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SCIENCE CHINA Life Sciences, Volume 59, Issue 10: 995-1005(2016) https://doi.org/10.1007/s11427-016-5104-8

Surgical treatment of hepato-pancreato-biliary disease in China: the Tongji experience

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  • ReceivedMay 16, 2016
  • AcceptedJul 3, 2016
  • PublishedAug 31, 2016

Abstract

Hepato-pancreato-biliary (HPB) tumors are common in China. However, these tumors are often diagnosed at intermediate/advanced stages because of the lack of a systemic surveillance program in China. This situation creates many technical challenges for surgeons and increases the incidence of postoperative complications. Therefore, Dr. Xiao-Ping Chen has made many important technical improvements, such as Chen’s hepatic portal occlusion method, the anterior approach for liver resection of large HCC tumors, the modified technique of Belghiti’s liver-hanging maneuver, inserting biliary-enteric anastomosis technique, and invaginated pancreaticojujunostomy with transpancreatic U-sutures. These techniques are simple, practical, and easy to learn. Owing to these advantages, complicated surgical procedures can be simplified, and the curative effects are greatly improved. These improved techniques have been widely applied in China and will benefit many additional patients. In this review, we introduce our experience of surgically treating intermediate/advanced hepatocellular carcinoma (HCC), hilar cholangiocarcinoma (HC), and pancreatic carcinoma, mainly focusing on technical innovations established by Dr. Chen in HPB surgery.


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  • Figure 1

    (Color online) Liver double-hanging maneuver and a simple technique for ligating of inflow and outflow vessels without hilar dissection during hepatectomy. A, Chen’s modified liver double-hanging maneuver in da Vinci robotic hepatectomy. B and C, Ligation of inflow and outflow vessels without hilar dissection during anatomical right hepatectomy. B, Ligation of the right hemihepatic pedicle. C, Ligation of the right hepatic vein.

  • Figure 2

    (Color online) Survival curves showing the overall survival rates of group A (PVTT was located in the hepatic resection area or protruded into the first branch of the main portal vein beyond the resection line for <1 cm) and group B (PVTT extended into the main portal vein). A significant difference is observed between the two curves (log-rank test; P<0.0164) (Chen et al., 2006b).

  • Figure 3

    (Color online) Disease-free survival curves of patients with hepatocellular carcinoma undergoing liver resection and splenectomy (the LS group) or liver resection alone (the L group). (Chen et al., 2005).

  • Figure 4

    (Color online) The recurrence curves (A) and overall survival curves (B) of the multicentric occurrence (MO) group and intrahepatic metastasis (IM) group (Huang et al., 2012).

  • Figure 5

    (Color online) In 1983, Chen developed the first canine model of auxiliary partial orthotopic liver transplantation.

  • Figure 6

    (Color online) Minor liver resection for hilar cholangiocarcinoma. A, Resection plane after minor liver resection for HC. B, Kaplan-Meier overall survival curves for patients undergoing minor and major liver resection for hilar cholangiocarcinoma. P=0.300 (Chen et al., 2009).

  • Figure 7

    (Color online) Diagram and intraoperative photograph of the inserting biliary-enteric anastomosis. A, Diagram of the inserting biliary-enteric anastomosis. B, The posterior wall of the jejunum has been anastomosed to the posterior biliary ductal wall. C, Anterior anastomosis has been completed by intermittent U suture between the jejunum and the edge of the liver transection plane.

  • Figure 8

    (Color online) Invaginated pancreaticojejunostomy with transpancreatic U-sutures technique. A, Expose the anterior wall of the jejunal loop. At about 1.5 cm from the bowel resection margin near the mesentery, insert the needle from outside. Then, stitch the needle from inside to outside at about 0.5 cm from the bowel resection margin. B, Steer the needle to the pancreas. At about 1.5 cm from the stump of the lower edge of the pancreas, insert the needle from the ventral pancreas (front) and run through the pancreatic parenchyma to the dorsal pancreas (back). C, Steer the needle to the posterior wall of the jejunal loop. Insert the needle from outside at about 1.5 cm from the bowel resection margin and stitch through to the inside. Stitch horizontally from inside and exit the needle from about 1.0 cm of the insert pinhole. D, Steer the needle to the dorsal pancreas (back) of the lower edge. Insert the needle at about 0.8–1.0 cm of the first pinhole, run through the pancreatic parenchyma, and exit the needle from the ventral pancreas (front). E, Steer the needle to the anterior wall of the jejunal loop. Insert the needle at about 0.5 cm from bowel resection margin from the outside to the inside, and then exit the needle from the inside to the outside at 1.5 cm of the bowel resection margin. F–G, The first horizontal U shape Varus stitching is completed.

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