Zhonghua wai ke za zhi [Chinese journal of surgery]最新文献

{"title":"[The application of the concept of minimal invasive spine surgery in the development and innovation of cervical expansive laminoplasty].","authors":"Y Sun","doi":"10.3760/cma.j.cn112139-20230402-00134","DOIUrl":"10.3760/cma.j.cn112139-20230402-00134","url":null,"abstract":"<p><p>Posterior cervical decompression is an important method for the treatment of cervical myelopathy resulting from cervical stenosis due to various pathology.Over the past 40 years,scholars from all over the world have made unremitting efforts in exploring the posterior decompression of the cervical spine and the protection and reconstruction of the cervical spine function,and have achieved remarkable results.The new concept of minimally invasive spinal surgery has stimulated the development of the new technology of cervical expansive laminoplasty via trans-muscular space approach and brought about new progress in the surgical treatment of cervical spondylosis.Cervical expansive laminoplasty via trans-muscular space approach provided a better solution for the posterior decompression while protecting and reconstructing the structure and function of the cervical spine.These achievements are not only the concrete embodiment and practice of the concept of minimally invasive spine surgery in posterior cervical spine surgery,but also show the persistent and endless pursuit of spinal surgeons to realize the concept of original ecological surgery in the cervical spine.</p>","PeriodicalId":23966,"journal":{"name":"Zhonghua wai ke za zhi [Chinese journal of surgery]","volume":"61 8","pages":"645-649"},"PeriodicalIF":0.0,"publicationDate":"2023-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9802625","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[Efficacy of polyetheretherketone rod hybrid surgery in preventing proximal junctional failure after adult spinal deformity surgery].","authors":"Y Zhao,&nbsp;B Y Xu,&nbsp;L T Qi,&nbsp;L Yue,&nbsp;R L Zhu,&nbsp;Z R Yu,&nbsp;X D Yi,&nbsp;C D Li","doi":"10.3760/cma.j.cn112139-20230410-00152","DOIUrl":"10.3760/cma.j.cn112139-20230410-00152","url":null,"abstract":"<p><p><b>Objective:</b> To investigate the clinical outcome and preventive effect of polyetheretherketone(PEEK) rod hybrid surgery on proximal junction failure(PJF) after long-segment fusion of adult spinal deformity. <b>Methods:</b> A retrospective study was conducted to analyze patients with degenerative scoliosis/kyphosis who underwent long-segment decompression and fusion surgery at Department of Orthopedics, Peking University First Hospital from January 2017 to December 2021. A total of 75 patients were included in the study, including 14 males and 61 females, aged (67.2±6.8)years (range:55 to 84 years). According to the operation method chosen by the patients, the patients were divided into PEEK rod hybrid group (20 cases) and traditional titanium rod group (55 cases). The general information of the patients was collected, and the coronal and sagittal parameters of the spine were measured before operation, at 1 month after operation, and at the last follow-up. The clinical effect of surgery was judged by the visual analogue scale (VAS) and Oswestry disability index (ODI). Whether proximal junctional kyphosis (PJK) and PJF occurred during the follow-up and the time of occurrence were recorded. Comparisons between groups were performed using independent sample <i>t</i> test, Mann-Whitney <i>U</i> test, <i>χ</i>² test and Fisher's exact probability method. The data before and after surgery in the same group were compared using the paired sample <i>t</i> test and the Wilcoxon test. <b>Results:</b> There were no significant differences in age, gender, body mass index, bone mineral density, distal instrumented vertebrae, surgical segments, osteotomy method, operation time, and intraoperative bleeding between the two groups (all <i>P</i>>0.05). The follow-up time of the PEEK rod group was shorter(<i>M</i>(IQR)16.5(4.8) <i>vs.</i> 25.0(12.0),<i>Z</i>=-4.230,<i>P</i><0.01). There were no significant differences in coronal, sagittal parameters, VAS and ODI between the two groups before operation (all <i>P</i>>0.05). Postoperative coronal Cobb angle, pelvic incidence, pelvic tilt, sacral slope, lumbar lordosis, thoracic kyphosis, sagittal vertical axis (SVA), VAS and ODI were significantly improved in both groups(all <i>P</i><0.05). At the last follow-up, the SVA of the PEEK rod hybrid group was(3.74±2.40)cm, which was significantly lower than that of the titanium rod group (6.28±4.06)cm (<i>t'</i>=-3.318, <i>P</i>=0.002). At the last follow-up, the ODI of the PEEK rod hybrid group was 30.7±6.1, significantly better than the titanium rod group 39.3±17.2(<i>t</i>=-3.203, <i>P</i>=0.046). PJK occurred in 2 patients (10.0%) in the PEEK rod hybrid group, and no PJF phenomenon was observed. In the titanium rod group, 18 patients (32.7%) developed PJK, and 11 patients (20.0%) developed PJF. There was a statistically significant difference in the incidence of PJF between the PEEK rod hybrid group and the titanium rod group (<i>P</i>=0.031). <b>Con","PeriodicalId":23966,"journal":{"name":"Zhonghua wai ke za zhi [Chinese journal of surgery]","volume":"61 8","pages":"656-665"},"PeriodicalIF":0.0,"publicationDate":"2023-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9802626","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[Clinical characteristics of patients with colon complications after necrotizing pancreatitis: a retrospective cohort study].","authors":"F Cao,&nbsp;J D Lu,&nbsp;A Li,&nbsp;C Zhang,&nbsp;Z Wang,&nbsp;C C Gao,&nbsp;X H Wang,&nbsp;F Li","doi":"10.3760/cma.j.cn112139-20230318-00111","DOIUrl":"https://doi.org/10.3760/cma.j.cn112139-20230318-00111","url":null,"abstract":"<p><p><b>Objective:</b> To investigate the clinical characteristics of colon complications in patients with necrotizing pancreatitis(NP). <b>Methods:</b> The clinical data of 403 patients with NP admitted to the Department of General Surgery,Xuanwu Hospital, Capital Medical University from January 2014 to December 2021 were retrospectively analyzed. There were 273 males and 130 females,aged (49.4±15.4) years(range: 18 to 90 years). Among them,there were 199 cases of biliary pancreatitis,110 cases of hyperlipidemic pancreatitis,and 94 cases of pancreatitis caused by other causes. A multidisciplinary diagnosis and treatment model was used to diagnose and treat patients. Depending on whether the patients had colon complications,they were divided into colon complications group and noncolon complications group. Patients with colon complications were treated with anti-infection therapy,parental nutritional support,keeping the drainage tube unobstructed,and terminal ileostomy. The clinical results of the two groups were compared and analyzed using a 1∶1 propensity score match(PSM) method. The <i>t</i> test,<i>χ</i>² test, or rank-sum test was used to analyze data between groups,respectively. <b>Results:</b> The incidence of colon complications was 13.2%(53/403),including 15 cases of colon obstruction,23 cases of colon fistula,and 21 cases of colon hemorrhage. After PSM,the baseline and clinical characteristics at admission of the two groups of patients were comparable (all <i>P</i>>0.05). In terms of clinical outcome,compared to patients with NP without colon complications,the number of patients with colon complications who received minimally invasive intervention(88.7%(47/53) <i>vs.</i> 69.8%(37/53),<i>χ</i>²=5.736,<i>P</i>=0.030),the number of minimally invasive interventions (<i>M</i>(IQR))(2(2) <i>vs.</i> 1(1), <i>Z</i>=4.638,<i>P</i>=0.034),the number of patients with multiple organ failure(45.3%(24/53) <i>vs.</i> 32.1%(17/53),<i>χ</i>²=4.826,<i>P</i>=0.041),and the number of extrapancreatic infections(79.2%(42/53) <i>vs.</i> 60.4%(32/53),<i>χ</i>²=4.476,<i>P</i>=0.034) increased significantly. The time required for enteral nutrition support(8(30)days <i>vs.</i> 2(10) days, <i>Z</i>=-3.048, <i>P</i>=0.002), parental nutritional support(32(37)days <i>vs.</i> 17(19)days, <i>Z</i>=-2.592, <i>P</i>=0.009),the length of stay in the ICU(24(51)days <i>vs.</i> 18(31)days, <i>Z</i>=-2.268, <i>P</i>=0.002),and the total length of stay (43(52)days <i>vs.</i> 30(40)days, <i>Z</i>=-2.589, <i>P</i>=0.013) were also significantly prolonged. However,mortality rates in the two groups were similar(37.7%(20/53) <i>vs.</i> 34.0%(18/53),<i>χ</i>²=0.164,<i>P</i>=0.840). <b>Conclusions:</b> Colonic complications in NP patients are not rare,which can lead to prolonged hospitalization and increased surgical intervention. Active surgical intervention can help improve the prognosis of these patients.</p>","PeriodicalId":23966,"journal":{"name":"Zhonghua wai ke za zhi [Chinese journal of surgery]","volume":"61 7","pages":"567-574"},"PeriodicalIF":0.0,"publicationDate":"2023-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9755108","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[Pay attention to whole cycle management of pancreatic cancer].","authors":"S Y Zou, B Y Shen","doi":"10.3760/cma.j.cn112139-20230306-00094","DOIUrl":"10.3760/cma.j.cn112139-20230306-00094","url":null,"abstract":"<p><p>The prognosis for pancreatic cancer is extremely poor. To improve the prognosis of pancreatic cancer, it is urgently needed to improve early detection to advance treatment. And basically, it is also necessary to emphasise basic research to find novel therapies. By promoting the disease-centered multidisciplinary team model, researchers should achieve high-quality closed-loop process management of the entire life cycle which consists of prevention, screening, diagnosis, treatment, rehabilitation,and follow-up, with the objective of establishing a standard clinical process to improve the outcome in essence. This article summarized the progress of pancreatic cancer at different stages of the whole cycle management recently and shared the experience of pancreatic cancer treatment from the author's team in the past ten years.</p>","PeriodicalId":23966,"journal":{"name":"Zhonghua wai ke za zhi [Chinese journal of surgery]","volume":"61 7","pages":"550-555"},"PeriodicalIF":0.0,"publicationDate":"2023-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10132324","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[Quality assessment indictors and benchmarks for pancreatic surgery].","authors":"Y W Ren,&nbsp;S W Guo,&nbsp;G Li,&nbsp;G Jin","doi":"10.3760/cma.j.cn112139-20221229-00551","DOIUrl":"https://doi.org/10.3760/cma.j.cn112139-20221229-00551","url":null,"abstract":"<p><p>Pancreatic surgery is the most complex type of abdominal surgery,with high technical requirements and long learning curve,and the quality of surgery is directly related to the prognosis of the patients. In recent years,more and more indicators have been used to evaluate the quality of pancreatic surgery,such as operation time,intraoperative blood loss,morbidity,mortality, prognosis and so on,and different evaluation systems have been established,including benchmarking,auditing,outcome evaluation based on risk factor adjustment and textbook outcomes. Among them,the benchmark is the most widely used to evaluate surgical quality and is expected to become the standard for comparison among peers. This article reviews existing quality evaluation indicators and benchmarks for pancreatic surgery and anticipates its future application prospects.</p>","PeriodicalId":23966,"journal":{"name":"Zhonghua wai ke za zhi [Chinese journal of surgery]","volume":"61 7","pages":"562-566"},"PeriodicalIF":0.0,"publicationDate":"2023-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9745885","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[Progress and reflection of conversion therapy for locally advanced pancreatic cancer].","authors":"J Xu,&nbsp;X J Yu","doi":"10.3760/cma.j.cn112139-20230329-00128","DOIUrl":"https://doi.org/10.3760/cma.j.cn112139-20230329-00128","url":null,"abstract":"<p><p>With the improvement of nonsurgical treatment in pancreatic cancer, the increasing accuracy of subclassification of anatomy, and the continuous refinement of surgical resection techniques, more and more locally advanced pancreatic cancer(LAPC) patients have the opportunity to undergo conversion surgery and achieve survival benefits,which has attracted the attention of scholars in this field. Despite the numerous prospective clinical studies conducted, there is still a lack of high-level evidence-based medical evidence in terms of conversion treatment strategies, efficacy evaluation, surgical timing and survival prognosis, and there are not yet specific quantitative standards and guiding principles for conversion treatment for these patients in clinical practice, and the indications for surgical resection rely more on the experience of each center or surgeon, lacking consistency. Therefore,the indicators for the evaluation of the efficacy of conversion treatment in patients with LAPC were summarized to reflect on the different modes of conversion treatment and clinical outcomes currently being explored, expecting to provide more accurate recommendations and guidance for the clinic.</p>","PeriodicalId":23966,"journal":{"name":"Zhonghua wai ke za zhi [Chinese journal of surgery]","volume":"61 7","pages":"540-545"},"PeriodicalIF":0.0,"publicationDate":"2023-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9755114","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[Evolution and progress of surgical intervention strategies for acute pancreatitis].","authors":"R Bai, T Q Lu, B Sun","doi":"10.3760/cma.j.cn112139-20221209-00520","DOIUrl":"10.3760/cma.j.cn112139-20221209-00520","url":null,"abstract":"<p><p>Acute pancreatitis is one of the common surgical acute abdominal diseases. Since people first recognized acute pancreatitis in the middle of the nineteenth century, a diversified minimally invasive treatment model with standardization has been formed today. According to the main line of surgical intervention of acute pancreatitis treatment,this period can be roughly divided into five stages:exploration stage, conservative treatment stage, pancreatectomy stage, debridement and drainage of the pancreatic necrotic tissue stage, and minimally invasive treatment as the first choice led by the multidisciplinary team mode stage. Throughout history, the evolution and progress of surgical intervention strategies for acute pancreatitis cannot be separated from the progress of science and technology, the update of treatment concepts and the further understanding of the pathogenesis. This article will summarize the surgical characteristics of acute pancreatitis treatment at each stage to explain the development of surgical treatment of acute pancreatitis,to help investigate the development of surgical treatment of acute pancreatitis in the future.</p>","PeriodicalId":23966,"journal":{"name":"Zhonghua wai ke za zhi [Chinese journal of surgery]","volume":"61 7","pages":"556-561"},"PeriodicalIF":0.0,"publicationDate":"2023-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10132320","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[Advances in the study of postpancreatectomy acute pancreatitis].","authors":"H M Chen,&nbsp;M H Dai","doi":"10.3760/cma.j.cn112139-20230221-00075","DOIUrl":"https://doi.org/10.3760/cma.j.cn112139-20230221-00075","url":null,"abstract":"<p><p>Postpancreatectomy acute pancreatitis (PPAP) is an acute inflammation of the remnant pancreas in the early postoperative period caused by a variety of factors. With the progress of related research,PPAP has been confirmed as an independent risk factor for many severe complications such as postoperative pancreatic fistula. In some cases, it progresses to necrotizing PPAP, increasing the risk of mortality. Currently, the International Study Group for Pancreatic Surgery has standardized and graded PPAP as an independent complication, taking into account factors including serum amylase, radiological features, and clinical impact. This review summarizes how the concept of PPAP was proposed, as well as the latest progress in the research related to its etiology, prognosis, prevention, and treatment. However, given the large heterogeneity of relevant studies and the fact that they were mostly retrospective, in the future, it is necessary to place more emphasis on PPAP and elucidate the problems through more standardized studies to optimize strategies for the prevention and management of complications after pancreatic surgery.</p>","PeriodicalId":23966,"journal":{"name":"Zhonghua wai ke za zhi [Chinese journal of surgery]","volume":"61 7","pages":"609-613"},"PeriodicalIF":0.0,"publicationDate":"2023-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10132321","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[Clinical value of lymph node dissection of No. 14cd during pancreaticoduodenectomy in patients with pancreatic head carcinoma].","authors":"P F Wu, K Zhang, L Tian, J Yin, J S Wei, C H Xi, J M Chen, F Guo, Z P Lu, Y Miao, K R Jiang","doi":"10.3760/cma.j.cn112139-20230221-00077","DOIUrl":"10.3760/cma.j.cn112139-20230221-00077","url":null,"abstract":"<p><p><b>Objectives:</b> To evaluate the positive rate of left posterior lymph nodes of the superior mesenteric artery (14cd-LN) in patients undergoing pancreaticoduodenectomy for pancreatic head carcinoma,to analyze the impact of 14cd-LN dissection on lymph node staging and tumor TNM staging. <b>Methods:</b> The clinical and pathological data of 103 consecutive patients with pancreatic cancer who underwent pancreaticoduodenectomy at Pancreatic Center,the First Affiliated Hospital of Nanjing Medical University from January to December 2022 were analyzed,retrospectively. There were 69 males and 34 females,with an age(<i>M</i> (IQR))of 63.0 (14.0) years (range:48.0 to 86.0 years). The <i>χ</i>² test and Fisher's exact probability method was used for comparison of the count data between the groups,respectively. The rank sum test was used for comparison of the measurement data between groups. Univariate and multivariate Logistic regression analyzes were used for the analysis of risk factors. <b>Results:</b> All 103 patients underwent pancreaticoduodenectomy successfully using the left-sided uncinate process and the artery first approach. Pathological examination showed pancreatic ductal adenocarcinoma in all cases. The location of the tumors was the pancreatic head in 40 cases,pancreatic head-uncinate in 45 cases,and pancreatic head-neck in 18 cases. Of the 103 patients,38 cases had moderately differentiated tumor and 65 cases had poorly differentiated tumor. The diameter of the lesions was 3.2 (0.8) cm (range:1.7 to 6.5 cm),the number of lymph nodes harvested was 25 (10) (range:11 to 53),and the number of positive lymph nodes was 1 (3) (range:0 to 40). The lymph node stage was stage N0 in 35 cases (34.0%),stage N1 in 43 cases (41.7%),and stage N2 in 25 cases (24.3%). TNM staging was stage ⅠA in 5 cases (4.9%),stage ⅠB in 19 cases (18.4%),stage ⅡA in 2 cases (1.9%),stage ⅡB in 38 cases (36.9%),stage Ⅲ in 38 cases (36.9%),and stage Ⅳ in 1 case (1.0%). In 103 patients with pancreatic head cancer,the overall positivity rate for 14cd-LN was 31.1% (32/103),and the positive rates for 14c-LN and 14d-LN were 21.4% (22/103) and 18.4% (19/103),respectively. 14cd-LN dissection increased the number of lymph nodes (<i>P</i><0.01) and positive lymph nodes (<i>P</i><0.01). As a result of the 14cd-LN dissection,the lymph node stage was changed in 6 patients,including 5 patients changed from N0 to N1 and 1 patient changed from N1 to N2. Similarly,the TNM stage was changed in 5 patients,including 2 patients changed from stage ⅠB to ⅡB,2 patients changed from stage ⅡA to ⅡB,and 1 patient changed from stage ⅡB to Ⅲ. Tumors located in the pancreatic head-uncinate (<i>OR</i>=3.43,95%<i>CI</i>:1.08 to 10.93,<i>P</i>=0.037) and the positivity of 7,8,9,12 LN (<i>OR</i>=5.45,95%<i>CI</i>:1.45 to 20.44,<i>P</i>=0.012) were independent risk factors for 14c-LN metastasis; while tumors with diameter >3 cm (<i>OR</i>=3.93,95%<i>CI</i>:1.08 to 14.33,<i>P</i>=0.038) and t","PeriodicalId":23966,"journal":{"name":"Zhonghua wai ke za zhi [Chinese journal of surgery]","volume":"61 7","pages":"582-589"},"PeriodicalIF":0.0,"publicationDate":"2023-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10132322","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[Surgical treatment strategies for pancreatic cancer with simultaneous liver metastasis].","authors":"J Huang, Z Y Yang, R L Wei, A T Y A H Atyah, Y L Sun, L Xu, W Y Zhou","doi":"10.3760/cma.j.cn112139-20230329-00125","DOIUrl":"10.3760/cma.j.cn112139-20230329-00125","url":null,"abstract":"<p><p><b>Objective:</b> To explore the outcome of different treatment strategies in patients with pancreatic cancer with synchronous liver metastasis (sLMPC). <b>Methods:</b> A retrospective analysis of the clinical data and treatment results of 37 patients with sLMPC treated in China-Japan Friendship Hospital was performed from April 2017 to December 2022. A total of 23 males and 14 females were included,with an age(<i>M</i>(IQR)) of 61 (10) years (range: 45 to 74 years). Systemic chemotherapy was carried out after pathological diagnosis. The initial chemotherapy strategy included modified-Folfirinox, albumin paclitaxel combined with Gemcitabine, and Docetaxel+Cisplatin+Fluorouracil or Gemcitabine with S1. The possibility of surgical resection (reaching the standards of surgical intervention) was determined after systemic treatment,and the chemotherapy strategy was changed in the cases of failed initial chemotherapy plans. The Kaplan-Meier method was used to estimate the overall survival time and rate,while Log-rank and Gehan-Breslow-Wilcoxon tests were used to compare the differences of survival curves. <b>Results:</b> The median follow-up time for the 37 sLMPC patients was 39 months,and the median overall survival time was 13 months (range:2 to 64 months) with overall survival rates of 1-,3-,and 5-year of 59.5%,14.7%,and 14.7%,respectively. Of the 37 patients,97.3%(36/37) initially received systemic chemotherapy, 29 completed more than four cycles,resulting in a disease control rate of 69.4% (partial response in 15 cases,stable disease in 10 cases,and progressive disease in 4 cases). In the 24 patients initially planned for conversion surgery,the successful conversion rate was 54.2% (13/24). Among the 13 successfully converted patients,9 underwent surgery and their treatment outcomes were significantly better than those (4 patients) of those who did not undergo surgery (median survival time not reached <i>vs.</i> 13 months,<i>P</i><0.05). Regarding the 9 patients whose conversion was unsuccessful, no significant differences were observed in median survival time between the surgical group (4 cases) and the non-surgical group (5 cases) (<i>P</i>>0.05). In the allowed-surgery group(<i>n</i>=13),the decreased in pre-surgical CA19-9 levels and the regression of liver metastases were more significant in the successful conversion sub-group than in the ineffective conversion sub-group;however, no significant differences were observed in the changes in primary lesion between the two groups. <b>Conclusion:</b> For highly selective patients with sLMPC who achieve partial response after receiving effective systemic treatment,the adoption of an aggressive surgical treatment strategy can significantly improve survival time;however, surgery dose not provide such survival benefits in patients who do not achieve partial response after systemic chemotherapy.</p>","PeriodicalId":23966,"journal":{"name":"Zhonghua wai ke za zhi [Chinese journal of surgery]","volume":"61 7","pages":"575-581"},"PeriodicalIF":0.0,"publicationDate":"2023-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9755112","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}