Objective To systematically evaluate the diagnostic efficacy of circulating tumor DNA (ctDNA) in hepatitis B viral hepatocellular carcinoma (HBV-HCC), and to study the clinical value of ctDNA. Methods The databases of PubMed, Embase, Web of Science, and Cochrane Library database were retrieved systematically from the establishment of the database to April 26, 2021. The characteristic information of literatures and the original data such as the sensitivity, specificity, and area under curve (AUC) of the receiver operating characteristic (ROC) curve were extracted. A meta-analysis was conducted by applying RevMan 5.3 and Stata 15.0 software. The combined sensitivity, combined specificity, positive likelihood ratio, negative likelihood ratio, and diagnostic odds ratio (OR) were calculated, ROC curve was plotted and the AUC was calculated, Deck’s funnel chart to assess publication bias, the Fagan diagram to test the diagnostic efficiency. Results Finally, 16 studies involving 3 744 patients were enrolled in this study, of which 1 852 were HBV-HCC patients, and 1 892 were HBV-infected patients without HCC. The meta-analysis results showed that ctDNA had a pooled sensitivity of 0.85 [95%CI (0.78, 0.90)], a specificity of 0.74 [95%CI (0.63, 0.83)], a diagnostic OR of 15.98 [95%CI (10.65, 23.99)], and the AUC of ROC was 0.87 [95%CI (0.84, 0.90)] in the diagnosis of HBV-HCC. The pooled sensitivity, specificity, diagnostic OR, and the AUC of ROC for ctDNA combined with AFP in the diagnosis of HBV-HCC were 0.86 [95%CI (0.80, 0.90)], 0.79 [95%CI (0.68, 0.87)], 22.69 [95%CI (13.64, 37.76)], and 0.90 [95%CI (0.87, 0.92)]. Meta-regression analysis found that the heterogeneity came from other non-covariate factors. The Fagan chart showed that while HBV-HCC was diagnosed by liquid biopsy-based on ctDNA, the probability of being diagnosed with hepatocellular carcinoma was 77%, if HBV-HCC was excluded, the probability of having the corresponding disease was 17%. Deek’s test showed no obvious publication bias (P>0.05). ConclusionsThe ctDNA can diagnose HBV-HCC with high sensitivity, specificity and accuracy, and can be used as a promising circulating biomarker in the early diagnosis of HBV-related HCC. The combination of ctDNA in serum and AFP is beneficial to improve the diagnostic accuracy of HBV-HCC.
ObjectiveTo summarize the key technical points, applicability, feasibility, and safety of laparoscopic spleen-preserving distal pancreatectomy (LSPDP).MethodA retrospective analysis was performed for the clinical data of 22 patients who were admitted to the Affiliated Hospital of North Sichuan Medical College from September 2016 to November 2019, all patients planned to receive LSPDP.ResultsTwenty of the 22 patients successfully completed LSPDP, and 2 patients converted to laparotomy. One patient was transferred to laparotomy to suture the damaged splenic artery. The spleen was observed to have no ischemia and the spleen preservation operation was continued. One patient was converted to laparotomy due to the difficulty of dissecting the tail of the pancreas which caused by severe abdominal adhesion. The operation time of LSPDP patients was (191±86) minutes (170–480 min), intraoperative blood loss was (365±50) mL (200–1 000 mL), and postoperative hospital stay was (9.9±2.6) days (7–16 d). Six patients of pancreatic fistula occurred after operation, including 3 cases of biochemical fistula, which were cured and discharged after symptomatic treatment, 3 cases of grade B pancreatic fistula, who all improved after anti-inflammatory, acid suppression, enzyme suppression, and double catheter drainage. Twenty patients were interviewed after the operation, and the follow-up time was 3–24 months (median of 15 months). During the follow-up period, no patient had recurrence or metastasis.ConclusionsUnder the conditions of strict screening of suitable cases, adequate preoperative imaging evaluation, intraoperative fine manipulation, and the application of appropriate operating instruments and cutting closure devices, LSPDP is safe and feasible to treat benign tumors of the pancreatic body and tail and some borderline tumors. During the operation, attention should be paid to the reasonable treatment and protection of splenic arteries and veins.
ObjectiveTo investigate perioperative safety of laparoscopic pancreaticoduodenectomy (LPD) in elderly patients (age ≥70 years old).MethodsThe retrospective cohort study was conducted. The clinicopathologic data of the patients underwent LPD and open pancreaticoduodenectomy (OPD) in the Affiliated Hospital of North Sichuan Medical College from January 2016 to December 2019 were collected. The patients who met the inclusion and exclusion criteria were divided into LPD with aged ≥70 years old group (group A), OPD with aged ≥70 years old group (group B), and LPD with aged <70 years old group (group C). The baseline data, intraoperative situations, and postoperative situations were compared between the group A and group B, and between the group A and group C, respectively.Results① There were no statistic differences in the age, gender, body mass index, hemoglobin, albumin, and total bilirubin, American Society of Anesthesiologists (ASA) grade, and comorbidity index before operation between the group A and group B (P>0.05). However, there were statistic differences in the hemoglobin, albumin, ASA grade, and comorbidity index before operation between the group A and group C (P<0.05). ② There were no significant differences in the operation time between the group A and group B (P>0.05), but the intraoperative blood loss of the group A was significantly less than the group B (P<0.05). The operation time, intraoperative blood loss, and conversion rate had no significant differences between the group A and group C (P>0.05). ③ There were no significant differences in the pathological pattern, tumor size, R0 resection rate, reoperative rate, and postoperative 90 d mortality between the group A and group B, and between the group A and group C, respectively. For the elderly patients, cases in the ICU, overall complications, specific complications (except for delayed gastric emptying) and Clavien-Dindo classification of complication after operation had no significant differences between the group A and group B (P>0.05), but there were more harvesting lymph nodes, lower postoperative pain score, shorter postoperative hospital stay, and less delayed gastric emptying cases in the group A than the group B (P<0.05). For the patients accepted LPD, there were no significant differences in the harvesting lymph nodes, postoperative pain score, postoperative hospital stay, and specific complications (except for pulmonary infection rate) between the group A and the group C (P>0.05), but the postoperative cases in the ICU were more, pulmonary infection rate was higher, overall complications rate and the ratio of Clavien-Dindo Ⅲ–Ⅳ classification of complication were higher in the group A as compared with the group C (P<0.05). ConclusionCompared with OPD, LPD might have some advantages in blood loss, harvesting lymph nodes, and recovery after surgery, even though perioperative safety of LPD in elderly patients is inferior to younger patients.