ObjectiveTo investigate feasibility, safety, and problems to be solved in treatment with programmed death receptor protein-1 (PD-1) monoclonal antibody for patients with recurrent liver cancer after liver transplantation (LT).MethodAll of the domestic and foreign cases reports about the application of PD-1 monoclonal antibody in the patients with recurrent liver cancer after the LT were analyzed and summarized.ResultsIn six patients with recurrent liver cancer after the LT who received the PD-1 monoclonal antibody, the acute graft rejections were observed in 3 patients, 2 patients had the progressive disease but there was no evidence of the graft rejection, 1 patient achieved the complete response and there was no evidence of graft rejection and no side effects.ConclusionsAt present, effect of PD-1 monoclonal antibody therapy is still not sure in patients with recurrent liver cancer after LT. If PD-1 monoclonal antibody is used off-label, close surveillance is needed to discovery possible acute graft rejection.
ObjectiveTo investigate the clinical effect of “Double R” pancreatojejunostomy in laparoscopic pancreaticoduodenectomy (LPD).MethodsThe clinical data of 20 patients underwent “Double R” pancreaticojejunostomy in the LPD from November 2018 to December 2019 in this hospital were collected retrospectively. The duration of pancreaticojejunostomy, incidence of postoperative pancreatic fistula, incidence of other complications, mortality, length of stay, and other clinical outcomes were analyzed.ResultsThere were 5 males and 6 females. The age was (56±10) years old. The body mass index was (22.6±4.4) kg/m2. The LPDs were successfully performed in all 20 patients, no patient transferred to the laparotomy, and no patient died within 30 d. There were 6 patients with papillary adenocarcinoma of the duodenum, 5 patients with adenocarcinoma of the lower part of the common bile duct, 2 patients with adenocarcinoma of the pancreatic duct, 3 patients with serous cystadenoma of the pancreatic head, 2 patients with intraductal papillary myxoma of the main pancreatic duct of the pancreatic head, 1 patient with duodenal adenoma with high grade intraepithelial neoplasia, 1 patient with metastatic renal clear cell carcinoma of the pancreatic head, 5 patients with soft pancreas, 12 patients with medium texture, 3 patients with hard texture. The diameter of distal pancreatic duct was (2.1±1.7) mm. The operative time was (380±69) min, the duration of pancreaticojejunostomy was (29±15) min, the intraoperative blood loss was (180±150) mL, the postoperative time of anal exhaust (2.2±0.8) d, postoperative time of fluid intake (3.5±1.1) d, postoperative time of half fluid intake (5.5±0.7) d, postoperative time of hospitalization (14±10) d. There were 3 complications in 2 patients, one of which suffered the pulmonary infection, the other suffered the delayed gastric emptying and gastrointestinal anastomosis bleeding, no bile leakage and abdominal hemorrhage happened. There were 2 cases of pancreatic fistula after the operation, all of them were biochemical pancreatic fistula.Conclusions“Double R” pancreaticojejunostomy method has some advantages of convenient operation, short operation time, and low incidence of pancreatic fistula. However, due to the limited sample size, its safety and feasibility still need to be verified by larger samples and more institutions.