | - B Y Shen
- Department of General Surgery, Pancreatic Disease Center, Research Institute of Pancreatic Diseases, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 20025, China
| | - W H Lou
- Department of General Surgery, Zhongshan Hospital, Fudan University, Shanghai 200032, China
| | - W C Wu
- Department of General Surgery, Zhongshan Hospital, Fudan University, Shanghai 200032, China
| | - D Ge
- Department of Thoracic Surgery, Zhongshan Hospital, Fudan University, Shanghai 200032, China
| | - Q L Zhu
- Department of Thoracic Surgery, Zhongshan Hospital, Fudan University, Shanghai 200032, China
| | - Y Xu
- Burning Rock Biotech, Guangzhou 510300, China
| | - J M Xu
- Department of General Surgery, Zhongshan Hospital, Fudan University, Shanghai 200032, China
| | - W J Chang
- Department of General Surgery, Zhongshan Hospital, Fudan University, Shanghai 200032, China
| | - P Lan
- Department of Colorectal Surgery, The Sixth Affiliated Hospital of Sun Yat-Sen University, Guangzhou 510655, China
| | - P H Zhou
- Endoscopy Center and Endoscopy Research Institute, Zhongshan Hospital, Fudan University, Shanghai 200032, China
| | - M J He
- Endoscopy Center and Endoscopy Research Institute, Zhongshan Hospital, Fudan University, Shanghai 200032, China
| | - G B Qiao
- Department of Thoracic Surgery, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou 510080, China
| | - S K Chuai
- Burning Rock Biotech, Guangzhou 510300, China
| | - R Y Zang
- Ovarian Cancer Program, Department of Gynaecologic Oncology, Zhongshan Hospital, Fudan University, Shanghai 200032, China
| | - T Y Shi
- Ovarian Cancer Program, Department of Gynaecologic Oncology, Zhongshan Hospital, Fudan University, Shanghai 200032, China
| | - L J Tan
- Department of Thoracic Surgery, Zhongshan Hospital, Fudan University, Shanghai 200032, China
| | - J Yin
- Department of Thoracic Surgery, Zhongshan Hospital, Fudan University, Shanghai 200032, China
| | - Q Zeng
- Health Management Institute, The Second Medical Center & National Clinical Research Center for Geriatric Diseases, Chinese PLA General Hospital, Beijing 100853, China
| | - X F Su
- Department of Cardiothoracic Surgery, Linfen People's Hospital, Shanxi 041000, China
| | - Z D Wang
- Clinical Research Center, Linfen People's Hospital, Shanxi 041000, China
| | - X Q Zhao
- Department of Pathology, Linfen People's Hospital, Shanxi 041000, China
| | - W Q Nian
- Phase I ward, Chongqing University Cancer Hospital, Chongqing 400030, China
| | - S Zhang
- Department of Liver Surgery and Transplantation, Liver Cancer Institute, Zhongshan Hospital, and Key Laboratory of Carcinogenesis and Cancer Invasion of Ministry of Education, Fudan University, Shanghai 200032, China
| | - J Zhou
- Department of Liver Surgery and Transplantation, Liver Cancer Institute, Zhongshan Hospital, and Key Laboratory of Carcinogenesis and Cancer Invasion of Ministry of Education, Fudan University, Shanghai 200032, China; Key Laboratory of Medical Epigenetics and Metabolism, Institutes of Biomedical Sciences, Fudan University, Shanghai 200032, China
| | - S L Cai
- Burning Rock Biotech, Guangzhou 510300, China
| | - Z H Zhang
- Burning Rock Biotech, Guangzhou 510300, China
| | - J Fan
- Department of Liver Surgery and Transplantation, Liver Cancer Institute, Zhongshan Hospital, and Key Laboratory of Carcinogenesis and Cancer Invasion of Ministry of Education, Fudan University, Shanghai 200032, China; Key Laboratory of Medical Epigenetics and Metabolism, Institutes of Biomedical Sciences, Fudan University, Shanghai 200032, China.
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Li JA, Xu YL, Ding N, Ji Y, Liu LX, Rao SX, Zhang YQ, Yao XZ, Fan Y, Huang C, Zhou YH, Wu LL, Dong Y, Zhang L, Rong YF, Kuang TT, Xu XF, Liu L, Wang DS, Jin DY, Lou WH, Wu WC. [Pancreas multidisciplinary team optimizes the diagnosis and treatment of pancreas-related diseases and improves the prognosis of pancreatic cancer patients]. Zhonghua Wai Ke Za Zhi 2022; 60:666-673. [PMID: 35775259 DOI: 10.3760/cma.j.cn112139-20220408-00149] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
Objectives: To evaluate the role of pancreas multidisciplinary team(MDT) clinic in the diagnosis of pancreatic diseases,patient compliance with MDT advice,and the impact of MDT on the postoperative survival of patients with pancreatic cancer. Methods: The study included 927 patients(554 males,373 females,aged (58.1±13.3)years (range: 15 to 89 years)) that had visited the pancreas MDT clinic of Zhongshan Hospital from May 2015 to December 2021,and 677 patients(396 males, 281 females, aged (63.6±8.9)years(range: 32 to 95 years)) who underwent radical surgery and with pathologically confirmed pancreatic adenocarcinoma from January 2012 to December 2020,of whom 79 patients had attended the pancreas MDT. The clinical and pathological data were collected and analyzed retrospectively. Diseases were classified in accordance with 2010 WHO classification of tumors of the digestive system and usual clinical practices. The Kaplan-Meier method was used for drawing the survival curve and calculating the survival rate. The univariate analysis was done by Log-rank test and the multivariate analysis was done by COX proportional hazards model. Survival rates were compared using χ2 test. Results: Among the 927 patients that had visited the MDT clinic,233 patients(25.1%) were referred due to undetermined diagnosis. A direct diagnosis was made in 109 cases (46.8%,109/233) by the MDT clinic, of which 98 were consistent with the final diagnosis,resulting in an accuracy of 89.9%(98/109). The direct diagnosis rate in the recent years(36.6%(41/112),from June 2019 to December 2021) decreased compared to that in the previous years(56.2%(68/121),from May 2015 to May 2019),yet the accuracy in the recent years(90.2%,37/41) was basically the same as before (89.7%,61/68). The rate of compliance of the entire cohort was 71.5%(663/927), with the compliance rate in the recent two and a half years(81.4%,338/415) remarkably higher than that in the previous four years(63.4%,325/512). Patients with pancreatic cancer that attended the MDT exhibited a trend toward longer median postoperative survival than patients that did not attend the MDT,but the difference was not statistically significant(35.2 months vs.30.2 months,P>0.05). The 1-year and 3-year survival rates of patients that attended the MDT were significanly higher than patients that did not attend the MDT(88.6% vs. 78.4%,P<0.05;32.9% vs. 21.9%,P<0.05,respectively),but the 5-year survival rate was not statistically different(7.6% vs. 4.8%,P>0.05). Conclusions: The pancreas MDT clinic is an accurate and convenient way to diagnose intractable pancreatic diseases,and in the recent years the patients' compliance rate with MDT advice has increased. Pancreatic cancer patients that have attended the MDT have higher 1-year and 3-year postoperative survival rates,but the long-term survival benefits of MDT still needs to be proved by clinical studies on a larger scale.
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Affiliation(s)
- J A Li
- Department of Pancreatic Surgery,Zhongshan Hospital Fudan University,Shanghai 200032,China
| | - Y L Xu
- Department of Pancreatic Surgery,Zhongshan Hospital Fudan University,Shanghai 200032,China
| | - N Ding
- Department of Pancreatic Surgery,Zhongshan Hospital Fudan University,Shanghai 200032,China
| | - Y Ji
- Department of Pathology,Zhongshan Hospital Fudan University,Shanghai 200032,China
| | - L X Liu
- Department of Interventional Radiology,Zhongshan Hospital Fudan University,Shanghai 200032,China
| | - S X Rao
- Department of Radiology,Zhongshan Hospital Fudan University,Shanghai 200032,China
| | - Y Q Zhang
- Endoscopy Center,Zhongshan Hospital Fudan University,Shanghai 200032,China
| | - X Z Yao
- Department of Radiology,Zhongshan Hospital Fudan University,Shanghai 200032,China
| | - Y Fan
- Department of Traditional Chinese Medicine,Zhongshan Hospital Fudan University,Shanghai 200032,China
| | - C Huang
- Department of Liver Surgery,Zhongshan Hospital Fudan University,Shanghai 200032,China
| | - Y H Zhou
- Department of Medical Oncology,Zhongshan Hospital Fudan University,Shanghai 200032,China
| | - L L Wu
- Department of Radiotherapy,Zhongshan Hospital Fudan University,Shanghai 200032,China
| | - Y Dong
- Department of Ultrasound,Zhongshan Hospital Fudan University,Shanghai 200032,China
| | - L Zhang
- Department of Pancreatic Surgery,Zhongshan Hospital Fudan University,Shanghai 200032,China
| | - Y F Rong
- Department of Pancreatic Surgery,Zhongshan Hospital Fudan University,Shanghai 200032,China
| | - T T Kuang
- Department of Pancreatic Surgery,Zhongshan Hospital Fudan University,Shanghai 200032,China
| | - X F Xu
- Department of Pancreatic Surgery,Zhongshan Hospital Fudan University,Shanghai 200032,China
| | - L Liu
- Department of Pancreatic Surgery,Zhongshan Hospital Fudan University,Shanghai 200032,China
| | - D S Wang
- Department of Pancreatic Surgery,Zhongshan Hospital Fudan University,Shanghai 200032,China
| | - D Y Jin
- Department of Pancreatic Surgery,Zhongshan Hospital Fudan University,Shanghai 200032,China
| | - W H Lou
- Department of Pancreatic Surgery,Zhongshan Hospital Fudan University,Shanghai 200032,China
| | - W C Wu
- Department of Pancreatic Surgery,Zhongshan Hospital Fudan University,Shanghai 200032,China
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5
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Zhang L, Lou WH. [Pay attention to the diagnosis and treatment of long-term complications after pancreatectomy]. Zhonghua Wai Ke Za Zhi 2022; 60:655-659. [PMID: 35775257 DOI: 10.3760/cma.j.cn112139-20220413-00162] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
Recently,with growing numbers of pancreatectomy and continuous improvement of comprehensive treatment,more patients have survived surgery of benign or malignant pancreatic tumors. As a result, pancreatic surgeons meet more long-term complications after pancreatic surgery. For many years,there is no uniform definition, diagnosis or therapeutic standard for long-term complications after pancreatic surgery. Such unsatisfactory situation has an indirectly negative impact on the life quality of patients as well as development of clinical research. By reviewing literature,the definition,diagnostic criteria and treatment strategies of some common long-term complications after pancreatic surgery were analyzed, including bilioenteric anastomotic stricture, pancreatic exocrine or endocrine insufficiency,and pancreatico-digestive tract anastomotic stricture,in order to improve the treatment effect of long-term complications and life quality of these patients.
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Affiliation(s)
- L Zhang
- Department of Pancreatic Surgery, Zhongshan Hospital, Fudan University, Shanghai 200032,China
| | - W H Lou
- Department of Pancreatic Surgery, Zhongshan Hospital, Fudan University, Shanghai 200032,China
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Liu L, Wang WQ, Lou WH. [Ten directions for improving clinical therapeutic effect of pancreatic cancer in the future]. Zhonghua Wai Ke Za Zhi 2022; 60:10-16. [PMID: 34954940 DOI: 10.3760/cma.j.cn112139-20211109-00525] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Pancreatic cancer is one of the most malignant digestive system tumors. In the recent decade, the effect of diagnosis and treatment of pancreatic cancer has improved due to the renewal of treatment concept and the popularization of effective treatment. However, the overall efficacy of pancreatic cancer is still dismal and the 5-year survival rate is only about 10%. Further improving the diagnosis and treatment of pancreatic cancer is the top priority of oncology research and clinical practice. Based on past clinical and scientific research experience, the authors have proposed ten hot spots and future directions for a reference, which focusing on early prevention, early diagnosis, and early treatment of pancreatic cancer, molecular typing and precise treatment, new drug development and regimen combination, surgical technology and strategy change, model establishment and database development, as well as innovation of traditional Chinese medicine and breakthrough of treatment concept. A breakthrough in the diagnosis and treatment of pancreatic cancer in the next ten years is raising hope, when doctors can truly prevent and control pancreatic cancer.
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Affiliation(s)
- L Liu
- Department of Pancreatic Surgery, Zhongshan Hospital, Fudan University, Shanghai 200032, China
| | - W Q Wang
- Department of Pancreatic Surgery, Zhongshan Hospital, Fudan University, Shanghai 200032, China
| | - W H Lou
- Department of Pancreatic Surgery, Zhongshan Hospital, Fudan University, Shanghai 200032, China
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7
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Wu WM, Chen J, Bai CM, Chi Y, Du YQ, Feng ST, Huo L, Jiang YX, Li JN, Lou WH, Luo J, Shao CH, Shen L, Wang F, Wang LW, Wang O, Wang Y, Wu HW, Xing XP, Xu JM, Xue HD, Xue L, Yang Y, Yu XJ, Yuan CH, Zhao H, Zhu XZ, Zhao YP. [The Chinese guidelines for the diagnosis and treatment of pancreatic neuroendocrine neoplasms (2020)]. Zhonghua Wai Ke Za Zhi 2021; 59:401-421. [PMID: 34102722 DOI: 10.3760/cma.j.cn112139-20210319-00135] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Pancreatic neuroendocrine neoplasms (pNENs) are highly heterogeneous, and the management of pNENs patients can be intractable. To address this challenge, an expert committee was established on behalf of the Group of Pancreatic Surgery, Chinese Society of Surgery, Chinese Medical Association, which consisted of surgical oncologists, gastroenterologists, medical oncologists, endocrinologists, radiologists, pathologists, and nuclear medicine specialists. By reviewing the important issues regarding the diagnosis and treatment of pNENs, the committee concluded evidence-based statements and recommendations in this article, in order to further improve the management of pNENs patients in China.
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Affiliation(s)
- W M Wu
- Department of General Surgery, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Science & Peking Union Medical College, Beijing 100730,China
| | - J Chen
- Department of Gastroenterology, the First Affiliated Hospital of Sun Yat-sen University, Guangzhou 510080,China
| | - C M Bai
- Department of Medical Oncology, Peking Union Medical College Hospital, Chinese Academy of Medical Science & Peking Union Medical College, Beijing 100730,China
| | - Yihebali Chi
- Department of Medical Oncology, National Cancer Center, National Clinical Research Center for Cancer, Cancer Hospital, Chinese Academy of Medical Science & Peking Union Medical College, Beijing 100021,China
| | - Y Q Du
- Department of Gastroenterology, Changhai Hospital Affiliated to Navy Medical University, Shanghai 200433,China
| | - S T Feng
- Department of Radiology, the First Affiliated Hospital of Sun Yat-sen University, Guangzhou 510080,China
| | - L Huo
- Department of Nuclear Medicine, Beijing Key Laboratory of Molecular Targeted Diagnosis and Therapy in Nuclear Medicine, Peking Union Medical College Hospital, Chinese Academy of Medical Science & Peking Union Medical College, Beijing 100730,China
| | - Y X Jiang
- Department of Ultrasound, Peking Union Medical College Hospital, Chinese Academy of Medical Science & Peking Union Medical College, Beijing 100730,China
| | - J N Li
- Department of Gastroenterology, Peking Union Medical College Hospital, Chinese Academy of Medical Science & Peking Union Medical College, Beijing 100730,China
| | - W H Lou
- Department of General Surgery, Zhongshan Hospital of Fudan University, Shanghai 200032,China
| | - J Luo
- Department of Pathology, China-Japan Friendship Hospital, Beijing 100029,China
| | - C H Shao
- Department of Pancreatic-biliary Surgery, Changzheng Hospital, Navy Medical University, Shanghai 200003,China
| | - L Shen
- Department of Gastrointestinal Oncology, Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Peking University Cancer Hospital & Institute, Beijing 100142,China
| | - F Wang
- Department of Nuclear Medicine, Nanjing First Hospital, Nanjing Medical University, Nanjing 210029,China
| | - L W Wang
- Department of Oncology, Renji Hospital, Shanghai JiaoTong University School of Medicine, Shanghai 200127,China
| | - O Wang
- Department of Endocrinology, Peking Union Medical College Hospital, Chinese Academy of Medical Science & Peking Union Medical College, Beijing 100730,China
| | - Y Wang
- Department of Interventional Oncology, the First Affiliated Hospital of Sun Yat-sen University, Guangzhou 510080,China
| | - H W Wu
- Department of Pathology, Peking Union Medical College Hospital, Chinese Academy of Medical Science & Peking Union Medical College, Beijing 100730,China
| | - X P Xing
- Department of Endocrinology, Peking Union Medical College Hospital, Chinese Academy of Medical Science & Peking Union Medical College, Beijing 100730,China
| | - J M Xu
- Department of Gastrointestinal Oncology, the Fifth Medical Center, Chinese People's Liberation Army General Hospital, Beijing 100071,China
| | - H D Xue
- Department of Radiology, Peking Union Medical College Hospital, Chinese Academy of Medical Science & Peking Union Medical College, Beijing 100730,China
| | - L Xue
- Department of Pathology, the First Affiliated Hospital of Sun Yat-sen University, Guangzhou 510080,China
| | - Y Yang
- Department of Hepatic Surgery and Liver Transplantation Center, the Third Affiliated Hospital of Sun Yat-sen University, Guangzhou 510630,China
| | - X J Yu
- Department of Pancreatic Surgery, Fudan University Shanghai Cancer Center, Shanghai 200032,China
| | - C H Yuan
- Department of General Surgery, Peking University Third Hospital, Beijing 100191,China
| | - H Zhao
- Department of Hepatobiliary Surgery, National Cancer Center, National Clinical Research Center for Cancer, Cancer Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing 100021,China
| | - X Z Zhu
- Department of Pathology, Fudan University Shanghai Cancer Center, Shanghai 200032,China
| | - Y P Zhao
- Department of General Surgery, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Science & Peking Union Medical College, Beijing 100730,China
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8
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Lou WH. [Hot topic in the comprehensive treatment of pancreatic neuroendocrine tumors]. Zhonghua Wai Ke Za Zhi 2020; 58:745-748. [PMID: 32993259 DOI: 10.3760/cma.j.cn112139-20200515-00384] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
The incidence of pancreatic neuroendocrine tumor is increasing gradually in recent years.There are still lots of debated issues in surgical management of this kind of tumor.Whether all small non-functional pancreatic neuroendocrine tumor need to be resected, whether primary and metastatic lesion need to be resected in metastatic disease, whether adjuvant therapy is necessary for resected tumor, whether enucleation is optimal for small pancreatic neuroendocrine tumor.Some data from real world study has provide primary answer to these questions.More high-quality study in the future will provide satisfactory answer.
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Affiliation(s)
- W H Lou
- Department of Pancreatic Surgery, Zhongshan Hospital, Fudan University, Shanghai 200032, China
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Li WL, Xu YD, Han X, Wu WC, Lou WH. [Clinical analysis and prognosis factors of malignancy in the patients with mucinous cystic neoplasms of the pancreas]. Zhonghua Wai Ke Za Zhi 2020; 58:225-229. [PMID: 32187927 DOI: 10.3760/cma.j.issn.0529-5815.2020.03.011] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Objective: To examine clinic pathological features of mucinous cystic neoplasms (MCN) of the pancreas and explore the prognosis factors associated with malignant transformation of MCN of the pancreas. Methods: This multicenter retrospective study included all patients with pancreatic MCN underwent surgery at Department of Pancreatic Surgery, Zhongshan Hospital of Fudan University between January 2008 and December 2018 and patients with MCN who confirmed by postoperative pathology from Multicenter Pancreatic Cystic Tumor Database. There were 50 males (14.4%) and 297 females (85.6%) and the mean age was 48.6 years (range: 24-77 years). According to the pathological results, all patients were divided into benign lesion group (including MCN and which associated with low/medium grade dysplasia) and malignant lesion group (including MCN with high-grade dysplasia or invasive carcinoma) . The preoperative clinical pathology and imaging features of the two groups were analyzed, and the risk factors associated with malignant transformation of MCN were statistically analyzed. Results: This multicenter retrospective study included 347 patients. Twenty-four of the 347 patients were malignant, including 7 males and 17 females. Univariate analysis showed that age, gender, carcino-embryonic antigen (CEA) , CA19-9, CA125, tumor maximum diameter, and tumor location were remarkably different in the two groups (P<0.05) . Logistic regression analysis found that the preoperative tumor maximum diameter (OR=1.023, 95% CI: 1.002-1.045, P=0.035) was an independent risk factor for MCN malignant transformation. Conclusions: Age, gender, CEA, CA19-9, CA125, tumor maximum diameter, and tumor location are important features of MCN malignant lesions.The maximum diameter of the preoperative tumor is an independent risk factor for MCN malignant transformation.
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Affiliation(s)
- W L Li
- Department of Pancreatic Surgery, Zhongshan Hospital, Fudan University, Shanghai 200032, China
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Li JA, Wu WC, Ji Y, Liu LX, Rao SX, Wang DS, Zhang YQ, Yao XZ, Fan Y, Huang C, Zhou YH, Lou WH. [Diagnostic value and patient compliance of a pancreas-oriented multidisciplinary clinic: a retrospective analysis from a Chinese pancreatic disease center]. Zhonghua Wai Ke Za Zhi 2019; 57:912-916. [PMID: 31826595 DOI: 10.3760/cma.j.issn.0529-5815.2019.12.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Objective: To evaluate the role of multidisciplinary team (MDT) clinic in the diagnosis of pancreatic diseases and patient compliance with MDT advice in the current medical system. Methods: The study included 512 patients that had visited the pancreas-oriented MDT clinic of Zhongshan Hospital between May 2015 and May 2019.The clinical and pathological data were collected and analyzed retrospectively. Diseases were classified in accordance with 2010 WHO classification of tumors of the digestive system and usual clinical practices. Compliance was determined according to whether a patient received corresponding therapies or undergoing further checks or follow-ups. Results: Among the 512 patients that had visited the MDT clinic, 121 patients were referred due to undetermined diagnosis. Classified according to the final diagnosis, the rate of undetermined diagnosis in different disease categories from high to low in order was inflammatory diseases of the pancreas (75.0%, 24/32), other lesions of the pancreas (56.1%,23/41), pancreatic cystic lesions (19.1%,17/89), pancreatic carcinomas (18.3%,48/262) and pancreatic neuroendocrine neoplasms (pNEN)(10.2%,9/88). The MDT clinic made diagnosis to 68 patients directly with an accuracy of 89.7%. The rate of compliance in the entire cohort was 63.4%. The rate of compliance of patients from June 2017 to May 2019 (68.4%) was higher than that of patients from May 2015 to May 2017(59.6%). The compliance rate of patients in different disease categories from high to low in order was inflammatory diseases of the pancreas(84.4%, 27/32), pancreatic carcinomas (67.9%, 178/262), pNEN(60.2%,53/88), other lesions of the pancreas (56.1%,23/41), and pancreatic cystic lesions(49.4%, 44/89). The compliance rate of patients with different MDT advice from high to low in order was best supportive care(78.6%,22/28), antitumor approaches beyond surgery(71.6%,159/222), further tests(62.6%, 77/123), surgery(53.7%, 65/121) and follow-up(49.2%, 31/63). In patients suggested for surgery, the compliance rate of patients with carcinomas(67.4%, 33/49) was higher than patients with other kinds of neoplasms. Conclusions: MDT clinic could facilitate the diagnosis of pancreatic diseases conveniently and inexpensively. The overall compliance rate of MDT clinic patients is rather low, and patients with carcinomas have a relative high rate of compliance with the suggestion of surgery.
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Affiliation(s)
- J A Li
- Department of Pancreatic Surgery, Zhongshan Hospital Fudan University, Shanghai 200032, China
| | - W C Wu
- Department of Pancreatic Surgery, Zhongshan Hospital Fudan University, Shanghai 200032, China
| | - Y Ji
- Department of Pathology, Zhongshan Hospital Fudan University, Shanghai 200032, China
| | - L X Liu
- Department of Interventional Radiology, Zhongshan Hospital Fudan University, Shanghai 200032, China
| | - S X Rao
- Department of Radiology, Zhongshan Hospital Fudan University, Shanghai 200032, China
| | - D S Wang
- Department of Pancreatic Surgery, Zhongshan Hospital Fudan University, Shanghai 200032, China
| | - Y Q Zhang
- Endoscopy Center, Zhongshan Hospital Fudan University, Shanghai 200032, China
| | - X Z Yao
- Department of Radiology, Zhongshan Hospital Fudan University, Shanghai 200032, China
| | - Y Fan
- Department of Traditional Chinese Medicine, Zhongshan Hospital Fudan University, Shanghai 200032, China
| | - C Huang
- Department of Liver Surgery, Zhongshan Hospital Fudan University, Shanghai 200032, China
| | - Y H Zhou
- Department of Medical Oncology, Zhongshan Hospital Fudan University, Shanghai 200032, China
| | - W H Lou
- Department of Pancreatic Surgery, Zhongshan Hospital Fudan University, Shanghai 200032, China
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Li JA, Han X, Fang Y, Zhang L, Lou WH, Xu XF, Wu WC, Kuang TT, Wang DS, Rong YF. [The value of preoperative CA19-9 combined with platelet-to-lymphocyte ratio in predicting invasive malignancy in intraductal papillary mucinous neoplasms]. Zhonghua Wai Ke Za Zhi 2019; 57:170-175. [PMID: 30861644 DOI: 10.3760/cma.j.issn.0529-5815.2019.03.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Objective: To explore preoperative predictive markers for invasive malignancy in intraductal papillary mucinous neoplasm(IPMN). Methods: The retrospective case-controlled study was adopted.Seventy-nine patients who underwent surgery and with pathologically confirmed IPMN from January 2005 to December 2014 at Department of Pancreatic Surgery, Zhongshan Hospital Fudan University were enrolled.Forty-six patients were male and 33 were female,with an average age of (62.9±8.9)years (range:37-82 years).Tumor sites:56 tumors were located at the head of the pancreas,22 were located at the body and tail of the pancreas,and 1 was located across the whole pancreas.Surgical procedures: 51 patients underwent pancreaticoduodenectomy, 22 patients underwent distal pancreatectomy, 4 patients underwent segmental pancreatectomy and 2 patients underwent total pancreatectomy.IPMNs were classified into non-invasive lesions and invasive carcinomas according to the histopathological findings of the tumor.Thirty-two tumors were non-invasive lesions and 47 were invasive carcinomas.The preoperative findings were compared between patients with non-invasive IPMN and patients with invasive carcinoma by univariate analysis using t test and χ(2) test accordingly,and factors with statistically significance were subsequently submitted to multivariate analysis. Results: Univariate analysis showed that tumor size(P=0.022), carcinoembryonic antigen(P=0.012), CA19-9(P=0.011), lymphocytes(P=0.034), neutrophil-to-lymphocyte ratio(P=0.010)and platelet-to-lymphocyte ratio(PLR)(P=0.004)were predictive markers with statistical significance.Multivariate analysis showed that CA19-9(P=0.012)and PLR(P=0.025) were independent predictive markers for invasive malignancy in IPMN.The area under curve of the combination factor of CA19-9 and PLR(0.864) was larger than that of CA19-9(0.806) or PLR(0.685) alone, and all the authentic indicators of the combination factor were better than those of each alone. Conclusions: CA19-9 and PLR are independent predictive markers for invasive malignancy in IPMN.The combination of CA19-9 and PLR has improved efficacy than each alone.
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Affiliation(s)
- J A Li
- Department of Pancreatic Surgery, Zhongshan Hospital, Fudan University, Shanghai 200032, China
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Zhang L, Lou WH. [Updates and analyzation of postoperative pancreatic fistula system of consensus statement on the diagnosis, treatment, and prevention of common complications after pancreatic surgery(2017)]. Zhonghua Wai Ke Za Zhi 2017; 55:504-506. [PMID: 28655078 DOI: 10.3760/cma.j.issn.0529-5815.2017.07.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
In 2017, following many thorough discussions, considering Chinese actual situation, more than 20 distinguished pancreatic surgeons brought about an update of the previous 2010 Chinese experts' consensus on the prevention and treatment of common complications after pancreatic surgery. Referred to the latest update of the postoperative pancreatic fistula consensus statement by the International Study Group of Pancreatic Surgery, the postoperative pancreatic fistula system of 2017 version Chinese consensus divided pancreatic fistula into pure fistula and mixed fistula based on whether other digestive fluid is mixed or not. The new version also presents key points of pancreatic fistula prevention and surgical strategy. In the paper, the authors analyzed the necessity, essentials and controversy of the update.
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Affiliation(s)
- L Zhang
- Department of Pancreatic Surgery, Zhong Shan Hospital, Fudan University, Shanghai 200032, China
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Gao N, Fu K, Lou WH. [Comparison of free anterolateral thigh perforator flaps versus free forearm flap for reconstruction in elderly patients undergoing glossectomy]. Zhonghua Kou Qiang Yi Xue Za Zhi 2017; 52:34-38. [PMID: 28072992 DOI: 10.3760/cma.j.issn.1002-0098.2017.01.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Objective: To evaluate the quality of life (QOL) in elderly patients with tongue cancer who underwent immediate free flap reconstruction surgery. In addition, the efficacy of the anterolateral thigh perforator free flap (ALTFF) and the radial free forearm flap (RFFF) for reconstruction was compared in patients with glossectomy. Methods: Ninty-eight patients undergoing complete or partial glossectomy and reconstruction with free flaps were grouped according to flap type. Oral functions were assessed using The University of Washington Quality of Life (UW-QOL), and the 14-item Oral Health Impact Profile questionnaires (OHIP-14) at 6 and 12 months after reconstructive surgery. Results: Eighty-six of 98 questionnaires (88%) were returned. There was significant difference between the 2 groups in the style of resection (P<0.05). For all oral function domains, the score improved progressively after the operation (6 and 12 months after the procedure). The UW-QOL questionnaire showed a significant difference between the 6 months postoperatively (ALTFF: 290.0 ± 7.8, RFFF: 236.6 ± 24.2) and 12 months postoperatively (ALTFF: 302.0±21.1, RFFF: 331.1±20.4) (P<0.05). The OHIP-14 questionnaire showed a total score of ALTFF (422.0± 15.2) which was significantly less than RFFF (434.0±38.7) at 6 months postoperatively (P<0.05). There were no meaningful differences between the 2 flap types for all oral function domains at 12 months. Conclusions: Using the RFFF or ALTFF for reconstruction of tongue defects after cancer resection influences oral function. There was no significant difference in quality of life between the two flaps at 12 months postoperatively.
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Affiliation(s)
- N Gao
- Department of Oral and Maxillofacial Surgery, The First Affiliated Hospital of Zhengzhou University, Zhengzhou 450052, China
| | - K Fu
- Department of Oral and Maxillofacial Surgery, The First Affiliated Hospital of Zhengzhou University, Zhengzhou 450052, China
| | - W H Lou
- Department of E.N.T., The First Affiliated Hospital of Zhengzhou University, Zhengzhou 450052, China
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Abstract
The purpose of this study was to analyse multi-detector row CT (MDCT) signs of peripancreatic arterial and venous invasion in pancreatic carcinoma. Among 101 patients with pancreatic carcinoma examined by MDCT, 54 candidates for surgery were pre-operatively evaluated for vascular invasion based on MDCT signs. The peripancreatic major vessels (including superior mesenteric artery, coeliac artery, common hepatic artery, superior mesenteric vein and portal vein) were examined carefully by surgeons during the operation. At surgical exploration, 78 of 224 vessels were invaded by tumour. The invaded peripancreatic major arteries (n = 29) and veins (n = 49) presented different MDCT signs: 43% of invaded veins (18/42, except for 7 occluded veins) were surrounded by tumour less than 50% of the vessel circumference compared with 97% (28/29) of the invaded arteries, which were surrounded by tumour more than 50% of the vessel circumference or were embedded in tumour (p<0.001). 69% (34/49) of the invaded veins had vascular stenosis or obliteration, compared with 41% (12/29) of the invaded arteries (p<0.05). Irregularity of the vein wall, 74% (31/42, except for 7 occluded veins); occurred more often than that of the artery wall, 45% (13/29) (p<0.05). In conclusion, the MDCT signs of peripancreatic arterial and venous invasion have different characteristics, which should be considered in pre-operative evaluation.
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Affiliation(s)
- H Li
- Department of Radiology, The Affiliated First People's Hospital, Shanghai Jiao Tong University, 85 Wujin Road, 200080, Shanghai, P R China
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Ye FL, Dong MM, Lou WH. [The first branchial fistula: an analysis of 16 cases]. Lin Chuang Er Bi Yan Hou Ke Za Zhi 2000; 14:458-9. [PMID: 12563718] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/28/2023]
Abstract
OBJECTIVE To discuss how to improve the level of diagnosis and treatment about the first branchial fistula. METHOD 16 cases with the first branchial fistula were analyzed retrospectively. RESULT Of all the patients underwent surgery, 14 cases were free from disease postoperatively within 0.5 years follow-up, 2 patients underwent re-operation because of recurrence. CONCLUSION Knowing about the disease fully, selecting proper surgical incision and possessing skilled surgical technique is important to improve the level of diagnosis and treatment about the first branchial fistula.
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Affiliation(s)
- F L Ye
- Departmant of Otolaryngology, First Affiliated Hospital of Henan Medical University, Zhengzhou 450052
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Lou WH. [Effect of sodium thiosulfate on cisplatin-induced ototoxicity]. Zhonghua Er Bi Yan Hou Ke Za Zhi 1990; 25:208-10, 255. [PMID: 2076324] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
The effect of sodium thiosulfate (STS) on cisplatin (CDDP)-induced ototoxicity in the guinea pigs was studied by surface preparation, outer hair cell counting, electrocochleographic, light and electron microscopic techniques. Seventy-eight guinea pigs were divided into five groups. Group I received intraperitoneal CDDP (2.5 mg/kg/day) alone: group V as control; the other three groups were given the same doses of CDDP as group I with intramuscular STS (600 mg/kg/day) administered 30 min before (group II) or 30 min (group III) and 6 hr (group IV) after CDDP. The results showed that CDDP produced serious ototoxicity both functionally and histologically when given without STS. The first row of outer hair cells (OHC) in basal turn was first damaged. The inner hair cells (IHC) were more resistant than the OHC. The pattern of destruction is similar to that produced by aminoglycosides. Concomitant use of STS, however, significantly reduced CDDP-induced ototoxicity. Transmission electron microscopy showed the degeneration of mitochondria to be the major and earliest sign of OHC damage induced by CDDP. Our present study documented the good protective efficacy of STS against CDDP cochleotoxicity. STS did not reverse the pathological changes already caused by CDDP. This study provided some experimental evidence for the prevention of CDDP ototoxicity in clinical cancer chemotherapy.
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Affiliation(s)
- W H Lou
- First Affiliated Hospital, Henan Medical University, Zhengzhou
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